Preventive/General IM Flashcards
(83 cards)
1
Q
5 Principles of screening?
A
1 - disease clinically important
2 - asymp period during which it can be detected
3 - effective/efficient screening method available
4 - treatment available
5 - early tx better than tx once pt is symptomatic
2
Q
What is lead-time bias?
A
artificial inc in survival time introduced w/ screening by dx’ing ds earlier w/out necessarily inc overall life expectancy
3
Q
What is length bias?
A
test less likely to detect rapidly progressive disease than slowly progressive
4
Q
What does USPSTF stand ford?
A
United State Preventive Services Task Force
5
Q
What conditions does USPSTF recommend NOT screening for?
A
prostate cancer, carotid stenosis, CAD in low risk pt’s, ovarian cancer, testicular cancer
6
Q
USPSTF mammogram recommendations?
A
every 2 years, ages 50-74 (BRCA testing only in HR pt’s)
7
Q
USPSTF colorectal cancer screening recommendations?
A
Men and women, 50-75 yo, options:
- yearly FOB or fecal IHC
- sigmoidoscopy every 5 years w/ FOB every 3 years
- colonoscopy every 10 years
8
Q
USPSTF recommendations for pap test?
A
- at least every 3 y in women 21-65 yo
- OR pap + HPV at least every 5 y in women 30-65
9
Q
USPSTF Hep C screening?
A
once for pt’s born between 1945 and 1965
10
Q
USPSTF bone mineral density test rec?
A
women >= 65 or at risk women
11
Q
AAA screening guideline?
A
one time in men 65-75 yo who have ever smoked
12
Q
USPSTF lung cancer screening guidelines?
A
- only in pt’s 55-80 yo who have a 30 pack year smoking history and currently smoke or quit within the past 15 years
- annual low dose CT
13
Q
What does the ACS recommend examining during periodic health visits?
A
thyroid, testicles, ovaries, LN’s, oral region, skin
14
Q
Two-question screen for depression? (mood, anhedonia)
A
- over the past 2 weeks, have you felt down, depressed, or hopeless?
- over the past 2 weeks, have you felt little interest or pleasure in doing things?
15
Q
USPSTF dyslipidemia screening guidelines?
A
men >= 35 and men and women >= 20 yo who have CV RF’s
16
Q
USPSTF DM screening guidlines?
A
DM II in asymp adults w/ sustained BP (treated or untreated) > 135/80 mmHg
17
Q
RF’s for women with inc risk of low bone density?
A
smoking, inactivity, secondary osteoporosis, prolonged glucocorticoid use, prolonged hyperthyroidism, celiac, FHx, inadequate calcium intake
18
Q
ACS DM screening recommendations?
A
screen all adults > 45 every 3 y (1/3 of people undx and early dx may prevent complications)
19
Q
What RF’s would make you consider screening for DM in younger adults?
A
overweight/obese, BP > 140/90, dyslipidemia, 1st degree relative, high risk ethnicity, polycystic ovary syndrome
20
Q
STI screening rec for women? Reasoning?
A
21
Q
Age range recommended by CDC for HIV screening?
A
15 - 64 yo
22
Q
What is the up-and-coming screening tool for CAD?
A
coronary artery calcium measurement by CT (in pt’s whose 10 y risk is 10-20%)
23
Q
How is the stage of HTN classified?
A
two different readings on two different occasions
24
Q
Flu vaccine recommendations? Types?
A
- everyone >= 6 mos
- tri/quad inactivated vacc: IM, ok for all groups
- intranasal live attenuated: pt’s 2 - 49 yo (avoid in pregnancy, DM, IC)
25
What population of patients should no receive either flu vaccine?
Hx Guillain-Barre
26
What two pneumococcal vaccines are available?
PPSV23 = 23 valent pneumococcal polysaccharide
PCV13 = 13 valent conjugate vaccine
27
Indications for PCV13 vaccine?
one-time therapy for all adults > 65 yo;
28
Indications of PPSV23 vaccine?
all adults >=65 y; and adults w/ CHD, chronic lung ds, DM, CSF leak, cochlear implants, EtOH, chronic liver ds, cigarettes, asplenia, IC
29
Pneumococcal vaccine schedule for pt's
PCV13 first, then PPSV23 at least 8 weeks later
30
Pneumococcal vaccine schedule for pt's >=65 who have never received vaccine before or received PPSV23 before 65 yo?
PCV13 first, then PPSV23 in 6-12 months
31
What type of vaccine in MMR?
live attenuated virus vaccine (contra in pregnant, IC)
32
HPV vaccine recommendation?
males and females ages 11-26
33
What kind of vaccine is varicella?
live attenuated virus
34
Zoster vaccine type and recommendations?
- live attenuated virus
- >= 60 yo regardless of history of shingles
- to prevent shingles and reduce incidence of post-herpetic neuralgia (glucocorticoids don't work)
35
What type of vaccine is the meningococcal vaccine? Who should get it?
- conjugate vaccine
| - young adults, asplenia, terminal complement deficiency, people traveling to endemic areas
36
Cutoffs for Stage I and II HTN?
I - 140-159 OR 90-99
| II - >= 160 OR >= 100
37
What studies should be ordered in a patient with HTN?
hematocrit, Glc, Cr, electrolytes, urinalysis, fasting lipid profile, EKG
38
Examples of end-organ damage in HTN emergency?
encephalopathy, papilledema, retinal hemorrhages/exudates, stroke, MI, aortic dissection, pulm edema, AKI
39
How many agents are needed to reach target BP in HTN? First-line med therapies in non-AA and AA patients?
- 2 to 3 agents
- non-AA: thiazide, ACEI or ARB, CCB
- AA: thiazide, CCB (less BP reduction and inc risk of stroke w/ ACEI)
40
When are beta blockers used to treat HTN?
HTN + CAD (dec CV mortality) (careful with asthma, chronic bronchitis)
41
What may limit use of ACEI
cough, angioedema, hyperkalemia
42
Initial treatment of HTN emergency?
1st: IV nitroprusside (cyanide tox w/ high doses > 24-48 h)
THEN: NG, labetalol, nicardipine, fenoldopam (D1 agonist, inc renal perfusion)
43
When is aggressive lowering of BP w/ a beta blocker indicated?
aortic dissection
44
MOA of clonidine? Uses?
- sympatholytic: A2 agonist, imidazoline agonist
- HTN urgency (oral - hourly til BP is achieved)
- ALSO: AHDH, anxiety, pain conditions, withdrawal, migraine, diarrhea
45
What 3 anti-hypertensives are ok in pregnancy?
labetalol, methyldopa, nifedipine
46
How do statins help people at risk for ASCVD?
PLEIOTROPIC!
- lower LDL-C
- improve endothelial function
- dec ox stress, inflammation, thrombosis
- plaque stabilization
47
What 5 drugs can cause dyslipidemia?
BB's, thiazides, estrogenic, glucorticoids, androgenic steroids
48
What are CHD risk equivalents?
TIA, DM, stroke, aortic aneurysm, PVD (claudication)
49
What are secondary causes of dyslipidemia?
hypothy, obstructive liver disease, nephrotic syndrome, EtOH, uncontrolled DM, smoking, kidney failure
50
What are the four statin benefit groups?
1: clinical ASCVD
2: LDL-C >= 190 mg/dL
3: DM + age 40-75 y w/ LDL-C of 70-189 mg/dL and no ASCVD
4: no ASCVD or DM and est 10 year ASCVD risk >=7.5%
51
What are 5 alt method for tx dyslipidemia?
bile acid sequestrants, fibrates, nicotinic acid, ezetimibe, omega 3 FA's
52
What are 5 AE's of statin therapy?
myalgia (CoQ-10), myositis, rhabdo, elev AST/ALT, hepatotoxicity
53
In low back pain, what raises concern for cauda equina syndrome?
perineal/saddle paresthesia, bowel/bladder dysfunction (overflow incontinence), dec anal sphincter tone, BILAT LE WEAKNESS!
54
What symp make you suspicious of ankylosing spondylitis?
3 months, INC CRP, ESR
55
If you suspect spinal compression...
high dose glucocorticoids and surgical decompression
56
What's a bummer about discectomy and laminectomy?
only show short term benefits (3 mos and 1-2 y respectively)
57
What is an irritating benign complication of viral URTI (most common cause of acute cough)?
acute viral airway infection can result in protracted bronchial hyperreactivity w/ secondary cough lasting weeks to months
58
When is antiviral therapy for influenza indicated?
hospitalized patients and those with severe, complicated or progressive disease (oseltamivier, zanamivir)
59
How long does it take for the flu vaccine to work?
2 weeks
60
ABx therapy for routine acute bronchitis?
NOT RECOMMENDED - does not have consistent effect on duration or severity of illness/complications (except in PERTUSSIS)
61
What is the purpose of abx tx for pertussis in adults?
decrease shedding/spread bc it doesn't appear to improve resolution of symptoms if initiated beyond 7-10 days after onset
62
5 findings in pneumonia? (low negative likelihood ratios)
tachy, RR > 28, oral T >100, crackles, diminished breath sounds
63
What are the 3 most common causes of chronic cough in pt's w/ normal CXR, non-smoking, not on ACEI?
- upper airway cough syndrome (post-nasal drip)
- asthma (don't forget cough-variant asthma)
- GERD
64
What causes GERD chronic cough? Tx?
vagally mediated distal esophageal-tracheobronchial reflex; PPI trial (24 h esoph pH monitoring is gold dx standard)
65
If you have a chronic cough pt with nml CXR, nml spirometry, negative methacholine challenge, what should you consider?
nonasthmatic eosinophilic bronchitis (tx inhaled glucocorticoids, avoidance of allergens) (dx. eo's in sputum)
66
In COPD, what drugs decrease sputum production?
tiotroprium/ipratroprium - anti-cholinergics
67
What characterizes bronchiectasis?
- type of chronic bronchitis
| - chronic/recurrent cough w/ voluminous (> 30 mL/day) sputum production w/ purulent exacerbations
68
How long does it take for ACEI cough to go away after stopping drug?
median time to resolution in 26 days
69
Two most common causes of hemoptysis in ambulatory patients?
infection (bronchitis, pneumonia) and malignancy (but don't forget LHF)
Dx: CXR - escalate to chest CT and fiberoptic bronchoscopy if no cause id'd
70
What is the question you should ask all smokers?
DO YOU WANT TO QUIT?
71
What is unique about nicotine gum as a replacement therapy?
shown to delay the weight gain associated w/ smoking cessation (also buproprion - can use together)
72
What is a risk to consider when prescribing bupriprion?
lowers seizure threshold
73
What is the most effective individual smoking cessation drug? How does it work?
Varenicline - high aff for A4B2 nicotinic receptors than nicotine --> blocks nicotine binding and stimulates receptor-med activity = REDUCES CRAVINGS!
74
What is the mneumonic for 8 major symptoms of depression?
SIG - E - CAPS
- sleep changes
- interest decreased
- guilt
- energy decreased
- cognition/concentration dec
- appetite changes
- psychomotor agitation/retardation
- suicidal ideation/preoccupation w/ death
75
What screening tool can be used to dx and assess severity of depression?
PHQ-9 (covers SIG-E-CAPS)
76
What is the serotonin syndrome triad?
mental status changes, autonomic hyperactivity, neuromuscular abnormalities
77
What is the most sensitive and specific screening tool for EtOH misuse?
AUDIT, and AUDIT-C (abbreviated 3 question version)
78
What are the early symptoms of EtOH withdrawal?
6-24 h after reduced/stopped; anxiety, tremulousness, tachy, elev BP, tremors
79
What three drugs are helpful with EtOH cessation?
(initially, BENZO's for withdrawal)
1 - naltrexone: short-term; can be used in pt's who are still actively drinking; reduces freq of relapse and # of drinking days by attenuating craving and blocking reinforcing effects of EtOH
2 - disulfiram: aldehyde dehydrogenase inhibitor = inc acetaldehyde = flushing, HA, emesis; improves abstinence and adherence to therapy
3 - acamprosate: GABA analogue; decreases drinking days, enhances abstinence and helps prevent withdrawal symptoms
80
In adolescents with menorrhagia, up to 20% have ______
heritable bleeding disorder, eg. Von Willebrand's
81
What is the most common cause of post-meno bleeding?
- endometrial ATROPHY! (but don't forget cancer...)
82
What is Sheehan syndrome?
pituitary necrosis 2/2 hemorrhage in pregnant women - pituitary is enlarged during pregnancy and is extra sensitive to dec blood flow 2/2 hemorrhage/hypovolemia (lactation issues are often a first sign)
83
Mneumonic for DDx of LAD?
CHICAGO
C - cancer
H - hypersensitivity (drug, vacc, serum sickness)
I - infection
C - connective tissue disease (SLE, RA, Sjogren)
A - atypical lymphoprolif disorder (Castleman disease - giant LN hyperplasia)
G - granulomatous disease (sarcoidosis, silicosis, berylliosis)
O - other unusual cause (Kikuchi disease - histiocytic necrotizing lymphadenitis)
