GENERAL INTERNAL MEDICINE Flashcards
Do patients need =<6 months to live to receive palliative care.
No. Palliative care is speciality care that provides extra support for pts w/severe dx.
*Hospice care is for =<6 months
What is Weber test, Tell me 2 things about Weber test
(1) If sound perceived as being in middle, pt has normal hearing
(2) IF sound lateralizes, there is either:
-Conductive loss: ipsilateral ear
-Senosineural loss: contralateral ear
Tell me 3 things about Rinne test
1) AC > Bone conduction
2) Conductinve loss: Bone conduction GREATER
3) Sensorineural loss: Air conduction GREATER
What Rinne/weber findings would I expect with:
conductive loss in left ear
Conductive loss LEFT ear
-Rinne test: BONE conduction > air conduction
-Weber test: lateralizes to LEFT ear
What Rinne/weber findings would I expect with:
sensorineural loss in left ear
Sensorineural loss LEFT ear
-Rinne test: AIR conduction > bone conduction
-Weber test: lateralizes to RIGHT ear
What drugs when interacting with warfarin INCREASE INR
TMP/SMX most severe
Other interactions include:
1) Amiodarone
2) Androgens
3) Azole antifungals
4) Erythromycin/clarithromycin/AZM
5) Fluoroquinolones
6) Vit E
7) Metronidazole
What is the perioperative strategy for anticoagulation with a patient with a mechanical mitral valve
(1) Stop anticoagulation FIVE days before sugery
(2) IF briding required (ie mechanical valves or 7-8score w/CHA2 DS2 VASc)
-Bridge with LWMH or UFH (if CR clearance <30)
-Start bridging therapy THREE days before surgery
(3) Can resume warfarin 12-24 hrs after surgery
What are 3 eye conditions seen with HIV
1) HIV retinopathy: cotton wool spots
2) CMV retinitis: LOW CD4< 50uL
3) toxoplasmosis: yellow/white lesions
Explain overdose management of :
-opioids
-Salicylates
OPIOIDS
-brady, constricted pupils, low BP
-Tx: naloxone
SALICYLATES
-tachypnea
-mixed acid-base (resp alk +metabolic acidosis)
-tx: deactivted charcoal
ACETAMINOPHEN
-n/v, acute liver failure
-Tx: (1) LESS than 4 hrs –>activated charcoal (2) GREATER than 4 hrs –>N-acetylcysteine (NAC)
What is calculation for NNT
NNT= 1/ARR
ARR= control event rate (placebo) - experimental event rate (tx arm)
*Remeber, ARR must be in decimal form. So 20% must be –>1/0.2
What does sensitivity refer to? Specificity?
SENSITIVITY: ability of test to correct identify person w/dx
SPECIFICITY: ability of test to correctly idenitify person as dx-free.
Sensitivity and specificity used to decr features of clinical test and independent of population
Describe opioid intoxication-sx? what 2 meds are associated with seizures? What med associated with prolonged QT?
THINK Opioid overdose:
-CONSTRICTED pupils
-hypotension, brady, decr bs, obtundation
-Assoc w/seizures: tramadol, meperidine
-Incr QTc: methadone
Pimary open angle glaucoma?
Acute angle-closure glaucoma?
Central retinal artery occlusion?
Occlusion of CENTRAL VEIN
-multiple hemorrages + some pain
-Asian descent: acute angle closure
-Non-Asian descent: primay open angle
Occlusion of CENTRAL ARTERY
-cherry spot
-central retinal artery occlusions
3rd nerve lesion
FIXED DILATED PUPIL
optic nerve lesion
Visual loss
