Gen Med Flashcards by Kaylie Goldner

If a patient comes with posterior hip pain along with a positive FABER test, what should you suspect?

SI joint dysfunction

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What is the FABER test? What is the specificity and sensitivity (high/low)?

Flexion
ABduction
External Rotation

Pain with these maneuvers on physical exam in SI joint dysfunction. High specificity but low sensitivity.

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You have a young patient who is a competitive gymnast. She has anterior pain at the groin and a positive FADIR test. What does she have?

Acetabular labrum tear

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What is the FADIR test?

Flexion
ADduction
Internal Rotation

Pain on these maneuvers on physical exam, tends to be positive in acetabular labrum tear and OA hip pain.

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What is better than melatonin for insomnia in the elderly?

CBT

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How long should surgery be delayed in someone who has a TIA/CVA?

delay urgent surgery by 3 months and elective surgery by 6-9 months as the risk is high for recurrence for up to 9-12 months.

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What medication could be helpful for someone with FTD (frontotemporal dementia) and compulsive behavior?

SSRI

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How might you treat someone with vaginal dryness and dyspareunia after menopause?

DON’T GO STRAIGHT TO TOPICAL ESTROGEN. Try vaginal moisturizer first.

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What medical condition is at high risk of occurring with Acitretin and Doxycycline?

IIH (idiopathic intracranial hypertension)

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True or false: A person over the age of 50 should receive the live attenuated zoster vaccination even if he has already had Shingles at age 50?

False: Give them the recombinant zoster vaccine as this is indicated over live attenuated

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What is Drug-induced hypersensitivity syndrome? (DIHS)
–Mild or Severe?
–What is the onset of the reaction?
–Describe the symptoms
–Is mucosal involvement common?

Also known as DRESS in the past.
Severity: severe, life-threatening med reaction
Onset: 2-6 weeks (delayed) after exposure to medicine
Description: fever and flu-like symptoms followed by burning skin pain and rash over the face and upper trunk which spreads distally and ultimately has FACIAL EDEMA and redness, commonly with mucosal involvement.

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What would you diagnose the following patient with? When was their drug exposure?

After starting a new medication, patient has fever and flu-like symptoms followed by burning skin pain and rash over the face and upper trunk which spreads distally and ultimately has FACIAL EDEMA and redness, commonly with mucosal involvement.

Drug-induced hypersensitivity syndrome (DIHS), previously DRESS. 2-6 weeks before symptom onset usually.

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A patient had a new medication 1 week ago, then comes in with purple-pink, dusky macules or plaques over the lips, face, fingers, and genitals.

Fixed drug eruption (Fixed as it is limited to certain areas of the body not all over)

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Patient started a new medication 1-2 weeks ago, then came in with erythematous papules and macules coalescing over the trunk and progressing distally across limbs but sparing the palms and soles. What do they have?

Exanthematous drug eruption

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How do you treat seborrheic dermatitis?

Zinc pyrithione shampoo or selenium sulfide shampoo

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What is STOP-BANG acronym?

Used to assess risk of OSA.
S - Snoring
T - Tiredness
O - Observed apneas
P - high bP
BMI > 35
Age > 50
Neck circumference >40 cm
Gender: Male

High risk is 5 points or more.

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Patient has psoriasis and COPD, started on steroids for an exacerbation, but the comes in a few days later with erythema over >80% of his body. What is this?

Erythroderma

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What SSRI might you add to CBT for binge eating?

Lisdexamfetamine

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What ABI cut offs do you start to worry about compression therapy and when is it contraindicated?

cautious if < 0.9
contraindicated if < 0.5

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What is the noble test?

thumb over lateral femoral condyle with repeated flexion and extension of the knee. If pain this suggests IT band syndrome.

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What test might you use for IT band syndrome testing?

Noble test

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Pain at what location suggests IT band syndrome?

knee pain at the lateral femoral condyle

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What two tests can test for meniscal injury?

McMurray - while patient is supine, lateral (first) then medial (second) rotation of the tibia while grabbing the ankle bringing knee from full flexion to extension, positive if pain is elicited.

Thessaly - patient stands on one leg bent 5 degrees while rotating internally to externally then bend more to 20 degrees , positive if join line pain is elicited

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For which of these tests is the patient standing, and what is it testing? Thessaly or McMurray

Thessaly - tests for meniscal injury

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How do you perform the McMurray test?

while patient is supine, lateral (first) then medial (second) rotation of the tibia while grabbing the ankle bringing knee from full flexion to extension, positive if pain is elicited.

How do you perform the Thessaly test?

patient stands on one leg bent 5 degrees while rotating internally to externally then bend more to 20 degrees , positive if join line pain is elicited

What maneuver elicits pain in patellofemoral syndrome?

Squatting

What therapy is good for PTSD?

First: Sertraline, paroxetine, or venlafaxine. Second line: add prazosin if nightmares

What is an unfortunate urologic side effect of midodrine?

urinary retention

How do you treat neurogenic orthostasis?

decrease antihypertensives then compression therapy with thigh-high hose or lower abdominal binders.

What conditions are associated with neurogenic orthostasis?

Parkinson disease, Lewy body dementia, DM, amyloidosis

What work up/treatment might you consider for chronic cough?

Nasal: flonase, decongestants and cough suppressants, CT sinuses, rhinoscopy. Pulm: sputum test, CT chest, spirometry, prednisone? GI: trial omeprazole, ambulatory pH monitoring if all negative: multimodal speech pathology referral +/- gabapentin

Which of the following should be avoided in cirrhosis/severe alcoholic hepatitis: lorazepam, oxazepam, chlordiazepoxide.

chlordiazepoxide (long half-life)

what are some treatment options for premature ejaculation?

SSRI but may only work for 6 months, may need viagra or topical anesthetic prn

What are the screening recommendations for lung cancer?

LDCT age 50-80 with 20+ pack year history still smoking or quit in the last 15 years or less.

Should this gentleman get LDCT scan? 78 years old with 25 pack year history quit 8 years ago.

Yes. he is between 50 and 80, has greater than 20 pack year history and will need scans for the next 2 years until he hits 80 (risk benefit after that).

Should this patient get LDCT scan? 55 year old woman with 18 pack year history still smoking.

No. age is right but hasn't hit 20 pack year history yet.

Should this patient have LDCT scan? 70 year old who has 30 pack year smoking history but quit 14 years ago.

Yes, would screen until quit 15 years ago.

Should this patient have LDCT scan? 45 years old smoked 1 pack per day since age 15 and still smoking.

No. start at age 50.

What are the BMI recommendations for bariatric surgery?

40 or greater or 35 and greater with comorbidity (FYI: recent study suggested if >10 yr history DM no difference between Bariatric and GLP-1 but Bariatric may be better if <10 years DM)

when is preventative ASA reasonable?

age 40-70, high risk ASCVD, low risk bleeding

young woman with breast mass - do you order the breast ultrasound right away or have her come back in 6 weeks for repeat exam?

do the ultrasound!

A patient has itchy hives that pop up over 24 hours and then when they go away they are hyperpigmented. She also has intermittent fevers and joint pain with this over the last several months. What does she likely have?

Urticarial vasculitis

What dietary modification should be made in someone taking viagra?

don't take near high fat meal as efficacy can be reduced

What skin condition should you check TSH in as it is associated with autoimmune thyroid disease?

Vitiligo

What lab test should be done for a patient with vitiligo?

TSH, vitiligo can be associated with autoimmune thyroiditis.

What are the recommendations for Dexa screening?

Women >65 OR <65 if FRAX or other tool with 10-year major osteoporotic fracture risk >8.4%

what are the normal recommendations of holding and restarting warfarin around surgery?

hold 5 days before, restart 12-24 hours after bridge if high risk for clot

treatment for impetigo

mupirocin

who needs high dose flu shot?

age > 65 OR Immunosuppressed < 65

Patient is taking the following and has just been started on anticoagulation long term for Afib: Turmeric, Biotin, Vitamin E, Fish oil. What should you tell them?

Turmeric, Vitamin E, and fish oil can increase risk of bleeding.

What is the danger of Beta carotene in certain patients?

if smoker or exposed to asbestos, can increase risk risk of lung cancer

what supplement should be stopped 5 days before thyroid test?

Biotin, can make labs look like thyrotoxicosis

what non-tetracycline medication can be used for acne if topicals fail?

Spironolactone

When is Tdap given in pregnancy?

between 27 and 36 weeks

what titers should women be checked for in preconception?

rubella and varicella (can get MMR vaccine 4 weeks before conception)

What is treatment duration for women and men with trichomoniasis?

women - 7 days, retest in 3 months men - 1 dose

What are physical exam findings in epididymitis?

testicular pain relieved with elevation, cremasteric reflex in tact

why does age of patient matter in epididymitis?

younger most likely G/C. if older than 35 more likely enteric bacterial infection and would treat with levofloxacin.

32 year old man comes in with testicular pain which is relieved with scrotal elevation and cremasteric reflex is still in tact. what does he probably have?

epididymitis, test for GC.

if you've tested for GC in epididymitis and its negative, what is the next most likely culprit?

enteric bacteria

What is the difference between photoallergic and phototoxic reactions?

Photoallergic (immune) - type IV hypersensitivity with eczema-like reaction after re-exposure to a substance. Phototoxic (nonimmune) - exaggerated sunburn +/- blistering

Patient has just been started on bactrim 5 days ago, and for the last 2-3 days she has had an itchy rash pop up over her arms. She has had bactrim in the past for a uti and never had any issues. what is going on?

Photoallergic reaction to a sulfonamide. Type 4 hypersensitivity reaction.

Patient starts having a phototoxic reaction. takes the following drugs, which is likely the culprit? Lisinopril, HCTZ, amiodarone, metoprolol, prednisone, bactrim prophylaxis.

Could be HCTZ or amiodarone. Bactrim more likely to cause photoallergic reaction.

Which of the following is eczema-like? Photoallergic or phototoxic?

photoallergic

What are the Modified Centor criteria:

If 3-4 points consider rapid strep testing: The Centor is a nice FELA. F: fever E: exudate L: tender cervical LAD A: absent cough -1 if 45 or older, only 1+ if 14 or younger.

Use the modified Centor criteria to determine if you should test: 46 yo F with tender cervical LAD, fever to 100.5, and exudates with cough.

The Centor is a nice FELA (fever, exudate, LAD, absent cough) 45 or greater -1. 2 or fewer don't test. Age --> -1 fever, LAD, and exudates --> 3 points Cough --> 0 Total --> 2 points = don't test.

What is the treatment for SJS?

Stop the offending agent. Steroids and IVIG not supported by strong evidence.

what are exam findings of episcleritis?

irritation without pain. Tearing. No photophobia or vision changes.

what can episcleritis be associated with?

usually idiopathic, but can be associated with RA, vasculitis, and IBD.

what is the difference between episcleritis and scleritis?

scleritis is much more painful, has photophobia where epi doesn't.

How is scleritis different from uveitis?

uveitis has ciliary flush but both have photophobia and a lot of pain.

Patient presents with mildly itchy rash with thin pink brown plaques in intertriginous areas. Wood lamp exam shows coral red fluorescence. What should you treat it with?

Erythromycin oral or topical. this is Corynebacterium-associated Erythrasma. Fluorescence can be red or pink.

What should you think about in a recurrent same organism UTI in a male?

Chronic prostatitis

What if someone has unilateral tinnitus with SNHL?

This could be acoustic neuroma, consider MRI

What age group can consider prostate cancer screening?

55 - 69

Patient presents wishing to have PSA. He is 72. Yay or nay?

no. stop at 69.

prepatellar bursitis needs fluid aspiration? True or False?

True - rule out infection and gout.

What drug is most effective for smoking cessation?

Varenicline

what happens when you give a transfusion in WAIHA?

all units will look incompatible by crossmatch. The autoantibody in warm autoimmune hemolytic anemia obscures detection of alloantibodies, complicating identification of compatible donors.

What are possible treatments of WAIHA?

steroids, second line would be rituximab and third line splenectomy

Cold agglutinin hemolytic anemia labs:

direct antiglobulin test positive for anti-compliment. (not IgG).

What could be signs of hyperviscosity syndrome?

ataxia, changes in hearing and vision, nystagmus, headache, AMS, mucosal bleeding from plt dysfunction and dysfibrinogenemia.

what risk does adding dextromethorphan to SSRI such as fluoxetine?

serotonin syndrome

what are signs of discontinuation syndrome in SSRIs? which SSRI is notoriously the worst for this?

dizziness, fatigue, headache, nausea. SSRI: paroxetine

treatment options better than trazodone for chronic insomnia?

doxepin, zolpidem

high risk females for breast cancer should start breast MRI at age:

Repeated over head stress leading to pain with abduction and external rotation

Superior Labrum Anterior and Posterior (SLAP) lesions. needs early ortho referral.

what is the LDL goal for people LDL >190

<100

do drugs like ketoconazole and diltiazem increase or decrease the effects of morphine?

increase

what condition has unclear cause but often triggered by infection leading to postexertional malaise with fatigue, unrefreshing sleep, orthostatic intolerance, or cognitive impairment?

Systemic exertion intolerance disease (myalgic encephalomyelitis/chronic fatigue syndrome)

what disease do statins make you more likely to have?

Type 2 diabetes

what might present as posterior knee fullness without pulsatility and swollen distal leg with positive Homan's sign?

Popliteal (baker) cyst with dissection - will want to differentiate from DVT with ultrasound - may require knee arthrocentesis with joint steroids Homan sign: pain of top posterior calf with dorsiflexion of foot (positive in DVT and thrombophlebitis or dissecting cyst)

When are isotonic fluids given first before D5W in hypernatremia?

Marked volume depletion, replete with isotonic until euvolemic then administer free water fluids.

How might your treatment choice for hypercalcemia differ between a case of malignancy-associated hypercalcemia with bone resorption vs sarcoidosis?

IV fluids for both + malignancy: reduce bone resorption with calcitonin and bisphosphonates sarcoidosis: prednisone (prednisone slows production of calcitriol - 1,25 Vit D)

Which drug is most helpful in treating hypercalcemia due to hyperparathyroidism?

Cinacalcet Acts on the calcium sensing receptors of the parathyroid gland to reduce secretion of PTH.