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Shelf Exam Study Materials > AAC/RCC: Gen. IM (IM Ess.) > Flashcards

AAC/RCC: Gen. IM (IM Ess.) Flashcards

1
Q

Orlistat: MOA, use, SE

A

MOA: inhibits pancreatic lipase ==> decreased fat absorption ==> weight loss
used in obese adults who have tried weight loss with only moderate success
should be used in conjunction with a reduced calorie diet. It is moderately effective in weight loss (2.9 kg [6.4 lb] at 12 months)
-gastrointestinal side effects are common
-more serious adverse effects = severe liver injury and malabsorption of fat-soluble vitamins

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2
Q

Buproprion: uses, effects

A
  • antidepressant

- used in patients who want to quit smoking and/or avoid gaining weight

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3
Q

Medication classes that cause weight gain

A
  • steroids
  • psych meds: antipsychotics, lithium, TCAs, some SSRIs
  • anti-diabetic drugs/insulin
  • anti-seizure meds: valproic acid, carbamazepine
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4
Q

Most important recommendation for long-term weight loss

A

reduction of caloric intake by 500-1000 calories/day

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5
Q

Criteria for bariatric intervention

A
  • BMI>35 w/comorbidities

- BMI>40 w/ or w/out comorbidities

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6
Q

B12 deficiency findings

A
  • macrocytic anemia
  • thrombocytopenia
  • mild neutropenia
  • inappropriately low reticulocyte count
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7
Q

Follow-up after Roux-en-Y gastric bypass

A

-twice yearly serum B12, ferritin, folate, vitamin D, and calcium for the first two years, and yearly after that

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8
Q

Risk factors for osteoporotic fx

A
  • old, white lady
  • chronic steroids
  • +/- trauma
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9
Q

Imaging for suspected spinal fx

A

xray

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10
Q

Ankylosing spondylitis presentation

A
  • young ( females
  • progressive/chronic onset
  • morning stiffness
  • not relieved with APAP/NSAIDs
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11
Q

AS workup

A
  • ESR
  • CRP
  • AP xray of pelvis and spine
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12
Q

When to image low back pain?

A
  • suspicion for vertebral fx
  • rapidly progressive neurologic sx
  • evidence of cord compression
  • sx of cauda equina (bowel/bladder incontinence, perianal anesthesia)
  • infection
  • malignancy
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13
Q

Pertussis presentation in adults

A
  • cough >2wks + one of following:
  • posttussive emesis
  • paroxysms of coughing
  • inspiratory whooping
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14
Q

Tx of upper airway cough syndrome

A
  • first gen. antihistamine (e.g. diphenhydramine)

- decongestant (pseudo-ephedrine)

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15
Q

Agents available for smoking cessation

A
  • motivational counseling/support
  • nicotine replacement therapy (gum, patch, nasal spray)
  • buproprion
  • varencicline
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16
Q

Buproprion benefits/contraindications/adverse effects

A
  • Benefits: anti-depressent, decreased weight gain, aids smoking cessation
  • contraindications: w/concomitant SSRI/anti-depressant or other psych condition (==> psych agitation/suicidal ideation), seizure disorder
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17
Q

Assessment of response to anti-depressant therapy

A
  1. Start SSRI & asses baseline PHQ-9 score
  2. F/U @ 2-4 wks to assess response and reevaluate P HQ–9 score
  3. PHQ-9 score decrease by 50% considered partial response
  4. Partial response or no response:
    A. increase dose
    B. if maximal dose, switch agents
    C. if failure of two trials of monotherapy, use dual therapy
  5. If resolution of symptoms continue therapy for 4 to 9 months
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18
Q

Simple counseling approach for drug abuse

A 
5 A's:
Ask
Advise
Assess
Assist
Arrange
Cinician asks patients about their illicit drug use at every visit, advises them to quit, assesses their willingness or readiness to quit at this time, assists them with a quit plan, and arranges for follow-up
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19
Q

Therapies for cocaine related chest pain/MI

A
  1. Nitroglycerin (vasodilation) and aspirin

2. calcium channel blockers and benzodiazepines–help to lower blood pressure heart rate and myocardial oxygen demand

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20
Q

Secondary amenorrhea definition

A

Absence of menses for greater than three months in a women was previously menstruating

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21
Q

Initial laboratory evaluation in secondary amenorrhea

A
  1. pregnancy test
  2. Serum TSH FSH and prolactin plus/minus serum testosterone and DHEA level
  3. if negative, progestin withdrawl test
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22
Q

Agents to decrease heavy menstrual bleeding

A

From most effective to least effective

  1. medroxyprogesterone acetate
  2. once daily oral contraceptives
  3. NSAIDs
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23
Q

indication for tilt table testing

A
  1. Tilt-table testing should be reserved for patients with recurrent episodes of syncope in the absence of known heart disease or in patients with documented heart disease in whom a cardiac cause has been excluded
  2. Tilt-table testing may also have a role in evaluating patients in whom documenting neurocardiogenic syncope is important (such as in high-risk occupational settings) and differentiating the cause of syncope from neurologic (such as seizure) or psychiatric etiologies
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24
Q

Indication for implantable loop recorder

A

An implantable loop recorder is useful in identifying an infrequent arrhythmia when previous, shorter-duration monitoring is not diagnostic.

25
Q

Doxacazin: MOA, common side effect

A
  • alpha-

- orthostatic hypotension

26
Q

??Low albumin + elevated CRP/ESR ==>

A

specific but not sensitive for malignancy

27
Q

Common sx/appearance of cataracts

A

-difficulties w/night vision

28
Q

Age-related macular degeneration (AMD) types

A

wet and dry

29
Q

Dry AMD

A
  • soft drusen (deposits of extracellular material) form in the area of the macula
  • It may be asymptomatic in the early stages and subsequently progress, with the gradual loss of central vision.
30
Q

Wet AMD

A
  • neovascularization of the macula with subsequent bleeding or scar formation
  • Visual loss may be more sudden (over a period of weeks) and is often more severe.
31
Q

Primary open-angle glaucoma (POAG) characteristics

A
  • progressive optic neuropathy associated with increased intraocular pressure without an identifiable blockage of the normal drainage pathways of the aqueous humor
  • common form of glaucoma and is the leading cause of irreversible blindness in the world
  • painless, gradual loss of peripheral vision in both eyes, which may be unnoticed by the patient. It is often asymmetric.
  • In later stages, it may progress to involve central visual acuity.
  • Clinical findings include an increased optic cup to disc ratio (>0.5), disc hemorrhages, and vertical extension of the central cup.
32
Q

Presbyopia characteristics

A
  • age-related change partly caused by reduced elasticity of the lens that results in difficulty seeing at a close range because of the diminished ability of the lens to accommodate
  • Other than decreased visual acuity, the physical examination of the eye is normal.
33
Q

Diphenhydramine in geriatric patients

A
  • avoid!

- anticholinergic ==> confusion, dry mouth, constipation, urinary retention

34
Q

Cauda equina syndrome

A
  • Symptoms of cauda equina syndrome may include saddle anesthesia, urinary retention and sometimes overflow incontinence, and lower extremity weakness
  • potential etiologies: myelopathy, cord compression caused by cancer, infection, and disk herniation.
35
Q

Pt. w/blisters and skin sloughing after course of antibiotics or other new medications ==> dx?

A
  • Steven-Johnson Syndrome vs. Toxic Epidermal Necrolysis
  • SJS = ≤10% of body surface area
  • TEN = least 30% of body surface area
36
Q

Characteristics of SJS/TEN

A
  1. fatigue, malaise, fever, sore throat, or a burning sensation in the eyes 1 to 3 days before skin lesions
  2. Skin: flat, purpuric, targetoid lesions that coalesce into patches, or there may be diffuse, tender erythema without identifiable individual lesions
  3. epidermis blisters and sloughs, leaving behind denuded dermis, and a positive Nikolsky sign (lateral pressure on nonblistered skin leads to denudation)
  4. Skin pain ++
  5. 2+ mucosal surfaces: eyes, nasopharynx, mouth, and genitals, are involved in more than 80% of cases
37
Q

Causes of SJS/TEN

A
  • SJS/TEN is most commonly caused by medications; antiepileptic agents, nonsteroidal anti-inflammatory drugs, antibiotics, pantoprazole, sertraline, tramadol, and allopurinol are the most frequently implicated drugs
  • The reaction most commonly occurs within 4 and 28 days of exposure
38
Q

Staphylococcal scalded skin syndrome characteristics

A
  • most common in children
  • also occurs in adults with underlying immunosuppression or acute kidney injury
  • perioral crusting and fissuring and early involvement of the intertriginous areas
  • Skin detachment and mucosal involvement do not occur.
39
Q

Bullous pemphigoid characteristics

A
  • chronic, vesiculobullous eruption that predominantly involves nonmucosal surfaces
  • associated with several autoimmune diseases
  • antibodies directed to the epidermal basement membrane that lead to development of subepidermal vesicles and blisters
  • blisters are tense and do not rupture easily
40
Q

Complication of ophthalmic zoster infection

A
  • blindness

- opthalmic zoster = medical emergency

41
Q

Miliaria characteristics

A

Miliaria is often referred to as “prickly heat” or “heat rash” and appears as erythematous papules that occur after occlusion of sweat ducts.

42
Q

Common Cause/Tx of folliculitis

A
  • most common cause is Staphylococcus aureus
  • treatment = topical antibiotics such as clindamycin or topical agents such as benzoyl peroxide
  • systemic oral antibiotics such as doxycycline can be used in recalcitrant or recurrent cases
43
Q

Receiver operating curve characteristics

A
  • shows the relationship between sensitivity and specificity
  • ROC curves/plots that have the greatest area under the curve have the best overall accuracy
  • essentially, the line that “crowds” the upper left corner = best (e.g. curve A)
44
Q

Recommendations for pneumonia vaccine

A
  • 65 years or older should receive sequential dual immunization with both the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13)
  • vaccines should be administered sequentially with PCV13 given first, followed by the PPSV23 vaccine 6 to 12 months later
45
Q

Initial screening in new-onset HTN

A

EKG

46
Q

Statin benefit groups

A
  1. Clinical atherosclerotic cardiovascular disease (ASCVD)
  2. LDL-C ≥190 mg/dL
  3. Diabetes and age 40 to 75 years with an LDL-C of 70 to 189 mg/dL and no ASCVD
  4. No ASCVD or DM and estimated 10-year ASCVD risk ≥7.5%
47
Q

Patients who should receive high-intensity statin therapy

A
  1. LDL-C of ≥190 mg/dL if
48
Q

Patients who should receive moderate-intensity statin therapy

A
  1. ASCVD if >75 years of age

2. Diabetes if 40 to 75 years of age with an LDL-C of 70 to 189 mg/dL and 10-year risk

49
Q

High-intensity statin doses/effects on lipids

A 
Atorvastatin (40)–80 mg
Rosuvastatin 20 (40) mg
High-intensity reduces LDL-C on average by approximately ≥50%
50
Q

Moderate-intensity statin doses/effects on lipids

A

Atorvastatin 10 (20) mg
Rosuvastatin (5) 10 mg
Simvastatin 20–40 mg
Moderate-intensity statin therapy lowers LDL-C on average by approximately 30 to ≤50%

51
Q

Indication for fibrates

A

TGs > 500 ==> prevention of pancreatitis

52
Q

Labs before starting statins

A

LFTs/AST & ALT

53
Q

Omeprazole trial needed for cough 2/2 GERD

A

8-12 wks before resolution/investigation of other causes

54
Q

Evaluation of hemoptosis

A

All patients with hemoptysis should have a chest radiograph
**patients at high risk for lung cancer should be referred for chest CT and fiberoptic bronchoscopy even if the chest radiograph is normal

55
Q

Tx of delirium in terminal illness

A

Low-dose antipsychotic agents are effective in the treatment of delirium associated with terminal disease.

56
Q

Dx of small vessel vasculitis

A
  • Cutaneous small-vessel vasculitis, often presenting as palpable purpura on dependent areas, has an unknown cause in upward of 60% of patients.
  • Dx via punch biopsy
  • Treatment is often supportive.
57
Q

Characteristics of porphyria cutanea tardea

A
  • PCT is the most common porphyria. Skin manifestations are varied and include blisters, erosions, hyperpigmentation, and hypertrichosis.
  • associated with Hep C
58
Q

Characteristics of erythema nodosum

A
  • painful, erythematous nodules on the anterior surfaces of both legs that evolve into bruise-like lesions that resolve in several weeks
  • hypersensitivity immune reaction that may be secondary to drugs, infection, systemic inflammation or idiopathic
  • self-limited and supportive tx
59
Q

Characteristics of Sebborheic keratosis

A

Seborrheic keratoses are benign waxy to verrucous papules ranging in color from flesh colored to yellow or tan, and they may be irregularly pigmented.

Shelf Exam Study Materials (18 decks)

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