COMP

Question 1

When should we start to screen for dyslipidemia?

Answer 1

If the patient has risk factors like diabetes, fm hx of dyslipidemia, risk factors for atherosclerosis or there obese then we would start screening at 20. If the patient doesn’t have any of the latter risk factors then we will wait until 35 to initially screen.

Question 2

What are the side affects of statins?

Answer 2

Myopathy and hepatitis (elevated ALT:AST)

Question 3

There is an increased chance of a patient acquiring myopathy while they are taking a statin with what other drug?

Answer 3

fibrates, in someone you suspect of having myopathy always check TSH levels and also consider if this patient has hypothyroidism.

Question 4

What labs should you check before starting a patient on a statin?

Answer 4

TSH and LFT’s

Question 5

What are the live vaccines that are given to adults.

Answer 5

HIM alive ; herpes zoster, influenza, and MMR

Question 6

What are the live vaccines we give children?

Answer 6

liv CRIME; chicken pox, rotavirus, MMR
influenza,

Question 7

What vaccines should patients with asplenia get?

Answer 7

SHIN (streptococcus, Haemophilus, and Nisseria M

Question 8

How often should the influenza vaccine be administered in adults ?

Answer 8

Annually vaccines can start as early as six months of age, contraindications include persons with egg allergies

Question 9

How often should the TDap vaccine be administered in adults ?

Answer 9

Adults > 19

Question 10

If someone steps on a nail what is the protocol for tetanus vaccination?

Answer 10

Question 11

What’s the protocol for administering rabies vaccine?

Answer 11

Question 12

When do we begin to vaccinate for HPV (papilloma)?

Answer 12

age 11

Question 13

When do we administer a shingles vaccine?

Answer 13

age 50

Question 14

When would we consider immunization for Hep A/B?

Answer 14

chronic liver dz or STD, specifically for Hep B if they have also been exposed or they work in healthcare

Question 15

How is strep pneumonia vaccine delivered.

Answer 15

Everyone should at most have a PCV13 vaccine in their lifetime, but PPSV23 can be administered up to three times.

Question 16

When do we start screening for HPV? and what is the frequency with follow up?

Answer 16

age 21

Question 17

When do we screen for diabetes?

Answer 17

Typically around age 35 or if the patient has fm hx, risk factors for CAD, obese, hyperlipidemia.

Question 18

When should a female start screening for breast cancer?

Answer 18

45-50 ( can start as early as 40 if there is genetic predisposition)

Question 19

Should females who smoke get a chest X-ray lie men if they have a significant smoking history?

Answer 19

Yes, typically this should start at age 65

Question 20

When should we start screening females for osteoporosis?

Answer 20

60

Question 21

When should we implement statins?

Answer 21

When ASCVD risk score is >7.5% (had a previous history of stroke or TIA, had an MI, angina, or heart surgery, or had a vascular surgery or hx of coagulation). LDL >100, triglycerides >150, Cholesterol >200.

Question 22

When should we screen for AAA in men?

Answer 22

age 65 with history of smoking

Question 23

When should we screen for lung cancer in males?

Answer 23

Age 55 with 20 year history of smoking.

Question 24

What other etiologies/differentials do we consider for someone with milk discharge from the nipple?

Answer 24

Pregnancy, anti-dopaminergic drugs, hypothyroidism.

Question 25

A 25 yo patient comes with c/o of production of milk form the breast. She also explains she sometimes has mild headache and blurred vision, what’s the next best step in management?

Answer 25

Prolactin.

Question 26

Why would someone with hypothyroidism have nipple discharge?

Answer 26

Elevated TRH would have activating effects on prolactin.

Question 27

After you’ve ruled out the other possibilities of milk production, what’s the best next step in management if you suspect a prolactinomma?

Answer 27

MRI of the pituitary

Question 28

What is the first line treatment in a prolactinomma?

Answer 28

Cabergoline (dopaminergic agonist), if the condition is refractory to medical management we consider surgical removal

Question 29

Hyponatremia that is 135-130 should be treated how?

Answer 29

Conservatively with water restriction

Question 30

If a patient has hypovolemic hyponatremina (125-130).

Answer 30

The patient should be given normal saline

Question 31

If the patient has hypervolemic hyponatremia how should we approach treatment?

Answer 31

The patient should be on fluid restriction and

Question 32

Total serum calcium=

Answer 32

bound calcium (bound to negatively charged things like proteins citrate phosphate) + free calcium

Question 33

What are the hormones that regulate calcium?

Answer 33

PTH and vitamin D

Question 34

How do low levels of albumin affect calcium levels?

Answer 34

The don’t change the free calcium, but their is a decrease the total calcium concentration