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CC July 2016 SUMMARY PART 1

rename
echoecho's version from 2016-10-11 13:08

Section

Question Answer
1) METFORMIN AND RENAL DISEASE =
In 2016, the FDA revised its warning regarding the use of Metformin and allowed for what?more liberal use in patients with renal disease
What test should be obtained before Metformin is initiated adn annually thereafter?a GFR
For patients with a GFR between ___ and ____ mL/minute/1.73 m2, Metformin should be discontinued before imaging procedures using iodinated contrast. GFR should be checked ____ hours afterward and the metformin restarted if renal function is stable?30; 60; 48
2) OTITIS MEDIA WITH EFFUSION (OME) =
OME should be diagnosed by documenting what?the presence of middle ear effusion using pneumotic otoscopy
If OME is suspected, but the diagnosis remains uncertain after pneumatic otoscopy is performed, what should be performed?tympanometry
Watchful waiting for _____ months is recommended in average-risk children with OME?3
3) MULTITARGET FECAL DNA TEST FOR COLORECTAL CANCER SCREENING =
Cologuard detects what?1) fecal occult blood 2) both aberrantly methylated DNA (NDRG4 and BMP3) and DNA muttion (KRAS) associated with precancerous and cancerous colorectal lesions
What is the recommended testing interval?3 years
Does the US Preventive Service Task Force currently recommended multitarget DNA testing as a screening method for colorectal cancer (CRC)?no (although the test is gaining increasing acceptance as an alternative to colonoscopy)
4) BREAST CANCER IN MALES =
Is male breast cancer common in the USA?no
What is one well-established risk factors?BRCA1 and BRCA2
Are diagnostic and treatment strategies similar to female breast cancer?yes
5) OPIOID-INDUCED PRURITIS =
Opioid-induced pruritus occurs in most patients receiving _____ opioids? Up to ____ of those receiving IV opioids, and 2-10% of those taking ____opioids?1) neuraxial (spinal or epidural) 2) half 3) oral
Opioid-induced pruiritis due to oral opioids responds to what medication?antihistamines
What two medications have evidence for effectiveness in treating opioid-induced pruirits after cesarean section?1) Nalbuphine (Nubain) 2) ondansetron (Zofran)
6) ANIMAL BITES =
Animal bites, especially _____ bites, are a common injury with substantial associated costs?dog
Decisions regarding closure of wounds should be based on what 3 conditions?1) location of the wound 2) time since the injury occurred 3) the type of wound (open or puncture)
Antibiotic prophylaxis of dog and cat bites has limited evidence for support, but if determined to be appropriate, the first choice is what medication?Amoxicillin/clavulanate (Augmentin)
7) ALCOHOL USE DISORDER =
The DSM-5 classifies AUD as mild, moderate or severe depending on the number of ____ criteria that are met in the prior 12 months?11
Is the amount of alcohol consumed one of the DSM-5 criteria for alcohol use disorder?no
Prevalence of alcohol use disorder is higher in what gender and higher with what 2 populations?1) men 2) Native American and Alaskan Native
National Institute of Alcohol Abuse and Alcoholism (NIAAA) defines moderate drinking as what?as 2 drinks per day (14 drinks per week) in men, and 1 drink per day (7 drinks in a week) in women
8) EPIDIDYMITIS =
What is epididymitis typically caused by?spread of microorganisms from the urethra, prostate or seminal vesicles to the epididymis
Among sexually active men, acute epididymitis is usually caused by what 2 organism?1) Neisseria gonorrhoeae OR 2) Chlamydia trachomatis
What is recommended to look for signs of inflammation?testing
9) CERVICAL RIPENING AGENTS AND INDUCTION OF LABOR =
What score can predict the success of induction of labor and can also help determine if cervical ripening is necessary?Bishop score
What agents are used for induction of labor?Prostaglandins
True of false? Maternal mortality, neonatal mortality and serious morbiditiy were rarely reported with any prostaglandin agent?true
10) ALCOHOL WITHDRAWAL SYNDROME =
Symptoms of alcohol withdrawal can be subdivided into 3 categories, name these?1) autonomic hyperactivity 2) gastrointestinal symptoms 3) psycho-neurological symptoms
Symptoms of alcohol withdrawal usually begins ___ to ____ hours AFTER stopping or reducing drinking. Certain symptoms are more likely to occur at specific intervals following the last drink?6; 24
What 2 medications are routinely given to every patient with alcohol withdrawal syndrome? What is the reasoning behind administering thiamine before or with any glucose infusion?1) thiamine (100 mg daily or 500 mg daily infusion for those requiring inpatient treatment) and folic acid 2) to prevent precipitation of Wernicke's encephalopathy
11) MINIMAL-CHANGE DISEASE =
Minimal-change disease is associated with nephrotic range proteinuria and almost always responds to what?corticosteroids
What medication should NOT be used to manage edema in minimal-change disease?diuretics
Minimal-change disease often recurs through what age group?adolescence
12) NSAID GASTROPATHY =
Do COX-2 inhibitors and nonselective COX-2 inhibitors have similar GI side effects?yes
What 3 medications are all effective at preventing chronic endoscopic gastric and duodenal ulcers related to NSAIDs?1) Misoprostol (Cytotec) 2) double-dose histamine-2 receptor antagonist 3) PPI
For patients > ____ years of age, consider prescribing topical medications instead of oral medications for arthritis?75
13) INTIMATE PARTNER VIOLENCE AGAINST MEN? =
Generally less common and less severe, intimate partner violence (IPV) perpetrated by women against male victims represents ___ to ____% of reported cases?7; 11
While screening of women of childbearing age is recommended by the USPSTF, only the Joint Commision on Accreditation of Health Care organizations (JCAHO) mandates _______ department personnel to screen ALL patients for intimate partner violence?ER
List contributory factors for women perpetrators include?1) substance abuse 2) prior abusive behavior directed at her and mental illness
14) BULIMIA NERVOSA =
What characterizes bulimia nervosa?binge eating and compensatory behavior to prevent weight gain
The typical pattern of electrolyte disturbance related to vomiting and/or diuretic abuse is ______ _______ with hypokalemia, hypochloremia and elevated bicarbonate?metabolic alkalosis
_______ from repeated vomiting, diuretic abuse or laxative abuse causes volume depletion and up-regulation of the renin-angiotensin-aldosterone system?dehydration
15) OPIOID ENDOCRINOPATHY =
Chronic opioid use can cause _______, resulting in decreased libido, ED in men and reduced fertility in men and women?hypogonadism
List two side effects of chronic opioid use?1) osteoporosis 2) adrenal suppression
16) HERPES SIMPLEX IN PREGNANCY =
The risk of neonatal infection is higher with ______ maternal infection than with recurrent infection?primary
Cesarean section is indicated for women with____ lesions or prodromal symptoms at the onset of labor?active
Prophylatic antiviral therapy started at ___- weeks gestation significantly reduces the risk of recurrence and the need for C-section?36
17) HIV THERAPY SELECTION =
There are now ____ treatment regimens recommended as preferred therapy for treatment-naive patients with HIV infection?6
Newer regimens are easier to administer and have an improved side-effect profile, true or false?true
When considering seelection of a regimen, there are multiple considerations including what?1) co-morbid conditions 2) patient characteristics 3) patient preference 4) viral characteristics 5) co-infections
18) INFORMED CONSENT =
Is informed consent a necessary component of the standard of care in most jurisdictions?yes
What 2 scenarios do NOT preclude the requirements for providing adequate information and obtaining meaningful consent?1) telemedicine 2) dealing with emergent medical conditions
The level of consent criteria (oral, written) may vary depending on what?the risk of the iliness or the procedure and whether consent for research protocols is required
19) U-500R INSULIN =
U-500R insulin is indicated for what type of patient?patients with severe insulin resistance (requiring > 200 units of insulin daily)
The duration of action is _____ to _____ hours, more like immediate or long-acting insulin? 8; 24
U-500R insulin administration is with a ______ syringe?tuberculin
20) GASTROPARESIS =
What is the most common identified cause of gastroparesis? Accounting for ____% of cases. No etiology is found in ___% of cases. Others are the result of what 2 causes? 1)diabetes (types 1 and 2) 2) 29% 3) 36% 4) surgery or medication-induced
Metoclopramide (Reglan) is approved by the FDA for no longer than ____ weeks due to what side effects?1) 12 2)tardive dyskinesis (estimated at 1%)
21) PID =
The risk of what 3 conditions is increased in women with a hx of PID?1) risk of infertility 2) ectopic pregnancy 3) chronic pelvic pain
Treatment of cervicitis caused by _________ or _______, even if asymptomatic, decreases the risk of progression to PID?1) N. gonorrhea 2) C. trachomatis
Early dx and treatment of PID decreases, but does not eliminate, the risk of _______?sequelae
22) ADRENAL INSUFFICIENCY =
Primary adrenal insufficiency may present as what?a deterioration of a longstnaidng problem OR as an acute adrenal crisis with hypotension, hyponatremia, hyperkalemia and weakness inadequately reponsive to fluid resuscitation
Dx is confirmed by the ________ challenge test?cosyntropin
Urgent treatment with _______ or ________ influsion should begin immediately on suspicion of the disorder and confirmatory tests planned after hemodynamic stability is achieved?1) hydrocortisone 2) dexamethasone
23) CULTURAL COMPETENCY AT THE END OF LIFE =
Addressing a patient's ethnicity, individual practices, spiritual beliefs country of origin and sexual orientation is important when providing culturally competent end-of-life care, true or false?true
Individual _____ and _______ greatly influence how medical information is received, especially regarding bad news, advanced directives and futility of treatment?beliefs; culture
Cultural factors influence a patient's decision and acceptance of care, true or false?
24) GALLBLADDER CANCER =
Gallstones > ____ cm and longer duration of cholelithiasis are associated with highest risk of gallbladder cancer?3
90% of gallbladder cancers are _________, and most cases are asymptomatic and found incidentally during cholecystectomy?adenocarcinomas
5-year survival varies from _____% with least advanced disease and ___% with advanced symptomatic disease?100; 0
Despite aggressive posttreatment surveillance, identifying recurrence early does little to improve survival, true or false?true
25) GONORRHEA =
The main stay of diagnostic testing for gonorrhea is what?Nucleic acid amplification tests (NAT), which include polymerase chain reaction, transcription-mediated amplification and strand displacement amplification techniques
Pts treated for gonorrhea should refrain from sexual activity for ____ days after treatment and should received screening for other STIs (chlamydia, HIV, syphilis)?7
Test of cure is NOT required for patients with uncomplicated infection who are adequately treated with a standard regimen, true or false?true
26) EXERCISE-INDUCED BRONCHOSPASM (EIB) =
The symptoms of EIB may mimic those of what 2 conditions?1) asthma 2) vocal cord dysfunction
If an individual does NOT respond to the short-acting beta-agonist (SABA) trial or is an elite athlete, experts recommend what testing?bronchial provocation testing
Exercise challenge testing is preferred over a _______ challenge?methacholine
Nonpharmacologic treatment of EIB, including what, can be effective in reducing symptoms?1) pre-exercise warm-up 2) using heat exchange masks 3) restricting dietary intake
27) OVARIAN CYSTS =
What % of women will have surgery for a suspicious adnexal mass in their lifetime?5-10%
List the characteristics of a benign ovarian cyst?1) sonolucent 2) thin-walled 3) unilocular cyst 4) smooth regular borders 5) < 10 cm
Are oral contraceptives effective for treatment of ovarian cysts?no
28) INTRAARTICULAR HYALURONIC ACID INJECTIONS =
What is the object of knee injections with hyalouronic acid?to improve viscosity of synovial fluid and reduce pain and improve function in severe osteoarthritis
Is there any good evidence from controlled, double-blind studies that support the above claims?no
Is there good evidence that supports the use of intraarticular hyaluronic acid injections as a means of preventing or delaying the need for joint replacement surgery?no
29) ACUTE APPENDICITIS IN CHILDREN =
Highest incidence is in children < _____ years of age with most cases occurring in the _____ decade of life?14; second
Abdominal signs may be LESS prominent in younger children (< ____ years of age) and in _______ appendicitis?5; pelvic
What is the preferred initial imaging modality because it minimizes radiation exposure?ultrasound
In uncomplicated cases of acute appendicitis, what are the treatment options?1) surgery (open or laparoscopic) and non-operative treatment with antibiotics
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