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Family Medicine > USMLE Uworld Questions > Flashcards

USMLE Uworld Questions Flashcards

1
Q

When should a pregnant woman have glucose checked?

A

24-28 weeks

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2
Q

At what age is routine cholesterol screening recommended?

A

35 (men), 45 (women)

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3
Q

At what age is influenza vaccine recommended

A

50, or younger if there are chronic medical problems or patient is pregnant

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4
Q

What is the most common vaccine preventable disease among travelers?

A

Hepatitis A

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5
Q

How do you screen for ovarian cancer in high risk patients?

A

Annual CA-125, Annual transvaginal ultrasound

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6
Q

What vaccines are contraindicated in those with egg allergies?

A

Influenza, yellow fever, MMR (with caution)

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7
Q

What is the immunologic mechanism for the pneumococcal vaccine?

A

T-cell independent B-cell response. Contains capsular polysaccharides of the 23 most prevalent types of pneumococcus. Whereas peptides get presented to T-cells by macrophages and B cells, polysaccharides cannot be presented to T cells. Thus, polysaccharide vaccines yield a B-cell only, T-cell independent response

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8
Q

What live vaccine is not contraindicated in HIV patients?

A

MMR (pending CD4 >200)

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9
Q

When do you start a patient on preventative medicines for osteoporosis?

A

T score less than 1.5 (with risk factors, or T score less than 2.0 (without risk factors)

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10
Q

How does the Hepatitis B vaccine work?

A

vaccine is recombinant hepatitis B surface antigent

Patient are immune when they develop anti-Hepatitis B surface antibodies (HBsAb)

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11
Q

What do you give to somebody with Hepatitis B exposure and unknown immunization status?

A

HBIG + Hepatitis B vaccination series

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12
Q

Who gets a DEXA Scan?

A

One time screening at 65 for all women, 60 y/o with risk factors for osteoporosis

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13
Q

What are the live vaccines?

A 
BCG
Oral polio
Oral typhoid
yellow fever
Intranasal influenza
Varicella zoster (shingles)
Varicella (chicken pox)
Anthrax
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14
Q

Who gets an abdominal US to screen for AAA?

A

Men >65 with a history of smoking (at any point in their lives). Men 65-75.

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15
Q

At what age does regular colon cancer screening start?

A

Age 50 or 10 years younger than youngest relative diagnosed with colon cancer

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16
Q

Who gets the pneumococcal vaccine?

A

Adults

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17
Q

When is Rh-antibody testing in pregnant women?

A

At first prenatal visit, and again at 24-28 weeks if Rh-negative

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18
Q

When does a woman get anti-Rh immunoglobulin

A

28 weeks, + delivery

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19
Q

When should women get mammograms?

A

10 years prior to youngest diagnosed relative
//
performed every two years starting at age 50 in women at average risk for breast cancer. Not necessary beyond age 75

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20
Q

In patients with CHD or risk equivalent, what is the goal LDL?

A

LDL 100

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21
Q

In patients with 2 or more risk factors for CHD, what is the LDL goal?

A

LDL 130

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22
Q

In patients with 0-1 risk factors, what is the LDL goal?

A

LDL 190

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23
Q

When should children get a vision screen for strabismus, amblyopia, and refractive errors?

A

0-5years

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24
Q

What are tests every pregnant woman should receive?

A 
HCT, Hgb, MCV
Influenza vaccine (flu season)
Rubella immunity
Varicella immunity
Offer Down syndrome, CF genetic screen
Rhesus type and antibody test
Cervical cytology
HIV
Chlamydia
Syphillis
Urine cx
Hepatitis B antigen
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25
Q

What are tests that at-risk pregnant women should receive?

A

Thyroid function (personal, fam hx, sxn, diabetes)
TB
Toxoplasmosis
Hgb electrophoresis (for ethnic women or if MCV

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26
Q

What animals are at risk for carrying rabies?

A

Bats, wildlife, animals with suspicion of being rabid. Small rodents are rarely infected with rabies

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27
Q

What are CAD risk factors for considering starting statin?

A

Male >45, female >55
Smoking
HTN
HDL 60 negates one factor

Risk equivalents:

  • DM
  • Sx CAD
  • AAA
  • PAD
  • 10 year CAD risk >20%
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28
Q

How do infants affected with TORCH infection present?

A

microcephaly, hepatosplenomegaly, thrombocytopenia, chorioretinitis, deafness

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29
Q

How often should women who have been treated for cervical intraepithelial neoplasia II/III have Pap smears with/without colposcopy and endocervical curettage?

A

every six months until three neg results obtained

then resume standard screening after that milestone is met

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30
Q

What organisms should individuals who have had a splenectomy be vaccinated against?

A

H. influenzae
Neisseria meningitidis
Strep. pneumo

Pneumococcal vaccine boosters required every 5 years

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31
Q

What is the recommended screening algorithm for prostate cancer?

A

USPSTF does not recommend for or against PSA screening in men under 75, must be determined on case by case basis by each physician and patient. Urology guys say PSA + digital rectal exam starting at age 40

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32
Q

What is a reasonable treatment for patients with persistent low HDL after max statin treatment

A

Initiate nicotinic acid (side effects include flushing, pruritis, nausea, paresthesias)

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33
Q

What inactivated vaccines should all HIV patients receive?

A 
Hep A (two doses)
Hep B (3 doses)
Influenza (yearly, no intranasal)
HPV (for high risk)
Td (every 10 years)
Strep pneumo/Pneumococcus (q 5 years)
Meningococcal (military recruits, college dorms)
H. flu type B (if didn't get in infancy)
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34
Q

What live vaccines should HIV patients receive (if CD4 >200 and no hx of AIDS defining illness?)

A

MMR
Zoster >60 years
Varicella
Yellow fever

35
Q

Which adults should receive penuomoccocal polysaccharide vaccine?

A

All adults >65

36
Q

What vaccines should chronic liver disease patients receive?

A 
Hep A
Hep B
Influenza
Invasive pneumococcal disease
Td booster
37
Q

How often should women be screened for chlamydia?

A

routine screening for all sexually active women age 24yo and younger and in other ASx women at increased risk

38
Q

What vaccine should be given to men who have sex with men?

A

Hep A

39
Q

HIV + pts never receiving Tdap should receive what?

A

Tdap before booster shots are administered

40
Q

What are adult guidelines for meningococcus vaccination?

A
  1. college freshman in dorm
  2. military recruit
  3. damaged spleen or spleen removal
  4. terminal compliment deficiency
  5. micorbiologist exposed to Neisseria meningitidis
  6. traveling/residing in countries where dz is common
41
Q

What are adult recommendations for H. influenza vaccines?

A

childhood vaccine

42
Q

What are current pap smear recommendations for women 21-29?

A

Pap every 3 yrs

43
Q

What are current pap smear recommendations for women 30-65?

A

pap every 3 years
OR
pap + HPV testing every 5 yrs if both are negative

44
Q

What are pap recommendations for immunocompromised pts?

A

at onset of sexual activity if prior to 21yrs
twice within first year
annually if HIV+, hx organ transplant, or taking chronic immunosupression

45
Q

What are the influenza recommendations?

A

annually for those > 6mo

46
Q

What are the tdap recommendations for

A

Tdap once as a substitute for Td booster

then Td booster every 10 years

47
Q

What are the recommendations for vaccination of infants and young children with DTaP?

A

All children should receive a series of DTaP at ages 2, 4, and 6 months, with boosters at ages 15-18 months and at 4-6 years. The fourth dose may be given as early as age 12 months if at least 6 months have elapsed since the third dose.

48
Q

What are Pneumococcal vaccine recommendations for 19-64yo?

A

1 or 2 doses for high-risk patients (DM)

49
Q

What are Pneumococcal vaccine recommendations for > 65 yo?

A

1 dose

50
Q

What are vaccine recommendations for travel to North Africa?

A

Hep A
Hep B
Typhoid
Polio booster

51
Q

What are high-risk countries for Hep A?

A

Asian and African countries

52
Q

What areas should individuals be vaccinated for yellow fever?

A

Sub-saharan africa

South America

53
Q

What are the indications for Meningococcal vaccination?

A

Asian countries
sub-saharan Africa
making pilgrimage or Hajj to Mecca or Saudi Arabia

54
Q

Individuals with PAD and/or sxs of claudication should be started on what medication?

A

Aspirin or clopidigrel

and supervised graded exercise program

55
Q

All pts w/o hx of CHD but w/PVD, DM, CKD, AAA, or symptomatic carotid artery dz are considered equivalent to what and should be started on what?

A

coronary heart dz equivalent
statins regardless of LDL level
Goal LDL

56
Q

With coronary heart disease or equivalent, what is the 10-year risk for MI, stroke, or coronary mortality?

A

greater than 20%

57
Q

If coronary risk is > 20%, what are the recommendations for pts?

A

lifestyle modification if LDL > 100

Drug Therapy is LDL > 130

58
Q

What are risk factors for MI, stroke, or coronary mortality?

A

cigarette smoking
BP > 140/90
Premature CHD in family
(45 and women > 55)

Negative Risk Factor is HDL > 60 which removes one risk factor

59
Q

If the MI, stroke, or Cv mortality risk > 20%, what are guidelines for LDL levels?

A

Initiate Lifestyle Modification if LDL > 130

If LDL > 130 and 10 yr risk 10-20% then initiate drug therapy

If LDL > 160 mg and 10yr risk

60
Q

If 0-1 risk factor and 10-yr risk

A

LDL > 160 w/lifestyle modifications

LDL > 190 initiate drug therapy

61
Q

What are colon CA screening tests?

A 
fecal occult blood test
flexible sigmoidoscopy
combination of FOBT and FS
Colonoscopy
Double contrast barium enema
62
Q

What are the mammography recommendations for pts 50-74?

A

mammography every 2 yrs

63
Q

What are lipid testing recommendations for men and women at average risk for CAD?

A

35 for men

45 for women

64
Q

What are lipid screening recommendations for nl individuals with average risk of CAD?

A

Check every 5 years

65
Q

What are osteopenia scores on the DEXA scan?

A

-1 to

66
Q

What are osteoporosis scores on the DEXA scan?

A

t score > -2.5

t score > -1 with evidence of fragility fracture

67
Q

What are the risk factors for osteoporosis?

A 
Post-menopausal women
Poor Ca2+ and Vit D intake
cigarette smoking
corticosteroid use
lack of weight bearing exercise
alcohol ingestion
low body mass
68
Q

What is unique about Ca2+ and Vit D levels in bone pathology?

A

Serum Ca2+ and Vit D are usually Normal

69
Q

What are recommendations for individuals with high-risk polyps on previous colonoscopy?

A

Repeat in 3-5 years

70
Q

How should individuals be treated with exposure to Hep B and unknown vaccination hx?

A

passive immunity through HepB IG

active immunity through HBV vaccine

71
Q

What live vaccines should HIV+ patients avoid?

A 
Oral typhoid
Intranasal influenza
Anthrax
BCG
Oral polio
72
Q

What is the indication for Td boosters in HIV+ pts?

A

Td booster every 10 years

73
Q

What are recommendations for HIV+ and Pneumococcal vaccinations?

A

revaccinate in 5 yrs if CD4+

74
Q

What are the recommendations for HIV+ and Influenza vaccinations?

A

annually with injection

intranasal contraindicated

75
Q

What are stipulations to intranasal influenza vaccine?

A

No immunocompromised state
No contact with immunocompromised individuals
Age

76
Q

What are the recommendations for Chlamydia and Gonorrhea screening?

A 
all sexually active pts under age 24
OR
aymptomative individuals at increased risk
-STI
-new/multiple partners
77
Q

What are the indications for screening lipid levels at 20yo?

A

What are the indications for screening lipid levels at 20yo? DM
FMHx premature CAD
familial hyperlipidemia
risk factors CAD

78
Q

What are risk factors for pancreatic CA?

A 
FMHx
increasing Age
Chronic Pancreatitis
Abdominal Radiation Therapy
Obesity
Tobacco
79
Q

What are risk factors for bladder CA?

A

Age
Men
Smoking
Industrial Chemical Exposure

80
Q

Is Bladder CA screened for?

A

Nope

81
Q

What are smoking cessation options?

A

What are smoking cessation options? counseling
Buproprion
Varenicline (Chantix)
(Amytryptilline and other TCAs but no FDA approval)

82
Q

What are CIN II/III recommendations?

A

Pap smear w/w/o colposcopy and endocervical curettage every 6 months until 3 negative screenings
Once this is achieved, pts can resume nl age appropriate screening

83
Q

What is the full list of indications for PPSV?

A 
Chronic Lung Dz
Asthma
COPD
Emphysema
Chronic CV dz
DM
Chronic Liver Dz
ETOHism
Cochlear implants
CSF leaks
Immunocompromising dz
Functional/Anatomic asplenia
Sickle Cells Dz
Hemoglobinopathies
Splenectomy
Acquired asplenia
84
Q

What are decubitus pressure ulcer risk factors?

A

sensory loss
nutrition
PVD
mobility issues

Family Medicine (3 decks)

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