January 2021

Misc

100

Are Omega-3 Fatty Acids safe in pregnancy and are they effective in reducing the risk of preterm birth

Yes and Yes

- reduce birth <37wks and <34wks

- increase risk of prolonged gestation >42

- Number needed to harm 102 

200

Are e-cigs with nicotine effective as smoking cessation tool

yes, at 1yr more effective then other quit tools 

300

In treatment-resistant depression, this medication when added on to SSRIs was effective in controlling symptoms. 

Quetiapine

400

Describe 3 phases of severe dengue

Febrile

Critical- starts 72hrs after fever, increased vascular permeability, fever, hemorrhagic manifestations, and marked thrombocytopenia 

500

What is the new drug Vascepa (isosapent ethyl) indicated for, does it work, 2 adverse effects, and cost? 

- CVD pts on max statin therapy with persistent elevated TGs

- yes effective at reduces risk of ischemic events 

- A-fib (including hospitalizations) and bleeding

- $130/mo vs $40/mo for fish oil 

Eating Disorders

100

What are approved medications for Anorexia Nervosa?

There are no FDA approved medications for anorexia. Olanzapine or SSRIs may be used as off-label. 

200

Name at least 1 criteria that define a Moderate degree of malnutrition. 

1. Percent of Median BMI 70-79%

2. BMI Z-score -2 to -2.9

3. % Weight loss >15% pre-illness weight loss

300

If elevated, this lab value may indicate purging behavior

Amylase

400

What is the first line treatment for anorexia nervosa or bulimia nervosa with grade A evidence?

Family-based therapy

Breast Cancer Screening

100

According to the USPSTF for women of average risk, mammography is recommended starting at age _ with a frequency of _. 

Starting at age 50, biennially. (Age 40-49 should be "individual decision").

200

What is the approximate lifetime risk of develping invasive breast cancer?

A) 5-10%

B)10-15%

C)15-20%

D)20-25%

B)12.8% or 1 in 8

300

When should breast cancer screening be discontinued?

At age 75 or if life expectancy is <10 years. (Some societies recommend if life expectancy is <5-7 years).

400

When might ultrasonography be considered in addition to mammography for screening?

In women with moderate risk and dense breasts (not high risk such as BRCA)

Hip Pain in Adults

200

Name 3 possible Dx for young active adults with anterior hip pain

- Femoroacetabula impingement

- labral tear

- femoral neck stress Fx 

300

What is the most common cause of lateral hip pain and its 2 underlying etiologies

Greater Trochanteric Pain Syndrome

- Bursitis

- Gluteus Medius Tendonopathy 

Typically woman 40-6- 

400

Describe the long-stride walking test and what it is testing for. 

Takes a long step on the unaffected leg with hip pointed forward. Narrows space between lesser trochanter and ischium on posterior (affected hip), which can reproduce pain of ischiofemoral impingement.

94% sensitivity and 85% specificity 

Labor Dystoc

100

Define Arrest of Labor in Latent stage 

You should not Dx arrested labor in latent stage 

Protracted labor: 

Nulliparous >20hrs

Mutliparous >14hrs 

200

Define Arrest of labor for active stage

>/= 6cm dilation, membrane rupture and either 

> 4hrs w/o cervical change with adequate CTXs 

or

> 6hrs w/o cervical change w/o adequate CTXs 

300

Define protracted labor in second stage

epidural:

Nulliparous- >/= 4hrs 

Multiparous >/= 3hrs

w/o epidural 

Nulliparous- >/= 3hrs 

Multiparous >/= 2hrs

400

After 3+ hrs in second stage how many woman will delivery spontaneously? 

only 1/4 

500

Name 3 ways to prevent arrested labor

- do not admit in latent labor

- labor support (Doula) 

- proper active management of labor (using cervical ripening, augmenting as indicated)  

Dysphagia

100

Describe 2 phases of swallowing

Oropharyngeal- food is chewed and mixed with saliva to form bolus, when swallowing initiated pollus propelled into oropharynx by tongue. Other structures simultaneously seal nasopharynx and larynx 

Esophageal- passes upper esophageal sphincter and enters esophageal body, propelled by peristalsis through midthoracic and distal esophagus and into stomach through fully relaxes lower esophageal sphincter 

200

Name 5 causes of oropharyneal dysphagia

- Stoke

- Parkinsons

- Alzheimers and other dementias

- ALS

- MS

- Myasthenia gravis

- Dermatomyositis/polymyositis

- Antipsychotic meds 

- structural causes (CA/masses, zenker diverticulum, head/neck radiation) 

- poor dentition/dentures

- dry mouth 

- 

300

What are the 3 most common causes of esophageal dysphagia? 

GERD

Functional esophageal d/o (IBS, functional dyspepsia) 

eosinophilic esophagitis 

400

Describe at least 3 characteristics that differentiate between oropharyngeal and esophageal dysphasia 

- Feeling that food is stuck, almost always esophageal

- Coughing, choking, or nasopharyngeal regurg, consistent with oropharngeal 

- Liquids and solids > esophageal 

- Liquids only > oropharyngeal 

- Solids only > esophageal mechanical obstruction (intrinsic or extrinsic) 

500

What are the first 2 tests of choice for esophageal dysphagia 

EGD followed barium swallow

Need Bx to dx eosinophilic esophagitis