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Board Certification > Deck 1 > Flashcards

Deck 1 Flashcards

1
Q

When in doubt about whether to immunize someone,

A

Better to give an extra vaccine dose than to give none. Risk of reaction with re-immunization is minimal.

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2
Q

When should you defer an immunization and when should you not defer?

A

Immunization should only be deferred if there’s a moderate to severe illness (with or without fever). For minor illness, you should still immunize.

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3
Q

What is the onset and duration of most immunizations (active immunity)

A

Onset is about a month, it lasts for years

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4
Q

What is passive immunity and when is it used

A

It’s when you directly give someone antibodies. It’s used post-exposure for certain infections (so the patient has to have a recent risk of exposure)

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5
Q

What is the onset and duration of passive immunity

A

Onset is a few hours, usually lasts 6 to 9 months

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6
Q

What are some infections we can treat with passive immunity

A

Varicella, Hep A, Hep B, tetanus, rabies

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7
Q

Herpes Zoster Vaccine (4 things)

A

Prevents herpes zoster (shingles) in adults aged 50 years and older.

Give 1 dose, then 2 to 6 months later, give another dose.

Can be given to immunosuppressed people.

If they have already received the live zoster vaccine, still give this one.

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8
Q

How to calculate packs per day years

A

2 packs per day for 30 years

2 PPD x 30 years = 60 pack year history

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9
Q

CAGE for other substances

A

Change the “E” to an “N”

Have you ever needed heroine to feel normal (not be in withdrawal)

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10
Q

CAGE scoring

A

2 or more “Yes’ “ means they almost definitely have substance abuse disorder

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11
Q

For all ages, what is the leading cause of death, and what is the 10th leading cause

A

Heart disease, suicide

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12
Q

Prostate screening recommendations

A

55 to 69 years old: Should be a case by case decision.

70 and older: Do not screen

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13
Q

Breast cancer Genetic Counseling recommendations

A

If they have certain risk factors, especially the BRCA 1 and 2 gene, screen them with the assessment tool. Based on the tool, you may need to do genetic testing.

If they don’t have the BRCA 1 and 2, do not screen routinely

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14
Q

Colorectal cancer

A

Screen from 45 to 75.

From 76 to 85 the decision is case by case.

Fecal Occult- yearly

DNA test- 1 to 3 years

Sigmoidoscopy- 5 years

CT colonoscopy- 5 years

Colonoscopy- 10 years

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15
Q

Lung cancer screening

A

CT scan for people 55 to 80 years old with a 30 pack-year history, who currently smoke or quit within the past 15 years.

Stop screening if they quit for more than 15 years or if they have another illness that limits their life expectancy anyway

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16
Q

Breast Cancer Screening

A

Age 40 to 45: Woman’s choice

45 to 54: Annual mammogram

54 to whenever they still have a life expectancy of 10 years: Biennially

Or

50 to 74: Biennially

BSE is not encouraged nor discouraged

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17
Q

Cervical Cancer

A

Do not screen before 21

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18
Q

Sensitivity

A

Likelihood of being sensitive enough to find a true positive

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19
Q

Specificity

A

Specific enough to know which is a true negative

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20
Q

Aspartate aminotransferase (AST) measures

A

damage to the liver

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21
Q

Aspartate aminotransferase (AST) findings

A

Can be elevated in valproate therapy, hepatitis, cirrhosis

Decreased in chronic alcoholic liver disease

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22
Q

Alanine aminotransferase (ALT) measures

A

liver damage

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23
Q

Alanine aminotransferase (ALT) findings

A

Can be elevated in valproate therapy, hepatitis, cirrhosis.

Deceased in chronic alcoholic liver disease.

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24
Q

y-Glutamyl transferase (GGT) measures

A

Cholestasis (flow of bile from the liver, either extrahepatic or intraheptatic)

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25
Q

y-Glutamyl transferase (GGT) findings

A

Can be elevated in alcohol abuse, chronic alcoholic liver disease

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26
Q

Alkaline phosphatase (ALP) measures

A

Cholestasis (flow of bile from the liver, either extrahepatic or intraheptatic)

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27
Q

Alkaline phosphatase (ALP) findings

A

Elevated in gallbladder disease, liver disease, bone injury, or rapid bone growth

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28
Q

Creatine kinase measures

A

muscle injury, it’s found in the brain, heart, and muscles

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29
Q

Creatine kinase findings

A

elevated in MI, myositis, vigorous exercise, neuroleptic malignant syndrome

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30
Q

Urea nitrogen (BUN) measures

A

Kidney functions

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31
Q

Urea nitrogen (BUN) findings

A

Elevated in impaired kidney function, significant dehydration

(Definitely check this during Li therapy!)

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32
Q

Creatinine measures

A

Kidney function. It’s a more specific measure than BUN

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33
Q

Glomerular Filtration Rate (GFR) measures what? What are 2 important parameters to know?

A

It’s the best measure of kidney function.

  • Older people have 30% reduced filtration.
  • If GFR is over 60, you don’t need to adjust the dose
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34
Q

Valproate therapeutic level

A

50 to 120

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35
Q

Valproate (and certain other AEDs, like carbamazepine) 10 recommended labs

A 
ALT, 
AST, 
ALP, 
bilirubin, 
albumin, 
total protein
CBC with WBC differential and platelet count, serum hCG, 
and valproate level.

Schedule:

  • Baseline
  • Monthly for a few months
  • 6 to 24 months
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36
Q

The patient is on valproate. What might you find on the liver panel

A

Elevated ALT and AST are common.

Usually happens in the first 6 months, especially with children.

The values will return to normal when the medication is discontinued.

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37
Q

What lab values tell you that you should discontinue valproate?

A

AST/ALT elevations more than 2 to 3 times the upper limit

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38
Q

For patients taking valproate, teach the patient to report symptoms of liver dysfunction such as,

A

abd pain, nausea, vomiting, and jaundice

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39
Q

Liver failure with valproate

A

It’s rare.

Usually happens in children under 10, development disability, or with major seizure disorder

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40
Q

Valproate hematologic considerations

A
  • Thrombocytopenia and neutropenia are the most common
  • Consider discontinuing if there is bone marrow depression
  • Tell patient to report signs of dysfunction like bruising, bleeding, slow healing, fever)
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41
Q

Valproate and Steven Johnson

A

Rare

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42
Q

Carbamazepine and Steven Johnson

A

Increased risk in Asians/Indians with a certain allele

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43
Q

Genetic testing before starting Carbamazepine

A

Recommended for Asians/Indians to check if they have an allele that increases risk for SJS

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44
Q

What are the 10 initial labs recommended for Lithium

A 
Kidney (BUN, creatinine, GFR)
TSH
Electrolytes 
CBC with WBC differential,
hCG
Urinalysis

EKG

Li level every 4 days

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45
Q

What are the 8 long-term labs recommended with Li

A

Kidney (BUN, Creatinine, GFR)
TSH
CBC
Urinalysis

EKG over age 50, q 6 to 12 months

Li level q 1 to 2 months or 6 to 12 months depending on patient

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46
Q

Li target levels

A

.8 to 1.2 for acute

.6 to 1 for maintenance

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47
Q

3 contraindication for Li

A

Acute renal failure

Severe dehydration

Sodium depletion

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48
Q

Li is NOT contraindicated in these kidney conditions:

A

Chronic stable kidney disease

kidney transplant

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49
Q

A patient with stable/chronic kidney disease or a kidney transplant is on Li. What lab tells you to reduce the Li dose?

A

Reduce is GFR is less than 60

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50
Q

3 important states that effect Li level

A

Dehydration increases Li
Decreased sodium increases Li
Increased sodium decreases Li

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51
Q

Li toxicity can begin at __ but more likely won’t occur until __

A

1.5

>2

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52
Q

Li toxicity: Worsening ___ symptoms correspond to the highest Li levels

A

neurologic

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53
Q

Is Li toxicity a medical emergency

A

Yes. Duh.

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54
Q

Li toxicity symptoms

A

Lethargy, fatigue, clumsiness, weakness, cramping, N/V, severe tremor, blurred vision, confusion

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55
Q

Li toxicity signs

A

Nystagmus, ataxia, increased DTR, AMS, arrhythmias

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56
Q

Meds that can increase Li level

A

ACE inhibitors, angiotensin II receptor blockers, NSAIDS

Tetracyclines, metronidazole

K-sparing diuretics, thiazide diuretics

(none are contraindicated though)

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57
Q

Meds that can decrease Li

A

Theophylline

not contraindicated though

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58
Q

Meds that can either increase or decrease Li (unpredictable)

A

Loop diuretics

CCBs

(none are contraindicated though)

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59
Q

Other Effects of Li (renal, cardiac, thyroid, neuro, general)

A

renal, Polyuria, polydipsia

cardiac, rare but conduction problems can happens

thyroid, hypofunction and goiter

neuro, fine tremor

general, weight gain

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60
Q

Clozapine: absolute neutrophil count must be ___ to start therapy

A

1500 or greater

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61
Q

Clozapine: treatment should be stopped if ANC is

A

less than 1000

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62
Q

Clozapine: For patients with Benign Ethnic Neutropenia,

A

They can still be treated, but there are special guidelines

63
Q

Clozapine: Monitoring schedule

A 
Weekly for 6 months
then
q 2 weeks for 6 months
then
Monthly if ANC is 1500 or more
64
Q

Clozapine: the incidence of agranulocytosis is

A

1 to 2 %

65
Q

The Clozapine Risk Evaluation and Mitigation Strategy

A

Clozapine is only available through this program and the provider must have a special certification to use the med

66
Q

Hep A: route of transmission

A

Fecal-oral

67
Q

Hep A: IZ and post-exposure prophylaxis

A

Yes there’s a vaccine and post exposure prohylaxis

68
Q

Hep A: Next steps if positive for infection

A

Do a liver panel

Notify public health authorities

Treat with supportive care. Liver transplant in rare cases

69
Q

Hep A: Disease markers

A

HAV IgM

Elevated hepatic enzymes (at least 10 times the normal limit)

70
Q

Hep A: the markers that show you have recovered and are immune:

A

HAV IgM and IgG, but with normal hepatic enzymes

71
Q

Hep A: You are still susceptible if your labs show

A

You don’t have antibodies

72
Q

Hep B: transmitted by

A

Blood, other body fluids

73
Q

Hep B: Is there a vaccine and post exposure prophylaxis

A

Yes, both

74
Q

Hep B: If the patient is positive, what do you do

A

Liver function tests

Screen for co infections

Immunize against Hep A

Refer to specialist for anti viral therapy

75
Q

Hep B: Sequelae

A

Chronic hep B

liver cancer

liver failure

76
Q

Hep B: the first disease marker to appear is

A

IgM ab

77
Q

Hep B: Disease marker that shows the infection is extra contagious and extra growing

A

HBeAg

78
Q

Hep B: the liver enzymes will be

A

at least 10 times the normal limit

79
Q

Hep B: disease markers of chronic infection

A

Asymptomatic

Liver enzymes are normal or only slightly elevated

HBsAg

79
Q

Hep B: disease markers of chronic infection

A

Asymptomatic

Liver enzymes are normal or only slightly elevated

HBsAg

80
Q

Hep B: disease marker for previous Hep B infection or immunization

A

HBsAb

81
Q

Hep B: You are still susceptible if your markers are

A

HBsAg negative
Anti-HBc negative
HBsAb negative

82
Q

Hep C: route of transmission

A

Blood, other body fluids

83
Q

Hep C: Is there immunization or post exposure prophylaxis

A

No

84
Q

Hep C: Next steps if positive

A

Liver function tests

Screen for co infections

Refer to specialist for antiviral treatment

85
Q

Hep C: Sequelae

A

Chronic Hep C

Cancer

Liver failure

86
Q

Hep C: Acute disease markers

A

Anti-HCV present

HCV viral RNA

Elevated liver enzymes

87
Q

Hep C: chronic disease markers

A

Anti HCV present

HCV viral RNA

normal or slightly elevated liver enzymes

88
Q

Hep C: markers of past disease

A

Anti-HCV present (non-protective antibody)

HCV RNA absent

Normal liver enzymes

89
Q

Hep D: route of transmission

A

Blood, other fluids

90
Q

Hep D: Is there a vaccine and post exposure prophylaxis

A

No, but if you prevent B you can prevent D

91
Q

Hep D: What to do if positive

A

Liver function tests

Screen for co infections

Refer to specialist for antiviral treatment

(Same as with B)

92
Q

Hep D: Sequelae

A

Severe infection
Liver failure
Death

93
Q

Hep D: disease markers

A

Acute or chronic hep B markers + hep D IgM

Usually elevated liver enzymes

94
Q

CN I

A

Olfactory

95
Q

CN II

A

Optic (vision)

96
Q

CN III

A

Oculomotor

Eyelid and eyeball movement

97
Q

CN IV

A

Trochlear

Turns eye downward and lateral

98
Q

CN V

A

Trigeminal
Chewing
Face and Mouth pain

99
Q

CN VI

A

Abducens

Turns eye laterally

100
Q

CN VII

A 
Facial
Facial expressions
Tears
Saliva
Taste
101
Q

CN VIII

A

Acoustic

102
Q

CN IX

A

Glossopharyngeal
Taste
Carotid BP

103
Q

CN X

A

Vagus
BP
HR
Digestion

104
Q

CN XI

A

Accessory
back muscles
Swallowing

105
Q

CN XII

A

Hypoglossal

Tongue

106
Q

Primary headache definition and examples

A

Headache not associated with other diseases

Migraine, cluster, tension

107
Q

Examples of causes of secondary headaches

A

Tumor, intracranial bleeding, increase ICP, use of nitrates, meningitis, accelerated HTN

108
Q

It’s not a primary headaches if (Snoop)

A

there are Systemic symptoms (fever, weight loss)

there are Secondary headache risk factors (HIV, HTN, etc)

109
Q

It’s not a primary headaches if (sNoop)

A

Neurologic symptoms (confusion, CN dysfunction)

110
Q

It’s not a primary headaches if (snOop)

A

Onset (sudden, onset with exertion)

111
Q

It’s not a primary headaches if (snoOp)

A

age of Onset (over 50 or under 5)

112
Q

It’s not a primary headaches if (snooP)

A

Prior headache history, Positional, Papilledema (vision problems)

113
Q

Hypothyroid presentation

A 
Memory loss
Menorrhagia 
Skin dryness
Onset gradual
Raised BP
114
Q

Hyperthyroid presentation

A

Emotional lability
Goiter
GI problems

115
Q

Graves disease

A

Type of hyperthyroidism, autoimmune in nature

116
Q

Toxic adenoma

A

Type of hyperthyroidism, metabolically active lesion

117
Q

Thyroiditis

A

type of hyperthyroidism,

viral, autoimmune, postpartum, transient

118
Q

Medications that can cause hyper or hypothyroid

A

amiodarone

interferon

119
Q

Thyroid Stimulating Test

A

It tells you the amount of TSH release by the pituitary’s anterior lobe. TSH is what tells the thyroid to release T4

The most reliable test to diagnose all common forms of hypo and hyperthyroid.

120
Q

Free T4 test

A

Tells you how much T4 (thyroxine) is there

It’s only used to confirm a hypo/hyper dx

121
Q

Thyroid peroxidase antibody test

A

It’s used to detect autoimmune thyroid disease

122
Q

Criteria for diabetes testing in asymptomatic adults

A

Over 45 years old.

Also,

Consider testing is they are overweight (BMI 25 or greater), and have other risk factors:
Physical inactivity
Family history
Non white
HTN
HDL
CVD
Polycystic ovary syndrome
123
Q

DM dx: Plasma glucose

A

Fasting result is 126 or greater
Random result is 200 or greater with symptoms like polys or unexplained weight loss

(100 to 125 is considered “impaired fasting glucose”)

124
Q

DM dx: Oral glucose tolerance test

A

2 hour plasma glucose is 200 or more after a 75 g glucose load

(140 to 199 is considered “impaired glucose tolerance”)

125
Q

DM dx: A1C

A
  1. 5 or greater

5. 7 to 6.4 is prediabetic

126
Q

For a diabetic patient, the A1C goals should be adjusted if

A

the regular goal is not realistic. For example it’s not realistic for an 80 year old with CVD to meet the normal goal

127
Q

Metabolic syndrome: the components are

A 
Large waistline 
Hypercholesterolemia 
Low HDL 
HTN 
High glucose
128
Q

Metabolic Syndrome pathophysiology

A

Causes include overweight, inactivity, and insulin resistance. Older age and genetic also play a role.

Increases risk of heart disease, DM, renal impairment, and stroke

129
Q

Metabolic Syndrome 7 Treatment and goals

A

Lose weight by diet and exercise

Stop smoking

Lower LDL with statins

Increase HDL

Reduce hypertension with meds

Reduce blood sugar with meds

Aspirin to reduce risk of blood clots

130
Q

Metformin can help patients taking SDAs to

A

lose weight and not become diabetic

131
Q

What does metformin do

A

Suppresses glucose production in the liver
Reduces hunger
promotes fat loss
Stops or reverses weight gain

132
Q

What should you know about adverse effects of metformin

A

The main one is GI upset, which can be abated by slow titration

Also B12 loss happens but that’s after many years

133
Q

Metformin is contraindicated in people with

A

GFR less than 30

134
Q

Which SDAs have the worst metabolic syndrome risk

A

Olanzapine
Clozapine
Quetiapine

135
Q

SDAs with the least metabolic risks are ziprasidone, lurasidone,

A

aripiprazole, brexpiprazole, paliperidone, asenapine, lumateperone

136
Q

Which 7 labs should you do for someone starting an SDA (only the labs related to metabolic syndrome)

A 
Personal history
Family history
Weight
Waist circumference
Lipids 
Glucose 
BP
137
Q

First line antihypertensives

A

Thiazide diuretic
CCB
ACE or ARB

(If you’re black, thiazide diuretic or CCB)

138
Q

When assessing cholesterol, ideally it should be after a

A

12 hour fast

139
Q

Statin Therapy Recommendation for patients with atherosclerotic coronary artery disease who are under 75 years old

A

High dose statin

140
Q

Statin Therapy Recommendation for patients with atherosclerotic coronary artery disease who are over 75 years old

A

moderate dose statin

141
Q

Statin Therapy Recommendation for people with LDL at least 190

A

high dose statin

142
Q

Statin Therapy Recommendation for patients with DM

A

moderate or high dose

143
Q

Statin Therapy Recommendation for patients with LDL 70 to 189 plus 10 year CVD risk of at least 7.5%

A

moderate or high

144
Q

Explain CD4 testing for an HIV

A

CD4 tells you their immune status. High CD4 count is good.

145
Q

Explain viral load testing for an HIV patient

A

Tells you how much of virus is present

146
Q

Explain treatment for HIV positive people

A

Antiretroviral therapy.
It’s indicated for all adolescents and adults with HIV.
Start as soon as possible
Treatment is lifelong

147
Q

Explain pre-exposure prophylaxis for HIV

A

Begin as soon as possible but after confirming they are HIV negative

148
Q

Explain post exposure prophylaxis for HIV

A

You give them meds to prevent seroconversion.

It’s indicated for someone who isn’t HIV positive, but was in a high risk situation in the past 72 hours.

Treatment lasts for 28 days.

149
Q

Screening recommendations for HIV

A

Screen people from 15 to 65 years old

150
Q

High risk behaviors for getting HIV

A

People who request testing for other STDs
Bisexual
Prostitutes

151
Q

Conventional testing method for HIV

A
  • Reactive immunoassay
  • Then confirm those results with a Western blot or immunofluorescent assay

Other approved tests are combination tests and qualitative HIV-1 RNA

152
Q

Is rapid HIV testing good?

A

Yes, rapid tests are very accurate. But, if it’s positive, you need to confirm with the conventional tests.

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