GIM

Question 1

When should you start statin based on LDL number?

Answer 1

> 20yo with LDL >190

high-intensity statin

Question 2

How long to continue lovenox after orthopedic surgery?

Answer 2

• 35 days if no increased bleeding risk

- 10-14 days if increased bleeding risk (minimum)

Question 3

Tx of bacterial conjunctivitis

Answer 3

• none, will go away in 2 weeks
• if treating – topical trimethoprim–polymyxin B or erythromycin
• if uses contacts can use topical fluoroquinolone, but otherwise not first line

Question 4

Tx and duration of acute bacterial prostatitis after urologic procedure

Answer 4

bactrim or cipro

6 weeks –> use bactrim b/c cipro can prolong QT

Question 5

Drug of choice for enuresis

Answer 5

impiramine (TCA)

Question 6

How long to continue SSRI for 1st episode of depression?

Answer 6

4-9 months

Question 7

SSRI and Bupropion (DNRI) should be avoided in which condition?

Answer 7

anorexia

Bupropion should also be avoided in bullemia b/c decreases seizure threshold, whereas SSRIs are used to treat bullemia.

Question 8

Patient on SSRI and with cloudy urine

Answer 8

retrograde ejaculation

Question 9

Meds that can increase blood glucose

Answer 9

olanzapine
statins
betablockers (Except carvedilol)
HCTZ
niacin 
PI (HIV managment)
steroids

Question 10

Treatment of acute dystonic reaction (as SE Of typical antipsychotics)

Answer 10

diphenhydramine/benztropine

Question 11

Serotonin Syndrome

• describe vitals/presentations
• key meds
• treatment

Answer 11

• hyperthermia, change MS, tremor, autonomic instability (high HR, low BP), N/V/D, HYPERreflexia
• SSRI, linezolid, tramadol
• Tx - benzos +/- cyproheptadine (H1B)

Question 12

Describe NMS (neurolopetic malignant syndrome) and its treatment

Answer 12

• hyperthermia, change MS, autonomic dysfunction (high BP, high HR), LEAD PIPE RIGIDITY with rhabdomyolysis and HYPOreflexia.
• Tx: Dantroline or bromocriptine

Question 13

Describe malignant hyperthermia and treatment

Answer 13

• hyperthermia, sustained muscle contraction (high HR high BP), HYPOreflexia, history of inhalation anesthetics
• Tx: RAPID COOLING +/- dantrolene

Question 14

Treatment of CCB overdose?

Answer 14

IVF, atpropine and slow IV CALCIUM CHLORIDE to counteract peripheral vasodilitory effects of CCV

Question 15

Organophosphate poisoning

• presentation
• what to measure to confirm?
• treatment

Answer 15

• wet - increase secretions (ie. salivation), sweating, N/V, shortness of breath, tremors, fasiculations, pupils CONSTRICTED, low HR
• RBC acetylcholinesterase level
• TX;
  1. remove contaminated clothes
  2. activated charcoal (if <4hr)
  3. IV atroprine**
  4. IV pralidoxime** (after atropine if needed)

Question 16

Treatment of non-displaced vs. displaced femur fracture

Answer 16

1. nondisplaced – surgery + 3 parallel pins
2. displaced – total hip arthroplasty (femur + ball + socket) … not hemiarthroplasty
3. inter-trocaneteric fractgure –> hip compression screws

Question 17

What can you use to treat bone pain from compression fracture? (after tylenol, nsaids)

Answer 17

Calcitonin (helps with bone pain 2/2 osteoporosis)

Question 18

Hallmarks of Optic Neuritis

Answer 18

acute vision loss, eye pain with movement, color perception change, and afferent pupillary defect; results of a funduscopic examination may be normal.

Question 19

Which immune globulins should you give to a pregnant woman that was expososed?

Answer 19

Hep A, Hep B, Measles, Varicella

Question 20

At what area is surgical treatment indicated for MS? what time of surgery

Answer 20

<1.0 sq. cm

Valvuloplasty (opening valve) - even in pregnancy if symptoms severe

Question 21

Pt with ASD wants to get pregnant when can she get pregnant vs needing to undergo surgery first?

Answer 21

If ASD shunt is..
<2:1 == can get pregnant
>2:1 == surgery first

Question 22

Cardiac contraindications to pregnancy?

Answer 22

pulmonary HTN
Eisenmenger syndrome
Marfans with dilated aortic root
Dilated cardiomyopathy with CHF
Severe AoS

Question 23

What heart sounds are normal during pregnancy?

Answer 23

S3
II/VI systolic murmur at apex

functional 2/2 normal volume overload in pregnancy

Question 24

What heart sounds do you hear with ASD?

Answer 24

1 - FIXED SPLIT 2nd heart sound (S2) *** 2/2 increased volume in right heart at all times
2 - mid diastolic rumble @ LLSB 2/2 large blood volume from RA –> RV
3 - mid systolic ruble @ LSB 2/2 large blood volume RV –> pulm valve
4. Partial or full RBBB from ASD (LA–>RA)

Question 25

Difference between AFLP vs HELLP?

Answer 25

in AFLP you have increased PT, ammonia, and direct bilirubin

Question 26

When to stop OCP prior to surgery?

Answer 26

1 month prior 2/2 increase renin substrate which can cause HTN

Question 27

When to stop anti-TNF meds prior to major surgery? When to restart?

Answer 27

2 weeks prior to surgery, resume 2-4 weeks after surgery, otherwise risk for wound dehiscence

Question 28

What is the name of plan B? Has to be used within ___ post coitus. Whats MOA?

Answer 28

Levonorgestrel within 72hrs of sex inhibits ovulation and implantation of zygote

Question 29

Complications of OCP

Answer 29

- HTN 2/2 increased renin substrate - Theophylline level inc and toxicity --> MAT - Euthyroid thyroxenemia (inc total T3 and T4 but nl TSH) - Hepatic adenoma (peliosis hepatis)-- if ruptures --> pain > shock > CT abd > surgery - Erythema Nodosum - PCT (porphoria cutanea tarda) - PE/DVT/CVA - budd chiari (hepatic v. thrombus) - abd pain, acites, pedal edema

Question 30

Difference in smoking cessation treatment in person with quit date vs. no quit date

Answer 30

1. Quit date = f/u 2 weeks post quit date > start 2 forms of NRT (gum/patch/inhaler) >> if fail then start wellbutrin or chantix 2. No quit date = start wellbutrin or chantix right away

Question 31

Unilateral R sided varicocele -- thoughts?

Answer 31

- uncommon and may be associated with a significant underlying abnormality .... - IVC obstruction due to tumor or thrombosis because the right gonadal vein directly empties into the inferior vena cava. - Experts recommend advanced imaging with CT for patients with right-sided varicoceles.

Question 32

Describe presentation of SCLERITIS

Answer 32

- severe eye pain that radiates to the periorbital region - watery discharge - Pain may occur with eye movement (inflammation of the extraocular muscles) - Sclera appears violaceous with notable edema - severe local tenderness can be elicited by exerting pressure on the overlying closed eyelid. - In approximately half of scleritis cases, an associated systemic rheumatic or inflammatory disorder is present.

Question 33

When to stop Warfarin vs. NOACs before surgery? when to resume?

Answer 33

Warfarin - 5 days -- 12 - 24 hr (pending bleeding risk and need for bridging) NOAC s - 2-3 days -- 48-72 hr

Question 34

How to treat patient with BPH and erectile dysfunction?

Answer 34

tadalafil (a phosphodiesterase-5 inhibitor) has been shown to be effective and is the only FDA-approved option to treat both conditions.

Question 35

What is cyclic mastalgia? treatment?

Answer 35

- severe breast pain (+/- lumps) around menstrual cycle - Tx - conservative measures (ie. well fitting bra) and if still pain can use Danazol (FDA approved) but limited by androgenic side effects

Question 36

When to screen for AAA?

Answer 36

All men aged 65 to 75 years who have ever smoked should undergo one-time abdominal ultrasonography to screen for abdominal aortic aneurysm.

Question 37

How to diagnose bacterial vaginosis

Answer 37

3 of the following 4 features - vaginal pH > 4.5 - thin and homogenous vaginal discharge - positive whiff test result - clue cells comprising at least 20% of all squamous cells on saline microscopy

Question 38

How do you treat cancer related pain in a patient with CKD or ESKD?

Answer 38

Hydromorphone (dilaudid) - opioid naiive Fentanyl patch -- opioid tolerant

Question 39

How do diagnose SEID? (systemic exertion intolerance disease)

Answer 39

Fatigue x 6 months + - substantial reduction in preillness activities - postexertional malaise - unrefreshing sleep - either cognitive impairment or orthostatic intolerance.

Question 40

Schizophrenia

Answer 40

At least TWO of following (1 month): - delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms Plus ONE area of functional impairment (6 months) - occupation, social interactions, or self-care Typical age of onset is early adulthood.