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Clincial Medicine > Prevention > Flashcards

Prevention Flashcards

1
Q

COPD diagnosis, look at FEV1/FVC. Obstructive lung disease present at less than __% when compared to others

A

70%

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2
Q

Tertiary prevention for COPD is to

A

Get patient to stop smoking

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3
Q

3rd leading cause of death in the world is:

A

COPD

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4
Q

2nd leading cause of death in the world is:

A

Stroke

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5
Q

1st leading cause of death in the world is:

A

Ischemic heart disease

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6
Q

After quitting smoking, HR normalizes after __ minutes, CO levels normalize after __ hours, risk of MI falls and lung function returns to normal curve after __-__ weeks, risk of CAD is 50% that of a smoker after __ year(s).

A

20 minutes
12 hours
2 - 12 weeks
1 year

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7
Q

Symptoms of nicotine withdrawal

A

Depression, insomnia, irritability, anxiety, impaired concentration, appetite changes

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8
Q

Smoking cessation can involve behavioral counseling, as well as (4) described alternative therapies:

A

Acupuncture, aversive therapy, financial incentive from employers, hypnosis

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9
Q

Five A’s of smoking cessation:

A 
Ask (about use every visit)
Advise (quitting)
Assess (willingness)
Assist (in attempt to quit)
Arrange (follow up)
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10
Q

7 options recognized by USPHS for smoking cessation:

A

Nicotine patch, gum, lozenge, inhaler, nasal spray
Bupropion
Varenicline

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11
Q

Action of bupropion

A

Enhances CNS release of dopamine

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12
Q

Action of Varenicline

A

Partial agonist of a4-B2 nicotine content acetylcholine receptor

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13
Q

Medications to limit disability of COPD

A

Short acting beta agonists (albuterol, lee albuterol)
Anticholinergics (ipratroium)
Long acting beta agonists
Long acting anticholinergics/antimuscarinics (tiotropium)
Corticosteroids
Best: LABA, LAMA, ICS combination

PDE-4 inhibitors
Theophylline
supplemental O2
Pneumococcal and influenza vaccinations

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14
Q

Supplemental oxygen improves survival for COPD for patients and is recommended for those with:

A

RA pulse ox less than 88%
PaO2 less than 55mmHg on RA
PaO2 less than 60mmHg with for pulmonary or polycythemia

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15
Q

Pulmonary rehab indicated in moderate to severe COPD and benefits may last up to:

A

18 months after rehab

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16
Q

Lung Volume Reduction Surgery provided survival advantage for COPD patients with:

A

Upper lobe emphysema and low exercise capacity

Some increased mortality

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17
Q

Lung transplant for COPD patients improves FC and should be considered in patients with:

A

Post-bronchodilator FEV1 less than 25% predicted
Resting hypoxemia
Hypercapnia
Pulmonary HTN

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18
Q

Diagnosing asthma with bronchodilator, FEV1 improves:

A

More than 15%

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19
Q

Diagnosing asthma, methocholine challenge drops FEV1:

A

More than 20%

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20
Q

Tertiary prevention for asthma involves:

A

Avoiding triggers and preventing or treating exacerbation a

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21
Q

Persistent moderate asthma:
exhibits symptoms _______
Night time awakenings _______
Short acting beta agonist _________
Interferes with normal activity _________
Lung function FEV1 is between __% and __%

A 
Daily
More than once a week
Daily
Some limitation
60% and 80%
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22
Q

Steps 1 - 6 for intermittent thru persistent asthma treatment:

A

1) SABA PRN
2) low dose inhaled glucocorticoids
3) 2 plus LABA or medium dose
4) medium dose glucocorticoid plus LABA
5) high dose glucocorticoid plus LABA and maybe omalizumab if allergies present
6) high dose glucocorticoid, LABA, oral systemic glucocorticoid.

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23
Q

Healthcare practitioners collect data on a single patient, epidemiologists:

A

Collect data on an entire population

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24
Q

Classical epidemiology: population oriented. Interested in:

A

Risk factors that can be altered to prevent or delay disease,min jury, and death.

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25
Q

Clinical epidemiology: patient oriented. Interested in:

A

Prevention and care of illness in individual patients at risk for or already have a disease.

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26
Q

Etiology

A

Cause or origin of a disease or abnormal condition

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27
Q

The way a disease progresses in the absence of medical or public health intervention is called

A

Natural history

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28
Q

Name agent, host, and environment for measles

A

Agent: highly infectious virus
Host: human
Environment: population of unvaccinated people

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29
Q

Name agent, host, environment, and vector for malaria

A

Host: human
Agent: parasite
Environment: General patient population
Vector: anopheles mosquito

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30
Q

BEINGS model (major categories of risk factors for disease)

A 
Biological and behavioral
Environmental
Immunologic
Nutritional
Genetic
Services, social factors, spiritual factors
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31
Q

Of the BEINGS model, an immunologic factor can be herd immunity which means

A

Vaccine diminishes ability to spread disease, leads to reduced disease transmission

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32
Q

The framework of examining people not as individuals but as members of communities in a social context is called

A

Ecological perspective

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33
Q

Number of new health related events in a defined population within a specific period of time is known as:

A

Prevalence

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34
Q

Proportion of people who experience the onset of a health related event during a specified time is known as:

A

Incidence proportion

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35
Q

Rate at which new events occur in a population is known as the:

A

Incidence rate

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36
Q

The number of existing cases in the total population at a specific point or period in time is the:

A

Prevalence

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37
Q

The prevalence of disease at a certain point in time is the:

A

Point prevalence

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38
Q

The number of cases that exist during a specific time period is the:

A

Period prevalence

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39
Q

Incidence or prevalence: existing cases that allow us to measure the burden of disease in area

A

Prevalence

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40
Q

Proportion of persons who are unaffected at the beginning of the study period, but who experience a risk event during the study period indicates what for the population?

A

Risk

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41
Q

People at risk at the beginning of the study period constitute the:

A

Cohort

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42
Q

Calculating rate of disease:

A

Number of events in defined time period/average number of people at risk for event

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43
Q

Rate can be used to estimate risk if the following are true about the frequency of event in numerator, proportion of population affected, and time interval:

A

Frequency: only occurs once in study interval
Proportion: is small
Time interval: is short

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44
Q

Calculating positive predictive value (PPV):

A

Number of true positives/number of all positives

Gives chance of positive test being a true positive.

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45
Q

Technical precision has high specificity and high sensitivity, but for a test to be a good one, it must have good:

A

Clinical precision

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46
Q

To calculate true positives:

A

with true disease x sensitivity

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47
Q

To calculate false negatives:

A

with true disease - true positives

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48
Q

To calculate true negatives:

A

without disease x specificity

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49
Q

To calculate false positives:

A

without disease - true negatives

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50
Q

To calculate # with true disease:

A

Prevalence x n

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51
Q

Sensitivity is defined as:

A

Number of true positives over true positives plus false negatives

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52
Q

Specificity is calculated as:

A

True (-) / false(+) + true(-)

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53
Q

SpPin

A

High specificity, positive test rules in disorder

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54
Q

SnNout

A

High sensitivity, negative rules out disorder

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55
Q

Which healthcare workers are at the highest risk for needle sticks?

A

Nurses, lab workers, non surgical physicians, non clinical lab techs

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56
Q

Modes of occupational transmission of HIV

A

Per cutaneous
Contact of mucous membranes or non intact skin
If visible blood: feces, nasal secretions, saliva, sputum, sweat, tears, urine, vomitus.

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57
Q

Chance of transmission from source patient to exposed patient

A
  1. 03% percutaneous

0. 09% mucous membrane

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58
Q

How long is Post Exposure Prophylaxis for HIV given?

A

28 days

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59
Q

PEP for HIV involves 3 active agents:

A

Raltegravir (400mg PO BID)

Truvada (1 PO daily, Tenofovir and emtricitabine)

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60
Q

Follow up testing after baseline HIV test:

A

Baseline CBC and LFTs at baseline/two weeks if initial studies are abnormal

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61
Q

Pre-exposure prophylaxis HIV medication recommendation:

A

Truvada oral daily

62
Q

How often should patients taking Truvada as pre-exposure prophylaxis be tested for HIV? Renal function?

A

Every 3 months for HIV

Every 6 months for renal function

63
Q

Latent tuberculosis presents with:

A

Fever, cough, weight loss, night sweats, hemoptysis, fatigue

64
Q

Testing for active tuberculosis:

A

CXR, sputum culture, PPD

65
Q

Detection of latent TB:

A

PPD, negative CXR, no presence of symptoms, not contagious

66
Q

What percentage of patients with latent TB will develop active disease without prophylaxis?

67
Q

Purified Protein Derivative test is interpreted __ hours after administration and interpreted in millimeters.

A

48 - 72 hours

68
Q

Induration of >5 mm is considered positive in:

A

HIV positive persons, recent contacts of TB patients, people with fibrotic changes in CXR with prior TB, patients with organ transplants or are immunosuppressed.

69
Q

Induration of >10 mm is considered positive in:

A

Recent immigrants from countries with high prevalence
Injection drug users
Residents or employees in jails, nursing homes, hospitals, AIDS facilities, homeless shelters
Mycobacteriology lab personnel

70
Q

Induration >15 mm is considered positive in:

A

Person with no known risk factors

71
Q

Effective treatment for latent TB infection involves:

A

Isoniazid or isoniazid and rifampin

72
Q

How much heroes the risk increase in HIV patients for latent TB to progress to TB?

A

7-10% each year

73
Q

Side effects of isoniazid include:

A 
Transaminitis (symptomatic in 80-90%, stop if 3x normal or more)
Peripheral neuropathy (0.2% of patients, esp with diabetes, HIV, renal failure, alcoholism)
74
Q

Side effects of Rifampin and Rifapentine (RPT):

A

Asymptomatic hyperbilirubinemia
Pruritus and self limiting rash
Orange bodily fluids
Drug-drug interactions

75
Q

Environmental factors for TB exposure:

A

Small enclosed spaces, inadequate ventilation, re circulation of infected air, inadequate disinfection, improper procedure for handling specimens.

76
Q

XDR-TB is resistant to:

A

Isoniazid, rifampicin, fluoroquinolone, at least 1 of 3 second line drugs (amikacin, capreomycin, kanamycin)

77
Q

Relative risk (RR) represents:

A

Ratio of risk in the treated group to the risk in the control group. Expressed as a percentage (e.g. 0.001 event rate/0.002 control event rate = .5).

78
Q

Relative risk reduction (RRR) represents:

A

The percent reduction in the risk in the treated group compared to control. Given as percentage. Higher RRR the better the treatment.

RRR = 1 - RR

79
Q

Absolute risk reduction (ARR) or risk difference represents:

A

The difference in risk rate between the control group and the treated group.

80
Q

Number needed to treat (NNT) represents:

A

The number of patients that need to be treated to prevent one bad outcome.

NNT = 1/ARR

81
Q

The number of assumptions required to assume a patient will benefit from a given recommendation in DOE vs POEM is: (high/low)

A

HIGH for DOE

LOW for POEM

82
Q

In EBM, after assessing the patient, one forms a clinical question with PICO:

A

Patient/population
Intervention or exposure (what is being done or is happening to pt)
Comparisons (what could be done instead of interventions?)
Outcomes (how does intervention affect pt?)

83
Q

Identify the components of PICO in the following:

In an elderly female with newly diagnosed atrial fibrillation, does use of anticoagulant compared to aspirin alone reduce risk of stroke and mortality?

A

P - elderly female with atrial fib
I - anticoagulant
C - aspirin
O - reduced risk of stroke and mortality?

84
Q

Match the category of clinical question with the type of study:

Therapy, diagnosis, screening, prognosis, causation

Cross sectional study or RCT, RCT, Cohort or case-control study (or case report), Longitudinal survey

A

Therapy - RCT
Diagnosis and screening - cross sectional or RCT
Prognosis - longitudinal survey
Causation - cohort or case-control study

85
Q

Primary prevention involves the modification of:

A

Risk factors; proactive

86
Q

Secondary prevention involves the modification of:

A

The disease to prevent recurrence; reactive

87
Q

Tertiary prevention involves the modification of:

A

Progression and complications with return to baseline as the goal; rehab

88
Q

Risk factors for cardiovascular disease

A 
Cigarette smoking
CAD
HF
DM
HTN
Dyslipidemia
Sedentary lifestyle
89
Q

How does cigarette smoking increase risk for CV disease?

A

Accelerates blood clotting, nicotine is vasoconstrictive, CO levels are increased reducing O2 delivery

90
Q

How does DM affect the CV system?

A

Increases risk of repeat MI, elevated Hba1c affects heart/kidneys/eyes, CAD equivalent

91
Q

How does HTN increase risk of CV disease? Directly? Indirectly?

A

Direct: damage to blood vessels
Indirect: increased demand on heart

92
Q

What tests are involved in a complete lipid profile?

A 
TC (total cholesterol)
TG (triglycerides)
HDL-C
LDL-C
VLDL-C
93
Q

VLDL-C is a precursor to LDL-C, which is a precursor for:

A

Atherogenesis

94
Q

TC = HDL-C + LDL-C + (TG/5) so as triglycerides go up,

A

LDL-C goes down

95
Q

Cholesterol guidelines:
LDL >___ mg/dL
If aged 40 to 75 with DM and ___

A

LDL > 190

70 > LDL > 190

96
Q

What are the metrics for metabolic syndrome diagnosis in terms of abdominal obesity, triglyceride levels, HDL-C levels, blood pressure, and fasting glucose?

A

Abdominal obesity: waist circumference (>40 inches for men, >35 inches for women)
TG: >150mg/dL
HDL-C: 130/85
Fasting glucose: >100mg/dL

97
Q

Possible etiologies of essential hypertension

A

Atherosclerosis, fluid retention, changes in renin-angiotensin-aldosterone system

98
Q

Possible etiologies of non-essential hypertension

A

Renal artery disease, chronic kidney disease, obstructive sleep apnea

99
Q

JNC 8 recommended treatment for treatment of HTN in general population (black, non black)

A

Non black: thiazides, CCB, ACEI, ARB

Black: thiazides or CCB

100
Q

JNC 8 recommendations for treatment of hypertension in persons with CKD

A

ACEI or ARB (never together!)

101
Q

HTN medication that is a good first choice, has been shown to reduce CV disease in RCT. May see negative side effects in elderly (orthostatic hypotension, AKI, electrolyte derangements).

102
Q

HTN medication that seems to be a good choice if CAD, DM, or CHF. It is contraindicated in conduction abnormalities and poses a significant risk if no heart disease is present.

A

Beta blockers

103
Q

Once people have access to adequate nutrition, clean water, and a safe environment, ___________ becomes the major determining factor of health.

104
Q

Behavioral change theory that focuses on the individual’s perceptions of the threat posed by a health problem, the benefit of avoiding the threat, and factors influencing the decision to act.

A

Health belief model

105
Q

Behavioral change theory that focuses on the individual’s motivation and readiness to change a problem behavior. (Precontemplation, contemplation, preparation, action, maintenance).

A

Stages of change model

106
Q

Behavioral change theory that focuses on the individual’s attitude toward a behavior, perceptions of norms, and beliefs about the ease or difficulty of changing.

A

Theory of planned behavior

107
Q

Behavioral change theory that focuses on the individual’s seven step journey from lack of awareness to action and maintenance. Similar to stages of change except development is linear and not circular.

A

Precaution adoption process model

108
Q

Behavioral theory of change that focuses on personal factors, environmental factors, and human behavior that exert influence on each other. People learn not only from their experiences by from observing others.

A

Social cognitive theory

109
Q

3 main concepts of motivational interviewing

A

1) ambivalence
2) I learn what I believe as I hear myself talk
3) change motivated by perceived disconnect between present behavior and personal goals/values

110
Q

4 main strategies of motivational interviewing

A

Empathy
Cognitive dissonance
Roll with resistance
Support self-efficacy

111
Q

When evaluating an obese patient, facial plethora may indicate:

112
Q

When evaluating an obese patient, hirsutism may indicate:

A

Cushiness, PCOS

113
Q

When evaluating an obese patient, peri orbital edema, lateral thinning of eyebrows, and scalloped tongue may indicate:

A

Hypothyroidism

114
Q

When evaluating an obese patient, erosion of dental enamel may indicate:

A

Bulimia nervous

115
Q

When evaluating an obese patient, acanthosis nigricans may indicate:

A

Insulin resistance or diabetes

116
Q

When evaluating an obese patient, a buffalo hump may indicate:

117
Q

When evaluating an obese patient, red striae may indicate:

A

Cushings vs obesity

118
Q

When evaluating an obese patient, acrochordon (skin tags) may indicate:

A

Insulin resistance or diabetes

119
Q

Body mass index is measured by:

A

Weight in kg / height^2 in m

120
Q

Over 90% of COPD linked to exposure to

A

Cigarette smoke

121
Q

Overweight BMI for adults and children respectively is:

A

25child BMI>95th percentile

122
Q

Obese BMI for adults and children respectively is considered

A

> 30

> 95th percentile

123
Q

Four categories of weight related problems:

A

Metabolic
Degenerative
Neoplasticism
An atomic

124
Q

T2DM, HTN, and elevated blood lipids are categorized as what type of weight related problem?

125
Q

Osteoarthritis, atherosclerotic changes, and pulmonary diseases are categorized as what sort of weight related problem?

A

Degenerative

126
Q

Many forms of cancer including colorectal, breast, prostate, esophageal and ovarian cancers, are considered what category of weight related problems?

A

Neoplasticism

127
Q

GERD and Obstructive Sleep Apnea are categorized as what type of weight related problem?

128
Q

Some contraindications for anti-obesity medications include:

A 
Pregnancy or lactation
Unstable cardiac disease
Uncontrolled hypertension
Unstable severe systemic illness
Unstable psychiatric disorder/anorexia
Incompatible drug therapy
Closed angle glaucoma
General anesthesia
129
Q

A weight management medication that inhibits pancreatic lipase and is taken orally with each meal containing fat is:

A

Oralist at

130
Q

A weight management medication that is a specific 5-HT2C serotonin agonist and is given as 10mg orally BID is:

A

Lorcaserin

131
Q

A weight management medication that is a sympathomimetic anticonvulsant (via GABA receptor modulation, carbonic anhydrase inhibition, glutamate antagonism) given orally in the morning with incremental doses every 14 days is:

A

Phentermine/ Topiramate ER

132
Q

A weight management medication that is an opioid receptor antagonist and a DOPA/NE re uptake inhibitor and is given orally and daily with increasing doses and frequency each week is:

A

Naltrexone SR/ Bupriopion SR

133
Q

A weight management medication that is a GLP-1 receptor agonist and is administered subq, increasing dosage at weekly intervals till 3mg/day is reached

A

Liraglutide 3mg

134
Q

Three weight management medications contraindicated with MAOIs

A

Lorcaserin, Phentermine, Naltrexone/Bupriopion

135
Q

4 weight management medications contraindicated in pregnancy

A

Lorcaserin, Phentermine, naltrexone/bupropion

136
Q

Criteria for surgical treatment of obesity:

BMI related

A

BMI of 40 or higher

BMI of 35-39.9 with co morbidity

137
Q

A bariatric surgical procedure that is reversible, safe, results in moderate weight loss

A

Adjustable gastric band

138
Q

A bariatric surgical procedure that is irreversible, results in moderate to extreme weight loss, and is less safe than adjustable gastric band:

A

Gastric sleeve

139
Q

A bariatric surgical procedure that is irreversible, results in drastic weight loss, and is least safe is

A

Gastric bypass

140
Q

A bariatric surgical procedure that is irreversible, results in extreme weight loss, and is least safe:

A

Biliopamcrestic diversion with duodenal switch

141
Q

In research design,none step above randomized controlled double blind studies in the hierarchy of evidence is

A

Systematic reviews and meta analysis

142
Q

Cross-sectional surveys, cohort studies, and case-control studies fall under the umbrella of what category of study?

A

Observational studies

143
Q

Randomized controlled trials and quasi-experimental designs fall under the umbrella of what category of study?

A

Experimental studies

144
Q

3 categories of energy expenditure:
1) basal metabolic rate (70%)
2)
3)

A

2) physical activity (25%)

3) thermos effect of food (5%)

145
Q

The point where lactic acid rises disproportionately during incremental exercise

A

Lactate threshold

146
Q

Influence vaccination is indicated in

A

All adults over 18
Anyone with medical problems
Health care workers

147
Q

Pneumovax contains 23 variants and is indicated in

A

Adults over 65
Chronic illness
Risk factors
Splenectomy

148
Q

Prevnar (PCV 13) given to all adults over what age and how long must one wait before administering pneumovax?

A

13 years old, 6 months

149
Q

Who has functional asplenia and should bebgiven pneumovax?

A

Sickle cell patients, splenic infarcts from sickle cell crises

150
Q

Hepatitis B vaccine seroconversion occurs a few months after the third dose. Those who don’t develop seroconversion are called:

A

Non responders

151
Q

Hepatitis A vaccine is recommended for:

A

Travelers

Chronic liver disease

152
Q

How long must one wait to give Td booster after Tdap?

A

No wait is necessary

Clincial Medicine (10 decks)

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