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Swanson - Primary Care 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
What is the treatment for PVCs post-MI?
Nothing! Ppx with Anti-arrhythmics post MI have even been show to increase mortality
26
Which drugs have been shown to improve the prognosis after MI?
Beta blockers, aspirin, and Coumadin
27
What type of shock can occur following an acute MI?
Hypovolemic hypotension or persistent hypotension and poor cardiac index
28
What type of drug is Ticlipidine and what are its side effects?
Anti-platelet agent (ADP receptor blocker) that may cause neutropenia and thrombocytopenia
29
What drug regimen should patients with chronic stable angina absolutely be on?
Aspirin, beta blocker, and statin
30
What is the acute treatment of unstable angina?
1. ASPIRIN 2. Nitrates or morphine for pain 3. Beta blocker, clipidogrel, heparin/LMWH, glycoprotein IIB/IIIA inhibitor
31
What drugs should be used for prinzmetal angina?
Calcium channel blockers and beta blockers can be used
32
In what cases are CABG procedures best indicated for?
Left main stem disease and diabetics with multiple vessel disease Although any case of vessel disease may benefit
33
What is the primary treatment for a patient with angina and HTN?
Cardio selective beta blocker is first line (verapamil may be added)
34
What are the symptomatic characteristics of unstable angina?
1. Angina at rest 2. Accelerating angina 3. New onset angina (3x per day)
35
What are the 5 major risk factors for CAD?
1. HTN 2. Smoking 3. Diabetes 4. Age >45 in men, >55 women 5. Family Hx of early MI in 1st degree relative
36
What are elevated Triglycerides most closely associated with?
Diabetics with poor glucose control
37
What is the treatment of choice for hypercholesterolemia?
DIET THERAPY
38
What natural substance can decrease LDL levels?
Plant stanol esters
39
What are the beneficial effects of fish/fish oil to plasma lipid levels?
- Reduce lipid levels (especially Trigs) and increase HDL - Inhibit platelet aggregation - decrease BP and viscosity
40
Which conditions are associated with elevations of cholesterol?
Hypothyroidism, lupus, pregnancy, OCP and Nephritic syndromes
41
What may be seen on chest radiography in a patient with diastolic heart failure?
Congestion with or without cardiomegaly
42
What are the cardinal features of diastolic heart failure on echo? Systolic?
Dia - Normal LVEF and usually normal LV cavity size (concentric LV hypertrophy usually present) Sys - LVEF
43
What is the recommended blood pressure for a patient with diabetes and CHF?
Systolic
44
What is the most important acute therapy for exacerbation of CHF? What should be initiated for long term care?
acute - Diuretic (furosemide) and O2 supplementation chronic - ACEI or ARB, and slow initiation of beta-blocker
45
What are possible underlying pathophysiological mechanisms for systolic heart failure?
LV chamber remodeling, CAD, valve disease, abnormal excitation-contraction coupling
46
What are the main indications for using digoxin (digitalis)?
CHF with reduced EF and A-fib with RVR
47
What are the clinical features of digoxin use?
Dig decreases sx of worsening heart failure, lower doses are as effective as higher, and use can reduce rate of hospitalizations in CHF
48
What is the most important characteristic found on echo in evaluating patients with systolic dysfunction?
low ejection fraction (
49
Which treatments have been shown to reduce hospitalizations and mortality in selective patients with CHF?
Beta blockers, spironolactone, ACEI, biventricular pacing
50
what is the minimum level for BP to attain in antihypertesnive therapy?
below 140/90
51
what is the first step in treating elevated blood pressure?
non-pharmacological therapy (weight loss, stop alcohol and cigarette smoking, aerobic exercise 4 hours per week, reduce salt, reduce fat)
52
What is the best antihypertensive therapy in CHF?
ACEI, beta block, and aldosterone inhibitors
53
What is the best antihypertensive therapy in patients with recurrent strokes?
ACEI and thiazide diuretics
54
What is the greatest utility of calcium channel blockers as an antihypertensive agent?
reducing cardiovascular disease and stroke in patients with diabetes
55
What is the utility of beta blockers outside of antihypertensive or cardiovascular treatment?
useful in migraine headache ppx
56
What is the utility of thiazides besides as an antihypertensive and diuretic?
treat osteoporosis by slowing demineralization process
57
Which patients may be more at risk of developing HTN secondary to another pathology (as opposed to essential)?
age >50 (e.g. renal artery stenosis); usually patients with essential HTN get it before 50
58
What are the main metabolic side effects of thiazide diuretic use and in which patients is it contraindicated?
hyperglycemia, hyperuricemia, hyperlipidemia hypomagnesemia, hyponatremia, hypokalemia sulfa allergies more at risk to be allergic
59
What medications are often needed in the treatment of HTN in CKD and what drugs should be avoided?
Need ACEI or ARB and loop diuretic to maintain fluid balance avoid triamterene which may lead to hyperkalemia
60
What are the recommended first line antihypertensive tx for african american patients?
thiazide diuretics initially, and Ca channel blockers
61
Which antiHTN drugs are contraindicated in patients with hypercholesterolemia?
high dose beta block without ISA, high dose diuretics
62
What is preferred to treat HTN in pregnant women? what should be avoided?
Alpha methyldopa, Mg sulfate, hydralazine Avoid ACEI or diuretics
63
What is the acute treatment for A-Fib?
if hemodynamically unstable, synchronized cardioversiom if stable, calcium channel or beta blockers
64
What is the treatment for PSVT in a stable patient?
Vagal maneuvers and adenosine
65
When and where do fat emboli mostly occur? how may they appear clinically?
FE is on upper body 2-3 days after major long bone injury hallmark is presence of purpura
66
What are the indications for IVC filter placement?
Indicated in patients with Venous thromboembolism and contraindication to anticoagulation, recurrence of VTE despite anticoag
67
What is the difference between COPD and asthma in terms of relationship between smooth muscle hyperplasia and bronchodilator responsiveness or methacoline sensitivitY?
In COPD no clear link between the hyperplasia and responsiveness/meth sensitivity
68
What clinical feature is most worrisome in an elderly patient with COPD?
Change in mental status
69
What is the basic pathophysiological process that leads to asthma? Which substances released by cells are responsible for this?
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
What are the components that may lead to reversible airflow obstruction in asthma?
bronchoconstrction, mucous plug formation, and edema
71
What is the best pre-exercise preventitive treatment for exercise induced bronchospasm?
INhaled beta 2 agonist 1st line, cromolyn or nedocromil can also be used
72
What is the best 1st line treatment for long term management of difficult to treat EIB?
Inhaled corticosteroids followed by montelukast, LABA then theophylline
73
What is the most usual cause of vocal cord dysfunction?
Largely psychogenic, found mainly in 20-40 yo females with anxiety/depression/other psych DO
74
What is exercise induced hyperventilation?
Common problem in athletes where they lose control of breathing and breathe high in chest with rapid shallow breaths vs using abdominal muscles
75
What is the treatment of moderate persistent asthma?
Inhaled corticosteroids, and if needed LABA
76
What is the treatment for severe asthma exacerbation (e.g. PEF
SABA x3 by inhaler or x1 by nebulizer If PEF emains low or wheezing/SOB persist repeat SABA and go to ER
77
What are the most common exam findings in patients with asthma exacerbation?
Increased RR, use of accessory muscles, followed by dyspnea/anxiety and then wheezes
78
What are the main risks of using a Long acting beta agonist for asthma?
associated with increased asthma related hospitalization and death (likely from tolerance development) --> never use as rescue inhaler
79
How can you differentiate mycoplasma pneumo from other causes?
Young adult, harsh nonproductive constant cough (no shaking chills or fever)
80
What should be empirical antibiotic treatment for presumed strep pneumo in a hospitalized patient?
Beta Lactam and a macrolide Abx OR quinolone monotx until susceptibilities are found
81
What should be considered in immunocompromised o COPD patients with presumed pneumonia who fail standard Abx therapy? How should you treat them?
Likely Legionella pneumonia, newer macrolides and quinolones should be given
82
What is the treatment of choice to cover Klebsiella pneumo?
3rd generation cephalosporin OR a carbapanem, aminoglycoside, or quinolone alone or in combo
83
What is the most common cause of nosocomial pneumo?
Aerobic gram negative bacteria
84
What is the underlying cause of GERD?
Transient relaxation of LES
85
What are the associated clinical signs of pharyngeal paralysis?
Dysphagia solids and liquids and aspiration into windpipe or regurgitation into nose common Associated with neuromuscular disorder (myasthenia gravis, ALS, stroke)
86
How long should it take for H pylori to be treated and heal completely?
3-6 weeks
87
What medication is cytoprotective in PUD?
Misoprostol (prostaglandin analogue) protects GI mucosa
88
What must be used with Dexamethasone therapy?
H2 antagonist or PPI, because dexa is a potent stimulator of gastric acid secretion
89
Which test is not useful to detect eradication of H pylori?
ELISA
90
What is the treatment of ascites and associated edema?
Sodium restriction, Spironolactone, paracentesis If unresponsive, Add diuretic furosemide or thiazide If refractory, paracentesis with albumin infusion
91
What is one of the most important physical exam findings in a patient with malignant pancreatic neoplasm?
Provocative maneuver, reproduce pain gently by assuming supine position, pain relief with spine flexion
92
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?
Pseudocyst Sentinel loop on plain film (isolated dilation of gut segment adjacent to pancreas)
93
Which treatments may be indicated in the management of the acute phase of ulcerative colitis?
Steroid enemas, oral corticosteroids, parenteral steroids
94
What is the treatment of choice for active or chronic UC, remission etc?
5ASAs
95
What is the utility of metronidazole in Crohn's disease?
Crohns colitis and Perianal Crohns
96
What is the utility of Alosetron (lotronex)?
Women with severe diarrhea predominant IBS
97
What conditions are frequently associated with IBS?
Functional disorders - fibromyalgia, interstitial cystitis, and migraine headaches
98
What is the preferred test to confirm appendicitis in pediatric patients?
Ultrasonography to avoid radiation
99
What are hyper plastic polyps?
Totally benign unclassified colon polyps
100
What is the definitive treatment for protruding internal hemorrhoids?
Rubber band ligation

USMLE STEP 2 (21 decks)

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