Preventive Medicine COPY

Question 1

Common indications of influenza and pneumococcal vaccine

Answer 1

• Patients with chronic lung, heart, liver, kidney, and cancer conditions
• HIV-positive patients
• Patients on steroids
• Patients with diabetes

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8553-8556). Kaplan Publishing. Kindle Edition.

Question 2

Specific indications for influenza vaccine (not applicable to pneumococcal)

Answer 2

• Recommended yearly in the general population.
• Everyone > 50
• Yearly
• Pregnant women
• Health care workers

Question 3

Specific indications for pneumococcal vaccine

Answer 3

Single injections in all patients > 65

Question 4

Meningococcal vaccination

1. When is it routinely given
2. Children at especially high risk

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8563-8566). Kaplan Publishing. Kindle Edition.

Answer 4

1. Age 11
2. Children at especially high risk are
   
   • Functional or anatomic asplenia
   • Terminal complement deficiency.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8563-8566). Kaplan Publishing. Kindle Edition.

Question 5

Smoking Cessation:

Who should be screened for tobacco use?

What is the most effective method of achieving smoking cessation?

What is usually tried first?

Answer 5

All patients should be screened for tobacco use and advised against it.

The most effective method of achieving smoking cessation is the use of oral medication, such as bupropion and varenicline.

Less effective therapies that can be tried first are nicotine patches and gums.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8570-8576). Kaplan Publishing. Kindle Edition.

Question 6

Varicella-Zoster Vaccine:

When should it be administered

Answer 6

Vaccination against the reactivation of varicella-zoster (shingles) should be performed in everyone above age 60.

The vaccine is a higher-dose form of the varicella vaccine given to children.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8570-8576). Kaplan Publishing. Kindle Edition.

Question 7

When to screen for osteoporosis and what by means?

Answer 7

At 65 years and with a bone densitometry

Question 8

Candidates for screening for abdominal aortic aneurysm (AAA)

Answer 8

Men age 65 who were ever smokers should be for AAA with ultrasound

Question 9

Hyperlipidemia

Screening age for

Men

Women

Answer 9

Men: >35

Women: >45

Question 10

Absolute risk reduction (ARR) or attributable risk

Answer 10

ARR = the absolute risk (rate of adverse events) in the placebo group minus the absolute risk in the treated patients

Question 11

Number needed to treat (NNT)

Answer 11

NNT = 1/ARR

Question 12

Good confirmatory tests must have a specificity. As the specificity increases, the positive predictive value also increases.

Why?

Answer 12

This is because the false positives decreases. From the formular below we see that as the false positives (FP) gets smaller the denominator becomes smaller and the PPV becomes bigger

PPV = TP / (TP + FP)

So the smaller the FP the bigger the PPV