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Shelf Exams/USMLE Step 2 CK ❄️ > Swanson - Primary Care > Flashcards

Swanson - Primary Care Flashcards

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USMLE® Step 1 flashcards
1
Q

What is likelihood ratio of a positive result?

A

Probability of that test result in the presence of disease divided by probability of test result in absence of disease

A / (A + C) divided by B / (B + D)

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2
Q

What is length time bias?

A

Bias from detection of slow growing tumors (detected more frequently in cancer screening programs, vs usual medical care)

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3
Q

How should individuals who smoke when under stressful work situations be managed?

A

Behavior modification techniques, and possibly bupropion

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4
Q

What is the difference between alcoholic dementia and alcohol amnestic disorder?

A

Amnestic disorder involves more difficulty with short-term memory (serial 7’s), dementia more for long term (information recall)

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5
Q

What BAL is noted to cause impairment in most state? Under the influence?

A

Impaired - 0.05%

DUI - 0.10%

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6
Q

Which drugs can be useful in the treatment of alcohol withdrawal?

A
  • Long-acting benzos (diazepam, librium)
  • Clonidine (for NE sx)
  • Antipsych (haldol, for hallucination and agitation)
  • Barbiturates and anticonvulsants
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7
Q

What is the best definition of alcoholism?

A

Alcohol abuse and alcohol dependency

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8
Q

What combination therapy is considered to be most effective for alcohol dependence?

A

Naltrexone + CBT

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9
Q

What are two major documented side effects of anorexic drugs?

A

HTN and renal failure (weight loss at 1 month, but not beneficial long-term)

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10
Q

Which drugs may promote weight loss?

A

Orlistat, bupropion, fluoxetine and topiramate

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11
Q

What are potential secondary causes to obesity? How frequently does this occur?

A

Iatrogenic disease (drugs), depression, cushings, hypothyroid

[

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12
Q

How can you differentiate eruptions of variola vs. varicella?

A

Variola are centripetal and come all at once.

Varicella are centrifugal and come in crops

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13
Q

What tests should be done for elderly nursing home patients presenting with fever and URTI sx?

A

CXR if + extra breath sounds on auscultation

CBC and blood culture to rule out bacteremia or secondary pneumonia

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14
Q

What may result in vaccinated individuals who still get the flu?

A

Reduced severity and duration of illness

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15
Q

What should be given to high risk individuals in whom influenza vaccine is contraindicated?

A

Oseltamivir or zanamivir prophlyaxis (only tamiflu in children

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16
Q

What is the optimal treatment of elderly patients with agitated depression?

A

TCAs and anxiolytics as needed

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17
Q

How do you treat anorexia in late stage cancer palliative care?

A

Prednisone or Megestrol Acetate

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18
Q

What is the first line for treating cancer associated nausea?

A

Thorough search for underlying cause, then begin with prochlorperazine, dimenhydrinate, or metoclopramide (alone or in combo as needed)

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19
Q

What is the most common sx in advanced cancer? What is the most common cause of N/V in advanced cancer?

A

Asthenia (fatigue)

Bowel obstruction from pressure of intrabdominal tumor on bowel

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20
Q

What is first line treatment for pleural effusion in a palliative care cancer patient?

A

Thoracentesis as needed and sclerosing agent if severe

If still not improving or recurs frequently can use bed elevation, O2, decreases fluid and or steroids as needed for sx relief

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21
Q

What effects may St Johns wort have on other drugs?

A

Cytochrome P450 inducer leading to subtherapeutic levels of some drugs like digoxin and OCPs

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22
Q

What is the first priority in patients presenting with history, physical exam, and ECG findings suspicious of MI?

A

Ascertain patent airway, without obstruction vomit or any blockage, and administer 100% O2

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23
Q

Up to how much time after onset of pain is tPA shown to be helpful in MI? Which patients do not benefit?

A

Up to 12 hours after onset of pain

Patients with non-Q wave infarcts and prior CABG not shown to benefit

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24
Q

What key drugs are needed concomitantly when treating MI with thrombolytic therapy? Which patients is this contraindicated in?

A

Aspirin and HEPARIN

No heparin given in uncontrolled HTN

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25
Q

What is the treatment for PVCs post-MI?

A

Nothing! Ppx with Anti-arrhythmics post MI have even been show to increase mortality

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26
Q

Which drugs have been shown to improve the prognosis after MI?

A

Beta blockers, aspirin, and Coumadin

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27
Q

What type of shock can occur following an acute MI?

A

Hypovolemic hypotension or persistent hypotension and poor cardiac index

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28
Q

What type of drug is Ticlipidine and what are its side effects?

A

Anti-platelet agent (ADP receptor blocker) that may cause neutropenia and thrombocytopenia

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29
Q

What drug regimen should patients with chronic stable angina absolutely be on?

A

Aspirin, beta blocker, and statin

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30
Q

What is the acute treatment of unstable angina?

A
  1. ASPIRIN
  2. Nitrates or morphine for pain
  3. Beta blocker, clipidogrel, heparin/LMWH, glycoprotein IIB/IIIA inhibitor
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31
Q

What drugs should be used for prinzmetal angina?

A

Calcium channel blockers and beta blockers can be used

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32
Q

In what cases are CABG procedures best indicated for?

A

Left main stem disease and diabetics with multiple vessel disease

Although any case of vessel disease may benefit

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33
Q

What is the primary treatment for a patient with angina and HTN?

A

Cardio selective beta blocker is first line (verapamil may be added)

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34
Q

What are the symptomatic characteristics of unstable angina?

A
  1. Angina at rest
  2. Accelerating angina
  3. New onset angina (3x per day)
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35
Q

What are the 5 major risk factors for CAD?

A
  1. HTN
  2. Smoking
  3. Diabetes
  4. Age >45 in men, >55 women
  5. Family Hx of early MI in 1st degree relative
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36
Q

What are elevated Triglycerides most closely associated with?

A

Diabetics with poor glucose control

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37
Q

What is the treatment of choice for hypercholesterolemia?

A

DIET THERAPY

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38
Q

What natural substance can decrease LDL levels?

A

Plant stanol esters

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39
Q

What are the beneficial effects of fish/fish oil to plasma lipid levels?

A
  • Reduce lipid levels (especially Trigs) and increase HDL
  • Inhibit platelet aggregation
  • decrease BP and viscosity
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40
Q

Which conditions are associated with elevations of cholesterol?

A

Hypothyroidism, lupus, pregnancy, OCP and Nephritic syndromes

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41
Q

What may be seen on chest radiography in a patient with diastolic heart failure?

A

Congestion with or without cardiomegaly

42
Q

What are the cardinal features of diastolic heart failure on echo? Systolic?

A

Dia - Normal LVEF and usually normal LV cavity size (concentric LV hypertrophy usually present)

Sys - LVEF

43
Q

What is the recommended blood pressure for a patient with diabetes and CHF?

A

Systolic

44
Q

What is the most important acute therapy for exacerbation of CHF? What should be initiated for long term care?

A

acute - Diuretic (furosemide) and O2 supplementation

chronic - ACEI or ARB, and slow initiation of beta-blocker

45
Q

What are possible underlying pathophysiological mechanisms for systolic heart failure?

A

LV chamber remodeling, CAD, valve disease, abnormal excitation-contraction coupling

46
Q

What are the main indications for using digoxin (digitalis)?

A

CHF with reduced EF and A-fib with RVR

47
Q

What are the clinical features of digoxin use?

A

Dig decreases sx of worsening heart failure, lower doses are as effective as higher, and use can reduce rate of hospitalizations in CHF

48
Q

What is the most important characteristic found on echo in evaluating patients with systolic dysfunction?

A

low ejection fraction (

49
Q

Which treatments have been shown to reduce hospitalizations and mortality in selective patients with CHF?

A

Beta blockers, spironolactone, ACEI, biventricular pacing

50
Q

what is the minimum level for BP to attain in antihypertesnive therapy?

A

below 140/90

51
Q

what is the first step in treating elevated blood pressure?

A

non-pharmacological therapy (weight loss, stop alcohol and cigarette smoking, aerobic exercise 4 hours per week, reduce salt, reduce fat)

52
Q

What is the best antihypertensive therapy in CHF?

A

ACEI, beta block, and aldosterone inhibitors

53
Q

What is the best antihypertensive therapy in patients with recurrent strokes?

A

ACEI and thiazide diuretics

54
Q

What is the greatest utility of calcium channel blockers as an antihypertensive agent?

A

reducing cardiovascular disease and stroke in patients with diabetes

55
Q

What is the utility of beta blockers outside of antihypertensive or cardiovascular treatment?

A

useful in migraine headache ppx

56
Q

What is the utility of thiazides besides as an antihypertensive and diuretic?

A

treat osteoporosis by slowing demineralization process

57
Q

Which patients may be more at risk of developing HTN secondary to another pathology (as opposed to essential)?

A

age >50 (e.g. renal artery stenosis); usually patients with essential HTN get it before 50

58
Q

What are the main metabolic side effects of thiazide diuretic use and in which patients is it contraindicated?

A

hyperglycemia, hyperuricemia, hyperlipidemia
hypomagnesemia, hyponatremia, hypokalemia

sulfa allergies more at risk to be allergic

59
Q

What medications are often needed in the treatment of HTN in CKD and what drugs should be avoided?

A

Need ACEI or ARB and loop diuretic to maintain fluid balance

avoid triamterene which may lead to hyperkalemia

60
Q

What are the recommended first line antihypertensive tx for african american patients?

A

thiazide diuretics initially, and Ca channel blockers

61
Q

Which antiHTN drugs are contraindicated in patients with hypercholesterolemia?

A

high dose beta block without ISA, high dose diuretics

62
Q

What is preferred to treat HTN in pregnant women? what should be avoided?

A

Alpha methyldopa, Mg sulfate, hydralazine

Avoid ACEI or diuretics

63
Q

What is the acute treatment for A-Fib?

A

if hemodynamically unstable, synchronized cardioversiom

if stable, calcium channel or beta blockers

64
Q

What is the treatment for PSVT in a stable patient?

A

Vagal maneuvers and adenosine

65
Q

When and where do fat emboli mostly occur? how may they appear clinically?

A

FE is on upper body 2-3 days after major long bone injury

hallmark is presence of purpura

66
Q

What are the indications for IVC filter placement?

A

Indicated in patients with Venous thromboembolism and contraindication to anticoagulation, recurrence of VTE despite anticoag

67
Q

What is the difference between COPD and asthma in terms of relationship between smooth muscle hyperplasia and bronchodilator responsiveness or methacoline sensitivitY?

A

In COPD no clear link between the hyperplasia and responsiveness/meth sensitivity

68
Q

What clinical feature is most worrisome in an elderly patient with COPD?

A

Change in mental status

69
Q

What is the basic pathophysiological process that leads to asthma? Which substances released by cells are responsible for this?

A

Inflammatory process that can lead to/involve bronchoconstriction and bronchial hyperreactivity

Mast cell release of histamine, proteolytic enzymes, heparin and chemotactic factors are all implicated

70
Q

What are the components that may lead to reversible airflow obstruction in asthma?

A

bronchoconstrction, mucous plug formation, and edema

71
Q

What is the best pre-exercise preventitive treatment for exercise induced bronchospasm?

A

INhaled beta 2 agonist 1st line, cromolyn or nedocromil can also be used

72
Q

What is the best 1st line treatment for long term management of difficult to treat EIB?

A

Inhaled corticosteroids followed by montelukast, LABA then theophylline

73
Q

What is the most usual cause of vocal cord dysfunction?

A

Largely psychogenic, found mainly in 20-40 yo females with anxiety/depression/other psych DO

74
Q

What is exercise induced hyperventilation?

A

Common problem in athletes where they lose control of breathing and breathe high in chest with rapid shallow breaths vs using abdominal muscles

75
Q

What is the treatment of moderate persistent asthma?

A

Inhaled corticosteroids, and if needed LABA

76
Q

What is the treatment for severe asthma exacerbation (e.g. PEF

A

SABA x3 by inhaler or x1 by nebulizer

If PEF emains low or wheezing/SOB persist repeat SABA and go to ER

77
Q

What are the most common exam findings in patients with asthma exacerbation?

A

Increased RR, use of accessory muscles, followed by dyspnea/anxiety and then wheezes

78
Q

What are the main risks of using a Long acting beta agonist for asthma?

A

associated with increased asthma related hospitalization and death (likely from tolerance development) –> never use as rescue inhaler

79
Q

How can you differentiate mycoplasma pneumo from other causes?

A

Young adult, harsh nonproductive constant cough (no shaking chills or fever)

80
Q

What should be empirical antibiotic treatment for presumed strep pneumo in a hospitalized patient?

A

Beta Lactam and a macrolide Abx OR quinolone monotx until susceptibilities are found

81
Q

What should be considered in immunocompromised o COPD patients with presumed pneumonia who fail standard Abx therapy? How should you treat them?

A

Likely Legionella pneumonia, newer macrolides and quinolones should be given

82
Q

What is the treatment of choice to cover Klebsiella pneumo?

A

3rd generation cephalosporin OR a carbapanem, aminoglycoside, or quinolone alone or in combo

83
Q

What is the most common cause of nosocomial pneumo?

A

Aerobic gram negative bacteria

84
Q

What is the underlying cause of GERD?

A

Transient relaxation of LES

85
Q

What are the associated clinical signs of pharyngeal paralysis?

A

Dysphagia solids and liquids and aspiration into windpipe or regurgitation into nose common

Associated with neuromuscular disorder (myasthenia gravis, ALS, stroke)

86
Q

How long should it take for H pylori to be treated and heal completely?

A

3-6 weeks

87
Q

What medication is cytoprotective in PUD?

A

Misoprostol (prostaglandin analogue) protects GI mucosa

88
Q

What must be used with Dexamethasone therapy?

A

H2 antagonist or PPI, because dexa is a potent stimulator of gastric acid secretion

89
Q

Which test is not useful to detect eradication of H pylori?

A

ELISA

90
Q

What is the treatment of ascites and associated edema?

A

Sodium restriction, Spironolactone, paracentesis

If unresponsive, Add diuretic furosemide or thiazide

If refractory, paracentesis with albumin infusion

91
Q

What is one of the most important physical exam findings in a patient with malignant pancreatic neoplasm?

A

Provocative maneuver, reproduce pain gently by assuming supine position, pain relief with spine flexion

92
Q

What is the most likely cause of a palpable abdominal mass in a patient with acute pancreatitis? What is the most likely plain film abdomen finding in any case of acute pancreatitis?

A

Pseudocyst

Sentinel loop on plain film (isolated dilation of gut segment adjacent to pancreas)

93
Q

Which treatments may be indicated in the management of the acute phase of ulcerative colitis?

A

Steroid enemas, oral corticosteroids, parenteral steroids

94
Q

What is the treatment of choice for active or chronic UC, remission etc?

A

5ASAs

95
Q

What is the utility of metronidazole in Crohn’s disease?

A

Crohns colitis and Perianal Crohns

96
Q

What is the utility of Alosetron (lotronex)?

A

Women with severe diarrhea predominant IBS

97
Q

What conditions are frequently associated with IBS?

A

Functional disorders - fibromyalgia, interstitial cystitis, and migraine headaches

98
Q

What is the preferred test to confirm appendicitis in pediatric patients?

A

Ultrasonography to avoid radiation

99
Q

What are hyper plastic polyps?

A

Totally benign unclassified colon polyps

100
Q

What is the definitive treatment for protruding internal hemorrhoids?

A

Rubber band ligation

Shelf Exams/USMLE Step 2 CK ❄️ (21 decks)

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