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General internal medicine 2 Flashcards

1
Q

To do before starting statin

A

Check alanine aminotransferase level

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2
Q

Physical exam suggesting epididymitis

A

Positive Prehn sign (relief of pain with scrotal elevation)

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3
Q

First and second line for chronic low back pain

A

1st line = nonpharmacologic treatment (acupuncture, CBT, exercise, yoga)
*even if radicular symptoms present
*tylenol is not effective for back pain
2nd line = NSAIDs in lowest effective dose

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4
Q

Management of in-flight emergency

A
  • Connect to ground-based physician (not flight diversion)
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5
Q

Treatment of premature ejaculation

A

Combination of SSRI + phosphodiesterase-5 inhibitor
- other options = topical anesthetic/lidocaine (reduces tactile stimulation and prolongs time to ejaculation), clomipramine

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6
Q

Treatment of menopausal symptoms

A

COMBINED estrogen + progesterone (unopposed estrogen exposure would increase risk for endometrial hyperplasia and malignancy so can only give estrogen alone if woman had hysterectomy and would be preferred)

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7
Q

Other criteria for treating vasomotor symptoms of menopause

A

Must be younger than 60 and within 10 years of menopause onset

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8
Q

Duration of postoperative pharmacologic VTE prophylaxis for major orthopedic surgeries (hip and knee)

A

35 days (assuming not increased bleeding risk + no preoperative bleeding) (thrombotic risk continues for quite a while)

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9
Q

Mattress type that is best evidenced for pressure ulcer prevention

A

Advanced static mattress

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10
Q

Treatment of epididymitis

A
  • younger = CTX + doxy (need to treat for both chlamydia and gonorrhea)
  • older AND those who have anal sex = CTX + quinolone (e coli, pseudomonas more common thus treatment)
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11
Q

Supportive care for epididymitis

A

Scrotal support, ice, NSAIDs

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12
Q

Other clinical features that are not present with strep throat

A

conjunctivitis, nasal congestion, rhinorrhea

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13
Q

Number of Centor criteria that warrant workup

A

3 or more

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14
Q

Centor criteria

A
  • Fever by history
  • Tonsillar exudates
  • Tender anterior cervical LAD
  • Absence of cough
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15
Q

Treatment of bacterial conjunctivitis

A

Trimethoprim-polymyxin B ophthalmic drops

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16
Q

Other clinical feature of bacterial conjunctivitis

A

Thin mucopurulent discharge

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17
Q

MMR vaccination for adults

A
  • all adults undocumented adults need at least one dose
  • healthcare workers, international travelers, postsecondary students need a second dose at least 28 days after the first dose
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18
Q

People who need hep A vaccine

A
  • travelers to endemic area
  • men who have sex with men
  • chronic liver disease
  • HIV
  • IVDU
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19
Q

Patients who require perioperative bridging

A

AF w/ mechanical valves

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20
Q

Next step in evaluation of tinnitus + hearing loss

A

MRI (rule out acoustic neuroma)

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21
Q

Caveat about FOBT for CRC

A

Requires dietary restriction to reduce false-positive results

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22
Q

Management of impaired physician colleague

A

Directly approach him or her

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23
Q

Management of LDL greater than 190

A

High-intensity statin

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24
Q

AAA screening indication

A

65 to 75 ever smokers

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25
Q

Definition of ever smoker

A

More than 100 cigarettes in their lifetime

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26
Q

Med to discontinue in patients following bariatric surgery

A

NSAIDS (increased internal bleeding risk)

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27
Q

Treatment of cancer related pain (lytic lesions) in CKD

A

Hydromorphone

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28
Q

Caveat about fentanyl patches

A

Can only be used in opioid-tolerant patients not opioid naive

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29
Q

Caveats about tramadol

A
  • don’t use for cancer pain (poor analgesic)
  • don’t use in CKD (accumulation of active metabolites)
  • has potential for significant drug interactions
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30
Q

weber test + interpretation

A
  • tuning fork placed on top of the head
  • if defective ear hears tuning fork louder, the finding indicates a conductive hearing loss in the defective ear (localizes to affected ear)
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31
Q

Rinne test interpretation

A

IF conductive hearing loss present – patient is not able to hear the tuning fork after it is moved from mastoid to pinna (bone conduction better than air conduction)
IF sensorineural hearing loss - patient will hear tuning fork by air conduction after they can no longer hear it through bone conduction (Air conduction better than bone conduction)

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32
Q

Congenital adrenal hyperplasia

A

group of autosomal recessive disorders characterized by impaired cortisol synthesis.[1][2] It results from the deficiency of one of the five enzymes required for the synthesis of cortisol in the adrenal cortex.[3] Most of these disorders involve excessive or deficient production of hormones

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33
Q

17 alpha hydroxylase deficiency clinical features

A

Mike in the driveway and driveway is covered in colorful tacs/17. He has a thong on and has no dick/xy: pseudohermaphroditism (ambiguous genitalia, undescended testes due to decreased sex hormones). Abby’s naked and completely flat chested/xx: females are born with normal genitalia, but lack secondary sexual development (OPPOSITE of 11-beta-hydroxylase). He has a BP cuff around his neck/hypertension. Garage is filled to the ceiling with small bananas/hypokalemia. He’s ramming a baseball bat up his vagina/primary ammenorhea. She/he’s completely bald and flat chested/lack of secondary sexual development, including breast buds or pubic hair.

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34
Q

21-hydroxylase deficiency presentation

A

Abby wrapped up in a net/21. She’s super hairy and has really bad acne and a huge clit/with delayed presentation (non-classic form) females present with xx virilization (so 46,xx karyotype but virilized) leads to enlarged clitoris/ambigouous genitalia (patient may have a scrotal sac and enlarged phallus and normal-sized ovaries) and partially fused labioscrotal folds. Baby next to her with a huge clit/In severe form, female infants present at birth with ambigous genitalia. Huge baby on left wall with thick pubes and armhair on top of a salt mound + three dicks (precocious puberty code/In classic, non-salt-wasting form, affected male infants present at ages 2-4 with early virilization + increased linear growth + salt-wasting or precocious puberty. She has a metal pole for an IV bag next to her and she’s sitting on top of a small salt mound/hypotension. Ceiling is covered in colorful tacs/without functioning 21-hydroxylase, precursor molecule 17-hydroxyprogesteron accumulates. Huge banana alongside the wall + group of higschool runners running around the room/21-hydroxylase deficiency results in the inability to synthesize aldosterone, resulting in salt wasting (causing hypotension), leading to hyponatremia and hyperkalemia.

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35
Q

NMS clinical features

A
  • fevers + rigidity + autonomic dysfunction
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36
Q

NMS vs serotonin syndrome

A
  • NMS = lead pipe rigidity

- Serotonin syndrome = clonus + hyperreflexia

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37
Q

Criteria for diagnosis of depression

A 
5 of 7 of below over a 2 week period:
- sleep (too much or too little)
- Depressed mood or loss of interest
- Guilt or worthlessness
- decreased Concentration
- Psychomotor Agitation or slowing
ALSO:
- weight changes
- recurrent thoughts of death or suicide
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38
Q

adjustment disorder vs depression

A

Adjustment disorder = clear precipitant + doesn’t meet 5 out of 9 criteria

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39
Q

Paroxetine SE to know

A

pregnancy category D

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40
Q

Mirtazepine SE’s to know

A
  • sedation

- weight gain

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41
Q

Duration of SSRI treatment

A

1st episode = 6-12 weeks
2nd episode = 2x interval from previous episode
3 episodes or suicide attempt = lifelong

42
Q

First line meds for obesity treatment after failed lifestyle modifications

A
  • Orlistat

- lorcaserin

43
Q

Bupropion contraindications

A
  • uncontrolled HTN
  • epilepsy
  • opiate use
44
Q

lorcaserin contraindications

A
  • caution with multiple serotonin active meds (serotonin agonist)
45
Q

phentermine, topiramate for weight loss contraindications

A
  • pregnancy, MAOI’s, hyperthyroid
46
Q

bariatric surgery indications

A
  • BMI over 40

- BMI over 35 with comorbidities

47
Q

Gastric banding SE’s

A
  • nausea, vomiting
  • ulcers
  • obstruction
48
Q

Sleeve gastrectomy SE’s

A
  • stenosis

- bleeding

49
Q

Gastric bypass SE’s

A
  • stenosis
  • cholelithiasis
  • dumping syndrome
  • SIBO
  • micronutrient deficiencies
50
Q

Presentation of biceps tendinopathy

A
  • pain in anterior shoulder + radiation distally over biceps muscle
51
Q

Biceps tendinopathy initial treatment

A
  • conservative measures, then NSAIDS
52
Q

Glenohumeral OA presentation

A
  • hx of chronic wear and tear or trauma + anterior or deep shoulder pain
53
Q

Lung cancer screening indication

A

50 to 80 years old + at least 20 pack-year smoking history + either current smokers or have quit within the past 15 years)

54
Q

Treatment of genitourinary syndrome of menopause

A

Initial therapy with moisturizers and lubricants

IF persistent symptoms –> vaginal estrogen

55
Q

Treatment of PCOS – infertility and amenorrhea treatment

A
  • First line = weight loss
  • If infertility –> weight loss (which can restore ovulation), second line: letrozole or clomiphene?
  • IF amenorrhea Or hirsutism –> OCP’s –> (suppressing pituitary LH secretion and decreasing ovarian androgen production)
56
Q

Other treatment for oligomenorrhea in PCOS

A

clomiphene

57
Q

Ophtho presentation of ankylosing spondylitis

A

His eyes are blood red + intensely scarred of lights/eye feature = anterior uveitis, presenting with pain + blurred vision + photophobia + conjunctival erythema.

58
Q

Cardiac complications of Ankylosing spondylitis

A

Big red aorta above him + big wide golden ring stuck in it + Ben glennon pushing his wheelchair/cardio complication = ascending aortitis, leading to dilation of the aortic ring + aortic insufficency + aortic regurgitation.

59
Q

Lumbar spinal stenosis clinical features

A
  • neurogenic claudication (pain worse when walking, standing and relieved with sitting or lying). Often symptomatic only when active.
  • also sensory loss, weakness in legs
60
Q

Trichomonas presentation

A

Picture a green mona + smelling terribly + itching herself + on fire/presentation = yellow-green discharge + foul smelling + itching and burning.

61
Q

Trichomonas treatment

A

Metro running around perimeter of yard/treat both partners with metronidazole.

62
Q

Visceral leishmaniasis presentation

A

Anna with leash around her neck. She’s sweating profusely + riding a hippo + has a huge pan on top of her head/presentation = spiking fevers + hepatosplenomegaly + pancytopenia.

63
Q

Treatment of leishmaniasis

A

Will Ferrell is in his old school car + huge bottle of pepsi with candy spilling out stuck into back/treat with amphotericin B or sodium sibogluconate.

64
Q

Indication for testosterone replacement therapy

A
  • clinically significant androgen deficiency (low libido, ED, loss of body hair, gynecomastia, testicular atrophy AND unequivocally low morning T (less than 200 typically) that is REPEATED
65
Q

Contraindications to testosterone replacement therapy

A
  • breast or prostate cancer
  • polycythemia
  • severe lower UTI symptoms
  • untreated OSA
66
Q

Prostatitis treatment

A 
Acute = Bactrim or fluoroquinolone
Chronic = fluorquinolones
67
Q

Chronic prostatitis clinical features

A
  • Persistent or recurrent LUTS

- Prostatic tenderness

68
Q

Antibiotic treatment duration for chronic prostatitis

A

4-6 weeks

69
Q

Diagnosis of IgG4 related disorders

A

biopsy showing IgG4-positie plasma cells

70
Q

Treatment of IgG4-related disease

A

steroids or other immunomodulators

71
Q

Other clinical features of IgG4-related disease

A
  • pancreatitis
  • sclerosis cholangitis
  • bilateral salivary and or lacrimal gland enlargement
72
Q

epididymitis clinical features

A
  • acute scrotal pain (POSTERIOR aspect of scrotum)
  • exquisite testicular tenderness
  • intact cremasteric reflex
  • may or may not have urinary symptoms
73
Q

epididymitis treatment

A
  • testicular elevation + NSAIDS + antibiotics
74
Q

clinical features of CVID

A
  • recurrent infections (rhino sinusitis, pneumonia, conjunctivitis)
  • chronic lung disease
  • often comorbid autoimmune disorders and GI disorders
  • granulomatous disease in lymphoid or solid organs
  • increased risk of malignancy
  • poor response to vaccinations
75
Q

lab features of CVID

A
  • extremely low IgG

- low IgA and or IgM

76
Q

treatment and monitoring of CVID

A
  • IVIG
  • age appropriate cancer screening
  • monitoring for lymphoma
77
Q

Wegener’s clinical features

A
  • pulmonary + renal disease + oronasal ulcers + persistent rhinorrhea
78
Q

Myeloperoxidase deficiency clinical features

A
  • recurrent candida infections
79
Q

primary ciliary dyskinesia clinical features

A

nasal polyposis + otitis + recurrent respiratory infections + situs inverses + infertility

80
Q

Clinical features of varicocele

A
  • soft scrotal mass that decreases in supine position and increases with standing
  • subfertility (increased scrotal temperature)
  • testicular atrophy
81
Q

varicocele management

A
  • scrotal support and NSAIDS

IF young with testicular atrophy – gonadal vein ligation

82
Q

Management of patient with anaphylaxis from hymenoptera sting

A
  • refer to immunology for immunotherapy (venom immunotherapy reduces risk of recurrent anaphylaxis)
  • epi pen
83
Q

Management of refractory scrotal pain

A

scrotal US (epididymitis, testicular torsion are frequently misdiagnosed clinically)

84
Q

risk factors for osteoporosis in men

A
  • *androgen deprivation therapy (can decrease bone mineral density within 6-9 months of starting drug)
  • chronic steroids
  • low-trauma fractures
  • hyperthyroidism
  • smoking, drinking
85
Q

first and second line of carpal tunnel

A

First step = nocturnal wrist splinting unless motor weakness or atrophy of thenar eminence or axonal injury then surgery
Refractory = steroid joint injections

86
Q

Management of hirsutism refractory to OCPs in PCOS

A

spironolactone (only after 6 months of OCPs)

87
Q

Hereditary hemorrhagic telangiectasia clinical features

A
  • spontaneous epistaxis + mucocutaneous telangiectasia + GI bleeding + AVM’s
88
Q

Tuberous sclerosis clinical features

A
  • hypo pigmented macules (ash leaf spots)
  • angiofibromas on face
  • seizures
  • shagreen patches in lower trunk
  • brown fibrous plaque on the face
89
Q

Peutz-Jeghers presentation

A
  • GI polyps

- flat blue-gray-to-brown spots resembling freckles on lis, perioral region, hands, feet, buccal mucosa

90
Q

management of urge incontinence

A
  • behavioral therapy (pelvic muscle exercises, bladder training, smoking cessation, weight loss, dietary changes)
  • voiding diary
91
Q

Second line for urge incontinence

A

Antimuscarinics (anticholinergics), beta-3 agonists

92
Q

Presentation of stress urinary incontinence

A
  • Leakage of urine with Valsalva (Coughing, sneezing)
  • Positive cough stress test
  • due to decreased urethral sphincter tone and urethral hypermobility
93
Q

presentation of urge incontinence

A
  • overwhelming urge to urinate
94
Q

cause + presentation of overflow incontinence

A
  • incomplete emptying and persistent involuntary dribbling

* due to impaired detrusor contractility and bladder outlet obstruction

95
Q

BPH vs urge incontinence

A
  • BPH causes obstructive voiding symptoms (decreased stream, nocturia)
  • urge incontinence is caused by detrusor hyperactivity leading to involuntary urine leakage + sudden urge to void
  • urge incontinence can happen in BPH patients
96
Q

Management of neuropsychological symptoms in alzheimers (agitation, aggression, paranoia, hallucinations)

A

behavioral and environmental therapy (structured routines, music therapy, etc)

97
Q

Orlistat SE’s

A
  • fat malabsorption (flatus, fecal incontinence, abdominal distention)
  • calcium oxalate stones (fat malabsorption can increase intestinal calcium binding, leading to decreased available calcium to bind oxalate)
98
Q

Orlistat mechanism

A

inhibits pancreatic lipase to alter fat digestion and decrease fat absorption

99
Q

Management of fat malabsorption SE’s from orlistat

A

low fat diet

*patient should also be on daily MVI

100
Q

Main SE’s of GLP-1 agonists

A
  • nausea
  • acute pancreatitis
  • AKI

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