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General Internal Medicine Flashcards

1
Q

Which HPV serotypes MCC of cervical cancers?

A

16, 18

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2
Q

Which HPV serotypes MCC of genital warts

A

6, 11

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3
Q

Vasomotor symptoms of menopause - tx?

A

Hormone therapy with estrogen and progesterone

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4
Q

What is the treatment for SAD - seasonal effectiveness disorder?

A

phototherapy and SSRI

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5
Q

Treatment for MDD

A

CBT or second gen anti depressant (HY)

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6
Q

What depression medication is safe for patients with cardiovascular disease?

A

sertraline

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7
Q

what anti-depressant has fewer sexual side effects and weight gain?

A

buproprion

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8
Q

what anti-depressant can cause weight gain and sedation?

A

mirtazipine (HY)

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9
Q

what anti-depressant is category D (do not use) in pregnancy?

A

paroxetine

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10
Q

when should you consider switching therapies for depression?

A

If <50% resolution in symptoms within 6-8 weeks

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11
Q

how long should pharmacotherapy be continued for someone with a first episode of depression

A

4-9 months

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12
Q

What are the long term side effects of lithium?

A

hypothyroidism, DI and kidney disease

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13
Q

What are first line treatments for bipolar disorder?

A

lithium
anticonvulsants
second gen antipsychotics

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14
Q

What can happen with patients with untreated bipolar disorder who are given SSRIs?

A

Can unmask mania

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15
Q

GAD - first line treatment?

A

CBT +/- meds. SSRIs and SNRIs

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16
Q

Social Anxiety disorder treatment?

A

CBT and SSRIs

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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

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18
Q

Treatment for PTSD?

A

CBT. Can use sertraline and paroxetine (do NOT use Benzos)

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19
Q

OCD treatment

A

CBT and SSRI

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20
Q

Treatment for anorexia and bulemia

A

Anorexia - CBT (no meds.)

Bulemia - CBT and antidepressants, fluoxetine or imipramine

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21
Q

Can bupropion be used for eating disorders?

A

NO! can increase risk of seizures

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22
Q

Treatment for schizophrenia

A

second gen antipsychotic (risperdone, quetiapine, olanzapine) and refer to psych

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23
Q

do women with high breast density need add’l screening beyond routine mammo?

A

no!

high value care

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24
Q

patient with acute cough - is radiology indicated if they have normal vital signs and normal lung exam?

A

no!

high value care

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25
Q

what is the treatment for baker’s cysts?

A

none necessary

high value care

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26
Q

what medications are effective for tinnitus?

A

none have been shown to be effective

high value care

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27
Q

How many Centor criteria should adults meet to warrant testing for strep?

A

3

fever
cervical LAD
tonsillar exudates
lack of cough

high value care

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28
Q

are meds or behavioral interventions more effective in smoking cessation?

A

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

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29
Q

are any meds recommended for stress urinary incontinence or functional urinary incontinence?

A

no

high value care

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30
Q

how should asymptomatic carotid bruit be managed pre-op?

A

no pre-op eval needed
not predictive of preioperative stroke

high value care

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31
Q

4cm hepatic adenoma in woman on OCPS - what’s the next step

A

stop OCPs

imaging q 6 months x 2 years

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32
Q

Man with father diagnosed with colon ca at age 52, when should he start screening colos?

A

40 yo (or 10 years before diagnosis of relative, whichever is earlier)

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33
Q

colon biopsy: lymphocytic infiltration and a subepithelial collagen band

What is the diagnosis?

A

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.

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34
Q

Screening recs for patients with family history of Lynch Syndrome?

A

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.

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35
Q

best way to prevent pressure ulcers?

A

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.

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36
Q

what medication can treat ED and BPH?

A

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.

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37
Q

how do you calculate the LR?

A

sensitivity / (1- specificity)

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38
Q

how do you calculate NNT?

A

1/ARR

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39
Q

timing of Tdap during pregnancy?

A

between 27 to 36 weeks gestation with every pregnancy

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40
Q

who needs MMR as an adult?

A

anyone born after 1957 without evidence of vaccination or immunity

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41
Q

who needs booster for PPSV23?

A

anyone who got first vaccine before age 65

functional or anatomic asplenia
immunocompromised or cancer patients

give 5 years after first dose

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42
Q

AAA screening recs?

A

men 65-75 who have smoked

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43
Q

Cervical cancer screening age range

A

21-65

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44
Q

lung cancer screening recs?

A

annual low dose CT scan in patients 55-80 with a 30pack year smoking history)

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45
Q

how does board basics want you to treat EtOH withdrawal?

A

CIWA or other symptom triggered regimen (not phenobarb)

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46
Q

what is the safest long-acting opiate in liver and kidney failure?

A

fentanyl

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47
Q

why should you avoid tramadol as an analgesic?

A

significant drug interactions especially with serotonergic medications

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48
Q

What is the treatment for anticipatory nausea?

A

benzos

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49
Q

What is the treatment for nausea 2/2 increased intracranial pressure?

A

glucocorticoids

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50
Q

what is a way to reduce dyspnea in nonhypoxic patients?

A

fans!

don’t be tricked!

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51
Q

What is the treatment for depression in a patient with a life expectancy of less than 6 weeks?

A

psychostimulant like methylphenidate (Ritalin)

Benzos can reduce anxiety in palliative care setting

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52
Q

duration of chronic cough

A

> 8 weeks

53
Q

Most common causes of chronic cough?

A

postnasal drip
asthma
GERD

54
Q

workup of chronic cough?

A

CXR

Smoking cessation and stop ACEi for 4 weeks before additional workup

55
Q

What is the diagnosis?

Chronic cough with postnasal drip, frequent throat clearning, nasal discharge

A

allergic rhinitis

tx 1st gen antihistamine decongestant or intranasal steroids

56
Q

What is the diagnosis?

asthma with cough with exercise or cold exposure and chronic cough

A

cough variant asthma

dx: methacholine or exercise challenge test if uncertain diagnosis
tx: standard ashtma therapy may take 6 weeks to respond

57
Q

What is the diagnosis?

chronic cough and GERD symptoms

A

tx for GERD may take 3 months to respond

58
Q

What is the diagnosis?

chronic cough with normal CXR, normal spirometry and negative methacholine challenge test?

A

possible nonasthmatic eosinophilic bronchitis

dx: sputum induction or bronchial wash for eosinophils
tx: inhaled steroids

59
Q

What is the treatment for systemic exertion intolerance disease (formerly chronic fatigue syndrome)?

A

CBT, graded exercise, no meds are approved

60
Q

what diagnostic maneuver can you use to distinguish central from peripheral vertigo?

A

dix hallpike

61
Q

What is the diagnosis?

vertigo that lasts days associated with nausea and often vomiting

A

vestibular neuritis

62
Q

What is the diagnosis?

vertigo lasting 10-30 seconds and nausea associated with abrupt head movement

A

BPPV

tx: epley manuever

63
Q

What is the diagnosis?

vertigo that lasts days associated with nausea and often vomiting with associated hearing loss

A

labyrinthitis

64
Q

What is the diagnosis for suspected central vertigo?

A

brain MRI

65
Q

What is the treatment for peripheral vertigo

A

steroids
centrally acting anti-histamines like meclizine
vestibular suppressants like benzos
anti-emetic drugs

66
Q

a positive romberg and wide based gait is suggestive of what back pathology?

A

spinal stenosis

67
Q

how do you diagnose spinal stenosis?

A

MRI

68
Q

What is the treatment for spinal stenosis

A

surgery

69
Q

what is the mgmt of neoplastic epidural spinal cord compression?

A

steroids, urgent MRI of entire spine

70
Q

Most common cause of knee pain in women <45yo

A

prepatellar bursitis

worse with prolonged sitting, descending stairs and overuse (running)

tx: PT and NSAIDs

71
Q

knee pain that presents with clicking, locking and pain - What is the diagnosis?

A

meniscal tear

72
Q

When should a patient have surgery for a meniscal tear?

A

symptoms that last beyond 4 weeks

73
Q

true hip pain usually presents where?

A

groin

don’t be tricked!

74
Q

Who needs an xray of their ankle

A

cannot bear weight

bone pain localized to the lateral or medial malleolus, base of the 5th metatarsal or navicular bone

75
Q

What are secondary causes of bilateral carpal tunnel syndrome

A 
diabetes
hypothyroidism
pregnancy
paraproteinemias
RA of the wrist
76
Q

How can you distinguish a rotator cuff tear vs. a rotator tendinitis on exam/history?

A

both usually have pain
weakness is suggestive of a tear > tendinitis

MRI is the best imaging modality for tears

77
Q

Patient with diabetes, LDL above what is an indication for a statin?

A

70

78
Q

who is a candidate for bariatric surgery?

A

patients with BMI > 40 or >35 with comorbiditis (severe oSA, DM, severe joint dz)

79
Q

diffusely tender testes is indicative of what illness?

A

orchitis

80
Q

What is the treatment for prostatitis

A

bactrim or FQ for 4-6 weeks

81
Q

GAIL scores above what is threshold for breast CA prophylaxis?

A

1.7%

82
Q

what is breast Ca prophylaxis?

A

tamoxifen before menopause

tamoxifen and raloxifene or exemestane after menopause

83
Q

Who should you screen for BRCA mutations

A

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
Q

how should you screen patients with BRCA mutations for breast cancer?

A

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
Q

what BI-RADS categories -> biopsy?

A

4 or 5

86
Q

what HPV genotypes are high risk for cervical Ca?

A

16 and 18

87
Q

When should you start cervical Ca screening?

A

age 21

88
Q

What are contraindications to hormonal birth control?

A 
uncontrolled HTN
breast Ca
VTE
Liver disease
migraine with aura

No estrogen if >35yo and smoke more than 15 cigarettes a day

89
Q

How can you treat the vasomotor sx of menopause?

A

systemic hormone therapy (need to include progesterone if woman has an intact uterus)

other options:
- venlafaxine
desvenlafaxine
paroxetine
citalopram
escitalopram
gabapentin
90
Q

What are common causes of abnormal anovulatory uterine bleeding

A 
PCOS
hypo or hyperthyroidism
hyperprolactinemia
chronic liver or kidney dz
medications
91
Q

What thickness of endometrium should prompt a biopsy in postmenopausal women?

A

> 4mm

92
Q

What is the treatment for endometriosis?

A

NSAIDs

OCPs

93
Q

what is the mgmt of trichomoniasis

A

oral Flagyl for patient AND partner
test for other STIs

*retest within 3 months!

94
Q

What is the diagnosis?

acute hyperpurulent ocular discharge in a sexually active adult

A

neisseria gonorrhoeae conjunctivitis

topical and systemic abx and Optho referral emergently

95
Q

What is the diagnosis?

itchy and tearing of eyes ad then nasal congestion

A

allergic conjunctivitis

96
Q

What is the diagnosis?

pain, photophobia, inflammation confined to corneal limbus, corneal irregularity and edema

A

iridocyclitis or keratitis

Consider spondyloarthropathies, sarcoid, zoster
emergency optho referral

97
Q

What is the diagnosis?

deep unilateral ocular pain, nausea, vomiting, fixed nonreactive pupil, shallow anterior chamber

A

acute angle closure glaucoma

emergency ophtho referral

98
Q

What is the diagnosis?

severe ocular pain that is worse with eye movement and light exposure, raised hyperemic lesion that obscures the vasculature

A

scleritis

commonly associated with collagen vascular diseases and rheumatoid diseases

emergent optho referral

99
Q

What is the diagnosis?

nonpainful red, flat, superficial lesion that allows visualization of the underlying vasculature

A

episcleritis

self-limited, no treatment

100
Q

What is the diagnosis?

red eye with scales and crusts around the eyelashes or dandruff like skin changes and greasy scales around the eyelashes

A

blepharitis

tx: warm compresses, topical abx

101
Q

Should you treat a red eye with topical steroids?

A

no

don’t be tricked!

102
Q

What is the treatment for wet age related macular degeneration

A

laser photocoagulation

103
Q

What is the diagnosis? curtain coming down over vision?

A

retinal detachment

optho emergency

104
Q

What is the diagnosis?

painless monocular vision loss in a diabetic

A

central retinal artery occlusion

105
Q

how manage progressive asymptomatic sensorineural hearing loss?

A

MRI or CT to evaluate for acoustic neuroma

106
Q

What is the diagnosis?

nonseasonal rhinitis with negative skin tests

A

chronic nonallergic rhinitis (vasomotor rhinitis)

107
Q

What is the diagnosis?

refractory congestion after chronic use of topical nasal decongestatnts

A

rhinitis medicamentosa

108
Q

What is the diagnosis?

nasal congestion in the last 6 or more weeks of pregnancy

A

pregnancy rhinits

109
Q

What is the treatment for rhinitis?

A

intranasal steroids

then intranasal antihistamines or oral combo antihistamines/decongestants

topical ipratropium

110
Q

what anti-depressant is safest for patients with CVD

A

sertraline

111
Q

What is the treatment for GAD

A
  1. CBT
  2. SSRIs or SNRIs
    benzos are okay for short term while titrating antidepressant doses
112
Q

what is the difference between malingering and factitious disorder

A

malingering: adopts a physical symptom for the purpose of gain

factitious disorder: patient adopts symptoms to remain in the sick role

113
Q

What is the treatment for bulemia

A

CVT and antidepressants - fluoxetine or imipramine

114
Q

What is the treatment for anorexia

A

CBT, no meds

115
Q

what is an abnormal get up and go test

A

> 12 seconds

116
Q

What is the diagnosis?

daytime frequency, nocturia, bothersome urgency

A

urge incontinence

117
Q

how treat urge incontinence

A
  1. bladder training

2. anti-cholinergic drugs - oxybutynin, tolterodine

118
Q

What is the diagnosis?

involuntary release of urine secondary to effort or exertion

A

stress incontinence

119
Q

What is the treatment for stress incontinence

A

pelvic floor muscle training

120
Q

What is the diagnosis?

urgency and involuntary release of urine

A

mixed incontinence - stress and urge

tx: bladder training and pelvic floor muscle training

121
Q

What is the diagnosis?

newly constant dribbling of urine, incomplete bladder emptying, high postvoid residuals

A

overflow incontinence

tx timed urination, intermittent cath

122
Q

is urodynamic eval helpful to diagnose incontinence

A

not usually

123
Q

who needs an EKG pre-op

A

CAD
significant arrhythmia
stroke or TIA history
PAD

124
Q

do low risk surgeries require cardiac testing even if a calculated risk score is elevated?

A

no

don’t be tricked!

low risk: cataract, carpal tunnel release, breast biopsy, inguinal hernia repair

125
Q

greatest benefit from smoking cessation pre-op is from quitting how long before surgery?

A

at least 8 weeks

126
Q

how long before surgery should you stop warfarin?

A

5 days

127
Q

how long should you stop NOAC before surgery

A

1-2 days unless GFR less than 50

128
Q

how long after surgery should you restart warfarin or a NOAC?

A

12 -24 for warfarin

24 for NOAC

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