Pre-Test

Question 1

Three categories of risk in pre-operative workup?

Answer 1

Low: risk of cardiac death less than 1%, including breast surgery, cataract surgery, superficial dermatologic surgery, and endoscopy. They generally do NOT need additional cardiac pre-op testing.

Moderate: 1-5% risk of cardiac death; includes carotid enarterectomies, head and neck surgeries, intrathoracic and intraperitoneal surgeries, ortho surgeries, and prostate surgeries.

High Risk: >5% cardiac risk; high anticipated blood loss, includes aortic or peripheral vascular surgery

Question 2

AAFP and USPSTF recommendations of genetic breast cancer screening?

Answer 2

recommends AGAINST genetic counseling or routine genetic testing for breast cancer mutations when women do not meet spec high risk criteria.

In NON Ashkenazi Jewish women, high risk criterie are:

• 2 first degree relatives with breast cancer, one whom was diagnosed <50 years old
• a combo of 3+ 1st or 2nd degree relatives with breast cancer regardless of dx
• a combo of breast and ovarian cancer among 1st and 2nd degree relatives
• a first degree relative with bilateral breast cancer
• a combo of 2+ 1st or 2nd degree relatives with ovarian cancer, regardless of age of dx
• a first or second degree relative with both breast and ovarian cancer at any age
• a male relative with breast cancer

Question 3

When should cervical cancer s screening begin?

Answer 3

at least every 3 years for women who have ever had sex and have a cervix.

screening can safely be delayed until 3 years after the onset of sexual activity or age 21, whichever comes first.

Question 4

Which is the only mandatory travel vaccine?

Answer 4

Yellow fever (in some countries)

Question 5

A patient using OCP’s has been having elevated BP at 3 separate occasions. Which would be the next appropriate step?

Answer 5

D/C OCP and recommend barrier method.

Question 6

The side effect most frequently cited as the reason for stopping OCPs is?

Answer 6

Irregular bleeding

Question 7

Management if a woman forgets to take her pill (OCP)?

Answer 7

If an active pill is missed at any time, and NO intercourse has occurred in the past 5 days, 2 pills should be taken immediately and a backup method should be used for 7 days.

If intercourse occurred in the previous 5 days, emergency contraception should be used immediately and pills should be restarted the following day. A backup method should be used for 5 days.

Question 8

What is true of progestin only contraceptive pills?

Answer 8

They should be taken every day of the month. There is no hormone free period.

No risk of increased thromboembolism

Question 9

As death approaches, what are signs that portend its arrival?

Answer 9

Remaining bed bound
Confusion
decreased conversation
Cool and mottled extremities
the "Death rattle"
decreased hearing/vision
diff swallowing
decreased oral intake
disorientation to time
drowsiness progressing to somnolence for extended periods 
dry mouth
hallucinations
increased distance from all but a few intimate others
decreased attention span
profound weakness

Question 10

Which cancer is increased in homosexual men?

Answer 10

Anal cancer

Question 11

Management of alcohol intake?

Answer 11

If a person is an alcoholic or has a history of substance abuse, there is NO safe drinking amount.

If patients do not have a hx of alcoholism, the general guidelines are as follows:

• no more than 7 drinks a week for non pregnant women and no more than 3 drinks per any one occasion
• for men, no more than 14 drinks a week and no more than 4 per any occasion
• for patients older than 65, it’s recommended that they ingest no more than 1 drink per day

There is no difference between the recommended amounts of beer, wine, or alcohol–1 beer=1 glass of wine=1 alcoholic beverage