Internal Medicine-General Flashcards
Risk factors for incontinence (MGOS)
M - Menopausal symptoms, and HRT. LMP
G - Gyn history. Previous abdominal or pelvic surgeries
O - Obstetric: how many pregnancies. Route of delivery.
S - Sexual: repeated infections/ dryness / dyspareunia
Diff Dx for Anuria
- Renal stones
- Medications: Glaucoma/antipsychotic/anti-colinergic (incontinence)
3 Neuro: Back problems -> trauma, metastasis, cauda equine/Stroke - Cancer: Prostate, Bladder (exposure to chemicals).
Medications that cause Insomnia
- Selective serotonin reuptake inhibitors (antidepressants such as Prozac® and Zoloft®)
- Dopamine agonists (includes some medications for Parkinson’s disease)
- Psychostimulants and amphetamines
- Anticonvulsants
- Cold medicines and decongestants
- Steroids
- Beta agonists
- Theophylline
- Medications to lower blood pressure (alpha agonists, beta blockers)
- Diuretics
- Appetite suppressants
- Caffeine
- Alcohol
- Niacin
Approach Dysphagia
- Oropharyngeal (difficulty initiating wallowing)
* Neurological*
* Muscular: Myastenia
* Structural: Zenker’s div - Esophageal (inability to move food down esophagus)
Solid foods only (mechanical):
-Progressive:
#Age>50: Carcinoma
#Heartburn: Peptic stricture*
-Intermittent: Lower esophageal ring*
- Solids & liquids (neuromuscular):
-Progressive:
#Reflux symptoms: Scleroderma*
#Achalasia*
-Intermittent: Diffuse esophageal spasm (DES)
6 Ps of ischemia
Pallor Pain Pulseless Paresthesia Paralysis Polar (cold)
Questions to R/O hypothyroidism
- Skin changes
- Abnormally cold/hot
- Constipation
- Weight changes
Back pain
- Sacroiliitis:
* Ankylosis spondylitis:
Risk factors for DDx of back pain
- Renal colic:
- Fluids intake, previous history, family history
Risk factors for DDx of Chest Pain
ACUTE:
- CAD (tightness, irradiated to jaw or arm, older)
- Major: High BP, high blood sugar, high cholesterol, fam hx of heart attack, SAD
- Minor: Obesity; exercise; fast food; stress
- Pericarditis (Young, sharp and stabbing pain relieved! leaning forward):
- Recent flu-like sx; medications (Isoniazide/Rifampicine); Hx of surgery; Hx of heart attack; Hx of kidney disease/puffy face/frothy urine; Hx of TB; Hx of autoimmune disease.
- Pulmonary embolism
- Recent long flight; Hx of malignancy; Family hx of blood clots; Female: pregnancy/OCPs/HRT
- Aortic dissection (tearing ripping pain)
- HTA, atherosclerosis, aneurysm, bicuspid aortic valve, aortic coarctation.
*Tension pneumothorax
- Panic attack
- Stressful events in life, death in family/friends
- Esophageal spasm (dysphagia with solids and liquids)
- Anxiety/depression, HTA, red wine or very hot or cold foods/drinks.
CHRONIC:
- Stable angina
- Same as CAD but in chronic pain
- GERD (heartburn, acidic taste, pain increased leaning forward):
- Stress, meals, smoking, drinking, heavy late meals.
- PUD
- Cancer
- Herpes Zoster
- Trauma
- Lymphoma/Thymoma
Risk factors for DDx of Dysphagia
- GERD (heartburn, acidic taste, pain increased leaning forward):
- Stress, meals, smoking, drinking, heavy late meals, a previous exam with a camera into the stomach?
- PUD
- Previous use of NSAIDs/multiple NSAIDs being taken, previous hx, corticosteroids use, >65yo, smoking/OH
- Carcinoma (>50, const sx):
- Fam hx, smoking (upper third, Squamous cell carcinoma), GERD->Barret (lower third, adenoCa)
- Peptic stricture (progressive! heartburn to solids only):
- Hx of GERD
- Lower esophageal ring (Shatzki, intermittent to solids only):
- Hx of GERD
- Esophageal spasm (intermittent to solids and liquids):
- Hx of GERD, radiation to esophagus
- Scleroderma (progressive, to solids and liquids)
- Skin changes, previous hx
- Achalasia (progressive, to solids and liquids)
- Allgrove sd, herpes, measles, autoimmune disease and HLA type 2.
Risk factors for DDx of CHF
*Compliance
— Are you receiving treatment? Which medications do you take? How much? For how long? Any change in medications? Change in dose?
— Do you take it on regular basis? Any chance that you may skip one or more doses?
— Do you take it by yourself or do you need help?
— Did you get your Digoxin level measured before / recently?
— Did you start new medication? Rx or (OTC) over the counter? e.g. indomethacin
— How about water pills?
— Are you under regular F/U? How often? When was the last time? Were you symptoms free at that time?
*Diet
— Do you have special diet? Salt-free diet? Do you monitor that?
— Any new changes in diet?
— Any chance of salty food, e.g. olives, canned food, dried meet and fish
*Medical
— Do you take medications on regular basis? Any new medication? Advil?
—Thyroid: Any hx of thyroid dx, any sweating/diarrhea?
—Heart: Any hx of heart disease / HTN (-> A Fib) / heart attack / CAD (ischemia) / did you feel your heart bouncing (arrhythmias)? Any congenital or valvular disease / Chest pain / tightness / dizziness / light-headedness / LOC?
—Resp: Any chest / lung disease (wheezes, cough, chest tightness)
—Kidney: Any kidney disease? Renal failure?
—Hemato: Any bleeding? Anemia?
DDx for bilateral ankle swelling
- CHF (99%)
- Lymphedema
- Kidney disease:
- Hx of kidney problems (changes in urine, bruising, frequency, burning, frothy urine, hx of sore throath, hx of DM, skin infection/rash)
- Liver disease
- Hypoalbuminemia
- Thyroid disease
DDx for headaches: What to ask
- Infection:
- Fever
- Neck stiffness
- Constitutional Symptoms
- Subdural hematoma
- Trauma/fall
- Subarachnoid hemorrhage
- Very acute/Very severe headache
- Neurological screening
- Cranial nerves questions
- Change in smelling/vision/hearing?
- Difficulty swallowing?
- Brain
- Dizziness/LOC/light headedness
- Hx of Seizures? Jerky movements?
- Personality and cognition
- UL/LL
- Weakness/numbness
- Difficulty in balance
- Spine
- Problems with urination/bowel movements
- Cranial nerves questions
- Temporal arteritis
- Age >55
- Can you comb your hair?
- Do you feel like a cord-structure?
- Visual disturbances/impairments?
- When chewing, painful?
- Any weaknesses/numbness in your shoulders/hips (PMR)?
- HTN
- Extra-cranial causes: Eyes/Ear/Nose/Teeth pain
- Medications: Coffee/OCPs
Abdominal pain: DDx per quadrant
- RUQ:
- Cholecystitis
- Cholangitis
- Hepatitis
- Right lower lobe pneumonia
- LUQ:
- Pancreatitis
- Splenic infarct
- Peptic Ulcer
- Left lower lobe pneumonia
- RLQ
- Appendicitis
- Bowel obstruction
- Strangulated hernia
- Pyelonephritis
- Nephrolitiasis
- IBD/IBS
- Ectopic pregnancy
- Ovarian torsion
- Ovarian cyst
- Pelvic Inflammatory disease
- LLQ
- All from RLQ +
- Diverticulitis
- Epigastrium
- GERD
- CAD
- Umbilical
- Mesenteric ischemia
- AAA (sharp pain+HTA)
