FM ITE General

AAA Screening

• Question:
  • A 58-year-old male
    
  • has a 20-pack-year
    
  • smoking history
    
  • QUIT 1 YR AGO
    
  • SHOULD U SCREEN THIS PT for AAA?
• Answer:
  • NO
    
  • ONLY SCREEN FOR AAA
    
  • IN AGE >65
    
  • MALES, SMOKER ONLY
    
  • AGE 65-75
• The U.S. Preventive Services Task Force (USPSTF) recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men age 65–75 who have ever smoked (Grade B recommendation).
• The USPSTF recommends against routine screening for AAA in women (Grade D recommendation).

Breast Cancer Screening

• Question:
  • WHICH FEMALE SHOULD GET MRI FOR BREAST CANCER SCREENING?
• Answer:
  • 1. GENETIC MUTATION
    
  • 2. ANY HISTORY OF RADIATION TO CHEST
    
  • 3. VERY HIGH FAMILY HISTORY
    
  • —
    
  • WRONG ANS= PT ON OCP

Diabetes

• Question:
  • PT WITH HISTORY OF DMT2- A1C 9
    
  • RECURRENT PANCREATITIS
    
  • INTOLERANT TO METFORMIN
    
  • WHAT MED CAN U PUT HER ON FOR DM?
    
  • SHE DOES NOT WANT TO START INSULIN
• Answer:
  • Start empagliflozin (Jardiance) = SGLT2 INHIBITOR
    
  • Empagliflozin, an SGLT2 inhibitor, is considered a second-line choice for patients who are intolerant of metformin.
    
  • CAN ALSO DO
    
  • VICTOZA= LIRAGLUTIDE=GLP1 AGONIST
    
    • = BUT CAN CAUSE PANCREATITIS
      
  • ALSO sitagliptin, a DPP-4 inhibitor

• Question:
  • Which one of the following comorbidities would falsely LOWER the hemoglobin A1c level in a patient with type 2 diabetes mellitus?
• Answer:
  • ONLY 2 THINGS FALSELY LOWER A1C =
    
    • Hemolytic anemia AND
      
    • BLOOD Loss

• Which one of the following U-100 insulin products has the longest duration of action?
  
  A) Degludec (Tresiba)
  B) Glargine (Lantus)
  C) Isophane NPH (Humulin N)
  D) Lispro (Humalog)
  E) Regular (Humulin R)

• Degludec (Tresiba)
• Ultralong-acting: 42 hours
• (in contrast, lispro 3-6.5 hours, regular 5-8 hours, isophane 12-16 hours, glargine 11-24 hours)

Lung Cancer Screening

• Question:
  • A 58-year-old male
    
  • has a 20-pack-year
    
  • smoking history
    
  • QUIT 1 YR AGO
    
  • SHOULD U SCREEN THIS PT for LUNG CANCER?
• Answer:
  • NO!
    
  • LUNG CANCER SCREENING
    
  • =
    
  • OVER AGE 55
    
  • (55 to 80)
    
  • =
    
  • 2 CATEGORIES:
    
    • CURRENT SMOKERS
      
    • +
      
    • 30 YR SMOKING HISTORY
      
    • (this pt has 20 yr smoking hx)
      
    • —
      
    • PAST SMOKERS
      
    • BUT
      
    • THOSE WHO QUIT WITHIN LAST 15 YEARS

• Question:
  • Lung cancer screening with low dose CT Chest annually
• Answer:
  • Adults 55-80yo with 30 pack year history and currently smoking or quit within last 15 years

Mercury

What fish have the highest mercury content?

• Shark & swordfish

Obesity

• Question:
  • Referral for bariatric surgical evaluation is indicated for patients with a BMI of
    
  • A) 35 kg/m2 and mild cognitive impairment
    
  • B) 36 kg/m2 and type 2 diabetes mellitus
    
  • C) 37 kg/m2 and no other medical problems
    
  • D) 40 kg/m2 and active alcohol abuse
    
  • E) 42 kg/m2 and uncontrolled schizophrenia
• Answer:
  • B) 36 kg/m2 and type 2 diabetes mellitus
    
    • refer FOR BARIATRIC SURGERY IF
      
      • 1. BMI >40
        
        • EVEN IF NO OTHER MED PROBLEMS
          
      • 2. BMI > 35 + CHRONIC MED PROBLEM

Biostatistics

• NNT = 1/ARR (absolute risk reduction)