General internal medicine 4 Flashcards
(116 cards)
1
Q
Management of statin myopathy
A
TSH (statins can worsen hypothyroid myopathy and hypothyroidism can exacerbate statin myopathy)
2
Q
Other features of hypothyroidism
A
- normocytic anemia
- diastolic hypertension
- mild CK elevation
3
Q
Treatment of acute gout in CKD patients
A
steroids (intra-articular if 1-2 joints or systemic if more than 2 joints involved)
*colchicine not recommended
4
Q
Other presentation of Celiac
A
- may present with no GI or intestinal symptoms
- elevated liver enzymes
- arthritis
- may just be IDA in someone with autoimmune history
5
Q
lymphocytic colitis clinical features
A
chronic, non bloody diarrhea
6
Q
atheroembolic disease clinical features
A
- AKI after arteriography involving the aorta
- livedo reticularis
- cyanotic, gangrenous toe
7
Q
Anterior uveitis clinical features
A
- unilateral painful, red eye and photophobia (similar to acute angle closure glaucoma but without system symptoms)
- hypopyon (white exudate in anterior chamber)
8
Q
hordeolum clinical features
A
- inflammation? (due to obstruction of meibomian gland, eyelash follicle, or lid-margin tear gland
9
Q
Anterior uveitis treatment
A
urgent ophtho consult
10
Q
Anterior uveitis vs. acute angle-closure glaucoma
A
- angle-closure glaucoma has more systemic presentation (headache, nausea and vomiting), anterior uveitis is localized
11
Q
work up of narcolepsy
A
- overnight sleep study then the next night a multiple sleep latency test (time to sleep onset is measured, pts with narcolepsy have a shorter sleep latency time)
12
Q
Pes anserinus pain syndrome clinical features
A
- point tenderness along the medial knee
13
Q
episcleritis clinical features
A
- foreign-body sensation in eye
- no significant pain or visual impairment
- redness
14
Q
treatment of episcleritis
A
topical lubricants
15
Q
scleritis clinical features
A
- pain + visual impairment + dark red sclera
16
Q
scleritis treatment
A
systemic steroids and immunosuppressants
17
Q
Additional initial workup of HTN
A
screen for diabetes with fasting glucose, A1c, or OGTT
18
Q
Presentation of copper deficiency
A
- similar to B12 (anemia, leukopenia, myeloneuroapthy)
+ malabsorptive condition
19
Q
Genital HSV treatment + indication for prophylaxis
A
ORAL acyclovir at symptom onset
IF 4 or more episodes a year –> chronic suppressive therapy
20
Q
complex regional pain syndrome clinical features
A
- throbbing pain, paresthesias, skin temperature changes, local edema
21
Q
deficiency associated with metformin
A
B12 deficiency
22
Q
Utility of synthroid following thyroidectomy in patients with thyroid cancer
A
Goal is to suppress TSH stimulation of residual tumor tissue to prevent recurrence of cancer
23
Q
Paget disease of the breast clinical features
A
- intense pruritus + ulcerative
24
Q
Management of paget disease of the breast
A
- bilateral mammography (rule out underlying breast cancer)
25
Management of nocturia in CHF patient with BPH
- optimize volume status before making medication changes for BPH (nocturia can be caused by improved renal perfusion pressure, so people diurese more over night)
26
Clinical features + physical exam for tarsal tunnel syndrome
- pain, paresthesias in sole of foot
| - positive Tinel's sign and or sensory loss
27
Indications for antibiotic treatment of rhinosinusitis
- long symptoms (over 10 days)
- severe symptoms (high fever, purulent nasal discharge, or facial pain for over 3 days )
- worsening symptoms 5 days or more after initially improving viral URI
28
Acromegaly sequelae
- Increased risk of esophageal, gastric cancer, colon cancer, melanoma (IGF-1 stimulates mucosal cell proliferation) (so need c-scope at time of diagnosis and q3 years)
29
Next step after diagnosis of osteoporosis in elderly men
- serum testosterone (frequently have hypogonadism) (also need baseline CBC, bmp, TSH, vitamin d)
30
bacterial keratitis clinical features
- contact lens + pain, photophobia, and conjunctival injection + corneal lesion
31
Antibiotics for bacterial keratitis
quinolone (pseudomonal coverage)
32
Treatment of acute angle-closure glaucoma
- timolol, apraclonidine, pilocarpine drops
| - IV acetazolamide
33
Corneal ulcer clinical features
- foreign body sensation
34
trochanteric bursitis clinical features
- lateral hip pain
| - pain radiating into buttock or toward knee
35
Malignant otitis externa clinical features
- Diabetic with severe ear pain + discharge + bone erosion + *high ESR
36
SCC of the ear presentation
pain and ulceration with erosion into the bone
37
malignant otitis externa vs squamous cell carcinoma
SCC = milder symptoms + normal to slightly elevated ESR
38
Treatment of malignant otitis externa
quinolones
39
Management of OA in elderly patients
- topical NSAIDS even if no NSAID contraindications (still associated with increased risk of complications in the elderly)
40
treatment of androgenic alopecia in women and men
Men: minoxidil, finasteride
Women: minoxidil
41
Clinical features of wilson disease
- hepatitis
- neuropsych
- parkinsonism (tremor, rigidity, clumsiness)
- hemolytic anemia
- recurrent nephrolithiasis
42
presbycusis clinical features
- bilateral, high-frequency hearing loss in elderly patient
- abnormal whispered voice test
- do fine one to one but have difficulty hearing in presence of background noise
43
otosclerosis clinical features
*unilateral hearing loss
44
Ototoxic drugs
- aminoglycosides
- platinum chemo
- loop diuretics
* NSAIDs
45
IT band syndrome clinical features
- lateral knee and thigh pain
| - pain with flexion and extension of the knee
46
IT band syndrome treatment
- exercise less, PT
47
Patellofemoral syndrome
- pain in anterior knee + pain reproduced by squatting
48
patellar tendinopathy clinical features
- pain in inferior patella
- tenderness at tendon insertion at inferior patellar margin
- jumping sports (basketball, volleyball)
49
Treatment of neuralgia paresthetica
- advise patient to wear less tight-fitting clothing
50
When do patients generally need further cardiac workup prior to surgery?
If underlying high-risk cardiac condition
51
High risk cardiac syndromes requiring further evaluation prior to surgery
- ACS
- decompensated heart failure
- significant arrhythmia
- severe valvular disease
52
description of severe AS
- late peaking systolic murmur
| - paradoxical splitting of S2
53
pre-op cardiac workup for patients with high risk underlying conditions (in general)
- TTE if concern for underlying valvular disease
| - stress test if concern for ACS
54
Upper limit of Pap testing, when pap tests can be discontinued
65 or total hysterectomy
55
Preferred screening for alcohol use in primary care
AUDIT-C (alcohol use disorders identification test-C)
56
Ocular side effects of PDE-5 inhibitors (viagra)
- bluish tinting, blurry vision, photophobia
57
zinc deficiency presentation
- abdominal pain, anorexia, depression, compromised wound healing, immune dysfunction
58
Emergency contraceptive options
1) oral levonorgestrel (up to 3 days)
| 2) copper containing IUD (up to 5 days)
59
Vaccines indicated for pregnant women
- Tdap during *each* pregnancy regardless of previous vaccination history (preferably during 3rd trimester to facilitate maternal antibody response)
60
MMR live or dead vaccine?
live
61
popliteal cyst presentation
- underlying knee disease or trauma
- posterior knee fullness, pain, and or stiffness
* may dissect or rupture, mimicking DVT (with also positive Homan's sign)
62
DVT vs dissecting synovial cyst
Dissecting synovial cyst = posterior knee fullness, knee effusion, absence of a palpable cord
63
bulimia vs binge eating disorder
bulimia = compensatory behavior (*excessive exercise, laxatives)
64
Basic calcium phosphate (BCP) deposition disease of the shoulder (Milwaukee shoulder) clinical features
- aggressive destruction of glenohumeral joint and rotator cuff
- large hemorrhagic effusion
- synovial fluid may or may not contain BCP (hydroxyapatite) crystals
65
Typical presentation of osteosarcoma on exam
- palpable soft-tissue mass
66
Treatment of frostbite
1) rapid rewarming with warm water
| 2) then air dry and cover with non adherent gauze
67
Chantix and psych history management
- psych history is not a contraindication to its use (this has now been disproved)
68
side effect to know of with chantix
- possible increased risk of CV events
69
Earliest indicator of return of spontaneous circulation in patients in cardiac arrest undergoing CPR
- sudden rise in end-tidal CO2 (sudden increase in cardiac output with return of spontaneous circulation causes rapid transport of CO2 accumulated in tissues to the lungs)
* this eliminates the need to stop CPR to check for a palpable pulse
70
Ottawa ankle rules in general
IF pain at mid foot zone or malleolar zone + inability to bear weight --> then image to rule out fracture
71
Medication to dose reduce or discontinue when SGLT2 is added
- diuretics or ACEs,arbs (SGLT2 inhibitors induce osmotic diuresis, which can lead to hypotension and decreased renal perfusion
72
Conservative fibromyalgia treatment
- regular exercise
| - good sleep hygiene
73
When lipid panel is indicated in primary care
- Men over age 35 and women over age 45 *regardless of weight
- Younger patients with RF's (smoking, HTN, Dm2, FH of cardiovascular disease)
74
Signs of early pregnancy
- fatigue
- weight gain
- amenorrhea
- enlarged uterus
75
adenomyosis clinical features
- enlarged, symmetric uterus
| - heavy, painful menses
76
Management of patient with high pre-test for influenza and negative influenza antigen test
- oseltamavir if within 48 hours or severely ill
* negative rapid influenza antigen testing (high false negative rate) OR a history of flu vaccine does not rule out infection (not fully protective)
77
Next step after Pap test showing ASCUS
HPV test
IF negative -- no increased risk of malignancy
If positive -- colposcopy
78
Treatment of foot drop
PT + ankle foot orthotics (to facilitate ambulation)
79
Workup of common peroneal nerve injury (foot drop)
- L-spine if associated with back pain
| - no workup if hospitalized, trauma, or leg cast (can be attributed to external compression)
80
Gait abnormality with cerebellar injury
ataxic: staggering, wide based
81
Gait abnormality with gait apraxia
magnetic: freezing
82
Gait abnormality with PD
short steps, shuffling
83
Management of lithium toxicity
dialysis
84
Cause of physiologic lekorrhea
- elevated estrogen levels from combined hormonal contraceptive use
85
Treatment of hypertriglyceridemia
- only treat with fibrates if triglycerides over 1000, otherwise lifestyle modification
- statins are first line but need to have another indication for statin
86
Medications associated with increased risk of new-onset diabetes
* thiazides
| - beta blockers (except for coreg)
87
Management of impaired colleague after approaching colleague
- report to state regulatory body (physician health program)
| * not supervisor
88
Inheritance pattern of Becker muscular dystrophy and Duchenne muscular dystrophy
X-linked recessive
89
Management of palpable breast mass in woman over age 30 who has negative mammogram + US
```
Core biopsy (to exclude malignancy)
*Palpable breast masses can be mammographically and monographically occult
```
90
Workup of palpable breast mass in woman over age 30
1) First step is mammography
| 2) Then US
91
abx for acute prostatitis
quinolones OR bactrim
92
Management of patient with osteoporosis despite being on bisphosphonate
- stop bisphosphonate, start teriparatide or denosumab
93
Mastalgia clinical features
- benign cyclical bilateral breast pain and tenderness prior to menses that resolves with menses
94
Retinal detachment clinical features
- floaters
- flashing lights
- occasional vision loss
95
Dry macular degeneration clinical features + fundoscopic features
- gradual vision loss
| - drusen (areas of retinal depigmentation)
96
Wet macular degeneration clinical features + fundoscopic features
- acute vision loss (does have to be entire visual field)
- subretinal fluid and or hemorrhage on funduscopic exam
- fundoscopy often normal
97
Indications for urology referral with BPH and PSA
- PSA greater than 7 (even if underlying BPH)
| - abnormal DRE
98
Management of patient with PSA between 3 and 7
Retest in a few weeks, refer to urology if persistently elevated
99
workup of suspected prosthetic joint infection
arthrocentesis (may happen months out from surgery)
100
Tympanic membrane rupture typical course
- typically resolves completely with oral and topical antibiotics
101
Tympanic membrane rupture clinical features
Pain + purulent otorrhea
102
Clinical features of anticonvulsant hypersensitivity syndrome
- fever, rash, pharyngitis, lymphadenopathy, edema, systemic organ involvement
(form of DRESS)
103
sialolithiasis clinical features
- pain + unilateral swelling of parotid gland + waxing and waning
104
sialolithiasis treatment
- sialogogues (lemon drops) to promote salivary secretion + heat + massage gland
105
Typical cause of involuntary weight loss in the elderly
- difficulties obtaining and preparing food
106
AST to ALT ratio in NAFLD
Typically less than 1
107
Why olanzapine is second line for anorexia
Stimulate weight gain
108
anorexia cuttoff
BMI of *18.5
109
Initial step in workup of suspected Paget disease
Bone scan
110
GCA clinical features
- elderly person with HA + blurry vision + constitutional symptoms + elevated ESR and inflammatory markers
111
Workup of snoring and anything else possibly suggesting OSA in a "mission critical person"
- sleep study
| * mission critical = airline pilot, rail traffic operator, military, etc
112
Erythrasma cause
corynebacterium infection
113
Erythrasma clinical features
- well-demarcated, red-brown, pruritic *plaques in interdigital or intertriginous areas
- can have "cigarette paper" scale
114
Erythrasma diagnosis
red fluorescence under a Wood's lamp
115
Erythrasma treatment
topical antibiotics if isolated, if multiple sites, oral abx
116
Explanation for patient with elevated wedge pressure and elevated PA pressure
- decompensated HFpEF commonly causes secondary pulmonary HTN
