General Internal Medicine Flashcards
Diagnostic physical exam finding for sacroiliac joint dysfunction
Pain with hip flexion, abduction, external rotation (FABER)
Most appropriate treatment for smoking cessation in hospitalized patients with ACS
Varenicline or combination nicotine replacement therapy
Vertigo that is suggested with abnormal result on any one of the three HINTS (Head Impulse, Nystagmus, and Test of Skew)
Central vertigo
Most common adverse effects of second generation antipsychotic agents
Weight gain and Hyperlipidemia
Pain with flexion and extension of knee while examiner’s thumb lies over the lateral femoral condyle
Iliotibial band syndrome
First line therapy for premenstrual dysphoric disorder
Second generation anti-depressant (i.e. SSRI)
Positive Likelihood ratio
2
5
10
Sensitivity/(1-specificity)
Increases probability of disease
15%
30%
45%
Negative Likelihood ratio
- 5
- 2
- 1
(1-sensitivity)/Specificity
Decrease the probability of disease
15%
30%
45%
Absolute risk
Patients with event in group / total patients in group
Relative risk
The ratio of the probability of developing a disease with a risk factor present to the probability of developing the disease without the risk factor present
Contraindication for nicotine
Recent MI, arrhythmia, unstable angina
Contraindication for bupropion
Seizure disorder and eating disorder
Contraindication to naltrexone
Patients receiving Or withdrawing from any opioid and in those with liver failure or hepatitis
Contraindication to acamprosate
Kidney disease
Adverse effect of disulfiram
Flushing, headache, emesis
Major risk factors for opioid overdose
1) receiving more than 50 morphine mg Eq/day
2)  Receiving opioids and benzodiazepines concurrently
Most effective long-term treatment for patellofemoral pain syndrome
Physical therapy
Unexplained fatigue lasting > 6 consecutive months that impairs the ability to perform desired activities, post exertional malaise, unrefreshing sleep, and either cognitive impairment or orthostatic intolerance (symptoms wors in upright position)
Systemic exertion intolerance disease
Appropriate management for chronic insomnia refractory to cognitive behavioral therapy for insomnia or who declined to participate in CPT – I.
Low-dose doxepin or non-benzodiazepine benzodiazepine receptor agonist (i.e. zolpidem, zaleplon, eszopiclone)
Primary treatment for chronic venous insufficiency
Compression therapy
Order of management In patients with chronic cough and negative findings on chest radiography after discontinuation of ACE therapy and tobacco
1) empiric treatment for upper airway cough syndrome
2) spirometry or empiric treatment for asthma
3) Sputum analysis for eosinophils or empiric treatment with inhaled glucocorticoids
4) Empiric treatment for GERD
deep anterolateral shoulder pain That worsens with abduction and external rotation. Pain is also often caused by repetitive overhead stress
Superior labrum anterior and posterior lesion
Vertigo with Vertical, horizontal, or torsional nystagmus
Central disease
Primary treatment for benign paroxysmal positional vertigo
Epley maneuver
First line therapy for insomnia
CBT
Positive Spurling test
Cervical radiculopathy
Pain occurs between 60 and 120° during passive abduction of the arm
Rotator cuff tendinopathy
First line therapy for urge incontinence
Bladder training with timed voiding
Red flags of cauda equina syndrome
1) Urinary retention or incontinence
2) Diminished perineal sensation
3) Bilateral motor deficits
Radiating back pain and lower of extremity numbness that is exacerbated by walking and spinal extension but improved by sitting and leading forward. A wide base gait and/or abnormal Romberg tests are highly specific
Spinal stenosis
Most common cause of knee pain and patience <45 years, especially women
Patellofemoral pain syndrome
Knee pain that is worse with activity and at night
Anserine bursitis
Indications for ankle x-ray following ankle trauma
1) inability to bear weight
2) Bone pain localized to the lateral or medial malleolus, base of a 5th metatarsal, navicular bone
Indications for carpal tunnel release surgery
1) severe carpal tunnel syndrome (Muscle weakness or EMG evidence of nerve injury)
ACC/AHA indications for Recommending Statin therapy to reduce risk of ASCVD
1) clinical ASCVD
2) LDL > 190
3) DM aged 40-75 years w/ LDL 70-189 + no clinical ASCVD
4) without clinical ASCVD or DM and LDL 70-189 + 10-year ASCVD > 7.5%
Initial management for gout in patients of Asian dissent
Genetic testing for the HLA-B *58:01 haplotype
Sudden onset, severe, persistent vertigo and hearing loss following viral inflammation
Management
Labyrinthitis
Prednisone
First line treatment for genitourinary syndrome of menopause
Daily vaginal moisturizer and vaginal lubricants
First line therapy for lower urinary tract symptoms secondary to BPH
Tamsulosin
Topical broad-spectrum antibiotic for bacterial conjunctivitis in patients who wear contact lenses
Ofloxacin
Tender prostate + positive urine culture
Empiric antibiotic coverage
Acute prostatitis
Bactrim or fluoroquinolone for 4 to 6 weeks
USPSTF recommended breast cancer screening
Biennial screening mammography Beginning at age 50 years for average risk women
USPSTF recommended cervical cancer screening
Every 3 years with cytology (pap test) for women aged 21 to 65 years
Can increase to every 5 years in women aged 30 to 65 years by either performing high-risk HPV testing or combining cytology and high-risk HPV testing
USPSTF recommended lung cancer screening
Annual low-dose CT chest for persons aged 50 to 80 years with at least a 20 pack year smoking history who are still smoking or who quit within the past 15 years
Dystrophic nails with yellow- red (oil stain) discoloration, pitting, and distal onycholysis. Commonly affecting the fingernails more than toenails
Nail psoriasis
Management for primary dysmenorrhea
Supportive care
 First line therapy for endometriosis
NSAIDs
Thin white discharge with fishy odor but without irritation or pain
Bacterial vaginosis
External and internal erythema with itching and irritation. Non-odorous white caurd-like to charge
Candidiasis
Frothy, yellow discharge. Erythema of the vagina and cervix “strawberry cervix”
Trichomoniasis
T cell mediated disease classically presenting with pruritic purple papules that are often flat topped and characteristically erupt on the low back, volar wrists, elbows, knees, ankles
Lichen planus
Urticarial lesions that last >24 hours that burn and sting rather than itch; wheals that resolve with hyperpigmentation; and associated symptoms, such as fever and joint pain
Urticaria vasculitis
Painless vision loss, unilateral flashing lights, floaters, visual field defect
Retinal detachment
Afferent pupillary defect and cherry red fovea that is accentuated by a pale retinal background
Central retinal artery occlusion
Facial nerve paralysis, sensorineural hearing loss, and vesicular lesion on and in the ear canal; often caused by a varicella zoster virus infection
Ramsay hunt syndrome
Appropriate preoperative warfarin management
Withhold 5 days prior to surgery. Restart 12 hours after surgery
Management nonbullous impetigo
Topical mupirocin or retapamulin
Hyperpigmentation disorder that occurs mostly on the sun exposed areas on the face. Most commonly affects women of childbearing age
Melasma
First therapy for stress incontinence
Pelvic floor muscle training for women (kegel exercises)
First line therapy for overflow incontinence
Time urination
Appropriate time of delay for elective surgery after a prior stroke
6 to 9 months
Appropriate empiric antibiotic treatment for acute bacterial prostatitis
Oral Bactrim or an oral fluoroquinolone
Appropriate diagnostic evaluation for a androgen deficiency
2 separate early morning (8 am) serum total testosterone levels < 300 combined with suggestive symptoms and/or signs
