General Internal Medicine Flashcards
Tdap (Age/freq, appropriate, contraindications?)
Everybody, q10 or q5 with wound, no contraindications
Pneumovax (Age/freq, appropriate, contraindications?)
Once before 65, once after, given to anybody with comorbid illness, so pretty much everybody
Can’t give with live vaccines (Prevnar, zoster). So give prevnar first, then pneumovax 8 weeks later.
Prevnar (Age/freq, appropriate, contraindications?)
Once after 65, everybody, can’t give with pneumovax.
Give prevnar first, then wait 8 weeks, then give pneumovax.
Zostavax (Age/freq, appropriate, contraindications?)
Give once at 60, everybody, don’t give with pneumovax
Hep A/B (Schedule, appropriate, contraindications?)
Day 1 =A/b
Month 1 = B
Month 6 = A/B
Everybody, no contraindications
Meningococcal vaccine (Age/freq, appropriate, contraindications?)
Age 11, college, military, hajj, no contraindication
HPV (Age/freq, appropriate, contraindications?)
11-26, everybody, no contraindications
Flu vaccine (Age/freq, appropriate, contraindications?)
Everybody, every year, contrainidcation is egg allergy
Colon cancer (Age, method)
Once 50, earlier if strong family hx.
Colonoscopy q10
Flex sig q5 with FOBT q3
FOBT q1
Breast Cancer (Age, method)
50-74, mammogram every 2 years
Lung Cancer (Age, method)
55-74 with 30 pack year history, low dose CT
Cervical Cancer (Age, method)
21-65 pap q3
30-65 pap+HPV q5
Ovarian Cancer (Age, method)
BRCA 1/2+ Only, Transvaginal US + CA-125.
Dyslipidemia (Age, method)
High risk, M @25 F@35
Low Risk M@35, F@45
Hep C (Age, method)
If born between 1945 and 1965, ivdu, blood before 1992, cocaine, tattoo, prison
HTN (Age, method)
Everybody everytime, diagnose with 2 readings 2 weeks apart
Osteoporosis (Age, method)
Females @ 65, 60 if high risk, one time DEXA
AAA (Age, method)
Male 65 and history of smoking, abdominal US
HIV (Age, method)
Everybody once or every year
DM2 (Age, method)
Patients w/persistent BP>135/80
Patients >45 q3y
If obese, HLD, or first degree relatives
STI (GC CL)
Sexually active females
How to diagnose hypertension?
2BP checks separated by 2 weeks.
What to follow up with when HTN diagnosed?
Urinalysis for occult blood/BUN:Cr ratio, BMP, Lipids, EKG
Best ways to reduce HTN?
Exercise, Dash diet, sodium restriction
JNC 8 BP targets
Target is 150/90 for pts>60
Target is 140/90 for patients
Meds to treat HTN?
Don’t use b blockers
Don’t use ace/arb in blacks (use HCTZ), unless CKD
How much does a single drug lower BP?
About 15/10
Causes of secondary hypertension
Hyperthyroid Hyperaldo Hypercalcemia Aortic coarctation Renovascular Stenosis Pheochromocytoma Cushing OSA
Drugs that cause HTN
Glucocorticoids OCP NSAIDs Antidepressants Decongestants Stimulants
How to treat hypertensive encephalopathy?
Labetalol
How to calculate LDL
LDL = total cholesterol - HDL - triglycerides/5
Secondary causes of hyperlipidemia?
Hypothyroidism, nephrotic syndrome, liver disease, alcoholism, diabetes
Diagnosis of HDL
Based on 2 fasting measurements at least 1 week apart
Metabolic syndrome
3/5 of following: Abdominal obesity, tg>150, HDL 130/85, fasting BG >110.
Treatment for hyperlipidemia if low-medium risk
Lifestyle modification and high fiber diet. Should drop cholesterol by 15%
Use statins for
ASCVD (mi, tia, cva, pad, angina)
LDL>190
Diabetes,age 40-75 and LDL from 70-190
>7.5 ASCVD risk
Use high dose statins for
ASCVD 7.5, LDL>70
LDL>190
Triglyceride levels that cause pancreatitis
> 500, start fibrates
How to work up back pain
See if there are alarm symptoms (focal neuro deficit, weakness, sensory loss, urinary symptoms, fever, IVDU). If so, give high dose dexamethasone, then get xray and MRI
If not, treat conservatively with 4-6 of nsaids.
Numbers to diagnose diabetes
1 random glucose >200
2 fasting bg >125
1 AIC>6.4
