General internal medicine 5

Question 1

Orthostatic hypotension is associated with an increased risk of

Answer 1

CV disease + all cause mortality

Question 2

Metatarsal stress fracture clinical features

Answer 2

• repetitive weight-bearing activities (running, dancing, jumping)
• metatarsal tenderness
• pain with axial loading of metatarsal (holding toe and pushing it in along long axis of metatarsal)

Question 3

Sesamoiditis clinical features

Answer 3

focal pain on plantar surface of first metatarsophalangeal joint

Question 4

morton neuroma clinical features

Answer 4

• between third and fourth toes

* clicking sensation

Question 5

initial step

Answer 5

KOH prep of nail scrapping (differentiate from other conditions that can appear similarly – psoriasis, eczema, lichen planus)

Question 6

PCOS diagnosis

Answer 6

• diagnosis of exclusion (need to exclude other causes of hyperandrogenism)

Question 7

PCOS clinical features

Answer 7

• androgen excess
• menstrual irregularities
• obesity
• polycystic ovaries on ultrasound

Question 8

other sequelae of prolactinomas

Answer 8

osteoporosis (hyperprolactinemia suppresses gonadotropin secretion, leading to hypogonadism and low estrogen levels)

Question 9

Next step in evaluation of hoarseness in someone with smoking history

Answer 9

Referral to ENT for laryngoscopy

Question 10

Slow-transit constipation cause

Answer 10

slow motility in proximal colon

Question 11

management of slow transit constipation

Answer 11

• fiber and lifestyle changes, bulk-forming laxatives

Question 12

Acute urinary retention clinical features

Answer 12

• delirium

- suprapubic mass

Question 13

hidradenitis suppuritiva management

Answer 13

mild – topical clindamycin
moderate – oral tetracyclines
severe – surgery or infliximab

Question 14

MCI definition

Answer 14

impaired cognition + preserved functioning

Question 15

Core feature of alzheimers

Answer 15

functional impairment

Question 16

polyarteritis nodosa association

Answer 16

Hep B and C

Question 17

treatment of polyarteritis nodosa

Answer 17

• ACE inhibitors
• cyclophosphamide
• prednisone

Question 18

sequela of uncorrected large ASDs

Answer 18

• chronic right sided volume overload and pulmonary HTN

Question 19

echocardiographic signs of cardiac tamponade

Answer 19

RA collapse during end diastole (Fluid accumulation in the pericardium causes an increase in intrapericardial pressure. RA has the lowest pressure of all cardiac chambers so its the earliest and most sensitive sign of tamponade. RV collapse can also happen.)

Question 20

McConnell sign clinical significance + description

Answer 20

• RV dilation and free wall hypokinesia with sparing of he apex
• PE

Question 21

strongyloidiasis clinical features

Answer 21

• peripheral eosinophilia
• GI issues (abdominal pain, worse with eating)
• pulmonary complaints
• from endemic area
• skin (serpiginous rash + pruritus from ground itch)

Question 22

strongyloidiasis treatment

Answer 22

• ivermectin or albendazole

Question 23

strongyloidiasis diagonsis

Answer 23

• ELISA IgG antibody or endoscopy for biopsy

* stool O&P frequently negative

Question 24

what is a hordeolum

Answer 24

stye

Question 25

osteitis fibrosa cystica

Answer 25

Jim McKusick/most characteristic skeletal manifestation of primary hyperparathyroidism. Bones covered in brown cysts all over the ground + he’s screaming in pain + skull deskinned and covered in small holes + skeleton hands looking like below/presentation = bone pain + subperiosteal erosions affecting the phalanges of the hand + “salt-and-pepper” skull + brown tumor bone cysts.

Question 26

stress incontinence pathophys

Answer 26

• urethral dysfunction that leads to leakage of urine with increased abdominal pressure

Question 27

otitis media with effusion clinical features

Answer 27

• acute otitis media associated with conductive hearing loss

Question 28

vestibular neuritis vs. labyrinthitis

Answer 28

• vestibular neuritis = preserved hearing

- labrynthitis = vestibular neuritis + unilateral hearing loss