General Internal Medicine

Question 0

(Vitamin deficiency) Hair loss, brittle hair

Answer 0

Biotin, protein, B12, Folate

Question 1

Screening recommendations for osteoporosis

Answer 1

DEXA for all women >65 y/o (q3-5 yrs)

OR

Women <65 if 1 or more risk factors

• Steroids
• low body weight
• current smoking
• alcohol use
• prior fragility fracture
• family hx of hip fracture

Question 2

(Vitamin deficiency) Coiled, corkscrew hair

Answer 2

Vit A and Vit C

Question 3

(Vitamin deficiency) Skin desquamation

Answer 3

riboflavin

Question 4

(Vitamin deficiency) Petechiae, perifollicular hemorrhage

Answer 4

Vitamin C

Question 5

(Vitamin deficiency) Ecchymosis

Answer 5

Vitamin C and K

Question 6

(Vitamin deficiency) Skin pigmentation, cracking, crusting

Answer 6

Niacin

Question 7

(Vitamin deficiency) Acro-orificial dermatitis (erythematous, vesiculobullous, pustular)

Answer 7

Zinc

Question 8

(Vitamin deficiency) Angular stomatitis, cheilosis

Answer 8

Vit B complex, iron, protein

Question 9

(Vitamin deficiency) Glossitis

Answer 9

Niacin, folate, B12

Question 10

(Vitamin deficiency) Ophthalmoplegia, foot drop

Answer 10

Thiamine

Question 11

(Vitamin deficiency) Paresthesia

Answer 11

Thiamine, B12, biotin

Question 12

(Vitamin deficiency) Depressed vibratory and position senses, Memory disturbance

Answer 12

B12

Question 13

(Vitamin deficiency) Wernicke-Korsakoff syndrome

Answer 13

Severe thiamine deficiency

Question 14

Five A’s of smoking cessation

Answer 14

• Ask about tobacco use
• Advise to quit
• Assess readiness to quit
• Assist in quitting
• Arrange for follow up

Question 15

Five R’s of smoking cessation

Answer 15

• Relevance of quitting smoking to their lives
• Risks of smoking
• Rewards of smoking
• Roadblocks to quitting
• Repeat motivational intervention at all visits

Question 16

USPSTF recommendations on cholesterol screening

Answer 16

Every 5 years for men >35 and women >45 who are at increased cardiovascular risk

Question 17

USPSTF recommendation on Pap smear screening

Answer 17

Every 3 years from 21 to 65 y/o

If combo of Pap + HPV testing, can be every 5 years for women >30 y/o

Question 18

USPSTF recommendation on mammogram

Answer 18

Every 1-2 years after age 50 y/o

Question 19

Pressure ulcer staging

Answer 19

• Stage I: Nonblanchable redness (skin intact)
• Stage II: Shallow ulcer with red/pink wound bed or serum-filled blister –> occlusive or semiperm dressing
• Stage III: Subcutaneous fat visible –> correct nutritional deficiencies, debridement, topical or systemic abx
• Stage IV: Exposed bone, tendon, or muscle –> same tx as Stage III

Question 20

Availability heuristic

Answer 20

Clinician has encountered similar presentation and jumps to the conclusion that the current diagnosis must be the same as the previous

Question 21

Anchoring heuristic

Answer 21

Clinician accepts at face value a prior diagnosis made by another clinicians

Question 23

Blind obedience heuristic

Answer 23

Acceptance of a dx or plan made by another of higher authority

Question 24

Premature closure heuristic

Answer 24

Full differential diagnosis is not considered

Question 25

USPSTF guidelines for frequency of HTN screening

Answer 25

Every 2 years

Question 26

(Vitamin deficiency) Myelopathy localizing to posterior columns and bilateral corticospinal tracts

Answer 26

Copper deficiency Copper deficiency, which can be caused by zinc toxicity, nutritional deficiency, or malabsorption syndrome, can result in a myelopathy localizing to the posterior columns and bilateral corticospinal tracts.

Question 27

USPSTF recommendations for aspirin for primary prevention

Answer 27

Aspirin in men ages 45-79 years for primary prevention of cardiovascular disease and in women ages 55-79 years for primary prevention of stroke if the bleeding risks do not outweigh benefit.

Question 28

Vitamin deficiency that causes night blindness

Answer 28

Vitamin A

Question 29

Manifestations of thiamine deficiency

Answer 29

- Wet beriberi - heart failure, ascites, peripheral edema | - Dry beriberi (CNS) - peripheral neuropathy, Wernicke-Korsakoff syndrome

Question 30

Riboflavin (Vit B2 deficiency)

Answer 30

- Normochromic, normocytic anemia - Hyperemic throat, cheilosis, angular stomatitis - Seborrheic dermatitis (perianal area) - Associated w/TCAs and phenothiazines

Question 31

Vitamin deficiency associated with glossitis, cheilosis, vomiting, seizures

Answer 31

Vitamin B6 (pyridoxine) Associated with drugs (INH, cycloserine, penicillamine), chronic alcoholism, general malabsorption syndromes

Question 32

B12 deficiency

Answer 32

- Macrocytic anemia - Smooth tongue - Decreased vibration and proprioception - Decreased reaction to pinprick (stocking/glove)

Question 33

Niacin deficiency

Answer 33

Pellagra - "3 D's" - Dermatitis on sun-exposed surfaces, dementia, diarrhea - Stomatitis - Proctitis - Mental status changes (depression to dementia)

Question 34

Vitamin C deficiency

Answer 34

Scurvy - Petechial hemorrhages and ecchymoses - Hyperkeratotic papules around hair follicles - Sjogren's - Hemorrhage into muscles, joints, purpura, and splinter hemorrhages

Question 35

Vitamin E deficiency

Answer 35

- Areflexia | - Decreased vibration/position sense

Question 36

Non-hormonal therapy for hot flushes

Answer 36

Venlafaxine

Question 37

Meniere's disease

Answer 37

a.k.a. idiopathic endolymphatic hydrops = Vertigo, unilateral low frequency hearing loss, and tinnitus

Question 38

Hawkins test

Answer 38

Shoulder impingement syndrome

Question 39

Apley scratch test

Answer 39

Rotator cuff tendinitis

Question 40

Finkelstein test

Answer 40

De Quervain tenosynovitis

Question 41

Audible or palpable snap on McMurray test

Answer 41

Meniscal damage

Question 42

Lachman test

Answer 42

ACL injury