MEHLMANMEDICAL HY RISK FACTORS

USMLE Step 1 and 2CK High Yield (HY) Risk Factors Flashcards

For the #1 way to improve general health, when in doubt, __ is the most common overall answer on NBME/USMLE.

smoking cessation

__ (I and II), followed by smoking, followed by HTN, in that order, are the most acceleratory (i.e., worst) risk factors for atherosclerosis.

Diabetes

__ is most common risk factor in the population for atherosclerosis, but diabetes, followed by smoking, are the two most acceleratory / worst.

HTN

__ is only most acceleratory for atherosclerosis of the carotid arteries.

HTN

If Q asks about how to decrease peri- or post-operative MI risk, answer will be __ on NBME.

smoking cessation

For duodenal ulcers caused by H. pylori, following antibiotic treatment, __ is most likely to promote healing of ulcers.

smoking cessation.

For autoimmune diseases (i.e., SLE, RA, etc.), the answer to how to decrease recurrence of flares is __.

smoking cessation

For a 4F + recurrent otitis media + parents smoke but only outside, the #1 way to decrease recurrence of otitis media in this patient is __.

parental smoking cessation

For a 55M + gangrene of the fingers + HTN + drinks alcohol and smokes, the #1 way to improve this patient’s condition is __.

smoking cessation

For a 66M + experiences stroke + has Hx of hypertension and smoking, the #1 way to decrease risk of recurrent stroke is __.

lisinopril

The order of risk factors for stroke on NBME/USMLE is: __ à HTN à smoking.

atrial fibrillation (AF)

For a 66M + experiences retinal artery occlusion + has Hx of hypertension and smoking, and carotid duplex ultrasonography shows 90% occlusion, the best way to decrease recurrence of stroke is __.

carotid endarterectomy

For a 65M + S4 heart sound + paradoxical splitting of S2 + left bundle branch block + lateralized apical impulse + ECG shows left-axis deviation + BP is 160/95 + smoker past 20 years, what is most likely to have prevented this patient’s findings? __.

management of hypertension

For a 79M + irregularly irregular rhythm on ECG + history of HTN, the most important risk factor for stroke in this patient is __.

atrial fibrillation, not hypertension

Each component is one point for the CHADS2 score à Congestive heart failure; Hypertension, Age >75, __.

Diabetes

If patient has Afib and 0 or 1 points from CHADS2 score, give __; if 2+ points, give warfarin.

aspirin

For a 45M + HTN + smoker + BMI of 30, the best way to decrease BP is __

weight loss

For a 45M + big paragraph vignette that mentions Hx of prosthetic valve and venous disease, what is the most important indication for anticoagulation in this patient? __

prosthetic valve

For a 53F + cirrhosis + lung cancer + severe abdominal pain requiring surgery + laparotomy shows purple, necrosed bowel, the risk factors are both the cirrhosis and __ due to malignancy.

hypercoagulable state

For a 53M + cirrhosis + blood in stool + no pain, the risk factor is increased venous pressure in superior rectal veins from __.

cirrhosis

For a 53M + cirrhosis + vomiting copious blood, the risk factor is increased pressure in left gastric vein due to __.

cirrhosis

For a 50M + undergoing dental procedure, the answer on USMLE is almost always do __ prophylaxis.

not give

For a 45F + HTN + high LDL and TGAs + low HDL + BMI of 23, the most important modification in this patient is __.

“exercise program”

For a 60M + HTN + LV ejection fraction of 35%, the drug which would improve mortality the most is __.,

lisinopril

For a 48M + BP 150/90 on multiple visits + normal BMI + non-diabetic, the best therapy for this patient is __.

hydrochlorothiazide

For a 38M + diabetic + no protein in the urine + LDL 95 mg/dL + BP 135/80 + HbA1c of 7%, what is most likely to decrease morbidity in this patient? __.

lisinopril

For a 38M + diabetic + mild proteinuria + LDL 95 mg/dL + BP 120/80 + HbA1c of 7%, what is most likely to decrease morbidity in this patient? __

lisinopril

For a 38M + diabetic + no proteinuria + LDL 110 mg/dL + BP 120/80 + HbA1c of 7%, what is most likely to decrease morbidity in this patient? __

statin

For a 38M + no proteinuria + LDL 95 mg/dL + BP 120/80 + HbA1c of 10%, what is most likely to decrease morbidity in this patient? __.

commence metformin

For a 50M + diabetic + high LDL + low HDL + high BMI, the best way to decrease long-term complications in this patient is __.

good glycemic control

For a 50M + diabetic on metformin and glyburide + HbA1c is 12% + bicarb of 20, the #1 way to improve glycemic control is __.

switch from metformin and glyburide to intermediate-acting insulin

For a 50M + on metformin + received IV contrast + now has creatinine of 1.5 mg/dL, what would have prevented this condition? __.

intravenous hydration

For a 50M + heavy smoker + Hx of HTN + BMI of 30, the best way to decrease diabetes risk in this patient is __.

weight loss

For a 65M + long history of alcoholism and smoking + pulsatile mass in epigastrium, the #1 way to have prevented this patient’s condition is __.

smoking cessation

For a 50F + subarachnoid hemorrhage, the biggest risk factor is __ in general population.

HTN

For an 82F + wobbly gait for 4 months + head CT shows crescent-shaped bleed, the biggest risk factor is __.

elderly have reduced cerebral volume

For a 14M + hits head while skateboarding + loses consciousness briefly + head CT shows biconvex-shaped bleed, the major risk factor is __.

head temporal trauma resulting in rupture of middle meningeal artery

For an 81M + Alzheimer + recurrent hemorrhagic stroke, the major risk factor is __.

Alzheimer

For a 50F + has diabetic foot ulcer, this condition could have best been prevented by __

wearing comfortable-fitting shoes

For a 62F + smoker + HTN + pain in legs with walking + diminished peripheral pulses + punched-out ulcer on bottom of foot + ankle-brachial indices are reduced, in addition to smoking cessation and BP control, which of the following is indicated for this patient? __

recommend an exercise/walking program

For a 51M + brawny edema and hyperpigmentation of lower legs + large, sloughy ulcer at left medial malleolus + peripheral pulses strong + ultrasound confirms diagnosis, the next step in management is __

compression stockings

For a 50M + being treated for Hodgkin + develops cardiomegaly + bilateral crackles, the most likely risk factor for this acute presentation is __

doxorubicin/Adriamycin causing dilated cardiomyopathy

For a 50M + being treated for Hodgkin + develops progressive dry cough + CXR shows reticulonodular pattern, the most likely risk factor for this acute presentation is __.

bleomycin causing pulmonary fibrosis

For a 50F + being treated for breast cancer + develops cardiomegaly, the biggest risk factor is __.

trastuzumab causing cardiotoxicity

For a 44M + worked in shipyard 20 years ago part-time + 6-month history of shortness of breath; CXR shows supra-diaphragmatic soft tissue densities, the diagnosis and risk factor is __.

asbestosis, working in construction involving insulation, or shipyards

For a 66M + worked in aerospace industry for 30 years + 1-year Hx of declining pulmonary function; biopsy of lung parenchyma shows non-caseating granulomas, the diagnosis and risk factor is __.

berylliosis, working in aeronautical industry

For a 32F + smoked for 5 years + loud P2 heart sound + JVD + bullous changes seen on CXR + father died of alcoholic cirrhosis, the risk factor for this patient’s condition is __.

deficiency of neutrophil elastase

For a 42F + long-standing history of rheumatoid arthritis managed with prednisone + undergoes appendectomy + experiences drop of BP to 80/40 during surgery, the risk factor for this precipitous drop in BP? __.

chronic prednisone use causing adrenal suppression

For a 42F + long-standing rheumatoid arthritis managed with multiple medications + 6-month Hx of dry cough + CXR shows reticular pattern, what’s the risk factor for this condition? __

methotrexate-induced pulmonary fibrosis

For a 39F + rheumatoid arthritis + low RBCs, WBCs and platelets + splenomegaly, what is the risk factor for this condition? __

rheumatoid arthritis

For a 50F + BMI 40 + smoker + HTN, the #1 way to decrease risk of osteoarthritis in this patient? __

weight loss

For a 62F + has peripheral edema + using high doses of naproxen for past 6 weeks to manage her osteoarthritis, the #1 way to minimize risk for this patient’s condition? __

avoidance of NSAIDs

For a 50M + 6-month history of declining mental function + microcytic anemia + drinks home-distilled liquor + smoker, the biggest risk factor for this patient’s condition? __

home- distilled alcohol

For a 50M + swollen big toe + smoker + works on farm in California + drinks home-distilled liquor, the biggest risk factor for this patient’s condition? __.

home-distilled liquor

For 70M + high creatinine + taking amitriptyline, the best way to prevent this patient’s condition? __.

avoidance of anticholinergic medications

For a 23F + works on fruit farm + doesn’t wear mask + doesn’t wear gloves + develops pinpoint pupils and salivation, what would most likely have prevented this patient’s condition? __

wearing gloves

For a 16F + consumed pills + now has tinnitus + low bicarb, low CO2, and high anion-gap, what is the risk factor? __

aspirin (salicylate)

For a 25M + uses a variety of illicit drugs + develops Parkinsonism, what is the risk factor? __

MPTP use (synthetic heroin)

For a 16F + consumed bottle of pills in suicide attempt + now has severe elevation in ALT and AST, what is the risk factor for this presentation? __

acetaminophen toxicity

For a 55M + high BMI + high blood lipids + does not drink or smoke + ALT and AST very slightly elevated, the #1 way to have prevented this condition? __

weight loss

For a 55M + drinks 2 beers a day + smokes a pack a day + all laboratory findings normal except slight elevation in both AST and ALT (AST slightly higher than ALT), what is most likely to have prevented the findings in this patient? __

cessation of alcohol

For a 55M + obese + gurgling sounds when swallowing + sometimes regurgitates undigested food + halitosis, what is the risk factor? __

obesity

For a 28F + spoon-shaped nails + chapped lips + trouble swallowing, what is the risk factor? __

iron deficiency anemia

For a 28F + eating clay, starch, and ice, what is the risk factor? __

iron deficiency

For a 40M + dysphagia to solids and liquids + barium swallow shows birds beak appearance, what is the risk factor? __

Trypanosoma cruzi (Chagas disease)

For a 40M + Hx of heavy smoking/alcohol + new-onset dysphagia, what is the risk factor? __

heavy smoking/alcohol

For a 40M + Hx of GERD + new-onset dysphagia, what is the risk factor? __

GERD

For a 45M + abdo pain an hour after meals + no other PMHx, the risk factor is __.

H. pylori

For a 67M + abdo pain an hour after meals + Hx of CABG four years ago + intermittent claudication, the risk factor is __.

atherosclerosis of SMA/IMA

For a 65M + long-standing diabetes + diarrhea, the risk factor is __ affecting hypogastric nerves.

diabetic neuropathy

For a 65M + long-standing diabetes + constipation, the risk factor is __ affecting pelvic splanchnic nerves.

diabetic neuropathy

For a 65M + long-standing diabetes + new-onset GERD, the risk factor is __

diabetic gastroparesis

For a 27F + exophthalmos + tachycardia + diarrhea, the risk factor is __ due to hyperthyroid state.

“motility disorder”

For a 44M + alcoholic + low calcium; following administration of calcium, serum levels do not rise appreciably; what is risk factor/cause? __

alcoholism causing hypomagnesemia

For a 23M + lost in woods for 3 weeks without food + given big meal following rescue + develops arrhythmia, the risk factor is __ presenting as hypophosphatemia causing arrhythmia.

refeeding syndrome

For a 27F + painful thyroid + low uptake of radioiodine on scan, the risk factor is __.

viral infection

For a 27F + gave birth 4 weeks ago + non-tender thyroid + hypothyroid state, the risk factor is __

recent pregnancy

For a 55F + started on new medication regimen + now has hypothyroidism, the risk factor is __

drug- induced thyroiditis

For a 55F + started on new medication regimen + now has mouth ulcers, the risk factor is __.

drug-induced neutropenia (agranulocytosis)

For a 44M + ataxia + confusion + ophthalmoplegia + confabulations, what is the risk factor for this condition? __

alcoholism causing thiamine deficiency, resulting in Wernicke-Korsakoff syndrome (WKS)

For a 60M + had gastrectomy performed 6 months ago + now has neuropathy, the risk factor is __

B12 deficiency due to gastrectomy

For a 60M + had gastrectomy performed 6 months ago + now has neuropathy and confusion, the risk factor is __.

thiamine (B1) deficiency due to gastrectomy

For a 24F + vegan + high MCV + hyper-segmented neutrophil on smear, the risk factor is __.

B12 deficiency due to veganism

For a 40F + moving around legs in bed aimlessly at night, the risk factor is __

iron deficiency anemia

For a 44M + fever 103F + diffuse abdominal pain with fluid wave, the major risk factors are __, recent peritoneal dialysis, or nephrotic syndrome

cirrhosis

For a 36F + new-onset shortness of breath and tachycardia; patient has 5-pack-year Hx of smoking + recently prescribed combined oral contraceptive pill, avoidance of __ would have prevented this patient’s acute presentation?

combined contraceptives

For a 55F + perimenopausal + family Hx of osteoporosis + severe vasomotor symptoms, what aspect of patient’s history makes __ a consideration?

HRT - severe vasomotor symptoms

For a 55F + perimenopausal + severe hot flashes + started on HRT a few months ago + stopped taking the progesterone component because of effects on her moods, what is most likely to be seen in this patient? __

endometrial hyperplasia

For a 55F + started taking HRT three months ago + has appearance of new breast cyst + mammogram prior to HRT showed no such cyst, the next best step in management is __.

biopsy of the cyst

For a 50F + BMI of 30 + irregular menses for many years + new-onset heavier vaginal bleeding, what is most likely risk factor for this patient’s condition? __

anovulation

For a 65F + started on tamoxifen as part of her breast cancer chemotherapy regimen, what aspect of her history makes her best candidate for this treatment? __

history of hysterectomy

For a 16F + concerned about risk for ovarian cancer because her great aunt was diagnosed with it; there is no family Hx of BRCA mutations, the next best step in management for this patient? __

oral contraceptive pills (any type)

For a 28F + pregnant at 35 weeks’ gestation + cocaine use + painful contractions of abdomen + vaginal bleeding, the risk factors are __ and deceleration injury.

cocaine use

For a 28F + pregnant at 35 weeks’ gestation + painless vaginal bleeding, a notable risk factor is __

previous C-section

For a 28F + post-partum hemorrhage + placenta is seen attached to myometrial layer, a risk factor is __.

previous C-section, as well as concurrent placenta previa

For a 34F + giving birth + fetal anterior shoulder caught behind mother’s pubic symphysis, a risk factor is __.

fetal macrosomia due to maternal diabetes

For a 32F + one-year Hx of amenorrhea + had dilation & curettage performed to remove miscarriage last year, the risk factor? __.

uterine synechiae (scarring) due to instrumentation within the uterus

For a 30F + 38 weeks’ gestation + fever 103F + CVA tenderness, the risk factor is __

uterus can compress ureters in third trimester

For a 30F + pregnant + severe epigastric pain after meals starting during third-trimester, the risk factor is __

progesterone slows biliary peristalsis

For a 4-month-old girl + small amount of blood in stool + exclusively breastfed until age 2 months + on formula since, what is the biggest risk factor for this patient’s condition? __.

“not being exclusively breastfed until 6 months of life”