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General internal medicine 4 Flashcards

1
Q

Management of statin myopathy

A

TSH (statins can worsen hypothyroid myopathy and hypothyroidism can exacerbate statin myopathy)

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2
Q

Other features of hypothyroidism

A
  • normocytic anemia
  • diastolic hypertension
  • mild CK elevation
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3
Q

Treatment of acute gout in CKD patients

A

steroids (intra-articular if 1-2 joints or systemic if more than 2 joints involved)
*colchicine not recommended

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4
Q

Other presentation of Celiac

A
  • may present with no GI or intestinal symptoms
  • elevated liver enzymes
  • arthritis
  • may just be IDA in someone with autoimmune history
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5
Q

lymphocytic colitis clinical features

A

chronic, non bloody diarrhea

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6
Q

atheroembolic disease clinical features

A
  • AKI after arteriography involving the aorta
  • livedo reticularis
  • cyanotic, gangrenous toe
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7
Q

Anterior uveitis clinical features

A
  • unilateral painful, red eye and photophobia (similar to acute angle closure glaucoma but without system symptoms)
  • hypopyon (white exudate in anterior chamber)
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8
Q

hordeolum clinical features

A
  • inflammation? (due to obstruction of meibomian gland, eyelash follicle, or lid-margin tear gland
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9
Q

Anterior uveitis treatment

A

urgent ophtho consult

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10
Q

Anterior uveitis vs. acute angle-closure glaucoma

A
  • angle-closure glaucoma has more systemic presentation (headache, nausea and vomiting), anterior uveitis is localized
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11
Q

work up of narcolepsy

A
  • overnight sleep study then the next night a multiple sleep latency test (time to sleep onset is measured, pts with narcolepsy have a shorter sleep latency time)
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12
Q

Pes anserinus pain syndrome clinical features

A
  • point tenderness along the medial knee
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13
Q

episcleritis clinical features

A
  • foreign-body sensation in eye
  • no significant pain or visual impairment
  • redness
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14
Q

treatment of episcleritis

A

topical lubricants

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15
Q

scleritis clinical features

A
  • pain + visual impairment + dark red sclera
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16
Q

scleritis treatment

A

systemic steroids and immunosuppressants

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17
Q

Additional initial workup of HTN

A

screen for diabetes with fasting glucose, A1c, or OGTT

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18
Q

Presentation of copper deficiency

A
  • similar to B12 (anemia, leukopenia, myeloneuroapthy)

+ malabsorptive condition

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19
Q

Genital HSV treatment + indication for prophylaxis

A

ORAL acyclovir at symptom onset

IF 4 or more episodes a year –> chronic suppressive therapy

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20
Q

complex regional pain syndrome clinical features

A
  • throbbing pain, paresthesias, skin temperature changes, local edema
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21
Q

deficiency associated with metformin

A

B12 deficiency

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22
Q

Utility of synthroid following thyroidectomy in patients with thyroid cancer

A

Goal is to suppress TSH stimulation of residual tumor tissue to prevent recurrence of cancer

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23
Q

Paget disease of the breast clinical features

A
  • intense pruritus + ulcerative
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24
Q

Management of paget disease of the breast

A
  • bilateral mammography (rule out underlying breast cancer)
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25
Q

Management of nocturia in CHF patient with BPH

A
  • optimize volume status before making medication changes for BPH (nocturia can be caused by improved renal perfusion pressure, so people diurese more over night)
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26
Q

Clinical features + physical exam for tarsal tunnel syndrome

A
  • pain, paresthesias in sole of foot

- positive Tinel’s sign and or sensory loss

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27
Q

Indications for antibiotic treatment of rhinosinusitis

A
  • long symptoms (over 10 days)
  • severe symptoms (high fever, purulent nasal discharge, or facial pain for over 3 days )
  • worsening symptoms 5 days or more after initially improving viral URI
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28
Q

Acromegaly sequelae

A
  • Increased risk of esophageal, gastric cancer, colon cancer, melanoma (IGF-1 stimulates mucosal cell proliferation) (so need c-scope at time of diagnosis and q3 years)
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29
Q

Next step after diagnosis of osteoporosis in elderly men

A
  • serum testosterone (frequently have hypogonadism) (also need baseline CBC, bmp, TSH, vitamin d)
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30
Q

bacterial keratitis clinical features

A
  • contact lens + pain, photophobia, and conjunctival injection + corneal lesion
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31
Q

Antibiotics for bacterial keratitis

A

quinolone (pseudomonal coverage)

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32
Q

Treatment of acute angle-closure glaucoma

A
  • timolol, apraclonidine, pilocarpine drops

- IV acetazolamide

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33
Q

Corneal ulcer clinical features

A
  • foreign body sensation
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34
Q

trochanteric bursitis clinical features

A
  • lateral hip pain

- pain radiating into buttock or toward knee

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35
Q

Malignant otitis externa clinical features

A
  • Diabetic with severe ear pain + discharge + bone erosion + *high ESR
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36
Q

SCC of the ear presentation

A

pain and ulceration with erosion into the bone

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37
Q

malignant otitis externa vs squamous cell carcinoma

A

SCC = milder symptoms + normal to slightly elevated ESR

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38
Q

Treatment of malignant otitis externa

A

quinolones

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39
Q

Management of OA in elderly patients

A
  • topical NSAIDS even if no NSAID contraindications (still associated with increased risk of complications in the elderly)
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40
Q

treatment of androgenic alopecia in women and men

A

Men: minoxidil, finasteride
Women: minoxidil

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41
Q

Clinical features of wilson disease

A
  • hepatitis
  • neuropsych
  • parkinsonism (tremor, rigidity, clumsiness)
  • hemolytic anemia
  • recurrent nephrolithiasis
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42
Q

presbycusis clinical features

A
  • bilateral, high-frequency hearing loss in elderly patient
  • abnormal whispered voice test
  • do fine one to one but have difficulty hearing in presence of background noise
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43
Q

otosclerosis clinical features

A

*unilateral hearing loss

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44
Q

Ototoxic drugs

A
  • aminoglycosides
  • platinum chemo
  • loop diuretics
  • NSAIDs
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45
Q

IT band syndrome clinical features

A
  • lateral knee and thigh pain

- pain with flexion and extension of the knee

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46
Q

IT band syndrome treatment

A
  • exercise less, PT
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47
Q

Patellofemoral syndrome

A
  • pain in anterior knee + pain reproduced by squatting
48
Q

patellar tendinopathy clinical features

A
  • pain in inferior patella
  • tenderness at tendon insertion at inferior patellar margin
  • jumping sports (basketball, volleyball)
49
Q

Treatment of neuralgia paresthetica

A
  • advise patient to wear less tight-fitting clothing
50
Q

When do patients generally need further cardiac workup prior to surgery?

A

If underlying high-risk cardiac condition

51
Q

High risk cardiac syndromes requiring further evaluation prior to surgery

A
  • ACS
  • decompensated heart failure
  • significant arrhythmia
  • severe valvular disease
52
Q

description of severe AS

A
  • late peaking systolic murmur

- paradoxical splitting of S2

53
Q

pre-op cardiac workup for patients with high risk underlying conditions (in general)

A
  • TTE if concern for underlying valvular disease

- stress test if concern for ACS

54
Q

Upper limit of Pap testing, when pap tests can be discontinued

A

65 or total hysterectomy

55
Q

Preferred screening for alcohol use in primary care

A

AUDIT-C (alcohol use disorders identification test-C)

56
Q

Ocular side effects of PDE-5 inhibitors (viagra)

A
  • bluish tinting, blurry vision, photophobia
57
Q

zinc deficiency presentation

A
  • abdominal pain, anorexia, depression, compromised wound healing, immune dysfunction
58
Q

Emergency contraceptive options

A

1) oral levonorgestrel (up to 3 days)

2) copper containing IUD (up to 5 days)

59
Q

Vaccines indicated for pregnant women

A
  • Tdap during each pregnancy regardless of previous vaccination history (preferably during 3rd trimester to facilitate maternal antibody response)
60
Q

MMR live or dead vaccine?

61
Q

popliteal cyst presentation

A
  • underlying knee disease or trauma
  • posterior knee fullness, pain, and or stiffness
  • may dissect or rupture, mimicking DVT (with also positive Homan’s sign)
62
Q

DVT vs dissecting synovial cyst

A

Dissecting synovial cyst = posterior knee fullness, knee effusion, absence of a palpable cord

63
Q

bulimia vs binge eating disorder

A

bulimia = compensatory behavior (*excessive exercise, laxatives)

64
Q

Basic calcium phosphate (BCP) deposition disease of the shoulder (Milwaukee shoulder) clinical features

A
  • aggressive destruction of glenohumeral joint and rotator cuff
  • large hemorrhagic effusion
  • synovial fluid may or may not contain BCP (hydroxyapatite) crystals
65
Q

Typical presentation of osteosarcoma on exam

A
  • palpable soft-tissue mass
66
Q

Treatment of frostbite

A

1) rapid rewarming with warm water

2) then air dry and cover with non adherent gauze

67
Q

Chantix and psych history management

A
  • psych history is not a contraindication to its use (this has now been disproved)
68
Q

side effect to know of with chantix

A
  • possible increased risk of CV events
69
Q

Earliest indicator of return of spontaneous circulation in patients in cardiac arrest undergoing CPR

A
  • sudden rise in end-tidal CO2 (sudden increase in cardiac output with return of spontaneous circulation causes rapid transport of CO2 accumulated in tissues to the lungs)
  • this eliminates the need to stop CPR to check for a palpable pulse
70
Q

Ottawa ankle rules in general

A

IF pain at mid foot zone or malleolar zone + inability to bear weight –> then image to rule out fracture

71
Q

Medication to dose reduce or discontinue when SGLT2 is added

A
  • diuretics or ACEs,arbs (SGLT2 inhibitors induce osmotic diuresis, which can lead to hypotension and decreased renal perfusion
72
Q

Conservative fibromyalgia treatment

A
  • regular exercise

- good sleep hygiene

73
Q

When lipid panel is indicated in primary care

A
  • Men over age 35 and women over age 45 *regardless of weight
  • Younger patients with RF’s (smoking, HTN, Dm2, FH of cardiovascular disease)
74
Q

Signs of early pregnancy

A
  • fatigue
  • weight gain
  • amenorrhea
  • enlarged uterus
75
Q

adenomyosis clinical features

A
  • enlarged, symmetric uterus

- heavy, painful menses

76
Q

Management of patient with high pre-test for influenza and negative influenza antigen test

A
  • oseltamavir if within 48 hours or severely ill
  • negative rapid influenza antigen testing (high false negative rate) OR a history of flu vaccine does not rule out infection (not fully protective)
77
Q

Next step after Pap test showing ASCUS

A

HPV test
IF negative – no increased risk of malignancy
If positive – colposcopy

78
Q

Treatment of foot drop

A

PT + ankle foot orthotics (to facilitate ambulation)

79
Q

Workup of common peroneal nerve injury (foot drop)

A
  • L-spine if associated with back pain

- no workup if hospitalized, trauma, or leg cast (can be attributed to external compression)

80
Q

Gait abnormality with cerebellar injury

A

ataxic: staggering, wide based

81
Q

Gait abnormality with gait apraxia

A

magnetic: freezing

82
Q

Gait abnormality with PD

A

short steps, shuffling

83
Q

Management of lithium toxicity

84
Q

Cause of physiologic lekorrhea

A
  • elevated estrogen levels from combined hormonal contraceptive use
85
Q

Treatment of hypertriglyceridemia

A
  • only treat with fibrates if triglycerides over 1000, otherwise lifestyle modification
  • statins are first line but need to have another indication for statin
86
Q

Medications associated with increased risk of new-onset diabetes

A
  • thiazides

- beta blockers (except for coreg)

87
Q

Management of impaired colleague after approaching colleague

A
  • report to state regulatory body (physician health program)

* not supervisor

88
Q

Inheritance pattern of Becker muscular dystrophy and Duchenne muscular dystrophy

A

X-linked recessive

89
Q

Management of palpable breast mass in woman over age 30 who has negative mammogram + US

A 
Core biopsy (to exclude malignancy)
*Palpable breast masses can be mammographically and monographically occult
90
Q

Workup of palpable breast mass in woman over age 30

A

1) First step is mammography

2) Then US

91
Q

abx for acute prostatitis

A

quinolones OR bactrim

92
Q

Management of patient with osteoporosis despite being on bisphosphonate

A
  • stop bisphosphonate, start teriparatide or denosumab
93
Q

Mastalgia clinical features

A
  • benign cyclical bilateral breast pain and tenderness prior to menses that resolves with menses
94
Q

Retinal detachment clinical features

A
  • floaters
  • flashing lights
  • occasional vision loss
95
Q

Dry macular degeneration clinical features + fundoscopic features

A
  • gradual vision loss

- drusen (areas of retinal depigmentation)

96
Q

Wet macular degeneration clinical features + fundoscopic features

A
  • acute vision loss (does have to be entire visual field)
  • subretinal fluid and or hemorrhage on funduscopic exam
  • fundoscopy often normal
97
Q

Indications for urology referral with BPH and PSA

A
  • PSA greater than 7 (even if underlying BPH)

- abnormal DRE

98
Q

Management of patient with PSA between 3 and 7

A

Retest in a few weeks, refer to urology if persistently elevated

99
Q

workup of suspected prosthetic joint infection

A

arthrocentesis (may happen months out from surgery)

100
Q

Tympanic membrane rupture typical course

A
  • typically resolves completely with oral and topical antibiotics
101
Q

Tympanic membrane rupture clinical features

A

Pain + purulent otorrhea

102
Q

Clinical features of anticonvulsant hypersensitivity syndrome

A
  • fever, rash, pharyngitis, lymphadenopathy, edema, systemic organ involvement
    (form of DRESS)
103
Q

sialolithiasis clinical features

A
  • pain + unilateral swelling of parotid gland + waxing and waning
104
Q

sialolithiasis treatment

A
  • sialogogues (lemon drops) to promote salivary secretion + heat + massage gland
105
Q

Typical cause of involuntary weight loss in the elderly

A
  • difficulties obtaining and preparing food
106
Q

AST to ALT ratio in NAFLD

A

Typically less than 1

107
Q

Why olanzapine is second line for anorexia

A

Stimulate weight gain

108
Q

anorexia cuttoff

A

BMI of *18.5

109
Q

Initial step in workup of suspected Paget disease

110
Q

GCA clinical features

A
  • elderly person with HA + blurry vision + constitutional symptoms + elevated ESR and inflammatory markers
111
Q

Workup of snoring and anything else possibly suggesting OSA in a “mission critical person”

A
  • sleep study

* mission critical = airline pilot, rail traffic operator, military, etc

112
Q

Erythrasma cause

A

corynebacterium infection

113
Q

Erythrasma clinical features

A
  • well-demarcated, red-brown, pruritic *plaques in interdigital or intertriginous areas
  • can have “cigarette paper” scale
114
Q

Erythrasma diagnosis

A

red fluorescence under a Wood’s lamp

115
Q

Erythrasma treatment

A

topical antibiotics if isolated, if multiple sites, oral abx

116
Q

Explanation for patient with elevated wedge pressure and elevated PA pressure

A
  • decompensated HFpEF commonly causes secondary pulmonary HTN

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