General IM Flashcards by Jay Manguba

Calculated as (all true-positive test results) / (true-positive and false-negative test results)

Sensitivity

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Calculated as (all true-negative results) / (true-negative and false-positive results)

Specificity

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Calculated as (true-positive test results) / (all positive test results)

Positive predictive value

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Calculated as (true-negative test results) / (all negative test results)

Negative predictive value

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The probability that the patient has the disease if the test is positive

Positive predictive value

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The probability that the patient does not have the disease if the test is negative

Negative predictive value

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A receiver operating characteristic curve is a graph of this relationship between sensitivity and specificity

Sensitivity vs. (1 - specificity)

it is a graph of the true-positive rate [y] vs. false-positive rate [x]

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Direction of change in positive predictive value as prevalence of the disease increases

Increases

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Direction of change in negative predictive value as prevalence of the disease increases

Decreases

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A measurement of the odds of having a disease independent of the disease prevalence

Likelihood ratio

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Formula for positive likelihood ratio

Sensitivity / (1 - specificity)

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Formula for negative likelihood ratio

(1 - sensitivity) / specificity

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A likelihood ratio of 2 increases the probability of disease by approximately this percentage

15%

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A likelihood ratio of 5 increases the probability of disease by approximately this percentage

30%

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A likelihood ratio of 10 increases the probability of disease by approximately this percentage

45%

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A likelihood ratio of 0.5 decreases the probability of disease by approximately this percentage

15%

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A likelihood ratio of 0.2 decreases the probability of disease by approximately this percentage

30%

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A likelihood ratio of 0.1 decreases the probability of disease by approximately this percentage

45%

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In this study design, the presence of the presumed risk factor and presence of the outcome are measured at the same time in a population

Cross-section

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In this study design, subjects are divided into groups based on the presence or absence of the outcome of interest and then the frequency of risk factors in each group is compared

Retrospective (case control)

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In this study design, subjects are divided into groups based on the presence or absence of the presumed risk factor and followed for a period of time; frequency of the outcome is compared at the end of the study

Prospective (cohort)

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In this study design, subjects are randomly divided into groups; one group receives the intervention and followed forward in time; frequency of the outcome is compared at the end of the study

Randomized controlled trial

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In this study, multiple small clinical trials using similar randomization techniques and interventions are combined into one large analysis to address very precise clinical questions

Systematic review

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The difference in absolute risk of patients who received the intervention and those who did not

Absolute risk reduction (ARR)

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The ratio of the absolute risk of patients who received the intervention and those who did not

Relative risk

A type of relative risk (RR) that calculates the risk of an outcome in a group exposed to a risk compared with a control group not exposed to the risk

Hazard ratio

Calculated as (1 / absolute risk reduction)

Number needed to treat

A type of error wherein it is incorrectly concluded that a statistically significant difference exists between the experimental and control groups

Type I error

A type of error wherein it is incorrectly concluded that no difference exists between the experimental and control groups

Type II error

A study that uses a P value of <0.5 will have this chance of type I error

<5%

Smoking cessation reduces all-cause mortality by up to this percentage

50%

This pharmacologic therapy increases smoking cessation rates about 3.5 times more than control; it has been associated with suicidal ideation and increased risk of cardiovascular events

Varenicline

This pharmacologic therapy increases smoking cessation rates about 2 times more than control; should be avoided with seizure disorder and eating disorder; may be associated with suicidal ideation

Buproprion

HPV vaccines are indicated in male and female patients of this age regardless of sexual activity, presence of genital warts, or previous postiive HPV infection

9-26 years

Inactivated influenza vaccine is contraindicated in patients with allergy to this food

Eggs

Inactivated influenza vaccine is contraindicated in patients with a history of this neurologic condition

Guillain-Barré syndrome

Vaccine indicated in smokers

Pneumococcal vaccine

Tdap vaccine is given to patients with a dirty wound if this number of years has elapsed since primary series

>5 years

Yellow fever vaccine is indicated for patients travelling to these regions (2)

Africa and South America

Meningococcal vaccine is indicated for patients travelling to this region

Sub-Saharan Africa

Frequency of blood pressure screening in the general population

Every 2 years

Screen for diabetes mellitus if blood pressure is at this level

>135/80 mmHg

Starting age and frequency of screening total and HDL cholesterol

Men 35 years, women 45 years | Every 5 years

Starting age and frequency of screening mammogram with or without clinical breast examination

50 years, every 1-2 years

Starting age and frequency of screening Pap test

21 years, every 3 years until age 65

Frequency of screening when Pap test is combined with HPV testing

Every 5 years

Abdominal aortic aneurysm screening recommendation

One-time screening for men 65-75 years of age who have ever smoked

Chlamydia screening is recommended for sexually active women of this age

24 years or less | may also screen older at-risk women

Starting age to screen for bone mineral density

Women 65 years (<65 years if fracture risk is equal to or greater than that of a 65-year old white woman who has no additional risk factors for fracture using the WHO FRAX algorithm)

Most common causes of secondary obesity (3)

Hypothyroidism, Cushing syndrome, polycystic ovary syndrome

BMI definition of overweight

25-29.9

BMI definition of obese class I

30-34.9

BMI definition of obese class II

35-39.9

BMI definition of obese class III

40 or more

Average weight reduction with orlistat

2.9 kg

Drug treatment for obesity is offered if this threshold in weight loss is not reached by the end of 3 months using dietary and exercise interventions

A selective serotonin receptor agonist that induces the feeling of early satiety; associated with average weight loss of 5.8 kg and improvement in glycemic control

Locaserin

This combination of an appetite suppressant and an anticonvulsant with a weight-loss effect has been approved for pharmacological treatment of obesity

Phentermine-topiramate

Indications for the use of locaserin or phentermine-topiramate for obesity

BMI 30 or more, or 27 with 1 or more obesity-related comorbidity

Indications for bariatric surgery

BMI >40, or >35 with serious obesity-related comorbidities (severe sleep apnea, diabetes, severe joint disease)

Mortality reduction with bariatric surgery

29%

Most common cause of involuntary weight loss in the young

Malignancy

Most common causes (4) of involuntary weight loss in extended care facilities

Depression, medications, dehydration, issues related to dementia

Vitamin deficiencies (2) associated with coiled, corkscrew hair

Vitamins A and C

Vitamin deficiency associated with skin desquamation

Riboflavin

Vitamin deficiency associated with petechiae and perifollicular hemorrhage

Vitamin C

Vitamin deficiency associated with skin pigmentation, cracking, and crusting

Niacin

Vitamin deficiency associated with acro-orificial dermatitis (erythematous, vesiculobullous, and pustular)

Zinc

Vitamin deficiency associated with ophthalmoplegia and foot drop

Thiamine

Vitamin deficiency associated with memory disturbance and depressed vibratory and position senses

Vitamin B12

Gold standard for diagnosing white coat hypertension

Ambulatory BP measurement

Elevated blood pressure detected by ambulatory BP measurement but with normal office BP measurement; associated with increased risk of sustained hypertension and increased cardiovascular mortality

Masked hypertension

Cyclosporine-induced hypertension is a compelling indication for the use of this antihypertensive agent class

Calcium channel blocker

With an ACE inhibitor or ARB, an increase in serum creatinine by this percentage is acceptable and not a reason to discontinue therapy for hypertension

33%

GFR at which thiazide diuretics are not effective as antihypertensives

<30 mL/min/1.73 m2

Most readily modifiable risk factor for falls

Medications

Leading cause of drugs implicated in falls

Psychotropic agents

"Timed Up and Go" test associated with increased risk for falls

>10 seconds (high risk if >14 seconds)

Supplementation of this vitamin reduces the frequency of falls in older patients who are deficient

Vitamin D

Duration of chronic cough

8 or more weeks

Most common causes (3) of chronic cough in patients who are nonsmokers, have a normal chest x-ray, and are not taking an ACE inhibitor

Upper airway cough syndrome (postnasal drip), asthma, and GERD

Before additional evaluation, patients with chronic cough should stop smoking and discontinue ACE inhibitors for this duration

4 weeks

Test for cough-variant asthma

Methacholine challenge

A 4-point criteria to stratify adult patients according to risk of group A streptococcal pharyngitis

Centor criteria

Components of the 4-point Centor criteria

Fever (subjective), absence of cough, tender anterior cervical lymphadenopathy, tonsillar exudates (0-1: no testing/treatment; 2-3: do rapid antigen detection test or culture, but not both; 4: treat without testing)

Septic thrombophlebitis of the internal jugular vein resulting in metastatic pulmonary infections; caused by Fusobacterium necrophorum

Lemierre syndrome

Treatment for Fusobacterium necrophorum pharyngitis

Ampicillin-sulbactam

Treatment for streptococcal pharyngitis in patients allergic to penicillin

Macrolide

Acute bacterial sinusitis is defined as lasting for this duration

7 or more days

First-line choice for suspected bacterial sinusitis

Amoxicillin-clavulanate

Treatment for acute bacterial sinusitis in patients allergic to penicillin

Doxycycline

Indication for imaging tests such as CT in sinusitis

Immunocompromised condition (e.g., AIDS)

A Weber test that lateralizes to the bad ear is indicative of this type of hearing loss

Conductive hearing loss | sensorineural hearing loss if it lateralizes to the good ear

Rinne test result in conductive hearing loss

Bone conduction > air conduction

Most common cause of sudden sensorineural hearing loss

Idiopathic

Most common cause of malignant external otitis

Pseudomonas aeruginosa

Facial nerve paralysis, sensorineural hearing loss, and vesicular lesions on and in the ear canal caused by varicella-zoster virus

Ramsay Hunt syndrome

Most common cause of red eye

Viral conjunctivitis

Treatment for bacterial conjunctivitis

Topical fluoroquinolones or bacitracin-polymyxin

Giant papillary conjunctivitis with itching and watery discharge, and preauricular lymphadenopathy

``` Chlamydial conjunctivitis (treat with oral tetracycline, erythromycin, or doxycycline) ```

Chronic fatigue is defined as fatigue lasting for this duration

More than 1 month

Chronic fatigue syndrome is defined as persistent or relapsing fatigue lasting for this duration

At least 6 months

Superior among the two major BPH drug classes

Alpha-adrenergic blockers

First-line drugs for treatment of erectile dysfunction

Oral sildenail, vardenafil, or tadalafil

First-line therapy for premature ejaculation

SSRIs

Second-line therapy for premature ejaculation

Clomipramine

Treatment for erectile dysfunction when oral PDE-5 inhibitors are ineffective

``` Intraurethral alprostadil (if ineffective, give intracavernous alprostadil) ```

Core components (3) of decisional capacity

Understanding the situation at hand, understanding the risks and benefits of the decisions being made, and being able to communicate a decision

In this standard for decision making, the surrogate makes the decision that he or she believes the patient would have made

Substituted judgment standard

In this standard for decision making, the surrogate selects the medical treatment that he or she personally feels is best for the patient

Best interests standard

Reasoning error wherein the clinician who has encountered a similar presentation jumps to the conclusion that the current diagnosis must be the same as the previous

Availability heuristic

Reasoning error wherein the clinician accepts at face value a previous diagnosis made by another clinician

Anchoring heuristic

Reasoning error wherein there is acceptance of a diagnosis or plan made by another of higher authority

Blind obedience

Reasoning error wherein full differential diagnosis is not considered

Premature closure

Average number of system-related or cognitive factors that contribute to medical error in a single case