Test 50 - Created Aug 13

Question 1

imaging for spinal stenosis

Answer 1

MRI (look for encroaching osteophytes, hypertrophy of ligamentum flavum, protrusion of disks -> narrowing of spinal canal)

Question 2

mgt of incidentaloma in adrenal gland

Answer 2

get labs: electrolytes, dexamethasone suppression test; 24hr urine catecholamine, metanephrine, VMA; 17 ketosteroid

remove if big, functional, or cancer

Question 3

what majorly determines survival in patients with primary CNS lymphoma

Answer 3

the degree of immunosuppression (CD4 count)

Question 4

Dupuytren contracture risk factors

Answer 4

age >50, male, Fhx, Northern European, DM!!

Question 5

presentation of immune reconstitution inflammatory syndrome

Answer 5

advanced HIV pt started on HAART -> wks later -> recurrent fever, cough, worsened pulmonary infiltrate (for ex); common in patients with initially low CD4 and high viral loads; more common in TB + HIV patients

Question 6

mgt of immune reconstitution inflammatory syndrome

Answer 6

no alteration in antiretroviral (or antiTB) tx; may need symptomatic tx w/ NSAIDs or steroids

Question 7

issue with basal cell carcinoma near eye and tx

Answer 7

can invade the orbit; no metastases; needs surgery

Question 8

power of a study

Answer 8

determining there is a difference in tx effectiveness when one truly exists (correctly rejecting a false H0); power = 1 - B

Question 9

type I error

Answer 9

determining there is a difference in treatment effectiveness when one truly does NOT exist (incorrectly rejecting a true H0); = a

Question 10

type II error

Answer 10

determining there is NO difference in tx effectiveness when one truly exists (incorrectly failing to reject a false H0); = B

Question 11

preferred antiarrhythmic therapy in patients with a. fib with no dz, LVH, CAD w/o HF, HF, or refractory

Answer 11

no dz - flecainide, propafenone
LVH - amiodarone
CAD w/o HF - sotalol
HF - amiodarone
refractory - ablation

Question 12

how long to continue antidepressant in pt w/ single episode of MDD

Answer 12

6 mo. after acute response

needs to be 1-3 yrs if recurrent, chronic episodes, S.I., or Fhx

Question 13

emergency contraception

Answer 13

within 5d: Cu IUD or ulipristal

within 3d: levonorgestrel (plan B) or OCPs

Question 14

contraindications to copper IUD

Answer 14

acute pelvic infection (including cervicitis), severe uterine cavity distortion, Wilson’s, complicated organ transplant failure

Question 15

post-exposure prophylaxis with sexual assault victim

Answer 15

chla - azithro
gono - CTX
trich - metro (unless neg wet mount
HIV - tenofovir/emtri/ralte; up to 72h after
Hep.B - vaccines (unless UTD)
Syphilis - none; monitor w/ testing

Question 16

mgt of retrosternal goiter with compressive sxs

Answer 16

surgery (radioactive radioiodine ablation can lead to some enlargement of thyroid, possibly making sxs worse)

Question 17

when selection bias occurs

Answer 17

when sample is unrepresentative of target population and may lead to incorrect measures of association

Question 18

sensitivity definition

Answer 18

probability of an individual testing (+) given the presence of disease

Question 19

specificity definition

Answer 19

probability of an individual testing (-) given the absence of disease

Question 20

positive predictive value

Answer 20

probability that an individual who tests (+) actually has the disease

Question 21

negative predictive value

Answer 21

probability that an individual who tests (-) actually does NOT have the disease

Question 22

starting age for colonoscopy

Answer 22

avg risk: 45

1* relative w/ cancer or high risk polyp: 40 or 10 yrs prior to age of dx in family member

UC pt: 8-10 yrs after dx