non science

Question 1

what are some drugs that can cause weight gain? alternatives?

Answer 1

paroxetine (SSRI), propranolol

paroxetine –> buproprion
propranolol –> ACE-I, CCBs

Question 2

what does OPQRST approach to weight history stand for?

Answer 2

O- onset
P- precipitating
Q- quality of life
R- remedy
S- setting
T- temporal pattern

Question 3

what BMI is considered obese?

Answer 3

at least 30

30-34.9 class I
35-39.9 class II
40 and above class III

Question 4

who are considered “high risk patients” who “need to lose weight”

Answer 4

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

Question 5

what waist circumference measurements indicate increased risk

Answer 5

again some BS

40 in and above in men
35 in and above in women

Question 6

what is waist circumference a surrogate measurement of?

Answer 6

visceral adipose tissue

Question 7

How is childhood obesity and overweight classified?

Answer 7

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

Question 8

which growth chart to use for kids?

Answer 8

under 2 use WHO
2-19 use CDC
20 and above use CDC

Question 9

what are the 543210 target behaviors for kids?

Answer 9

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

Question 10

what parenting style has best outcomes for kids?

Answer 10

authoritative (both rules and affection)

Question 11

what is a conflict of interest?

Answer 11

when a professional judgement on a primary interest (patient welfare) tends to be unduly influenced by a secondary interest (financial gain)

Question 12

what are the 4 types of COIs?

Answer 12

1) detrimental patient outcomes
2) compromise of judgement/decision-making
3) potential for #1 or #2
4) appearance of #1 or #2

Question 13

what is a “conflict of principle”?

Answer 13

when you lose no matter what you choose

Question 14

describe the continuum of substance use and problems

Answer 14

risky use (increased chance problems)

harmful use (experience problems)

disorder (mild, moderate, severe)

Question 15

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)

Answer 15

increased probability of developing alcohol use disorder, liver disease, financial and marital problems, serious injuries

Question 16

what are risk factors for rx opioid misuse?

Answer 16

current/past hx of substance use
any mental health diagnosis
younger age (<40)
male

Question 17

what are warning signs of rx drug misuse

Answer 17

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

Question 18

what is the goal of a brief intervention?

Answer 18

to reach non dependent problem drinkers; harm reduction with goal to cut to low risk, not abstinence

Question 19

what are the components of the brief intervention?

Answer 19

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

Question 20

what are the 4 As of opioid use?

Answer 20

analgesia, activities of daily living, adverse effects, abberant drug related behaviors

Question 21

Positive pemberton’s sign indicates what?

Answer 21

substernal extension

Question 22

what landmark is just superior to thyroid isthmus?

Answer 22

cricoid cartilage

Question 23

what are the signs of recurrent laryngeal nerve compression (large benign goiter or malignant thyroid lesions)

Answer 23

three Ds

dysphonia, dysphagia, dyspnea

Question 24

neck mass is/is not likely to be thyroidal if it doesn’t move with swallowing

Answer 24

IS NOT LIKELY

Question 25

does thyroglossal duct cyst move up with tongue extension?

Answer 25

yes

Question 26

on neck inspection where do you most commonly see thyroglossal duct cyst?

Answer 26

midline above thyroid gland

Question 27

what are they likely pointing to on thyroid ultrasound on lower right side?

Answer 27

esophagus

Question 28

when are cortisol levels highest? lowest?

Answer 28

highest in morning, lowest in middle of night

Question 29

when to assess for Cushing’s (in terms of sample collection)

Answer 29

at night

Question 30

when to assess for Addison’s (in terms of sample collection)

Answer 30

in the morning

Question 31

when to collect late night salivary cortisol

Answer 31

12 am

Question 32

when to collect sample for low dose dexamethasone suppression test

Answer 32

1 mg dexamethasone at 12am, measure at 8am

Question 33

as CBG decrease (ex genetic deficiency or nephrotic syndrome), what happens?

Answer 33

free fraction of cortisol increases

if likely a problem, measure free cortisol rather than total

Question 34

what else other than protein binding can alter cortisol levels?

Answer 34

OCPs can increase cortisol levels by increasing CBG. pregnancy also does this

Question 35

why can immunoassays overestimate cortisol values?

Answer 35

crossreactivity

Question 36

what type of specimen is needed to measure free cortisol

Answer 36

saliva or urine