non science Flashcards
what are some drugs that can cause weight gain? alternatives?
paroxetine (SSRI), propranolol
paroxetine –> buproprion
propranolol –> ACE-I, CCBs
what does OPQRST approach to weight history stand for?
O- onset P- precipitating Q- quality of life R- remedy S- setting T- temporal pattern
what BMI is considered obese?
at least 30
30-34.9 class I 35-39.9 class II 40 and above class III
who are considered “high risk patients” who “need to lose weight”
this is all a bunch of BS but for purposes of this exam only
BMI 30 and above
BMI 25 and above with at least one risk factor
what waist circumference measurements indicate increased risk
again some BS
40 in and above in men
35 in and above in women
what is waist circumference a surrogate measurement of?
visceral adipose tissue
How is childhood obesity and overweight classified?
obesity = 95th percentile and above (class I 119% of 95th percentile, class II 120-139% of 95th percentile, class III 140% or more of 95th percentile)
overweight = 85 - 94th percentile
healthy = 5 - 84th percentile
underweight = <5th percentile
which growth chart to use for kids?
under 2 use WHO
2-19 use CDC
20 and above use CDC
what are the 543210 target behaviors for kids?
5 servings fruit/veggies per day 4+ cups water per day 3 servings low fat dairy 2 hrs or less screen time 1 hr physical activity 0 sugar sweetened beverages
what parenting style has best outcomes for kids?
authoritative (both rules and affection)
what is a conflict of interest?
when a professional judgement on a primary interest (patient welfare) tends to be unduly influenced by a secondary interest (financial gain)
what are the 4 types of COIs?
1) detrimental patient outcomes
2) compromise of judgement/decision-making
3) potential for #1 or #2
4) appearance of #1 or #2
what is a “conflict of principle”?
when you lose no matter what you choose
describe the continuum of substance use and problems
risky use (increased chance problems)
harmful use (experience problems)
disorder (mild, moderate, severe)
what risks increase for individuals above limits (ie at risk drinking)? (no more than 3 drinks/occasion and 7 per week women; 4 per occasion and 14 per week men)
increased probability of developing alcohol use disorder, liver disease, financial and marital problems, serious injuries
what are risk factors for rx opioid misuse?
current/past hx of substance use
any mental health diagnosis
younger age (<40)
male
what are warning signs of rx drug misuse
self increase dose or frequency, use to get high or when angry/upset, early refills, lost rxs, obtained from more than one MD, bought over internet or from someone else, worsening sxs, deteriorating function, focus obtaining medication not tx sxs, attend med refill not ancillary care/consultation visits
what is the goal of a brief intervention?
to reach non dependent problem drinkers; harm reduction with goal to cut to low risk, not abstinence
what are the components of the brief intervention?
ASK - re alcohol and substance use ADVISE - to change if pos screen ASSESS - willingness to change ASSIST - in making a change if willing ARRANGE - follow up to support change
what are the 4 As of opioid use?
analgesia, activities of daily living, adverse effects, abberant drug related behaviors
Positive pemberton’s sign indicates what?
substernal extension
what landmark is just superior to thyroid isthmus?
cricoid cartilage
what are the signs of recurrent laryngeal nerve compression (large benign goiter or malignant thyroid lesions)
three Ds
dysphonia, dysphagia, dyspnea
neck mass is/is not likely to be thyroidal if it doesn’t move with swallowing
IS NOT LIKELY
does thyroglossal duct cyst move up with tongue extension?
yes
on neck inspection where do you most commonly see thyroglossal duct cyst?
midline above thyroid gland
what are they likely pointing to on thyroid ultrasound on lower right side?
esophagus
when are cortisol levels highest? lowest?
highest in morning, lowest in middle of night
when to assess for Cushing’s (in terms of sample collection)
at night
when to assess for Addison’s (in terms of sample collection)
in the morning
when to collect late night salivary cortisol
12 am
when to collect sample for low dose dexamethasone suppression test
1 mg dexamethasone at 12am, measure at 8am
as CBG decrease (ex genetic deficiency or nephrotic syndrome), what happens?
free fraction of cortisol increases
if likely a problem, measure free cortisol rather than total
what else other than protein binding can alter cortisol levels?
OCPs can increase cortisol levels by increasing CBG. pregnancy also does this
why can immunoassays overestimate cortisol values?
crossreactivity
what type of specimen is needed to measure free cortisol
saliva or urine
