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USMLE2 Medicine 01
Preventive Medicine
Question | Answer |
---|---|
colon CA - who should get screened? | 1. If no FHx, start screening at 50. 2. If ONE 1st degree relative diagnosed <60yo 3. >1 first degree relative with colon CA (dx at any age) |
If someone has no FHx of colon CA, when should they be screened and what should they get done? | Start screening at 50yo. 1. q year FOBT, 2. q 5y sigmoidoscopy and barium enema, 3. q 10 y colonoscopy |
If someone has FHx of colon CA, when should they be screened and what should they get done? | Start screening at age 40 or 10 years younger than age of diagnosis of youngest affected family member, whichever comes first. 1. q year FOBT, 2. q FIVE YEARS colonoscopy |
Mammography - who and how often? | women > 40 if no history of BrCA, q1-2y |
Breast exam by physician - who and how often? | any woman >20 q 3 years |
What should a woman with strong family history (1st degree relative) of BrCA get? | prophylactic tamoxifen |
Cervical cancer screening | Pap smear. Start age: 3 years after sexually active or 21 (whichever comes first). If < 30, screen q1y if conventional PAP, q2y if liquid. If >=30, screen q2y if >3 normal annual PAPs. |
Pt leaving for travel in two weeks wants to be immunized against Hep A. What do you give him? | vaccine and IVIg (usually vaccine +6mo booster covers for 10 years) |
Malaria prophylaxis. What if in a malaria med-resistant area? What if pregnant? | Chloroquine. Mefloquine if resistant area. Atovaquone and proguanil together if pregnant. |
What if pt needs Malaria and rabies immunizations together? | intra muscular rabies (instead of intradermal), then can use chloroquine. (Chloroquine blunts the response to intradermal rabies) |
Who should get N. meningitidis vaccine? | 1. travel to Nepal, Africa, India, Saudi Arabia - mecca. 2. asplenia or complement deficiences, 3. at age 11 |
Traveler gets loose stools (no fever or blood) - what to take? Traveler gets bloody diarrhea - what to take? | Loperamide if no blood/fever. If more severe sx's with blood, fluoroquinolone (ie cipro) or azithromycin. |
Tetanus and diphtheria immunizations | need 3 shots and booster q10 y |
who should get flu vaccine? | 1. >50yo, 2. any age: cardio/pulm disease, DM, Hbopathy, chronic care facilities, 3. pregnant in 2nd or 3rd trimester |
who should get Strep PNA vaccine? | 1. >65yo, 2. sickle cell or splenectomy, 3. CPulm dz, EtOH/cirrhosis, 4. Alaska or Native American, 5. immunocompromised |
Who is considered immunocompromised? | hematologic malignancies, chronic renal failure, nephrotic syndrome, HIV, immunosuppression |
who should get Hep B vaccination? | 1. IVDU, 2. male homosexuality, 3. household or sexual contact with HepB carriers, 4. blood product exposure, 5. chronic liver dz |
live attenuated vaccines | varicella, MMR |
who can't get live attenuated vaccines? | 1. IVIg, must wait 1 mo, 2. pregnant, 3. immunocompromised (HIV+ but asymptomatic OK to get vaccine) |
5 A's of smoking cessation | Ask Advise Attempt Assist Arrange |
who should be screened for osteoporosis? | DEXA scan for all women >65 if no risk factors. If low body weight or increased risk of fractures, then start at age 60. |
What should a male smoker >65yo be screened for? | AAA with U/S - one time. |
Cholesterol screening | no risk factors: men >35, women >45 if risk factors for CAD, >20 yo |
DM screening | only if have DM risk: obese, impaired fasting glucose, high risk ethnicity, +FamHx. |
Diagnosis of DM | 1. 2 fasting glucose >126, 2. random glucose >200 + sx's |
blood pressure screening | >18 yo q2 2y |
alcoholism assessment | CAGE 1. felt the need to Cut down on drinking? 2. Annoyed by criticism of drinking? 3. Guilty about drinking? 4. Eye opener? POSITIVE screen if 2 YES's |
tx for a prolactinoma | dopamine agonist: cabergoline or bromocriptine |
order of intervention for prolactinoma | dopamine agonist first, then surgery esp if compression of other structures or neuro sx's, last radiation |
Non pregnant woman with elevated prolactin level. What to do? | If >100, get MRI of pituitary. |
what is acromegaly? | excessive GH secretion from ant pituitary |
acromegaly increases risk for what? | DM |
What is the best initial test for acromegaly? what is confirmatory test? | IGF-1. Need to confirm with oral glucose challenge (100g glucose) --> then check GH. Confirmed is high GH since glucose load should normally suppress GH. |
How to follow disease in acromegaly? | IGF (also called somatomedin) |
How to tx acromegaly | 1. transphenoidal surgery, then 2. octreotide (somatostatin; blocks GH) - BEST medical therapy, then 3. bromocriptine/cabergoline (dopamine agonists; dopamine inhibits GHRH), then 4. pegvisomant (block GH from binding to its receptor peripherally) |
what is the most common cause of death in acromegaly? | cardiac failure |
severe HA, n/v, depression of consciousness, pt w h/o pituitary adenoma | pituitary aPOPlexy - acute hemorrhagic infarction of adenoma --> EMERGENCY! The adenoma POPs! |
post-partum pt won't lactate. what should you check? | pituitary function (think: Sheehan post-partum necrosis) |
who is at greater risk for cervical cancer? what special screening rules apply to them? | 1. DES exposure before birth, 2. HIV, 3. immunocompromised (steroids, organ transplant, on immunosuppressives, chemo). Even if >30 and 3 nl PAP's, still get yearly screen. |
how old to start prostate screening? what does it consist of? | 50yo. DRE and PSA. |
who should start prostate screening earlier and at what age? | 45 yo if 1. AA, 2. strong fam hx, 3. relative dx <65yo |
should adults get a booster of inactivated polio? | yes!! esp if traveling to polio-endemic country! |
malaria prophylaxis | chloroquine or mefloquine, 2 weeks before travel until 4 weeks after travel |
malaria prophylaxis with primaquine | 1-2 days before and 7 days after travel (shorter than chloroquine or mefloquine |
drug helpful in smoking cessation | first line: bupropion; second line: clonidine or amitryptiline |
best screening test for DM | fasting plasma glucose |
screening for DM | start at age 45 q3y |
....not shown to be effective in preventing EtOH-impaired driving! | designated driver programs |