General Medicine

Question 1

Osteoporosis screening schedule

Answer 1

Age 65yrs

Younger than age 65yrs if FRAX 10yr risk major osteoporotic fracture >=9.3%

Question 2

Lean model for quality improvement

Answer 2

eliminate non-value added (waste) within a system

value stream mapping: show all steps and time for each step -> find problems/delays

Question 3

DMAIC

Answer 3

Define, Measure, Analyze, Improve, Control

focus on quality control of each step, rather than whole process

Question 4

PDSA

Answer 4

Plan, Do, Study, Act

focus on specific points in a system

Question 5

Six sigma

Answer 5

production model

reduce variation

Question 6

uveitis

Answer 6

unilateral eye pain, redness, and photophobia

ciliary flush, miosis

Question 7

risk factors for adverse driving event

Answer 7

cognitive dysfunction, caregiver report of unsafe skills, history of citations or accidents, driving fewer than 60 miles per week, alcohol or medications that affect the central nervous system, emotional aggression or impulsivity, impaired mobility (including neck range of motion, range of motion of the extremities, and coordination), visual impairment, and medical disorders that predispose to loss of consciousness

Question 8

acromioclavicular joint degeneration

Answer 8

pain located on the superior aspect of the shoulder, tenderness to palpation of the acromioclavicular joint, and pain with shoulder adduction and abduction beyond 120 degrees.

Question 9

SPIKES

Answer 9

Setting - plan ahead
Perception - figure out what pt knows
Invitation - ask how much pt wants to hear
Knowledge - break the bad news in short declarative sentences
Empathy - resist temptation to fix
Strategize - shift hope to achievable goals

Question 10

risk factors for statin adverse events

Answer 10

aka when to use moderate instead of high intensity statin

1. age >75yrs
2. CKD
3. on meds that interact w statins: eg diltiazem

Question 11

cohort study standard outcome measure

Answer 11

relative risk
probability of developing a specific outcome in a group with an exposure or risk factor present to the probability of developing the specific outcome in a group without the exposure or risk factor present

Question 12

case control study

Answer 12

compare the outcomes of patients with a disease (cases) to those without a disease (controls)

Question 13

case control study outcome measure

Answer 13

odds ratio
compares the odds (the ratio of the probability that the event will happen to the probability that the event will not happen) between study groups. The odds ratio is required for studies using retrospective data, such as case-control studies in which the groups being compared may not have a similar risk for the condition

Question 14

sacroiliitis

Answer 14

tenderness to palpation of the sacroiliac joint, pain that is reproduced with the FABER (Flexion, ABduction, External Rotation) test, and no pain with passive range of motion of the hips

Question 15

management of prepatellar bursitis

Answer 15

bursa aspiration

Question 16

cervical Ca screening

Answer 16

cytology only every 3yrs for age 21-30
if at 30, pt/provider wish to spread out to every 5yrs, can perform cytology w HPV cotesting
stop at age 65yrs

Question 17

best antipsychotic for extrapyramidal symptoms

Answer 17

clozapine

first generation anti-psychotics are the worst

Question 18

patellofemoral pain syndrome

Answer 18

anterior knee pain that is slow in onset and typically made worse with running, climbing stairs, and prolonged sitting.

Question 19

Dix Hallpike central vs peripheral vertigo

Answer 19

no latency, last >1min, less severe: central vertigo

latency, last

Question 20

labrynthitis vs vestibular neuonitis

Answer 20

labrynthitis: hearing loss and vertigo

vestibular neuronitis: vertigo

Question 21

waist circumference

Answer 21

don’t need to measure if BMI >35
measure at level of iliac crest
central adiposity: waist circumference >102 cm [40 in] in men and >88 cm [35 in] in women

Question 22

when to stop cervical cancer screening

Answer 22

can stop in women age 65 years and older if:
- three consecutive negative Pap smears or two consecutive negative Pap smears plus human papillomavirus test results within the last 10 years, with the most recent test performed within 5 years
continue if: HIV infection, women with in utero exposure to diethylstilbestrol (DES), and women who have had previous treatment of a high-grade precancerous lesion

Question 23

when to bridge perioperatively

Answer 23

when risk for thromboembolism is 5-10%

not for mechanical valves or A fib (risk

Question 24

treatment of moderate dry age related macular degeneration

Answer 24

high dose anti oxidants (vitamins and zinc)

Question 25

Rinne test

Answer 25

air conduction > bone conduction in normal hearing and in sensorineural hearing loss

Question 26

Weber test

Answer 26

normal to hear equally in both ears
if lateralizes to one side, there is either conductive hearing loss in that side or sensorineural hearing loss in the other ear

Question 27

primary open angle glaucoma

Answer 27

presentation: bilateral peripheral visual loss that occurs gradually and painlessly
findings on fundoscopic exam:
increased cup:disc ratio (>50%)
vertical extension of the central cup 
disc hemorrhages
increased intraocular pressure (>22)
treatment: beta blockers, prostaglandins

Question 28

when to administer TdaP in pregnancy

Answer 28

27-36wks gestation regardless of vaccination status

Question 29

systemic exertion intolerance disorder

Answer 29

A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than six months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest; and
Post-exertional malaise;* and
Unrefreshing sleep*
At least one of the two following manifestations is also required:
Cognitive impairment* or
Orthostatic intolerance±

Question 30

central pain

Answer 30

classically post stroke or spinal cord injury, fibromyalgia is another cause

Question 31

nociceptive pain

Answer 31

tissue injury pain

Question 32

risk factors for ovarian Ca -> endometrial biopsy for anovulatory bleeding

Answer 32

obesity, nulliparity, age 35 years or older, diabetes mellitus, family history of colon cancer, infertility, and treatment with tamoxifen

Question 33

otosclerosis

Answer 33

gradual onset, difficulty hearing low-pitched sounds, and no history of exposure to loud noises