General Internal Medicine Flashcards
(Vitamin deficiency) Hair loss, brittle hair
Biotin, protein, B12, Folate
Screening recommendations for osteoporosis
DEXA for all women >65 y/o (q3-5 yrs)
OR
Women <65 if 1 or more risk factors
- Steroids
- low body weight
- current smoking
- alcohol use
- prior fragility fracture
- family hx of hip fracture
(Vitamin deficiency) Coiled, corkscrew hair
Vit A and Vit C
(Vitamin deficiency) Skin desquamation
riboflavin
(Vitamin deficiency) Petechiae, perifollicular hemorrhage
Vitamin C
(Vitamin deficiency) Ecchymosis
Vitamin C and K
(Vitamin deficiency) Skin pigmentation, cracking, crusting
Niacin
(Vitamin deficiency) Acro-orificial dermatitis (erythematous, vesiculobullous, pustular)
Zinc
(Vitamin deficiency) Angular stomatitis, cheilosis
Vit B complex, iron, protein
(Vitamin deficiency) Glossitis
Niacin, folate, B12
(Vitamin deficiency) Ophthalmoplegia, foot drop
Thiamine
(Vitamin deficiency) Paresthesia
Thiamine, B12, biotin
(Vitamin deficiency) Depressed vibratory and position senses, Memory disturbance
B12
(Vitamin deficiency) Wernicke-Korsakoff syndrome
Severe thiamine deficiency
Five A’s of smoking cessation
- Ask about tobacco use
- Advise to quit
- Assess readiness to quit
- Assist in quitting
- Arrange for follow up
Five R’s of smoking cessation
- Relevance of quitting smoking to their lives
- Risks of smoking
- Rewards of smoking
- Roadblocks to quitting
- Repeat motivational intervention at all visits
USPSTF recommendations on cholesterol screening
Every 5 years for men >35 and women >45 who are at increased cardiovascular risk
USPSTF recommendation on Pap smear screening
Every 3 years from 21 to 65 y/o
If combo of Pap + HPV testing, can be every 5 years for women >30 y/o
USPSTF recommendation on mammogram
Every 1-2 years after age 50 y/o
Pressure ulcer staging
- Stage I: Nonblanchable redness (skin intact)
- Stage II: Shallow ulcer with red/pink wound bed or serum-filled blister –> occlusive or semiperm dressing
- Stage III: Subcutaneous fat visible –> correct nutritional deficiencies, debridement, topical or systemic abx
- Stage IV: Exposed bone, tendon, or muscle –> same tx as Stage III
Availability heuristic
Clinician has encountered similar presentation and jumps to the conclusion that the current diagnosis must be the same as the previous
Anchoring heuristic
Clinician accepts at face value a prior diagnosis made by another clinicians
Blind obedience heuristic
Acceptance of a dx or plan made by another of higher authority
Premature closure heuristic
Full differential diagnosis is not considered
USPSTF guidelines for frequency of HTN screening
Every 2 years
(Vitamin deficiency) Myelopathy localizing to posterior columns and bilateral corticospinal tracts
Copper deficiency
Copper deficiency, which can be caused by zinc toxicity, nutritional deficiency, or malabsorption syndrome, can result in a myelopathy localizing to the posterior columns and bilateral corticospinal tracts.
USPSTF recommendations for aspirin for primary prevention
Aspirin in men ages 45-79 years for primary prevention of cardiovascular disease and in women ages 55-79 years for primary prevention of stroke if the bleeding risks do not outweigh benefit.
Vitamin deficiency that causes night blindness
Vitamin A
Manifestations of thiamine deficiency
- Wet beriberi - heart failure, ascites, peripheral edema
- Dry beriberi (CNS) - peripheral neuropathy, Wernicke-Korsakoff syndrome
Riboflavin (Vit B2 deficiency)
- Normochromic, normocytic anemia
- Hyperemic throat, cheilosis, angular stomatitis
- Seborrheic dermatitis (perianal area)
- Associated w/TCAs and phenothiazines
Vitamin deficiency associated with glossitis, cheilosis, vomiting, seizures
Vitamin B6 (pyridoxine)
Associated with drugs (INH, cycloserine, penicillamine), chronic alcoholism, general malabsorption syndromes
B12 deficiency
- Macrocytic anemia
- Smooth tongue
- Decreased vibration and proprioception
- Decreased reaction to pinprick (stocking/glove)
Niacin deficiency
Pellagra
- “3 D’s” - Dermatitis on sun-exposed surfaces, dementia, diarrhea
- Stomatitis
- Proctitis
- Mental status changes (depression to dementia)
Vitamin C deficiency
Scurvy
- Petechial hemorrhages and ecchymoses
- Hyperkeratotic papules around hair follicles
- Sjogren’s
- Hemorrhage into muscles, joints, purpura, and splinter hemorrhages
Vitamin E deficiency
- Areflexia
- Decreased vibration/position sense
Non-hormonal therapy for hot flushes
Venlafaxine
Meniere’s disease
a.k.a. idiopathic endolymphatic hydrops = Vertigo, unilateral low frequency hearing loss, and tinnitus
Hawkins test
Shoulder impingement syndrome
Apley scratch test
Rotator cuff tendinitis
Finkelstein test
De Quervain tenosynovitis
Audible or palpable snap on McMurray test
Meniscal damage
Lachman test
ACL injury
