General Medicine Flashcards
(104 cards)
1
Q
ABI (LE SBP/UE SBP) < 0.9
1.0
> 1.3
A
< 0.9: Diagnostic for PAD
1.0: normal
> 1.3: arteriosclerosis
2
Q
Next step after inconclusive ABI
A
Exercise ABI
3
Q
Management for PVD with intermittent clarification
A
Supervised exercise program
Cilostazol + statin
4
Q
Post gastric bypass surgery
Nystagmus
Ophthalmoplegia
A
Thiamine deficiency
5
Q
Bariatric surgery
Microcytic anemia
Blast cells and ring sideroblasts
A
Copper deficiency
6
Q
Bariatric surgery
Macrocytic anemia
A
B12 deficiency
7
Q
Bariatric surgery
Cardiomyopathy
A
Selenium deficiency
8
Q
Flashes/streaks of light
Black dots, wavy curtains
Cobwebs
A
Retinal detachment
9
Q
Sudden onset of painless vision loss
Cherry red spot in macula
A
Retinal artery occlusion
10
Q
Sudden painless vision loss
Multiple hemorrhages on fundoscopy
A
Retinal vein occlusion
11
Q
Edge of phone or door is blurry
Yellowish spots on fundoscopy
A
Macular degeneration
12
Q
Management for a-v nicking on fundoscopy
A
Anti-hypertensive
13
Q
DM
Mild vision loss
Fundoscopy with Aneurysms, hemorrhages and exudates
Management
A
Dx: non-proliferation or background retinopathy with macular edema
Tx: tighter glycemic control (A1c < 6.5)
14
Q
DM
Blurry vision
Fundoscopy with neovascularization
Management
A
Dx: proliferative DM retinopathy
Tx: Laser therapy
15
Q
Headache. Blurry vision
Mid-dilated pupil. Sluggishly reactive
Ciliary flush. Hazy cornea
A
Glaucoma
16
Q
crystals in retinal artery on fundoscopy
Next diagnostic step
A
Infective endocarditis
Carotid duplex US
17
Q
Difficulty driving at night
Glare from oncoming traffic
Difficulty reading road signs
A
Cataract
18
Q
Layering of WBCs (“white deposits”) in anterior chamber
Intraocular WBCs on slit-lamp
A
Endophthalmitis
19
Q
Conjunctivitis
Thick discharge
A
Bacterial
20
Q
Conjunctivitis
Gritty/sandy or burning eye
A
Viral
21
Q
Conjunctivitis
Watery discharge
Itching
A
Allergic
22
Q
Uveitis
Redness, pain, photophobia, +/- miosis, blurry vision
A
Anterior uveitis
23
Q
Uveitis
Only blurry vision
A
Posterior uveitis
24
Q
Dendritic ulcer (branching pattern) with fluorescein stain positive on corneal exam
A
HSV 1 keratitis
25
Redness in eye on mechanical ventilation Also with contact lenses
Pseudomonas keratitis
26
Increased intraocular pressure
Progressive visual loss due to optic nerve damage
Gradual loss of peripheral vision
Glaucoma
Open-angle: cup to disc ratio > 50%
27
Management for acute glaucoma
Pilocarpine drops
Emergent transfer to ophthalmologist
28
Woods lamp after fluoroscein reveals pattern of parallel lines of vertical abrasion
Foreign body
29
Small nodule under tarsus
Chalazion
| Obstruction of meibomian glands
30
Pustule on lid margin
Hordeolum
| Inflammation of gland of Zeis or moll
31
Vascular structure in conjuntiva
Can spread to cornea and impair vision
Management
Dx: Pterygium
Tx: surgery
32
AIDS
| fundoscopy with cheese, ketchup appearance
CMV retinitis
33
Chronic ear infection
Discharge and mass protruding through the tympanic membrane
Hearing loss
Cholesteatoma
34
Otitis externa + DM
Management
Dx: malignant otitis externa
Tx: systemic antipseudomonal coverage
35
Pre-op management when on anti-TNF meds
Hold meds 2 weeks before surgery and restart 2-4 weeks after
(Would otherwise cause wound dehiscence)
36
Alcohol
Delirious
Normal VS
Alcoholic hallucinations
37
Alcohol
Delusional
Seizure
Tachycardic, hypertensive
Delirium tremors
38
Alcohol
| Confusion, ataxia, nystagmus, Diplopia
Wernicke’s encephalopathy
| Thiamine deficiency
39
Alcohol
| Anterograde and partial retrograde amnesia
Korsakoff’s psychosis
40
Lab that will identify chronic heavy alcohol use
Increased carbohydrate deficient transferrin
41
Alcohol
Leg pain
Weakness of foot and decreased ankle jerk
Alcoholic neuropathy
42
White/gray spots on conjunctiva
Vitamin A deficiency
43
Blurring of disk margin
Elevated liver enzymes
Hypercalcemia
Vitamin A toxicity
44
Tea and toast diet
Bleeding gums
Perifollicular hemorrhages
Normal CoAgs
Vitamin C deficiency (scurvy)
45
TB patient on INH
Neuropathy
MCV low
Pyridoxine/vit B6 deficiency
46
```
Alcohol
Sensory ataxia
Rhomberg +
Dementia, Decreased proprioception
Spasticity, optic neuropathy
Normal pink-prick sensation
```
Subacute degeneration of cord
| Vitamin B12 deficiency
47
Constipstion
Dry mucous membranes
Hypercalcemia
Vitamin D toxicity
48
Dementia
Dermatitis
Diarrhea
Niacin deficiency (Pellagra)
49
Diarrhea
| Transverse vertical white lines on nails
Arsenic poisoning
50
TPN
Alopecia
Hyperkeratotic rash
Anemia, loss of taste
Zinc deficiency
51
Anxiety
Chest pain
SoB
Click on cardiac exam
MVP
| More common with panic disorders
52
Duration of treatment with anti-depressant for 1st episode of depression
4-9 months
53
Appropriate time to switch antidepressants if no response
After 6-8 weeks
54
SSRI
| Cloudy urine
Retrograde ejaculation
55
Indications for electroconvulsive therapy
```
Refractory depression
Psychotic features
Suicidality
Catatonic stupor
Pregnancy
```
56
Treatment for manic depressive bipolar disorder
Lamotrigine
57
Treatment for manic bipolar disorder
Lithium or valproic acid/atypical antipsychotic
58
Side effects of lithium
DI
Hypothyroid
Hypercalcemia
Hand tremors
59
Side effect of clozapine
Agranulocytosis
60
Side effect of olanzapine
Metabolic syndrome
| Increased BG and weight
61
Side effects of typical antipsychotics
```
Acute dystonic reaction (Tx: benadryl/benztropine)
Akathisia
Tardive Dyskinesia
NMS (hyporeflexia)
Prolonged QT interval
```
62
Hyperthermia
AMS, tremor, autonomic instability
Hyperreflexia
Serotonin syndrome
63
```
Hyperthermia
AMS
autonomic dysfunction
Lead pipe rigidity. Rhabdomyolysis
Hyporeflexia
```
Neuroleptic malignant syndrome
64
```
OR
Hyperthermia
HTN, sustained muscle contraction
Difficulty ventilating
Hyporeflexia
```
Malignant hyperthermia
65
Hyperthermia
AMS
Tachycardia
Decreased BMs and urinary retention
Anticholinergic delirium
66
Management for Bulimia
Fluoxetine and psychotherapy
67
```
Increased secretion
Profuse sweating
N/V, sob
Tremors, fasciculations
Miosis, bradycardia
```
Management
Organophosphorous poisoning
Remove clothing
Activated charcoal
Atropine/pralidoxime
68
Management for Metoprolol toxicity refractory to atropine
Glucagon
| Epinephrine gtt
69
Management for urge incontinence
Lifestyle changes
- weight loss
- bladder training
Kegel
Anticholinergics (oxybutynin)
70
Management for Stress incontinence
Weight loss
| -kegel
71
Management for overflow incontinence
```
Urethral obstruction (PSA < 1.8)
-alpha blockers (Terazosin, tamsulosin)
```
```
Prostrate hyperplasia (PSA > 1.8)
-alpha block + 5a reductase inhibitor (finasteride)
```
Detrusor underactivity
DM neuropathy, MS, anticholinergics
-Bethanacol
72
Management for BPH
1) with normal BP and PSA
2) HTN
3) hematuria
1) tamsulosin
2) terazosin
3) finasteride
73
Management for pressure ulcers
Stage 1: skin intact
-static foam or gel mattress
Stage 2: shallow ulcer
-occlusive or semipermeable dressing
Stage 3: visible fat
-debridement + prn Abx
Stage 4: visible bone, tendon, muscle
-debridement + prn Abx
74
Pregnancy screening
- UTI
- OGTT
- GBS
12w
24w
36w
75
Postpartum
| Fever. Chills
```
Postpartum endometreitis
(GBS)
```
76
```
Pregnant
Postexposure ppx
-Hep A
-Hep B
-measles
-varicella
```
- Immunoglobulin
- HBIG
- Immunoglobulin within 1 week
- Varicella immunoglobulin within 10 days
77
Vaccines contraindicated in pregnancy
Live vaccines
- MMR
- varicella
- oral polio
- yellow fever
- HPV
78
PCV 13 administration
1x only
| Immunocompromised
79
PPSV 23 Administration
Give every 5-10 years
80
Mild mitral stenosis and management
1.5 sq cm
| No treatment
81
Moderate mitral stenosis and management
1-1.5 sq cm
| Beta blocker
82
Severe mitral stenosis and management
<1.0 sq cm
| Valvuloplasty
83
Cardiac contraindications to pregnancy
```
pHTN
Eisenmenger syndrome
Marian syndrome w/ dilated aortic root
Dilated CM with CHF
Severe aortic stenosis
```
84
Murmur in ASD
Mid-diastolic (RA >> RV)
| Mid-systolic (RV >> PA)
85
Postpartum
Fatigue, SOB, + JVD
Dilated CM with LVEF 30%
Postpartum cardiomyopathy
| Can occur ins 3rd trimester
86
Pregnant
| +S3, II/VI systolic murmur at apex
Normal volume overload of pregnancy
87
Pregnant
HTN, pedal edema
Thrombocytopenia/coagulopathy
proteinuria ,AKI
Management
DIC due to pre-eclampsia
Deliver baby
88
Etiology of DIC in pregnancy
```
Dead fetus
Abruptly placentae
Amniotic fluid embolism
Acute fatty liver of pregnancy
Pre-eclampsia
```
89
Pre-eclampsia + seizure
Management
Eclampsia
Mg Sulfate
90
Management for postpartum lactating with prolactin > 200
MRI to r/o prolactinoma
Bromocriptine
91
Management for patient on OCP or tamoxifen going for elective surgery
Stop meds 1 month prior
92
2-3rd trimester
Itching
Elevated transaminases and ALP
No vomiting
Management
Intrahepatic cholestasis if pregnancy
Cholestyramine
Ursodeoxylate
Early delivery at sign of fetal distress
93
1st trimester
No itching
Elevated transaminases
Vomiting
Hyperemesis gravidarum
94
2-3rd trimester
Itching
Normal transaminases
No vomiting
Pruritus gravidarum
95
Carinitine or choline deficiency or tetracycline use
Management
AFLP
Delivery of fetus
96
Management for dysfunctional uterine bleeding
Levonorgestrel IUD
97
Dysmenorrhea, dyspareunia
Enlarged ovaries and palpable bands on ligaments
No pelvic motion tenderness
Laparoscopy to r/o endometriosis
98
Postcoital contraception
Levonorgestrel within 72 hours
| Inhibits ovulation and zygote implantation
99
Adverse effects of OCP
HTN, DVT/PE, stroke
Peliosis hepatis, budd-chiari
Elevates theophylline level and causes toxicity (MAT on EKG)
Euthyroid thyroxinemia (total T3 inc but normal TSH)
Mood swings, erythema nodusum, PCT
100
Contraindications to OCP
```
H/o DVT, stroke
Pregnancy, CAD, HTN (>160/100)
Migraines with aura
Breast cancer (currently or < 5 yrs)
Smoker > 35 y/o & > 15 cigg per day (progesterone only)
Chronic hepatitis
```
101
```
Trying to conceive
Infertility treatment
SOB, abd distention/pain
Ascites, enlarged ovaries, Inc number of ovarian follicles
Hemoconcentrated
```
Hyperstimulation syndrome
102
Pelvic pressure
Constipation
Sensation of incomplete evacuation
Rectocele
103
Medicare A
Medicare B
Medicare D
Hospitals/care facilities
Physicians/providers
Prescriptions
104
Fiduciary relationship between physician and patient
Justice
Autonomy
Non-maleficence
Beneficence
