Autism Spectrum Disorder
ASD require deficits in three areas of communication and social interaction across multiple settings, with at least two _______ behaviors, not explained by another condition, and causing functional impairment.
restricted or repetitive behaviors
According to recent guidelines, name at least two / five core components of a standard cardiac rehabilitation program, aside from exercise.
What are dietary changes and psychosocial support
- strength straining
- exercise program
- medical assessments
- nutrition
- psychological support
Universal screening for vitamin B12 deficiency is recommended.
True or False
False; however any patient w/ risk factors + ones symptom should be tested.
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- risk factors: malabsorption syndromes or gastrointestinal surgeries such as bariatric surgery, gastrectomy, ileal bowel resection, celiac disease, and Crohn disease, especially in those with extensive ileal involvement. Atrophic gastritis, age > 60, and more.
- symptoms: fatigue, generalized weakness, and pallor from anemia, along with neuropsychiatric symptoms such as brain fog, depression, memory loss, cognitive impairment, and even psychosis or delirium in severe cases. Neurological features often precede hematologic changes and may encompass paresthesias, numbness, peripheral neuropathy, impaired gait, ataxia (and more)
This age is the most commonly recommended starting point for routine colorectal cancer screening in average-risk adults, per the US Preventive Services Task Force.
What is 45 years old?
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Screening for colorectal cancer should begin at 45 for average-risk, asymptomatic adults, per USPSTF. Assess family history and adjust timing if first-degree relatives had colorectal cancer or adenomas
Lymph nodes that are larger than ____ cm, hard, or attached to surrounding structures may indicatemalignancy or granulomatous diseases, especially in chil-dren
2cm
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Lymph nodes are normally 1 cm or smaller, except fori nguinal lymph nodes, which can be as large as 2 cm in healthy adults.
American Academy of Pediatrics recommends screening for autism at ages ___ and ___ months in addition to routine developmental surveillance
18 - 24 mo
routine screening not recommended in adult populations
Name at least two measures that are typically assessed during cardiac rehabilitation to track patient progress
mood (using validated depression and anxiety screening tools), bloodpressure control, weight, physical fitness level, diabetes and lipidcontrol, ability to exercise, tobacco cessation)
- 12 to 24 wks, 1 hr sessions, once weekly
- most commonly monitored by cardiologists, but sometimes PCP involvement
- high rates of mood disorder in this group so they have considered more integration of mental health but more studies are needed
List the 4 skin manifestations of vitamin B12 deficiency based on article.
glossitis
hyperpigmentation
jaundice
pallor
This novel stool-based test, approved in 2024, utilizes RNA biomarkers to enhance detection of colorectal cancer and advanced adenomas, and requires a simplified stool collection process compared to its DNA-based predecessor.
What is ColoSense?
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- ColoSense is the first FDA-approved multitarget stool RNA (mt-sRNA) test, with 94% sensitivity for CRC and 45% for advanced adenomas.
- for coloagard, the test sensitivity for CRC ranges from 67%to 86%, the detection of advanced neoplasia is much lower, at 20% to 30%.
Enlargement of this node location is most indicative of malignancy across all ages
Enlarged supraclavicular nodes are particularly worrisome due to their drainage of the thoracic and abdominal cavities—thus often reflecting metastatic disease from those regions. While many enlarged lymph nodes are benign, supraclavicular lymphadenopathy as a ‘red alert’ signal that mandates thorough investigation and consideration for urgent imaging and tissue diagnosis.
What is the single diagnostic test for autism?
no single test;
clinical criteria includes: deficits of communication/ social interaction across multiple settings
at least 2 restricted/repetitive behaviors
and causing functional impairment
MCHAT is the screening tool most commonly used
Name other conditions (other than myocardial infarction) for which cardiac rehabilitation is recommended by professional guidelines.
What is heart failure, coronary artery bypass surgery, heart transplantation, or valve replacement?
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Cardiac rehabilitation isn’t just for post-MI patients: it benefits those after valve surgeries, heart transplants, and with chronic heart failure. Raising awareness of these expanded indications can help address under-referral and improve access for diverse patient populations.
Repeat bloodwork on a patient reveals persistently elevated serum B12 over 1,000 pg/mL, despite no supplementation. What group of conditions is most concerning
What are solid tumors, hematologic malignancies, and chronic liver or kidney disease?
List the three primary direct visualization modalities for colorectal cancer screening and specify the recommended screening interval for each after a normal result.
What are colonoscopy (every 10 years if normal)
computed tomography colonography or “virtual colonoscopy” (every 5 years)
and flexible sigmoidoscopy (every 5 years, or every 10 years when combined with annual fecal immunochemical testing)
_____ is the imaging modality of choice for patients less than tan 14yo while ______ is typically better for patients 14 and older.
US; CT.
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Ultra-sonography was shown to have a high sensitivity (98%) andnegative predicative value (97%) to differentiate lymphade-nopathy as benign or malignant in adults at a tertiary referralcenter
both are grade C recommendations
At what age can a lack of response to name serve as an early symptom of autism?
A: By nine months of age, not responding to name can be an early sign.
Early indicators such as failure to respond to name or facial expressions call for vigilance from parents and healthcare providers for quicker screening and intervention
Initiating cardiac rehabilitation within this time frame after a cardiac event leads to improved compliance and better outcomes.
What is 1 to 2 weeks after the event?
On screening, B12 is 190 pg/m (borderline. _____ is the next best diagnostic steps. Work up for ______ is the next step if clear cause of B12 is not found.
methylmalonic acid; atrophic gastritis
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Atrophic gastritis should be suspected in patients with unexplained vitamin B12 deficiency, a family history of atrophic gastritis, or a personal history of an autoimmune condition. Anti–intrinsic factor antibody is specific and anti–parietal cell antibody is sensitive for autoimmune gastritis, but definitive testing requires endoscopic biopsy. Identifying atrophic gastritis is important because of the risk of gastric cancers and micronutrient deficiencies
In which clinical scenarios (5) is colorectal cancer screening recommended to begin earlier than the standard age, and at what age should these high-risk individuals initiate screening? need to list all 5 scenarios.
- prior history of adenomatous polyps
- inflammatory bowel disease
- a history of abdominal or pelvic radiation
- a known genetic syndrome (e.g., Lynch syndrome or FAP)
- or having a first-degree relative diagnosed with colorectal cancer or advanced adenoma before age 60
What is the MIAMI mnemonic in the w/u of LAD? must name all 5.
The MIAMI mnemonic—Malignancy, Infection, Autoimmune, Miscellaneous, Iatrogenic—helps remember the main categories in the differential diagnosis for lymphadenopathy. This framework encourages clinicians to think broadly and systematically, so they don’t miss rare etiologies or focus too narrowly on only common causes. It's crucial for guiding the initial assessment, ordering appropriate tests, and prioritizing workup based on risk factors and clinical context.
What are the five foundational elements that make up the SPACE framework for meeting the needs of autistic individuals in healthcare and educational settings?
The SPACE framework stands for Sensory needs, Predictability, Acceptance, Communication, and Empathy.
The SPACE framework emphasizes building environments and routines that address sensory sensitivities, provide predictability, foster acceptance, support diverse communication styles, and encourage empathetic understanding—all key for making care and learning accessible and affirming for autistic people
____, ____, and ____ patients are referred at 20%, 36%, and 50% lower rates than White patients, leading to increased mortality and worse long-term cardiac outcomes in those groups
Black, Hispanic, and Asian patients are referred at 20%, 36%, and 50% lower rates than White patients, leading to increased mortality and worse long-term cardiac outcomes in those groups
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- highlights inequities in these patient populations, similar to other inequities that are present in other areas of healthcare
- Based on insurance status and location, costs can range from $0 per session to more than $82 per session
- systematic referral systems (like we have here) have been started to help w/ above but inequities still persist
- Patients cite lack of knowledge of programs and the desire to manage the CHD on their own as the main reasons they stop attending rehabilitation
What are the lab tests needed to w/u atrophic gastritis (3). If this is negative but suspicion remains high, what is the gold standard test?
anti-intrinsic factor antibody
antiparietal cell antibody testing
Helicobacter pylori infection
If suspicion remains high or antibody tests are positive, upper gastrointestinal endoscopy with histological analysis of multiple gastric biopsies is the gold standard for definitive diagnosis
This newly FDA-approved blood-based test for colorectal cancer screening offers a non-stool, non-endoscopic approach and is considered an option for patients unable or unwilling to undergo conventional screening.
What is Shield?
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- Shield is the first FDA-approved blood-based test for colorectal cancer screening, increasing accessibility for select patients but has limited sensitivity for advanced precancerous lesions, making it a second-line option behind established stool- and visualization-based methods.
- allegedly covered by medicare per their website and allegedly will also cover f/u colonoscopy if positive
- no screening guidelines have included this as of yet
- no screening intervals have been established
______ is a better initial test than ________, especially for lymphomas, because it is less prone to sampling errors and retains tissue architecture, which aids in diagnosis.
We can refer to _____ and ____ to get these done.
core needle bx; fine needle aspiration
IR (fine needle aspiration and core needle bx) and general surgery (above + excisional)
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Traditionally, patients with cervicallymphadenopathy undergo fine-needle aspiration sampling, fol-lowed by excisional lymph node biopsy for definite diagnosis,because intact tissue is required. A core needle biopsy combinedwith immunohistochemical and molecular investigative tech-niques is an alternative to traditional fine-needle aspiration andexcisional biopsy