USMLE Uworld Questions Flashcards
When should a pregnant woman have glucose checked?
24-28 weeks
At what age is routine cholesterol screening recommended?
35 (men), 45 (women)
At what age is influenza vaccine recommended
50, or younger if there are chronic medical problems or patient is pregnant
What is the most common vaccine preventable disease among travelers?
Hepatitis A
How do you screen for ovarian cancer in high risk patients?
Annual CA-125, Annual transvaginal ultrasound
What vaccines are contraindicated in those with egg allergies?
Influenza, yellow fever, MMR (with caution)
What is the immunologic mechanism for the pneumococcal vaccine?
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
What live vaccine is not contraindicated in HIV patients?
MMR (pending CD4 >200)
When do you start a patient on preventative medicines for osteoporosis?
T score less than 1.5 (with risk factors, or T score less than 2.0 (without risk factors)
How does the Hepatitis B vaccine work?
vaccine is recombinant hepatitis B surface antigent
Patient are immune when they develop anti-Hepatitis B surface antibodies (HBsAb)
What do you give to somebody with Hepatitis B exposure and unknown immunization status?
HBIG + Hepatitis B vaccination series
Who gets a DEXA Scan?
One time screening at 65 for all women, 60 y/o with risk factors for osteoporosis
What are the live vaccines?
BCG Oral polio Oral typhoid yellow fever Intranasal influenza Varicella zoster (shingles) Varicella (chicken pox) Anthrax
Who gets an abdominal US to screen for AAA?
Men >65 with a history of smoking (at any point in their lives). Men 65-75.
At what age does regular colon cancer screening start?
Age 50 or 10 years younger than youngest relative diagnosed with colon cancer
Who gets the pneumococcal vaccine?
Adults
When is Rh-antibody testing in pregnant women?
At first prenatal visit, and again at 24-28 weeks if Rh-negative
When does a woman get anti-Rh immunoglobulin
28 weeks, + delivery
When should women get mammograms?
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
In patients with CHD or risk equivalent, what is the goal LDL?
LDL 100
In patients with 2 or more risk factors for CHD, what is the LDL goal?
LDL 130
In patients with 0-1 risk factors, what is the LDL goal?
LDL 190
When should children get a vision screen for strabismus, amblyopia, and refractive errors?
0-5years
What are tests every pregnant woman should receive?
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
What are tests that at-risk pregnant women should receive?
Thyroid function (personal, fam hx, sxn, diabetes)
TB
Toxoplasmosis
Hgb electrophoresis (for ethnic women or if MCV
What animals are at risk for carrying rabies?
Bats, wildlife, animals with suspicion of being rabid. Small rodents are rarely infected with rabies
What are CAD risk factors for considering starting statin?
Male >45, female >55
Smoking
HTN
HDL 60 negates one factor
Risk equivalents:
- DM
- Sx CAD
- AAA
- PAD
- 10 year CAD risk >20%
How do infants affected with TORCH infection present?
microcephaly, hepatosplenomegaly, thrombocytopenia, chorioretinitis, deafness
How often should women who have been treated for cervical intraepithelial neoplasia II/III have Pap smears with/without colposcopy and endocervical curettage?
every six months until three neg results obtained
then resume standard screening after that milestone is met
What organisms should individuals who have had a splenectomy be vaccinated against?
H. influenzae
Neisseria meningitidis
Strep. pneumo
Pneumococcal vaccine boosters required every 5 years
What is the recommended screening algorithm for prostate cancer?
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
What is a reasonable treatment for patients with persistent low HDL after max statin treatment
Initiate nicotinic acid (side effects include flushing, pruritis, nausea, paresthesias)
What inactivated vaccines should all HIV patients receive?
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)
What live vaccines should HIV patients receive (if CD4 >200 and no hx of AIDS defining illness?)
MMR
Zoster >60 years
Varicella
Yellow fever
Which adults should receive penuomoccocal polysaccharide vaccine?
All adults >65
What vaccines should chronic liver disease patients receive?
Hep A Hep B Influenza Invasive pneumococcal disease Td booster
How often should women be screened for chlamydia?
routine screening for all sexually active women age 24yo and younger and in other ASx women at increased risk
What vaccine should be given to men who have sex with men?
Hep A
HIV + pts never receiving Tdap should receive what?
Tdap before booster shots are administered
What are adult guidelines for meningococcus vaccination?
- college freshman in dorm
- military recruit
- damaged spleen or spleen removal
- terminal compliment deficiency
- micorbiologist exposed to Neisseria meningitidis
- traveling/residing in countries where dz is common
What are adult recommendations for H. influenza vaccines?
childhood vaccine
What are current pap smear recommendations for women 21-29?
Pap every 3 yrs
What are current pap smear recommendations for women 30-65?
pap every 3 years
OR
pap + HPV testing every 5 yrs if both are negative
What are pap recommendations for immunocompromised pts?
at onset of sexual activity if prior to 21yrs
twice within first year
annually if HIV+, hx organ transplant, or taking chronic immunosupression
What are the influenza recommendations?
annually for those > 6mo
What are the tdap recommendations for
Tdap once as a substitute for Td booster
then Td booster every 10 years
What are the recommendations for vaccination of infants and young children with DTaP?
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.
What are Pneumococcal vaccine recommendations for 19-64yo?
1 or 2 doses for high-risk patients (DM)
What are Pneumococcal vaccine recommendations for > 65 yo?
1 dose
What are vaccine recommendations for travel to North Africa?
Hep A
Hep B
Typhoid
Polio booster
What are high-risk countries for Hep A?
Asian and African countries
What areas should individuals be vaccinated for yellow fever?
Sub-saharan africa
South America
What are the indications for Meningococcal vaccination?
Asian countries
sub-saharan Africa
making pilgrimage or Hajj to Mecca or Saudi Arabia
Individuals with PAD and/or sxs of claudication should be started on what medication?
Aspirin or clopidigrel
and supervised graded exercise program
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?
coronary heart dz equivalent
statins regardless of LDL level
Goal LDL
With coronary heart disease or equivalent, what is the 10-year risk for MI, stroke, or coronary mortality?
greater than 20%
If coronary risk is > 20%, what are the recommendations for pts?
lifestyle modification if LDL > 100
Drug Therapy is LDL > 130
What are risk factors for MI, stroke, or coronary mortality?
cigarette smoking
BP > 140/90
Premature CHD in family
(45 and women > 55)
Negative Risk Factor is HDL > 60 which removes one risk factor
If the MI, stroke, or Cv mortality risk > 20%, what are guidelines for LDL levels?
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
If 0-1 risk factor and 10-yr risk
LDL > 160 w/lifestyle modifications
LDL > 190 initiate drug therapy
What are colon CA screening tests?
fecal occult blood test flexible sigmoidoscopy combination of FOBT and FS Colonoscopy Double contrast barium enema
What are the mammography recommendations for pts 50-74?
mammography every 2 yrs
What are lipid testing recommendations for men and women at average risk for CAD?
35 for men
45 for women
What are lipid screening recommendations for nl individuals with average risk of CAD?
Check every 5 years
What are osteopenia scores on the DEXA scan?
-1 to
What are osteoporosis scores on the DEXA scan?
t score > -2.5
t score > -1 with evidence of fragility fracture
What are the risk factors for osteoporosis?
Post-menopausal women Poor Ca2+ and Vit D intake cigarette smoking corticosteroid use lack of weight bearing exercise alcohol ingestion low body mass
What is unique about Ca2+ and Vit D levels in bone pathology?
Serum Ca2+ and Vit D are usually Normal
What are recommendations for individuals with high-risk polyps on previous colonoscopy?
Repeat in 3-5 years
How should individuals be treated with exposure to Hep B and unknown vaccination hx?
passive immunity through HepB IG
active immunity through HBV vaccine
What live vaccines should HIV+ patients avoid?
Oral typhoid Intranasal influenza Anthrax BCG Oral polio
What is the indication for Td boosters in HIV+ pts?
Td booster every 10 years
What are recommendations for HIV+ and Pneumococcal vaccinations?
revaccinate in 5 yrs if CD4+
What are the recommendations for HIV+ and Influenza vaccinations?
annually with injection
intranasal contraindicated
What are stipulations to intranasal influenza vaccine?
No immunocompromised state
No contact with immunocompromised individuals
Age
What are the recommendations for Chlamydia and Gonorrhea screening?
all sexually active pts under age 24 OR aymptomative individuals at increased risk -STI -new/multiple partners
What are the indications for screening lipid levels at 20yo?
What are the indications for screening lipid levels at 20yo? DM
FMHx premature CAD
familial hyperlipidemia
risk factors CAD
What are risk factors for pancreatic CA?
FMHx increasing Age Chronic Pancreatitis Abdominal Radiation Therapy Obesity Tobacco
What are risk factors for bladder CA?
Age
Men
Smoking
Industrial Chemical Exposure
Is Bladder CA screened for?
Nope
What are smoking cessation options?
What are smoking cessation options? counseling
Buproprion
Varenicline (Chantix)
(Amytryptilline and other TCAs but no FDA approval)
What are CIN II/III recommendations?
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
What is the full list of indications for PPSV?
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
What are decubitus pressure ulcer risk factors?
sensory loss
nutrition
PVD
mobility issues
