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General internal medicine 3 Flashcards

1
Q

Management of acute otitis media

A
  • amoxicillin
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2
Q

Management of acute otitis media that doesn’t improve within 48-72 hours

A

Broaden to amoxicillin-clavulanate (to cover h influenza)

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3
Q

Management of unresolved chronic otitis media with effusion

A

Myringotomy with tympanostomy tube placement

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4
Q

Management of lumbosacral radiculopathy

A
  • light exercise, maintain light-normal activity
  • NSAID
    IF no improvement –> MRI
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5
Q

Presentation of lumbosacral radiculopathy + physical exam

A
  • back and shooting leg pain
  • numbness and or weakness in legs
  • pain reproduced with straight leg raise
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6
Q

Algorithm for acute low back pain

A

Red flags?
IF yes – MRI
IF no – light activity + NSAIDS

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7
Q

Red flags in acute low back pain

A
  • urinary retention
  • saddle anesthesia
  • motor weakness
  • bilateral neurological symptoms
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8
Q

Definition of osteopenia

A

T-score of -1 to -2.5

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9
Q

Definition of osteoporosis

A

T-score of -2.5 or less OR hx of **fragility fracture

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10
Q

Definition of fragility fracture

A
  • fracture resulting from a fall from standing height or less
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11
Q

What s the FRAX risk assessment tool used for

A

Risk assessment tool for patients over age 50 who have osteopenia to determine need for treatment

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12
Q

What is acute cervicitis? Presentation

A
  • inflammation of the cervix (comparable to urethritis in men) typically due to STI (gonorrhea, chlamydia, trichomonas)
  • friable cervix + purulent discharge
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13
Q

Management of cervicitis

A

1) NAAT for chlamydia and gonorrhea
2) Empiric CTX + doxy (cover both chlamydia and gonorrhea)
3) wet mount for trichomonas and BV

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14
Q

Vaginal discharge features in BV

A
  • thin, malodorous vaginal discharge
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15
Q

wet mount in trichomoniasis

A

typically shows motile organisms

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16
Q

Differential for vaginal discharge

A

1) gonorrhea, chlamydia
2) trichomonas
3) BV
* *foreign object, latex, douching
* verify not forgetting anything

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17
Q

Exam findings indicating PID?

A

Patient has cervical motion, uterine, or adnexal tenderness on pelvic exam

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18
Q

Presentation of struvite stones/staghorn calculi

A
  • *signs/symptoms of nephrolithiasis (hematuria, right flank pain, dysuria) + recurrent UTIs (stones continue to seed infections)
  • also very alkaline urine + reduced GFR
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19
Q

Cause of struvite stones

A

Urease-producing bacteria (proteus, klebsiella) (conversion of urea to ammonia raises urine pH and stones precipitate)

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20
Q

First line therapy of stag horn calculi

A
  • abx for UTI + Percutaneous nephrolithotomy, often with lithotripsy
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21
Q

Management of HIV therapy during pregnancy + management of delivery + breastfeeding

A
  • Start ART ASAP (decreases risk of neonatal transmission)
  • delivery = IF viral load is below 1,000, women can deliver vaginally without intrapartum zidovudine
  • IF viral load greater than 1,000 – AZT intrapartum + cesarean delivery
  • don’t breastfeed if living in US (formula is readily available in US)
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22
Q

Initial evaluation for BPH

A
  • Review meds for meds that can cause retention

- Exam for prostate nodules or masses

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23
Q

Initial lab workup of BPH

A

UA + PSA + creatinine

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24
Q

Initial treatment of BPH

A

IF mild symptoms – behavioral modification (decrease less caffeine and alcohol, double voiding, drink fluids earlier in the day)
IF moderate to severe symptoms – alpha blockers or 5-alpha-reductase inhibitors

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25
Q

Management of non healing pressure ulcers

A

IF signs of infection –> debridement + topical abx (assuming no signs of systemic infection, then need systemic abx and debridement)
IF signs of cellulitis (erythema, warmth, swelling) –> systemic abx for cellulitis

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26
Q

Signs of infection in ulcers

A

erythema
purulent drainage
tenderness
*grayish slough (necrotic tissue)

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27
Q

Management of non healing ulcer that is refractory to topical antibiotics

A
  • tissue biopsy for culture

- consider MRI to exclude osteo

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28
Q

Opioid course for moderate postop pain after discharge

A

3 days

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29
Q

Management of statin myopathy (in addition to checking TSH)

A
  • stop statin, restate statin with lower myopathic potential (rosuvastatin, pravastatin, fluvastatin)
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30
Q

Other features of PAD

A
  • lower-extremity claudication (not just in calves, can also be hips or thighs or feet or buttocks)
  • slow wound healing
  • pain increased with walking and relieved with rest
  • pain with walking uphill
  • thigh or leg or hip weakness
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31
Q

Preferred medication for migraines during pregnancy

A

Acetaminophen

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32
Q

Options for migraine treatment in pregnant patient not responding to APAP

A
  • NSAIDS (only in 2nd trimester, associated with fetal toxicity during 1st and 3rd trimesters)
  • opioids (third line)
  • antiemetics
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33
Q

First line and second line pain management for vertebral compression fractures

A
  • NSAIDS, APAP, opioids

Second line: intranasal calcitonin

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34
Q

First line abx for cat bites and abx if penicillin allergy

A

First line: augmentin

IF penicillin allergy: doxycycline/metronidazole

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35
Q

Presentation of hearing loss inelderly

A
  • often social isolation
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36
Q

Proctitis clinical features

A
  • tenesmus (constant urge to defecate) + purulent discharge + small volume stools containing blood
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37
Q

most common causative organism in proctitis

A

gonorrheoeae

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38
Q

workup of proctitis

A
  • culture discharge and test for HSV and PCR for chlamydia

- RPR and HIV

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39
Q

Knee pain following parathyroidectomy

A
  • can precipitate a pseudogout attack (due to abrupt drop in serum calcium levels, which triggers shedding of calcium pyrophosphate crystals into the synovial fluid)
40
Q

joints affected by pseudogout

A
  • knee (most common), wrists and ankles

- can affect multiple joints concurrently

41
Q

Workup of dysmenorrhea

A
  • just pelvic exam (no need for US or any other workup)
42
Q

Treatment of dysmenorrhea

A

NSAIDS and/or combination OCPs
IF persistent pain after 3 months of NSAIDS and or OCPS – pelvic US to rule out secondary causes of pain (fibroids, uterine abnormalities)

43
Q

Workup of patient with refractory dysmenorrhea and normal US

A

Diagnostic laparoscopy (rule out endometriosis)

44
Q

Rhinitis medicamentosa clinical features

A
  • chronic overuse of vasoconstrictor nasal sprays that leads to worsening nasal congestion and discharge due to tachyphylaxis with rebound vasodilation and rhinorrhea
45
Q

Treatment of rhinitis medicamentosa

A
  • stop decongestant

- trial intranasal steroids (flonase)

46
Q

advice to give patients for reducing risk of recurrent nephrolithiasis

A
  • increase fluid intake
  • increase dietary (not supplemental) calcium (high dietary calcium binds oxalate in the GI tract thereby decreasing absorption of oxalate and excretion into urine)
  • increase fruit and vegetable intake
  • decrease sodium and protein intake
  • increase citrate (binds urinary calcium)
47
Q

Preoperative management of tamoxifen

A
  • discontinue 2-4 weeks prior to any surgery associated with moderate or high risk of VTE (elevated VTE risk)
48
Q

Management of neuralgia paresthetica

A
  • reassurance and conservative treatmentment (avoid tight garments, weight loss)
49
Q

Management of caregiver distress

A
  • support services (respite care, support groups)
50
Q

First and second line treatment of fibromyalgia

A

1) regular cardiovascular exercise + sleep hygiene

2) TCA + SNRI

51
Q

postprandial hypotension clinical features

A
  • lightheadedness + orthostasis within 2 hours of eating

- common in elderly

52
Q

management of postprandial hypotension

A
  • decreased portion sizes, increased salt and water intake, low carb meals, avoid alcohol
53
Q

Management of corrosive ingestion (eg bleach)

A
  • EGD (grade severity of injury)
54
Q

Initial management + subsequent management of dry macular degeneration

A

Initial: smoking cessation + daily antioxidant vitamins and zinc
Subsequent: VEGF inhibitor

55
Q

Clinical features of dry acute macular degeneration

A
  • gradual vision loss

- difficulty with reading and driving at night

56
Q

Clinical features of wet acute macular degeneration

A
  • acute vision loss
  • *metamorphosis (distortion of straight lines)
  • fluid or hemorrhage on funduscopy
57
Q

General indications for PRBC transfusion

A

1) Hgb less than 7

2) Symptomatic + hgb less than 10

58
Q

Osteoporosis screening age

A

IF no RF’s – 65

*IF 1 or more RF’s for osteoporosis – earlier

59
Q

Osteoporosis RF’s

A 
RA
smoking, drinking
low body weight
sedentary lifestyle
chronic liver or renal disease
60
Q

Management of classic heat stroke

A
  • evaporative cooling
  • IV fluid boluses
  • IF younger – ice water immersion (higher mortality in elderly patients)
61
Q

Initial evaluation of avascular necrosis

A
  • MRI (more sensitive than plain film)
62
Q

Avascular necrosis of hip presentation

A
  • groin pain on weight bearing + limited internal rotation and range of motion
63
Q

Plain film of avascular necrosis of hip

A

“crescent sign”

64
Q

Clinical features + exam features patellofemoral syndrome (PFPS)

A
  • knee pain worse with squatting, moving up or down (walking up stairs)
  • tenderness on direct compression of the patella during knee extension
65
Q

What designates a patient as increased risk for CRC on basis of family history?

A
  • first-degree relative at age less than 60
66
Q

How often do patients at elevated risk of CRC need c-scopes?

A
  • every 5 years
67
Q

acceptable alternatives to c-scope

A
  • CT colongraphy q 5 years
  • FIT-DNA testing q 3 years
  • Flex sig q 10 years
68
Q

First step in evaluation of suspected Marfan syndrome

A
  • TTE (rule out aortic root disease)
69
Q

Marfan syndrome clinical features

A
  • skeletal abnormalities + lens dislocation + CV system abnormalities + long slender fingers (arachnodactyly)
70
Q

Klinefelter syndrome clinical features

A

-gynecomastia + infertility + cryptorchidism +

71
Q

Initial step in evaluation of suspected klinefelter syndrome

A

karyotype (47,XXY karyotype)

72
Q

Management of chronic fatigue syndrome

A
  • CBT

- graded exercise therapy

73
Q

Next step after diagnosis of adrenal incidentaloma

A

Test for hypersecretion

74
Q

Management of patient on chronic NSAID

A

IF moderate or high risk for GI bleed – switch to selective COX-2 inhibitor OR add PPI

75
Q

First line treatment of corneal abrasion

A

Topical antibiotic ointment

76
Q

Initial workup of HTN

A
  • TSH (both hyperthyroidism and hypothyroidism can raise blood pressure)
  • UA
  • A1c
  • lipids
  • BMP, CBC
  • EKG
77
Q

psychosocial factor associated with increased mortality in the elderly

A

loneliness

78
Q

Turner syndrome features

A
  • CV abnormalities (bicuspid aortic valve, coarctation of the aorta, aortic root dilatation)
  • skeletal abnormalities (short stature, webbed neck, scoliosis)
  • retinal hemorrhages on fundoycopic exam
79
Q

Description of aortic coarctation murmur

A
  • continuous murmur in anterior chest (due to flow through large collateral vessels)
80
Q

Clinical features of aortic coarctation

A
  • (headache and epistaxis)
  • HTN
  • differences in BP between upper and lower extremities
  • diminished and or delayed femoral pulses
81
Q

Treatment of aortic coarctation

A
  • surgical repair
82
Q

Term for hair loss of pregnancy

A
  • telogen effluvium
83
Q

Other triggers for telogen effluvium

A
  • severe weight loss, major illness or surgery, psychiatric trauma
84
Q

Terms for impairment of near vision and distance vision

A

presbyopia = near vision loss

myopic shit = distance vision loss

85
Q

Presentation of early cataract formation

A

difficulty with distance vision + asymmetric

86
Q

What is hirsutism?

A
  • terminal, dark hair growth in androgen-dependent areas (chin, upper abdomen, chest back, upper lip)
87
Q

Management of hirsutism

A
  • serum total testosterone level to rule out underlying androgen disorders
88
Q

Optic neuritis clinical features + imaging features

A
  • acute monocular vision loss + *central scotoma (black spot in center of vision)
  • periventricular white matter lesions
89
Q

Treatment of optic neuritis

A

IV methylprednisolone

90
Q

Diagnosis of acute intermittent porphyria

A
  • urinary porphobilinogen (PBG) *during an acute attack
91
Q

perioperative management of patient who has previously been on steroids

A
  • treat with stress-dose steroids perioperatively (HPA axis suppression from steroids takes a while to resolve – up to 6-12 months after discontinuation)
  • especially if cushingoid appearance
92
Q

Preeclampsia timing

A

20 weeks to *6 weeks postpartum

93
Q

Utility of urine chloride in metabolic alkalosis

A

Low in vomiting, high in diuretic use or abnormal renal sodium handling (Gitelmans and Bartters)

94
Q

Clinical features of plugged milk ducts

A
  • painful, tender, palpable masses + no signs of infection in breastfeeding woman
95
Q

Galactocele clinical features

A

large, subareolar milk-retaining cyst due to a blocked milk duct

96
Q

clinical features of lactational mastitis

A

localized breast pain without a focal mass + infectious symptoms (complication of engorgement and plugged milk ducts)

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