General internal medicine 3 Flashcards
(96 cards)
1
Q
Management of acute otitis media
A
- amoxicillin
2
Q
Management of acute otitis media that doesn’t improve within 48-72 hours
A
Broaden to amoxicillin-clavulanate (to cover h influenza)
3
Q
Management of unresolved chronic otitis media with effusion
A
Myringotomy with tympanostomy tube placement
4
Q
Management of lumbosacral radiculopathy
A
- light exercise, maintain light-normal activity
- NSAID
IF no improvement –> MRI
5
Q
Presentation of lumbosacral radiculopathy + physical exam
A
- back and shooting leg pain
- numbness and or weakness in legs
- pain reproduced with straight leg raise
6
Q
Algorithm for acute low back pain
A
Red flags?
IF yes – MRI
IF no – light activity + NSAIDS
7
Q
Red flags in acute low back pain
A
- urinary retention
- saddle anesthesia
- motor weakness
- bilateral neurological symptoms
8
Q
Definition of osteopenia
A
T-score of -1 to -2.5
9
Q
Definition of osteoporosis
A
T-score of -2.5 or less OR hx of **fragility fracture
10
Q
Definition of fragility fracture
A
- fracture resulting from a fall from standing height or less
11
Q
What s the FRAX risk assessment tool used for
A
Risk assessment tool for patients over age 50 who have osteopenia to determine need for treatment
12
Q
What is acute cervicitis? Presentation
A
- inflammation of the cervix (comparable to urethritis in men) typically due to STI (gonorrhea, chlamydia, trichomonas)
- friable cervix + purulent discharge
13
Q
Management of cervicitis
A
1) NAAT for chlamydia and gonorrhea
2) Empiric CTX + doxy (cover both chlamydia and gonorrhea)
3) wet mount for trichomonas and BV
14
Q
Vaginal discharge features in BV
A
- thin, malodorous vaginal discharge
15
Q
wet mount in trichomoniasis
A
typically shows motile organisms
16
Q
Differential for vaginal discharge
A
1) gonorrhea, chlamydia
2) trichomonas
3) BV
* *foreign object, latex, douching
* verify not forgetting anything
17
Q
Exam findings indicating PID?
A
Patient has cervical motion, uterine, or adnexal tenderness on pelvic exam
18
Q
Presentation of struvite stones/staghorn calculi
A
- *signs/symptoms of nephrolithiasis (hematuria, right flank pain, dysuria) + recurrent UTIs (stones continue to seed infections)
- also very alkaline urine + reduced GFR
19
Q
Cause of struvite stones
A
Urease-producing bacteria (proteus, klebsiella) (conversion of urea to ammonia raises urine pH and stones precipitate)
20
Q
First line therapy of stag horn calculi
A
- abx for UTI + Percutaneous nephrolithotomy, often with lithotripsy
21
Q
Management of HIV therapy during pregnancy + management of delivery + breastfeeding
A
- Start ART ASAP (decreases risk of neonatal transmission)
- delivery = IF viral load is below 1,000, women can deliver vaginally without intrapartum zidovudine
- IF viral load greater than 1,000 – AZT intrapartum + cesarean delivery
- don’t breastfeed if living in US (formula is readily available in US)
22
Q
Initial evaluation for BPH
A
- Review meds for meds that can cause retention
- Exam for prostate nodules or masses
23
Q
Initial lab workup of BPH
A
UA + PSA + creatinine
24
Q
Initial treatment of BPH
A
IF mild symptoms – behavioral modification (decrease less caffeine and alcohol, double voiding, drink fluids earlier in the day)
IF moderate to severe symptoms – alpha blockers or 5-alpha-reductase inhibitors
25
Management of non healing pressure ulcers
IF signs of infection --> debridement + topical abx (assuming no signs of systemic infection, then need systemic abx and debridement)
IF signs of cellulitis (erythema, warmth, swelling) --> systemic abx for cellulitis
26
Signs of infection in ulcers
erythema
purulent drainage
tenderness
*grayish slough (necrotic tissue)
27
Management of non healing ulcer that is refractory to topical antibiotics
- tissue biopsy for culture
| - consider MRI to exclude osteo
28
Opioid course for moderate postop pain after discharge
3 days
29
Management of statin myopathy (in addition to checking TSH)
- stop statin, restate statin with lower myopathic potential (rosuvastatin, pravastatin, fluvastatin)
30
Other features of PAD
- lower-extremity claudication (not just in calves, can also be hips or thighs or feet or buttocks)
- slow wound healing
- pain increased with walking and relieved with rest
* pain with walking uphill
* thigh or leg or hip weakness
31
Preferred medication for migraines during pregnancy
Acetaminophen
32
Options for migraine treatment in pregnant patient not responding to APAP
- NSAIDS (only in 2nd trimester, associated with fetal toxicity during 1st and 3rd trimesters)
- opioids (third line)
- antiemetics
33
First line and second line pain management for vertebral compression fractures
- NSAIDS, APAP, opioids
| Second line: intranasal calcitonin
34
First line abx for cat bites and abx if penicillin allergy
First line: augmentin
| IF penicillin allergy: doxycycline/metronidazole
35
Presentation of hearing loss inelderly
- often social isolation
36
Proctitis clinical features
- tenesmus (constant urge to defecate) + purulent discharge + small volume stools containing blood
37
most common causative organism in proctitis
gonorrheoeae
38
workup of proctitis
- culture discharge and test for HSV and PCR for chlamydia
| - RPR and HIV
39
Knee pain following parathyroidectomy
- can precipitate a pseudogout attack (due to abrupt drop in serum calcium levels, which triggers shedding of calcium pyrophosphate crystals into the synovial fluid)
40
joints affected by pseudogout
- knee (most common), wrists and ankles
| - can affect multiple joints concurrently
41
Workup of dysmenorrhea
- just pelvic exam (no need for US or any other workup)
42
Treatment of dysmenorrhea
NSAIDS and/or combination OCPs
IF persistent pain after 3 months of NSAIDS and or OCPS -- pelvic US to rule out secondary causes of pain (fibroids, uterine abnormalities)
43
Workup of patient with refractory dysmenorrhea and normal US
Diagnostic laparoscopy (rule out endometriosis)
44
Rhinitis medicamentosa clinical features
- chronic overuse of vasoconstrictor nasal sprays that leads to worsening nasal congestion and discharge due to tachyphylaxis with rebound vasodilation and rhinorrhea
45
Treatment of rhinitis medicamentosa
- stop decongestant
| - trial intranasal steroids (flonase)
46
advice to give patients for reducing risk of recurrent nephrolithiasis
- increase fluid intake
- increase *dietary* (not supplemental) calcium (high dietary calcium binds oxalate in the GI tract thereby decreasing absorption of oxalate and excretion into urine)
- increase fruit and vegetable intake
- decrease sodium and protein intake
- increase citrate (binds urinary calcium)
47
Preoperative management of tamoxifen
- discontinue 2-4 weeks prior to any surgery associated with moderate or high risk of VTE (elevated VTE risk)
48
Management of neuralgia paresthetica
- reassurance and conservative treatmentment (avoid tight garments, weight loss)
49
Management of caregiver distress
- support services (respite care, support groups)
50
First and second line treatment of fibromyalgia
1) regular cardiovascular exercise + sleep hygiene
| 2) TCA + SNRI
51
postprandial hypotension clinical features
- lightheadedness + orthostasis within 2 hours of eating
| - common in elderly
52
management of postprandial hypotension
- decreased portion sizes, increased salt and water intake, low carb meals, avoid alcohol
53
Management of corrosive ingestion (eg bleach)
- EGD (grade severity of injury)
54
Initial management + subsequent management of dry macular degeneration
Initial: smoking cessation + daily antioxidant vitamins and zinc
Subsequent: VEGF inhibitor
55
Clinical features of dry acute macular degeneration
- gradual vision loss
| - difficulty with reading and driving at night
56
Clinical features of wet acute macular degeneration
- acute vision loss
- *metamorphosis (distortion of straight lines)
- fluid or hemorrhage on funduscopy
57
General indications for PRBC transfusion
1) Hgb less than 7
| 2) Symptomatic + hgb less than 10
58
Osteoporosis screening age
IF no RF's -- 65
| *IF 1 or more RF's for osteoporosis -- earlier
59
Osteoporosis RF's
```
RA
smoking, drinking
low body weight
sedentary lifestyle
chronic liver or renal disease
```
60
Management of classic heat stroke
- evaporative cooling
- IV fluid boluses
- IF younger -- ice water immersion (higher mortality in elderly patients)
61
Initial evaluation of avascular necrosis
- MRI (more sensitive than plain film)
62
Avascular necrosis of hip presentation
- groin pain on weight bearing + limited internal rotation and range of motion
63
Plain film of avascular necrosis of hip
"crescent sign"
64
Clinical features + exam features patellofemoral syndrome (PFPS)
- knee pain worse with squatting, moving up or down (walking up stairs)
- tenderness on direct compression of the patella during knee extension
65
What designates a patient as increased risk for CRC on basis of family history?
- first-degree relative at age less than 60
66
How often do patients at elevated risk of CRC need c-scopes?
- every 5 years
67
acceptable alternatives to c-scope
- CT colongraphy q 5 years
- FIT-DNA testing q 3 years
* Flex sig q 10 years
68
First step in evaluation of suspected Marfan syndrome
- TTE (rule out aortic root disease)
69
Marfan syndrome clinical features
- skeletal abnormalities + lens dislocation + CV system abnormalities + long slender fingers (arachnodactyly)
70
Klinefelter syndrome clinical features
-gynecomastia + infertility + cryptorchidism +
71
Initial step in evaluation of suspected klinefelter syndrome
karyotype (47,XXY karyotype)
72
Management of chronic fatigue syndrome
- CBT
| - graded exercise therapy
73
Next step after diagnosis of adrenal incidentaloma
Test for hypersecretion
74
Management of patient on chronic NSAID
IF moderate or high risk for GI bleed -- switch to selective COX-2 inhibitor OR add PPI
75
First line treatment of corneal abrasion
Topical antibiotic ointment
76
Initial workup of HTN
- TSH (both hyperthyroidism and hypothyroidism can raise blood pressure)
- UA
- A1c
- lipids
- BMP, CBC
- EKG
77
psychosocial factor associated with increased mortality in the elderly
loneliness
78
Turner syndrome features
- CV abnormalities (bicuspid aortic valve, coarctation of the aorta, aortic root dilatation)
- skeletal abnormalities (short stature, webbed neck, scoliosis)
- retinal hemorrhages on fundoycopic exam
79
Description of aortic coarctation murmur
- continuous murmur in anterior chest (due to flow through large collateral vessels)
80
Clinical features of aortic coarctation
- (headache and epistaxis)
- HTN
- differences in BP between upper and lower extremities
- diminished and or delayed femoral pulses
81
Treatment of aortic coarctation
- surgical repair
82
Term for hair loss of pregnancy
- telogen effluvium
83
Other triggers for telogen effluvium
- severe weight loss, major illness or surgery, psychiatric trauma
84
Terms for impairment of near vision and distance vision
presbyopia = near vision loss
| myopic shit = distance vision loss
85
Presentation of early cataract formation
difficulty with distance vision + asymmetric
86
What is hirsutism?
- terminal, dark hair growth in androgen-dependent areas (chin, upper abdomen, chest back, upper lip)
87
Management of hirsutism
- serum total testosterone level to rule out underlying androgen disorders
88
Optic neuritis clinical features + imaging features
- acute monocular vision loss + *central scotoma (black spot in center of vision)
* periventricular white matter lesions
89
Treatment of optic neuritis
IV methylprednisolone
90
Diagnosis of acute intermittent porphyria
- urinary porphobilinogen (PBG) *during an acute attack
91
perioperative management of patient who has previously been on steroids
- treat with stress-dose steroids perioperatively (HPA axis suppression from steroids takes a while to resolve -- up to 6-12 months after discontinuation)
* especially if cushingoid appearance
92
Preeclampsia timing
20 weeks to *6 weeks postpartum
93
Utility of urine chloride in metabolic alkalosis
Low in vomiting, high in diuretic use or abnormal renal sodium handling (Gitelmans and Bartters)
94
Clinical features of plugged milk ducts
- painful, tender, palpable masses + no signs of infection in breastfeeding woman
95
Galactocele clinical features
large, subareolar milk-retaining cyst due to a blocked milk duct
96
clinical features of lactational mastitis
localized breast pain without a focal mass + infectious symptoms (complication of engorgement and plugged milk ducts)
