General Internal Medicine Flashcards
1
Q
Which HPV serotypes MCC of cervical cancers?
A
16, 18
2
Q
Which HPV serotypes MCC of genital warts
A
6, 11
3
Q
Vasomotor symptoms of menopause - tx?
A
Hormone therapy with estrogen and progesterone
4
Q
What is the treatment for SAD - seasonal effectiveness disorder?
A
phototherapy and SSRI
5
Q
Treatment for MDD
A
CBT or second gen anti depressant (HY)
6
Q
What depression medication is safe for patients with cardiovascular disease?
A
sertraline
7
Q
what anti-depressant has fewer sexual side effects and weight gain?
A
buproprion
8
Q
what anti-depressant can cause weight gain and sedation?
A
mirtazipine (HY)
9
Q
what anti-depressant is category D (do not use) in pregnancy?
A
paroxetine
10
Q
when should you consider switching therapies for depression?
A
If <50% resolution in symptoms within 6-8 weeks
11
Q
how long should pharmacotherapy be continued for someone with a first episode of depression
A
4-9 months
12
Q
What are the long term side effects of lithium?
A
hypothyroidism, DI and kidney disease
13
Q
What are first line treatments for bipolar disorder?
A
lithium
anticonvulsants
second gen antipsychotics
14
Q
What can happen with patients with untreated bipolar disorder who are given SSRIs?
A
Can unmask mania
15
Q
GAD - first line treatment?
A
CBT +/- meds. SSRIs and SNRIs
16
Q
Social Anxiety disorder treatment?
A
CBT and SSRIs
17
Q
Panic disorder vs attacks.
A
Disorder = recurrent, unexpected attacks and persistent worry about future attacks
CBT and SSRIs, can use long acting benzos until first line treatments are effective
18
Q
Treatment for PTSD?
A
CBT. Can use sertraline and paroxetine (do NOT use Benzos)
19
Q
OCD treatment
A
CBT and SSRI
20
Q
Treatment for anorexia and bulemia
A
Anorexia - CBT (no meds.)
Bulemia - CBT and antidepressants, fluoxetine or imipramine
21
Q
Can bupropion be used for eating disorders?
A
NO! can increase risk of seizures
22
Q
Treatment for schizophrenia
A
second gen antipsychotic (risperdone, quetiapine, olanzapine) and refer to psych
23
Q
do women with high breast density need add’l screening beyond routine mammo?
A
no!
high value care
24
Q
patient with acute cough - is radiology indicated if they have normal vital signs and normal lung exam?
A
no!
high value care
25
what is the treatment for baker's cysts?
none necessary
high value care
26
what medications are effective for tinnitus?
none have been shown to be effective
high value care
27
How many Centor criteria should adults meet to warrant testing for strep?
3
fever
cervical LAD
tonsillar exudates
lack of cough
high value care
28
are meds or behavioral interventions more effective in smoking cessation?
both are more effective than either alone
combining more than one form of nicotine replacement (short and long) is more effective than monotherapy
high value care
29
are any meds recommended for stress urinary incontinence or functional urinary incontinence?
no
high value care
30
how should asymptomatic carotid bruit be managed pre-op?
no pre-op eval needed
not predictive of preioperative stroke
high value care
31
4cm hepatic adenoma in woman on OCPS - what's the next step
stop OCPs
imaging q 6 months x 2 years
32
Man with father diagnosed with colon ca at age 52, when should he start screening colos?
40 yo (or 10 years before diagnosis of relative, whichever is earlier)
33
colon biopsy: lymphocytic infiltration and a subepithelial collagen band
What is the diagnosis?
microscopic colitis
The first step in the management of microscopic colitis is to discontinue a potentially causative medication, after which supportive treatment with antidiarrheal agents such loperamide can be tried, with budesonide recommended for patients whose symptoms do not respond.
34
Screening recs for patients with family history of Lynch Syndrome?
Patients with Lynch syndrome should begin screening colonoscopy between ages 20 and 25 years or 2 to 5 years before the earliest age of colorectal cancer diagnosis in the family, whichever comes first, and colonoscopy should be repeated every 1 to 2 years if the baseline examination is normal.
35
best way to prevent pressure ulcers?
Proper patient positioning and an advanced static mattress or mattress overlay made of specialized sheepskin, foam, or gel provide the best protection against the development of pressure injuries in hospitalized patients.
36
what medication can treat ED and BPH?
For patients with concomitant benign prostatic hyperplasia and erectile dysfunction, tadalafil (a phosphodiesterase-5 inhibitor) is the only FDA-approved single agent to treat both conditions.
37
how do you calculate the LR?
sensitivity / (1- specificity)
38
how do you calculate NNT?
1/ARR
39
timing of Tdap during pregnancy?
between 27 to 36 weeks gestation with every pregnancy
40
who needs MMR as an adult?
anyone born after 1957 without evidence of vaccination or immunity
41
who needs booster for PPSV23?
anyone who got first vaccine before age 65
functional or anatomic asplenia
immunocompromised or cancer patients
give 5 years after first dose
42
AAA screening recs?
men 65-75 who have smoked
43
Cervical cancer screening age range
21-65
44
lung cancer screening recs?
annual low dose CT scan in patients 55-80 with a 30pack year smoking history)
45
how does board basics want you to treat EtOH withdrawal?
CIWA or other symptom triggered regimen (not phenobarb)
46
what is the safest long-acting opiate in liver and kidney failure?
fentanyl
47
why should you avoid tramadol as an analgesic?
significant drug interactions especially with serotonergic medications
48
What is the treatment for anticipatory nausea?
benzos
49
What is the treatment for nausea 2/2 increased intracranial pressure?
glucocorticoids
50
what is a way to reduce dyspnea in nonhypoxic patients?
fans!
don't be tricked!
51
What is the treatment for depression in a patient with a life expectancy of less than 6 weeks?
psychostimulant like methylphenidate (Ritalin)
| Benzos can reduce anxiety in palliative care setting
52
duration of chronic cough
>8 weeks
53
Most common causes of chronic cough?
postnasal drip
asthma
GERD
54
workup of chronic cough?
CXR
Smoking cessation and stop ACEi for 4 weeks before additional workup
55
What is the diagnosis?
Chronic cough with postnasal drip, frequent throat clearning, nasal discharge
allergic rhinitis
tx 1st gen antihistamine decongestant or intranasal steroids
56
What is the diagnosis?
asthma with cough with exercise or cold exposure and chronic cough
cough variant asthma
dx: methacholine or exercise challenge test if uncertain diagnosis
tx: standard ashtma therapy may take 6 weeks to respond
57
What is the diagnosis?
chronic cough and GERD symptoms
tx for GERD may take 3 months to respond
58
What is the diagnosis?
chronic cough with normal CXR, normal spirometry and negative methacholine challenge test?
possible nonasthmatic eosinophilic bronchitis
dx: sputum induction or bronchial wash for eosinophils
tx: inhaled steroids
59
What is the treatment for systemic exertion intolerance disease (formerly chronic fatigue syndrome)?
CBT, graded exercise, no meds are approved
60
what diagnostic maneuver can you use to distinguish central from peripheral vertigo?
dix hallpike
61
What is the diagnosis?
vertigo that lasts days associated with nausea and often vomiting
vestibular neuritis
62
What is the diagnosis?
vertigo lasting 10-30 seconds and nausea associated with abrupt head movement
BPPV
tx: epley manuever
63
What is the diagnosis?
vertigo that lasts days associated with nausea and often vomiting with associated hearing loss
labyrinthitis
64
What is the diagnosis for suspected central vertigo?
brain MRI
65
What is the treatment for peripheral vertigo
steroids
centrally acting anti-histamines like meclizine
vestibular suppressants like benzos
anti-emetic drugs
66
a positive romberg and wide based gait is suggestive of what back pathology?
spinal stenosis
67
how do you diagnose spinal stenosis?
MRI
68
What is the treatment for spinal stenosis
surgery
69
what is the mgmt of neoplastic epidural spinal cord compression?
steroids, urgent MRI of entire spine
70
Most common cause of knee pain in women <45yo
prepatellar bursitis
worse with prolonged sitting, descending stairs and overuse (running)
tx: PT and NSAIDs
71
knee pain that presents with clicking, locking and pain - What is the diagnosis?
meniscal tear
72
When should a patient have surgery for a meniscal tear?
symptoms that last beyond 4 weeks
73
true hip pain usually presents where?
groin
don't be tricked!
74
Who needs an xray of their ankle
cannot bear weight
| bone pain localized to the lateral or medial malleolus, base of the 5th metatarsal or navicular bone
75
What are secondary causes of bilateral carpal tunnel syndrome
```
diabetes
hypothyroidism
pregnancy
paraproteinemias
RA of the wrist
```
76
How can you distinguish a rotator cuff tear vs. a rotator tendinitis on exam/history?
both usually have pain
weakness is suggestive of a tear > tendinitis
MRI is the best imaging modality for tears
77
Patient with diabetes, LDL above what is an indication for a statin?
70
78
who is a candidate for bariatric surgery?
patients with BMI > 40 or >35 with comorbiditis (severe oSA, DM, severe joint dz)
79
diffusely tender testes is indicative of what illness?
orchitis
80
What is the treatment for prostatitis
bactrim or FQ for 4-6 weeks
81
GAIL scores above what is threshold for breast CA prophylaxis?
1.7%
82
what is breast Ca prophylaxis?
tamoxifen before menopause
tamoxifen and raloxifene or exemestane after menopause
83
Who should you screen for BRCA mutations
women with 1 or more 1st degree relatives on the same side who had breast cancer or ovarian ca before age 50
two or more relatives of any age with breast, prostate or pancreatic cancer
84
how should you screen patients with BRCA mutations for breast cancer?
MRI at 25yo, then mammos at 30
ovarian Ca screening with pelvic exmas, US and Ca-125 (i feel like MKSAP q bank contradicts this)
85
what BI-RADS categories -> biopsy?
4 or 5
86
what HPV genotypes are high risk for cervical Ca?
16 and 18
87
When should you start cervical Ca screening?
age 21
88
What are contraindications to hormonal birth control?
```
uncontrolled HTN
breast Ca
VTE
Liver disease
migraine with aura
```
No estrogen if >35yo and smoke more than 15 cigarettes a day
89
How can you treat the vasomotor sx of menopause?
systemic hormone therapy (need to include progesterone if woman has an intact uterus)
```
other options:
- venlafaxine
desvenlafaxine
paroxetine
citalopram
escitalopram
gabapentin
```
90
What are common causes of abnormal anovulatory uterine bleeding
```
PCOS
hypo or hyperthyroidism
hyperprolactinemia
chronic liver or kidney dz
medications
```
91
What thickness of endometrium should prompt a biopsy in postmenopausal women?
>4mm
92
What is the treatment for endometriosis?
NSAIDs
| OCPs
93
what is the mgmt of trichomoniasis
oral Flagyl for patient AND partner
test for other STIs
*retest within 3 months!
94
What is the diagnosis?
acute hyperpurulent ocular discharge in a sexually active adult
neisseria gonorrhoeae conjunctivitis
topical and systemic abx and Optho referral emergently
95
What is the diagnosis?
itchy and tearing of eyes ad then nasal congestion
allergic conjunctivitis
96
What is the diagnosis?
pain, photophobia, inflammation confined to corneal limbus, corneal irregularity and edema
iridocyclitis or keratitis
Consider spondyloarthropathies, sarcoid, zoster
emergency optho referral
97
What is the diagnosis?
deep unilateral ocular pain, nausea, vomiting, fixed nonreactive pupil, shallow anterior chamber
acute angle closure glaucoma
emergency ophtho referral
98
What is the diagnosis?
severe ocular pain that is worse with eye movement and light exposure, raised hyperemic lesion that obscures the vasculature
scleritis
commonly associated with collagen vascular diseases and rheumatoid diseases
emergent optho referral
99
What is the diagnosis?
nonpainful red, flat, superficial lesion that allows visualization of the underlying vasculature
episcleritis
self-limited, no treatment
100
What is the diagnosis?
red eye with scales and crusts around the eyelashes or dandruff like skin changes and greasy scales around the eyelashes
blepharitis
tx: warm compresses, topical abx
101
Should you treat a red eye with topical steroids?
no
don't be tricked!
102
What is the treatment for wet age related macular degeneration
laser photocoagulation
103
What is the diagnosis? curtain coming down over vision?
retinal detachment
optho emergency
104
What is the diagnosis?
painless monocular vision loss in a diabetic
central retinal artery occlusion
105
how manage progressive asymptomatic sensorineural hearing loss?
MRI or CT to evaluate for acoustic neuroma
106
What is the diagnosis?
nonseasonal rhinitis with negative skin tests
chronic nonallergic rhinitis (vasomotor rhinitis)
107
What is the diagnosis?
refractory congestion after chronic use of topical nasal decongestatnts
rhinitis medicamentosa
108
What is the diagnosis?
nasal congestion in the last 6 or more weeks of pregnancy
pregnancy rhinits
109
What is the treatment for rhinitis?
intranasal steroids
then intranasal antihistamines or oral combo antihistamines/decongestants
topical ipratropium
110
what anti-depressant is safest for patients with CVD
sertraline
111
What is the treatment for GAD
1. CBT
2. SSRIs or SNRIs
benzos are okay for short term while titrating antidepressant doses
112
what is the difference between malingering and factitious disorder
malingering: adopts a physical symptom for the purpose of gain
factitious disorder: patient adopts symptoms to remain in the sick role
113
What is the treatment for bulemia
CVT and antidepressants - fluoxetine or imipramine
114
What is the treatment for anorexia
CBT, no meds
115
what is an abnormal get up and go test
>12 seconds
116
What is the diagnosis?
daytime frequency, nocturia, bothersome urgency
urge incontinence
117
how treat urge incontinence
1. bladder training
| 2. anti-cholinergic drugs - oxybutynin, tolterodine
118
What is the diagnosis?
involuntary release of urine secondary to effort or exertion
stress incontinence
119
What is the treatment for stress incontinence
pelvic floor muscle training
120
What is the diagnosis?
urgency and involuntary release of urine
mixed incontinence - stress and urge
tx: bladder training and pelvic floor muscle training
121
What is the diagnosis?
newly constant dribbling of urine, incomplete bladder emptying, high postvoid residuals
overflow incontinence
tx timed urination, intermittent cath
122
is urodynamic eval helpful to diagnose incontinence
not usually
123
who needs an EKG pre-op
CAD
significant arrhythmia
stroke or TIA history
PAD
124
do low risk surgeries require cardiac testing even if a calculated risk score is elevated?
no
don't be tricked!
low risk: cataract, carpal tunnel release, breast biopsy, inguinal hernia repair
125
greatest benefit from smoking cessation pre-op is from quitting how long before surgery?
at least 8 weeks
126
how long before surgery should you stop warfarin?
5 days
127
how long should you stop NOAC before surgery
1-2 days unless GFR less than 50
128
how long after surgery should you restart warfarin or a NOAC?
12 -24 for warfarin
24 for NOAC
