General Internal Medicine Flashcards
Tumor marker CA 19-9 is associated with which cancer?
Pancreatic cancer.
What cancer is associated with tumor marker CA 125?
Ovarian cancer.
What cancer is associated with HPV 16 and HPV 18?
Cervical cancer.
What trimester in pregnancy is ideal for air travel?
Second trimester.
What level is increased on bloodwork in a patient with folate deficiency?
Mean corpuscular volume (MCV).
What is the minimum timeframe that a patient must live in a tropical country before developing tropical sprue?
1 month.
What are 5 major medications that can cause folate deficiency?
Phenytoin, Trimethoprim, Metformin, Methotrexate and Sulfasalazine
Which vitamin is most likely to be deficient in a patient with celiac disease: B1, B2, C, or D?
Vitamin D.
In addition to fat-soluable vitamins, what else is not absorbed in patients with celiac disease?
Folic acid, Iron, Vitamin B12.
Positive antibodies to tissue transglutaminase suggests what diagnosis?
Celiac disease.
What type of antidepressant is imipramine?
Tricyclic antidepressant.
What is the first-line agent for major depression?
The first-line agent for major depression is a selective serotonin reuptake inhibitor (SSRI).
True or False: One of the most common side effects of selective serontonin reuptake inhibitors is sexual dysfunction including decreased libido
True.
What type of antidepressant is duloxetine?
Serotonin-norepinephrine reuptake inhibitor (SNRI)
After a patient falls, what is the strongest predictor of a fracture?
Presence or absence of osteoporosis.
At what age is osteoporosis screening initiated in women?
65 years.
In addition to age greater than 65 years, what are the risk factors for osteoporosis?
Chronic glucocorticoid use, previous fracture, low body weight (less than 127 lbs), cigarette smoking, excessive alcohol consumption, family history of hip fracture.
What are the 3 main effects of serotonin syndrome?
Neuromuscular excitation, Autonomic hyperactivity, and Altered mental status.
What is the most common diagnostic feature of serotonin toxicity?
Clonus (usually at the ankle)
Of the following 3 pain medications, which is most commonly implicated in the development of serotonin syndrome? Oxycodone, Tramadol, Hydrocodone/acetaminophen
Tramadol.
What is the likely diagnosis in individuals who restrict their caloric intake to a minimum because of the fear of gaining weight and losing their ideal body image?
Anorexia nervosa.
What are the main signs and symptoms of anorexia nervosa?
Symptoms include dry skin, cold intolerance, and soft downy hair (also known as lanugo). Signs include hypothermia, hypotension and bradycardia.
What is the preferred treatment for eating disorders?
Cognitive behavioral therapy. If necessary after trying psychotherapy, selective serotonin reuptake inhibitors (SSRIs) may be prescribed.
At what age should cholesterol screening be initiated in males?
35 years of age.
At what age is colorectal cancer screening initiated in patients without family history of colorecal cancer?
50 years.
According to the latest guidelines by the USPSTF, when should Pap smears be initiated?
Age 21, regardless of sexual history
What are the major reversible causes of dementia?
Hypothyroidism, Vitamin B12 deficiency, Depression, Polypharmacy, Normal pressure hydrocephalus, or infections like Syphilis, Lyme disease, Meningitis and Whipple’s disease
What are the major degenerative causes of dementia?
Multi-infarct dementia, Dementia with Lewy bodies, Parkinson’s, Frontotemporal dementia (Pick’s disease) and Alzheimer’s dementia.
How are reflexes affected in Subacute combined degeneration and Multi-infarct dementia?
Increased reflexes.
Which type of anti-psychotic (atypical or typical) is preferred due to the reduced risk of tardive dyskinesia?
Atypical anti-psychotic
What type of anti-psychotic (atypical or typical) are Haloperidol and Fluphenazine?
Typical anti-psychotic
What are some examples of symptoms related to tardive dyskinesia?
Involuntary movements of the trunk and lower face including tongue rolling, lip smacking, facial grimacing, and repetitive chewing.
Both postural and kinetic components are seen in which tremor?
Essential tremor.
What is the typical frequency range of essential tremors?
7-10 Hertz
What are the main treatments for essential tremors?
Propranolol, Primidone, Gabapentin, Alprazolam, or Topiramate
What are the 3 main indications for prescribing prophylactic medication to patients experiencing migraine headaches?
Beta blockers, Calcium channel blockers, Riboflavin (Vitamin B2), Topiramate, Amitriptyline
Which tricyclic antidepressant is typically used for prophylaxis against migraines?
Amitriptyline.
What type of urinary incontinence occurs because of increased detrusor bladder activity?
Urge incontinence.
What agents can be used in the treatment of urge incontinence?
Anti-cholinergic agents (e.g. oxybutynin, tolteridine, and imipramine)
What do the 5 R’s represent in the motivational interviewing technique for smoking cessation counseling?
Relevance, Risk, Reward, Roadblock, Repetition
HLA-2 allele presents to which CD marker?
HLA-2 allele presents to CD4 marker.
HLA-1 allele presents to what CD marker?
HLA-1 allele presents to CD8 cell marker.
(CD4 or CD8) is involved in cell mediated immunity.
CD4 is involved in cell mediated immunity
What signs and symptoms are seen in patients using phencyclidine in low doses?
Loss of coordination, slurred speech and loss of balance.
What signs and symptoms are seen in patients using phencyclidine in high doses?
Depersonalization–a sensation of “living a dream,” hallucinations and hostile or aggressive behavior.
To what category of drugs does phencyclidine belong?
NMDA receptor antagonists.
In overflow incontinence, is the detrusor activity increased, decreased, or the same as unaffected patients?
Detrusor activity is decreased.
Which type of urinary incontinence is defined by increased detrusor (bladder muscle) activity?
Urge incontinence
If behavioral therapy (e.g. frequent voiding, biofeedback) fails to control urge incontinence, what is the mainstay of pharmacological treatment?
Anti-cholinergics (e.g. oxybutinin or tolterodine)
What type of urinary incontinence is due to increased intra-abdominal pressure overwhelming the urinary sphincter tone?
Stress incontinence.
