Hopkins

Question 1

DM meds that can worsen heart failure

Answer 1

TZDs (Pioglitazone) –> black box warning

DPP4 inhibitors also may

Question 2

DM meds that improve CKD. have added benefit of wt loss

Answer 2

SGLT2 (empagliflozin). Also good for HF

GLP-1 agonists (liraglutide)

Question 3

DM meds with risk of hypoglycemia

Answer 3

Insulin

Sulfonylureas (glyburide, glipizide, glimepiride)

Question 4

Tips for starting basal insulin

Answer 4

start at 10 units/day or 0.1-0.2 units/kg. Titrate to am fasting glucose. increase by 2 units q3 days til at goal <130.

Question 5

when to get screening mammograms?

Answer 5

every 2 years for ages 50-74. age 40-49 is individual conversations

Question 6

who gets breast MRI?

Answer 6

annual for age 25-30 for high risk group:

• known BRCA carrier
• untested pt with 1st deg with BRCA
• chest radiation when age 10-30 (i.e. Hodgkin lymphoma)
• lifetime risk >25%

Question 7

Results of Pap leading to colposcopy

Answer 7

LSIL with +HPV

HSIL

Question 8

T/F: HPV testing should be performed with pap smears in women <30

Answer 8

False, up to 30% can have transient infection <30 yo. Do HPV testing when >30 and also when there is ASCUS

Question 9

most common cause of PSA between 4-10

Answer 9

BPH. Still is recommended to get Prostate Biopsy if PSA >4. 15% of men with prostate cancer have normal PSA.

Question 10

when can you stop cervical cancer screening?

Answer 10

65

Question 11

lung cancer screen recommendations

Answer 11

annual LDCT for ages 55-80 if 30 pack year hx and current smoker/quit within the past 15 years

Question 12

when would you screen for prostate cancer?

Answer 12

based on individual convo and risk for ages 55-69 only

Question 13

what rise of PSA would make you refer for biopsy?

Answer 13

if PSA <4: rate of 0.35/year

>4: rate of 0.75/year

Question 14

most important risk factor for breast cancer

Answer 14

AGE

not personal hx of cancer or fhx of brca

Question 15

how much do statins reduce LDL?

Answer 15

Low: <30%
Medium: 30-50%
High: >50% (Atorva 40-80; Rosuva 20-40)

Question 16

Goal LDL while on Statin

Answer 16

LDL<70. Next step is to add ezetimibe. Then you add a PCSK9 inhibitor (evolocumab and alirocumab).

Question 17

Statin guidance for Diabetics

Answer 17

Age 20-39: If any complications (proteinuria, retinopathy, neuropathy) then moderate intensity statin
Age 40-75: ASCVD >20 = high intensity statin, <20 = moderate intensity statin

Question 18

when should all diabetics be started on a statin?

Answer 18

age 40

Question 19

define severe hypercholesterolemia

Answer 19

LDL > 190. Indication for high intensity statin if age > 20. Goal is >50% reduction and LDL < 100

Question 20

Live attenuated vaccine list

Answer 20

MMR
Varicella
Zoster
Intranasal influenza

Question 21

what are the only real contraindications to vaccine?

Answer 21

anaphylaxis to vaccine or component; relative CI if moderate to severe illness

Question 22

who gets pneumococcal vaccine

Answer 22

all adults >65, don’t need revaccination after. if got it at younger age revaccinate at 65.

Do PCV 13, then PPSV 23 8 weeks later

Question 23

T/F: If it has been more than 5 years since tetanus booster and you have puncture injury, give Tetanus immunoglobulin

Answer 23

False, revaccinate with tetanus booster

Question 24

when do antibodies form from vaccine?

Answer 24

IgM detectable in 7-10 days, peaks in 2-6 weeks

Question 25

Td and Tdap

Answer 25

Normally doing Td. Everyone gets Tdap at least once in life. Adults who never had Tdap should get one. All pregnant get Tdap each pregnancy

Question 26

Describe Primary Hyperaldosteronism

Answer 26

Resistant hypertension, hypokalmeia. Feedback causes low renin. (ren-Ag-Ald)

Question 27

How do you manage hypertension in 65yo with BP <140/90 with 10 year ASCVD risk <10%?

Answer 27

Lifestyle mod to get BP <130/80