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MKSAP - Internal > General Internal > Flashcards

General Internal Flashcards

1
Q

sensitivity

A

percentage of pts with disease who have a positive screening test
- a / a+c

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2
Q

specificity

A
  • percentage of normal pts with a negative screening test

- d / d+b

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3
Q

What happens to PPV and NPV as the prevalence of a disease decreases?

A

as prevalence decreases, PPV decreases and NPV increases

- opposite is true if disease prevalence increases

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4
Q

positive predictive value

A

TP/ TP + FP

- probability that a person actually has disease given a positive test result

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5
Q

positive likelihood ratios of 2,5 and 10 increase the probability of disease by….

A

15%, 30% and 45% respectively

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6
Q

screening for abdominal aortic aneurysm

A

men aged 65-75 who smoked, should undergo one time screening with USG

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7
Q

screening for osteoporosis

A

women 65 yo or older or women over 60 yo w/ significant fracture risk factors
men only with certain RFs - long term steroid use, androgen deprivation

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8
Q

pneumococcal vaccine

A

all pts > 65 yo

  • if over 65, should get second dose in 5 years
  • second dose after 5 yrs also for pts with CKD, asplenia, cancer or IC pts
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9
Q

influenza vaccine in COPD pts

A

annually - trivalent killed vaccine

- its actually recommended for everyone over 6 months of age

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10
Q

who is the intranasal trivalent live attenuate influenza virus vaccine indicated for?

A

pts ages 5 to 49 who are NOT pregnant, IC or living with an immunosuppressed pt

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11
Q

what is the best end-point for measuring the effect of cancer screening on patient outcomes?

A

cancer-specific mortality

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12
Q

length bias

A

preferential detection of asymptomatic, more indolent cancers by any screening test
- this influences the case fatality ratio

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13
Q

lead time bias

A

patient survival after cancer diagnosis is artificially prolonged by screening

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14
Q

indications for herpes zoster vaccine

A

immunocompetent patients age 60 or older

  • live attenuated zoster vaccine, single subcutaneous dose
  • reduces incidence of herpes zoster and postherpetic neuralgia
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15
Q

contraindications to herpes zoster vaccine

A

live vaccine, therefore:

  • people with active, untreated TB
  • pregnant women
  • immunocompromised pts
  • pts receiving chemo, radio or immunosuppressants
  • living in same house as IC pt
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16
Q

in whom is tetanus immune globulin indicated?

A

pts who have not completed the primary series of tetanus immunizations or in pts who have an unclear immunization history

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17
Q

recommendations for HPV vaccine

A

all females between ages 9 and 26, regardless of sexual activity

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18
Q

acceptable CRC screening methods

A

screening should begin at age 50

  1. annual FOBT
  2. colonscopy every 10 years
  3. flexible sigmoidoscopy every 5 years + FOBT every 3 years
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19
Q

pt with syncope with prodromal symptoms of nausea, lightheadedness and diaphoresis lasting > 10 secs

A

vasovagal (neurocardiogenic) syncope

- may also have brief myoclonic jerks after LOC

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20
Q

in pt with suspected vasovagal syncope, but otherwise healthy - what do you do next?

A

no further testing required

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21
Q

syncope with sudden LOC and lack of preceding symptoms resulting in pt falling and injuring themself

A

cardiogenic syncope - ex. heart block

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22
Q

tx. of trifascicular heart block

A

if asymptomatic - nothing

if symptomatic - pacemaker

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23
Q

indications for permanent pacemaker implantation

A

intermittent 3rd degree block
type 2- 2nd degree block
alternating BBB

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24
Q

implantable loop recorder

A

continously records the ECG and allowes pt to save the previous 30 sec and 2 mins (Adjustable) after they have an episode

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25
Q

causes of obstructed cardiac output that lead to syncope

A

severe aortic stenosis
hypertrophic obstructive cardiomyopathy
cardiac ischemia

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26
Q

best test to evaluate recurrent syncope

A

implantable loop recorder

- records pt activated events and automatically records bradycardic and tachycardic events

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26
Q

what do you do with depressed pt who does not respond to full-dose therapy within 6 weeks?

A

should receive another medication (can be within same class) OR referral to psychotherapy

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27
Q

when can you add methylphenidate to depression tx?

A

no benefit of methylphenidate augmentation in treatment-resistant depression

28
Q

indications for ECT therapy in depression?

A

profound suicidal ideations
psychotic features present
pt fails to respond to multiple antidepressants

29
Q

best predictor of completed suicide

A

previous suicide attempts

30
Q

when does a greiving person become a candidate for anti-depressant therapy?

A

symptoms of major depression for at least 2 weeks, 8 or more weeks after their loved one’s death
- essentially, when sx. persist for more than 2 months

31
Q

which anti-depressant also causes sedation and weight gain?

A

mirtazipine

32
Q

what drug is used to prevent alcohol-withdrawl induced seizures?

A

lorazepam

- prophylactic, on fixed schedule, even if asymptomatic

32
Q

pts scoring > 10 points on clinical institute withdrawl assessement scale for alcohol withdrawl

A

need additional medication for withdrawl symptoms - usually benzos

33
Q

pts scoring > 15 on clinical institute withdrawl assessement scale for alcohol withdrawl

A

require hospitalization

33
Q

initial tx. of cocaine intoxication

A

sedation with lorazepam, IV or IM

34
Q

drug of choice for drug induced seizures

A

benzodiazepines

35
Q

which drugs are not recommended during acute cocaine intoxication?

A

B-blockers - worsen vasoconstriction due to unopposed alpha blocking effects

36
Q

what drug is useful in alcohol dependence and in decreasing frequency of relapses?

A

naltrexone

37
Q

management of hypoventilation caused by opioid overdose

A

naloxone - if inadequate, endotracheal intubation needed

38
Q

IV fomepizole is used for…

A

ethylene alcohol or methyl alcohol poisoning

39
Q

tx of cyanide poisoning

A

inhalation of amyl nitrate followed by IV sodium nitrate/sodium thiosulfate

40
Q

CAGE questionnaire

A

best choice screening test for alcohol problems
C - do you feel you should cut down?
A - have people annoyed you by criticizing your drinking?
G - have you ever felt bad or guilty about it?
E - have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

41
Q

Tx. of lumbar spinal stenosis unresponsive to conservative tx

A

surgery - minimum of 3 months of failed nonsurgical interventions

42
Q

pt with back pain gradually worsening over weeks/months, fever and elevated ESR > 100 mm/hr with tenderness over palpated portion of spine

A

vertebral osteomyelitis

43
Q

preferred imaging modality in evaluating vertebral osteomyelitis or spinal epidural abscess

A

MRI of spine

44
Q

Tx. of vertebral osteomyelitis/epidural abscess

A

IV antibiotics - guided by blood cultures

44
Q

when should you order an MRI for back pain?

A

pt has evidence of motor impairment, has not responded to therapy or symptoms are increasing; or if fever is present

44
Q

first line tx of acute, nonspecific lower back pain

A

acetaminophen or NSAIDs

- most pts improve w/in 1 month

45
Q

triad of back pain, muscle weakness and loss of bowel/bladder control suggests?

A

spinal cord compression

46
Q

cough variant asthma

A

presence of airway hyperresponsiveness; confirmed when cough resolves with asthma-therapy - do a trial of albuterol

46
Q

MCC of chronic cough

A

asthma
post-nasal drip (chronic sinusitis)
GERD

47
Q

what do you do in pts with chronic cough > 8 weeks who does not smoke, does not take an ACEi and has a normal CXR?

A

trial of first gen. antihistamine-decongestant medication

48
Q

what should you consider in pts who fail to respond to tx. directed at UACS, GERD and asthma?

A

non-asthmatic eosinophillic bronchitis

- confirmation with bronchial biopsy OR respond to inhaled corticosteroids

50
Q

all pts with hemoptysis should have?

A

chest XRAY

- if high risk for malignancy, do CT scan even if normal CXR

52
Q

are B-agonists useful in acute bronchitis?

A

help decrease cough severity and duration in adults when there is also WHEEZING

54
Q

which drugs can be used for smoking cessation?

A

nortriptyline and buproprion - similar efficacy to nicotine replacement therapy
varenicline - most effective

56
Q

what should varenicline not be combined with?

A

nicotine replacement therapy - increases risk of adverse effects

58
Q

what is the black box warning on varenicline and bupropion?

A

both pose risk of serious neuropsychiatric changes including behavioral changes, hostility, agitation, depressed mood, suicidal thoughts and behaviors and attempted suicide

60
Q

indications for bariatric surgery

A
  1. BMI > 35 and serious medical comorbidities
  2. BMI > 40 and failed attempts at weight loss
  3. progressive obesity (> 5kg/yr before age 30)
61
Q

pt has persistent N and V occuring within the first few months after gastric bypass surgery - what could this be and what test should you order?

A

stomal stenosis (stricture at anastomosis of gastric pouch and jejunum) - get upper endoscopy to further assess

62
Q

most appropriate management of heavy menstrual bleeding due to a known cause, ie. large fibroid

A

oral medroxyprogesterone acetate

- if pt is dizzy or orthostatic from blood loss, consider IV estrogen

63
Q

next step in evaluation of secondary amenorrhea in a patient who just stopped OCP

A

progestin withdrawl challenge
- menses after challenge excludes anatomic defects and chronic anovulation w/o estrogen (in other words, indicated relatively normal estrogen production and patent outflow tract)

64
Q

what are the initial lab tests that should be done in evaluating secondary amenorrhea

A

FSH, TSH and PRL levels

65
Q

CAGE questionnaire

A

best choice screening test for alcohol problems
C - do you feel you should cut down?
A - have people annoyed you by criticizing your drinking?
G - have you ever felt bad or guilty about it?
E - have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

66
Q

what do you do in pts with chronic cough > 8 weeks who does not smoke, does not take an ACEi and has a normal CXR?

A

trial of first gen. antihistamine-decongestant medication

67
Q

all pts with hemoptysis should have?

A

chest XRAY

- if high risk for malignancy, do CT scan even if normal CXR

68
Q

what is the most worrisome side effect of bupropion?

A

1 in 1000 risk of seizures

69
Q

next step in pts over 35 with abnormal uterine bleeding

A

endometrial biopsy to R/O endometrial cancer or hyperplasia

MKSAP - Internal (11 decks)

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