General Internal Medicine

Question 1

Diagnostic physical exam finding for sacroiliac joint dysfunction

Answer 1

Pain with hip flexion, abduction, external rotation (FABER)

Question 2

Most appropriate treatment for smoking cessation in hospitalized patients with ACS

Answer 2

Varenicline or combination nicotine replacement therapy

Question 3

Vertigo that is suggested with abnormal result on any one of the three HINTS (Head Impulse, Nystagmus, and Test of Skew)

Answer 3

Central vertigo

Question 4

Most common adverse effects of second generation antipsychotic agents

Answer 4

Weight gain and Hyperlipidemia

Question 5

Pain with flexion and extension of knee while examiner’s thumb lies over the lateral femoral condyle

Answer 5

Iliotibial band syndrome

Question 6

First line therapy for premenstrual dysphoric disorder

Answer 6

Second generation anti-depressant (i.e. SSRI)

Question 7

Positive Likelihood ratio
2
5
10

Answer 7

Sensitivity/(1-specificity)

Increases probability of disease
15%
30%
45%

Question 8

Negative Likelihood ratio

0. 5
1. 2
2. 1

Answer 8

(1-sensitivity)/Specificity

Decrease the probability of disease
15%
30%
45%

Question 9

Absolute risk

Answer 9

Patients with event in group / total patients in group

Question 10

Relative risk

Answer 10

The ratio of the probability of developing a disease with a risk factor present to the probability of developing the disease without the risk factor present

Question 11

Contraindication for nicotine

Answer 11

Recent MI, arrhythmia, unstable angina

Question 12

Contraindication for bupropion

Answer 12

Seizure disorder and eating disorder

Question 13

Contraindication to naltrexone

Answer 13

Patients receiving Or withdrawing from any opioid and in those with liver failure or hepatitis

Question 14

Contraindication to acamprosate

Answer 14

Kidney disease

Question 15

Adverse effect of disulfiram

Answer 15

Flushing, headache, emesis

Question 16

Major risk factors for opioid overdose

Answer 16

1) receiving more than 50 morphine mg Eq/day

2)  Receiving opioids and benzodiazepines concurrently

Question 17

Most effective long-term treatment for patellofemoral pain syndrome

Answer 17

Physical therapy

Question 18

Unexplained fatigue lasting > 6 consecutive months that impairs the ability to perform desired activities, post exertional malaise, unrefreshing sleep, and either cognitive impairment or orthostatic intolerance (symptoms wors in upright position)

Answer 18

Systemic exertion intolerance disease

Question 19

Appropriate management for chronic insomnia refractory to cognitive behavioral therapy for insomnia or who declined to participate in CPT – I.

Answer 19

Low-dose doxepin or non-benzodiazepine benzodiazepine receptor agonist (i.e. zolpidem, zaleplon, eszopiclone)

Question 20

Primary treatment for chronic venous insufficiency

Answer 20

Compression therapy

Question 21

Order of management In patients with chronic cough and negative findings on chest radiography after discontinuation of ACE therapy and tobacco

Answer 21

1) empiric treatment for upper airway cough syndrome
2) spirometry or empiric treatment for asthma
3) Sputum analysis for eosinophils or empiric treatment with inhaled glucocorticoids
4) Empiric treatment for GERD

Question 22

deep anterolateral shoulder pain That worsens with abduction and external rotation. Pain is also often caused by repetitive overhead stress

Answer 22

Superior labrum anterior and posterior lesion

Question 23

Vertigo with Vertical, horizontal, or torsional nystagmus

Answer 23

Central disease

Question 24

Primary treatment for benign paroxysmal positional vertigo

Answer 24

Epley maneuver

Question 25

First line therapy for insomnia

Answer 25

CBT

Question 26

Positive Spurling test

Answer 26

Cervical radiculopathy

Question 27

Pain occurs between 60 and 120° during passive abduction of the arm

Answer 27

Rotator cuff tendinopathy

Question 28

First line therapy for urge incontinence

Answer 28

Bladder training with timed voiding

Question 29

Red flags of cauda equina syndrome

Answer 29

1) Urinary retention or incontinence 2) Diminished perineal sensation 3) Bilateral motor deficits

Question 30

Radiating back pain and lower of extremity numbness that is exacerbated by walking and spinal extension but improved by sitting and leading forward. A wide base gait and/or abnormal Romberg tests are highly specific

Answer 30

Spinal stenosis

Question 31

Most common cause of knee pain and patience <45 years, especially women

Answer 31

Patellofemoral pain syndrome

Question 32

Knee pain that is worse with activity and at night

Answer 32

Anserine bursitis

Question 33

Indications for ankle x-ray following ankle trauma

Answer 33

1) inability to bear weight | 2) Bone pain localized to the lateral or medial malleolus, base of a 5th metatarsal, navicular bone

Question 34

Indications for carpal tunnel release surgery

Answer 34

1) severe carpal tunnel syndrome (Muscle weakness or EMG evidence of nerve injury)

Question 35

ACC/AHA indications for Recommending Statin therapy to reduce risk of ASCVD

Answer 35

1) clinical ASCVD 2) LDL > 190 3) DM aged 40-75 years w/ LDL 70-189 + no clinical ASCVD 4) without clinical ASCVD or DM and LDL 70-189 + 10-year ASCVD > 7.5%

Question 36

Initial management for gout in patients of Asian dissent

Answer 36

Genetic testing for the HLA-B *58:01 haplotype

Question 37

Sudden onset, severe, persistent vertigo and hearing loss following viral inflammation Management

Answer 37

Labyrinthitis Prednisone

Question 38

First line treatment for genitourinary syndrome of menopause

Answer 38

Daily vaginal moisturizer and vaginal lubricants

Question 39

First line therapy for lower urinary tract symptoms secondary to BPH

Answer 39

Tamsulosin

Question 40

Topical broad-spectrum antibiotic for bacterial conjunctivitis in patients who wear contact lenses

Answer 40

Ofloxacin

Question 41

Tender prostate + positive urine culture Empiric antibiotic coverage

Answer 41

Acute prostatitis Bactrim or fluoroquinolone for 4 to 6 weeks

Question 42

USPSTF recommended breast cancer screening

Answer 42

Biennial screening mammography Beginning at age 50 years for average risk women

Question 43

USPSTF recommended cervical cancer screening

Answer 43

Every 3 years with cytology (pap test) for women aged 21 to 65 years Can increase to every 5 years in women aged 30 to 65 years by either performing high-risk HPV testing or combining cytology and high-risk HPV testing

Question 44

USPSTF recommended lung cancer screening

Answer 44

Annual low-dose CT chest for persons aged 50 to 80 years with at least a 20 pack year smoking history who are still smoking or who quit within the past 15 years

Question 45

Dystrophic nails with yellow- red (oil stain) discoloration, pitting, and distal onycholysis. Commonly affecting the fingernails more than toenails

Answer 45

Nail psoriasis

Question 46

Management for primary dysmenorrhea

Answer 46

Supportive care

Question 47

 First line therapy for endometriosis

Answer 47

NSAIDs

Question 48

Thin white discharge with fishy odor but without irritation or pain

Answer 48

Bacterial vaginosis

Question 49

External and internal erythema with itching and irritation. Non-odorous white caurd-like to charge

Answer 49

Candidiasis

Question 50

Frothy, yellow discharge. Erythema of the vagina and cervix “strawberry cervix”

Answer 50

Trichomoniasis

Question 51

T cell mediated disease classically presenting with pruritic purple papules that are often flat topped and characteristically erupt on the low back, volar wrists, elbows, knees, ankles

Answer 51

Lichen planus

Question 52

Urticarial lesions that last >24 hours that burn and sting rather than itch; wheals that resolve with hyperpigmentation; and associated symptoms, such as fever and joint pain

Answer 52

Urticaria vasculitis

Question 53

Painless vision loss, unilateral flashing lights, floaters, visual field defect

Answer 53

Retinal detachment

Question 54

Afferent pupillary defect and cherry red fovea that is accentuated by a pale retinal background

Answer 54

Central retinal artery occlusion

Question 55

Facial nerve paralysis, sensorineural hearing loss, and vesicular lesion on and in the ear canal; often caused by a varicella zoster virus infection

Answer 55

Ramsay hunt syndrome

Question 56

Appropriate preoperative warfarin management

Answer 56

Withhold 5 days prior to surgery. Restart 12 hours after surgery

Question 57

Management nonbullous impetigo

Answer 57

Topical mupirocin or retapamulin

Question 58

Hyperpigmentation disorder that occurs mostly on the sun exposed areas on the face. Most commonly affects women of childbearing age

Answer 58

Melasma

Question 59

First therapy for stress incontinence

Answer 59

Pelvic floor muscle training for women (kegel exercises)

Question 60

First line therapy for overflow incontinence

Answer 60

Time urination

Question 61

Appropriate time of delay for elective surgery after a prior stroke

Answer 61

6 to 9 months

Question 62

Appropriate empiric antibiotic treatment for acute bacterial prostatitis

Answer 62

Oral Bactrim or an oral fluoroquinolone

Question 63

Appropriate diagnostic evaluation for a androgen deficiency

Answer 63

2 separate early morning (8 am) serum total testosterone levels < 300 combined with suggestive symptoms and/or signs