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GIM Flashcards

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0
Q

Absolute risk reduction (ARR) =

A

EER - CER (experimental group event rate - control)

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1
Q

Absolute risk (AR) = event rate =

A

Pts w event in group/total # of pts in group

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2
Q

Number needed to treat (NNT) =

A

1/ARR

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3
Q

Relative risk reduction (RRR) =

A

EER/CER

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4
Q

Chronic cough -r/o

A

Smoking, ACEI, do a CXR

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5
Q

Chr cough - not smoker, not on ACEI, CXR-N

DDx

A
  1. Upper airway cough sy (previous post-nasal drip)
  2. GERD
  3. Asthma
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6
Q

Chr cough - not smoker, not on ACEI, CXR-N

Tx

A

In order:

  1. Antihistamine (1st gen) +decongestant
  2. Nasal steroid
  3. Tx for asthma (in young)
  4. Tx for GERD (in old)
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7
Q

Signs of upper airway cough sy (post-nasal drip)

A
  1. Throat clearing
  2. Cobble stoning at the back of the throat
  3. Tongue coated at 1/3 of the back
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8
Q

SAH - preferred investigation

A
  • first 48 hrs: Plain head CT

- after: MRI

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9
Q

Clinical presentation of SAH

A

Sudden onset unprovoked Headache w neck stiffness & n/v

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10
Q

Prodromal signs and syx in SAH

A

Syx: headache, dizziness, orbital pain, diplopia, visual loss

Signs: sensory or motor disturbance, seizure, ptosis, bruit, dysphagia

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11
Q

Prodromal signs/syx in SAH are 2ry to:

A
  1. Sentinel leaks - warning bleeds 30-50%! - sudden onset of h/a w neck pain, age>40
  2. Mass effect of aneurysm expansion
  3. Emboli
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12
Q

Headache most typical DDx in young vs old

A

Young: some form of migraine
Old: SAH, GCA, met to the brain, SDH if on Warfarin until proven otherwise

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13
Q

Migraine clinical presentation

A 
Family Hx 96%
Pulsating, worse w activity
Causes gastroparesis: n/v
Mild to severe, can be disabling
Hx of motion sickness
\+/- photo- and phonofobia
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14
Q

Migraine adjunctive Tx

A

Metoclopride taken it causes gastroparesis (all therapies are more effective)

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15
Q

Migraine trigeminal variant

A

Recurrent sinus h/a, involving the trigeminal nerve distribution, BILATERALLY!

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16
Q

Idiopathic acute neuro sensory hearing loss (N structural exam)
Tx

A 
Prednisone po x10d
Otological referral
?Mg
No benefits from acyclovir
If no response, intra-tympanic steroids
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17
Q

PVD useful physical signs

A

Absent pulses -spec 90%, LR+9-44
Femoral bruit -spec 95%, LR+5

Less helpful: cool skin, cap refill time

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18
Q

Triggers of RLS

A

Fe-deficiency
?VitD deficiency
Metoclopramide, antihistamines, neuroleptics

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19
Q

Multiple sensory deficits

A

Vague unsteadiness only w walking

Tactile input helps balancing

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20
Q

Dizziness DDx

A
  1. Vertigo
  2. Syncope/pre-syncope
  3. Disequilibrium
  4. Ill-defined lightheadedness (panic d/o, anxiety w hyperventilation
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21
Q

Acute viral labyrinthitis

  • clinical presentation &
  • Tx
A

Vertigo, movement makes it worse, but than lasts for minutes (vs BPPV)
Tx: methylprednisone 100mg x3d, then taper over 22d (NEJM)

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22
Q

Vertigo w brainstem infarct

A

Vertical nystagmus - central cause!
Non-fatiguable
Older pt w atherosclerosis
+ other brainstem or cerebellar symptoms (dysarthria, dysmetria, diplopia, motor sy)

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23
Q

Vertigo DDx

A

BPPV
vestib neuronitis
Ménière’s disease (tinnitus, hearing loss, ear fullness, vertigo)
Central cause (15%)

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24
Skin manifestations of sarcoid
Hutchinson plaque: granulomatous skin plaques on neck/thorax Lupus pernio: purplish plaque resembling frostbite on ears/cheeks/nose Erythema nodosum (Lofgren) Macular or papular sarcoidosis (most common in black ppl) Annular sarcoid, scar&tattoo infiltration
25
Sarcoid clinical presentation
Lymphopenia, hyperCa, low gr fever, wt loss
26
Highest spec of this finding in sarcoid
Bilateral hylar lymphadenopathy
27
Sarcoid most common in this population
``` Northern Europe (Sweden) US: black population ```
28
Lofgren sy
Self-limiting | Fever, bilat hilar lymphadenopathy, erythema nodosum, arthritis/arthralgia
29
Clinical significance of lupus pernio
Lung and bone involvement more common | Usually more severe clinical picture
30
Treatment indications for sarcoid
Symptomatic; if hyperCa, skin d, iritis/uveitis, arthritis, pulmonary sy, cardiac/CNS involvement (steroids, MTX, cyclosporine)
31
Obstructive PFTs
decreased FEV1, N or incr FVC, incr TLC | DLCO: asthma - N, COPD - decr
32
Restrictive PFTs
Decr FEV1, FVC, TLC, DLCO
33
Postprandial abdo pain DDx
GERD, SBO, mensenteric ischaemia, chilecystitis, pancreatitis, IBS
34
Chr mesenteric ischaemia clinical presentation
Post-prandial abdo pain, wt loss, decr appetite, diarrhea - FOB positive, malabsorption, evidence of PVD/CAD
35
Mesenteric ischemia - small bowel vs colitis
SB: wt loss, abdo pain, diarrhea Colitis: bloody diarrhea, not painful, positive c-scope, thumbprinting in Ba-studies
36
Acute mesenteric ischemia
Severe abdo pain, out-of proportion, nausea/vomiting, diarrhea, incr WBC, lactic acidosis RFs: MI/CHF/arrhythmia (A.fib)
37
Thyroid hormones binding to
Fe, antacids, Ca, cholestyramine, sucralfate
38
Thyroid hormone absorption
Absorbs better at night, PPI and H2 blocker interferes w absorption
39
PPI interferes w
Ca, Fe, ketokonazole, itraconazole absorption
40
PPI is risk for
C. Diff and it's recurrence | Hip#
41
Osteoporosis is ass w following meds
Steroids, long-term heparin (LMWH too), thiazolisendions, SSRIs, PPIs, loop diuretics
42
Warfarin most severe interactions
``` TMP/Sulfa Erythromycin Amiodarone Propafenone Metronidazole Itraconazole/ketokonazole/fluconazole ```
43
Warfarin possible interactions
Quinolones Omeprazole Clarythromycin Azithromycin
44
ABx ok w Warfarin
Penicillins Cephalosporins Nitrofurantoin
45
Tylenol and Warfarin
Regular Tylenol >2 g/d effects INR at 2-5 days
46
Prednisone and warfarin
Prednisone effects INR at D6
47
Simvastatin + gemfibrozil?
Avoid b/o rhabdo | Rather statin + fenofibrate
48
Clarithro + macrolide:
Clarithro: CYP3A4 inhibitor
49
CCB + simvastatin
Diltiazem and Verapamil raises simvastatin levels
50
Simvastatin and lovastatin
Similar metabolism
51
Increased risk for statin toxicity
Fibrates, azoles, amiodarone, erythro/clarithro, protease inhibitors, verapamil/diltiazem
52
Muscle toxicity of statins: | Fluvastatin, pravastatin, atorvastatin, simvastatin
Fluvastatin
53
The least muscle-toxic statin
Fluvastatin
54
The most muscle toxic statin
Simvastatin
55
Myalgias & statins
Dose & drug dependent Correct hypothyroidism! More in: Asians & small body mass
56
Bx w statin myopathy
Positive even if CK normal, but they are in myalgia | Muscles are damaged in asymptomatic pts
57
Approach to myalgia if on statin
- check CK and TSH - if severe, stop statin, restart at a lower dose, or - change to another statin or use only on alternate days - if sy persist, stop statin, use zee timing, colesevelam, red yeast rice (active ingredient: lovastatin)
58
TMP/Sulfa and MTX interaction
Septra displaces MTX from plasma protein binding and competes w it's renal elimination => incr MTX levels (and toxicity)
59
Penicillins and MTX
Penicillins compete w MTX renal elimination
60
Grapefruit juice (naringin) metabolic activity
CYP3A4 inhibitor
61
Grapefruit juice drug interactions
CCB (nifedipine was the first described food-drug interaction) Statins (simva, lova) Cyclosporine BZD Saquinavir (anti-HIV proteinase inhibitor)
62
Simvastatin
``` Warfarin Amiodarone Fibrates Clarithro Azoles ```
63
HyperK 2ry to these drugs
``` ACEI/ARB K-sparing diuretics TMP-Sulfa NSAIDS Salt substitute (Kcl!) ```
64
No Septra for pts on:
Warfarin MTX Sulfa-allergy Elderly, renal insuff
65
Topiramate mechanism and side effect
Carbonic anhydrase inhibitor, causing NAGMA
66
Bisphosphonates and MSK pain
5-20% on weekly doses
67
SSRIs side effects
UGIB (more so if on NSAIDS, make sure pt on PPI) HypoNa Sexual dysfunction (20-40%, delayed ejaculation/orgasm)
68
Drugs provoking CHF
NSAIDS Pioglitazone, rosiglitazone Kayexalate Dihydropyridinee

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