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General internal medicine Flashcards

1
Q

Approach to breast cancer screening in women aged 40-49

A

Individualized, shared decision making

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2
Q

Postoperative VTE prophylaxis in patient undergoing major orthopedic surgery (hip, knee)

A

Continue low molecular weight heparin following hospital discharge for up to 35 days

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3
Q

First line for neuropathic pain syndromes

A
  • SNRI’s (duloxetine)

- Gabapentin

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4
Q

FDA warning about gabapentinoids

A

May cause respiratory depression in patients with opioid use and COPD

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5
Q

Management of depression at the end of life

A

methylphenidate

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6
Q

Treatment of bacterial conjunctivitis

A

Trimethoprim-polymyxin B or erythromycin topical abx

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7
Q

Treatment of eye irritation due to seasonal allergies

A

olopatadine ophthalmic drops

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8
Q

What does acceptability of number needed to treat depend on?

A

Risks associated with the condition, cost and side effects of treatment

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9
Q

Treatment of choice for bacterial prostatitis

A

6 week course of bactrim or cipro (most due to e coli)

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10
Q

Vaccination of a health care worker

A
  • 2nd dose of MMR (increased risk of contracting measles, mumps, and rubella) (if not received in childhood)
  • Hep B vaccination
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11
Q

Management of in-flight medical emergency

A

Connect with ground-based physician (most airlines have 24-hour call centers with a ground-based physician to aid in event of an in-flight emergency)

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12
Q

Management of elderly patient with advise on driving who has multiple risk factors for accidents

A

Advise patient to stop driving

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13
Q

risk factors for accidents

A

Cognitive impairment, minor accidents, concerns from family members

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14
Q

Clinical features of systemic exertion intolerance disease (SEID)

A 
Fatigue of at least 6 months duration
Postexertional malaise
Unrefreshing sleep
Cognitive impairment
Orthostatic intolerance (symptoms worse when standing up)
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15
Q

First step with suspected cauda equina

A

STAT MRI

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16
Q

Evaluation of a breast mass

A

IF younger than 30 + low risk mass –> just US (breast tissue is more dense in younger women which limits utility of mammography)
IF older than 30 –> mammograph + US

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17
Q

What is the definition of a breast mass

A

Lesion that persists throughout the menstrual cycle and differs from the surrounding breast tissue

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18
Q

Main utility of US in evaluation of breast masses

A

Ability to differentiate cystic from solid lesions

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19
Q

appearance of breast cyst on exam

A

Symmetric, round borders, mobile

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20
Q

Next step if US reveals a solid lesion in young woman with breast mass

A

biopsy

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21
Q

Indications for bariatric surgery

A

Patient who doesn’t lose weight with lifestyle modifications
BMI of 40 or greater
OR BMI of 35 + obesity-related comorbid conditions

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22
Q

Features of ACE inhibitor induced cough

A

Dry cough + within 1-2 weeks of starting ACEi

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23
Q

Term for genetic cunsomer testing

A

Direct-to-consumer (DTC) genetic testing

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24
Q

How most consumer genetic testing works + clinical relevance

A
  • Genotyping Single-nucleotide polymorphisms (SNPs)
  • common but low penetrance (therfore most people don’t develop disease and thus contribute little to overall disease risk)
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25
Q

USPSTF recommendation on prostate cancer screening

A

Age 55-69 – Discuss potential benefits and harms of PSA screening for PC

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26
Q

USPSTF recommendation on aspirin and colorectal cancer

A

Adults 50-59 with a 10 year ASCVD risk of 10% or higher

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27
Q

Initial evaluation of chronic insomnia

A

Sleep diary (need to identify adverse environmental factors, inappropriate exposure to screens)

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28
Q

Lab correlated with restless legs syndrome

A

Low ferritin

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29
Q

Clinical features of optic neuritis

A

Acute vision loss + eye pain with movement + color perception change + afferent pupillary defect + often woman with MS

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30
Q

Cervical cancer screening

A

Age 25-65

- HPV/Pap cotest every 5 years or a Pap test every 3 years.

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31
Q

When cervical cancer screening can be discontinued

A

Age 65 when *patient has had adequate prior negative screening

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32
Q

Initial evaluation of cognitive impairment in the elderly

A

Abbreviated testing such as –
Mini-Cog
Mini-Mental State Examination (now proprietary though with cost per use)
Montreal Cognitive Assessment
*don’t usually need formal neurocognitive testing beyond these to diagnose cognitive impairment

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33
Q

Cervical sprain clinical features

A

Aching sensation isolated to neck + decreased ROM + tenderness to palpation
- most common cause of neck pain

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34
Q

Myelopathy definition

A

Spinal cord injury caused by severe compression

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35
Q

Next step after patient is diagnosed and treated for trichomonas vaginalis infection

A
  • Treat partner (empirically, don’t test) + screen for other STIs (highly correlated with HIV)
  • Retest woman after 3 months also
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36
Q

new term for hypochondriasis

A

illness anxiety disorder

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37
Q

Definition of somatic symptom disorder

A

One or more somatic symptoms + at least 6 months + significant impact on life + associated with excessive thoughts or feelings related to symptoms

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38
Q

Other drugs and classes of drugs that can cause lower extremity edema

A
  • Vasodilators (minoxidil, hydral, CCB’s, alpha-blockers)
  • NSAIDS
  • pregabalin (calcium channel blocker)
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39
Q

MDD criteria

A

5 of 9 symptoms

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40
Q

Physical exam finding that suggests epidydimitis

A

Positive Prehn sign (relief of pain with scrotal elevation)

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41
Q

Physical exam finding that suggests varicocele

A

Scrotal mass that increases with standing and decreases while supine

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42
Q

Study used to identify a hydrocele

A

transillumination study (mass will transilluminate if hydrocele)

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43
Q

pharmacologic treatment of low back pain per boards (once nonpharmacologic options fail)

A

NSAIDs at lowest possible dose

- little to no evidence that acetaminophen is effective in reducing pain

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44
Q

evaluation of recurrent unilateral epistaxis

A

Nasal endoscopy (rule out neoplasm)

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45
Q

Preoperative DAPT management for patient who has had STENT placed recently

A

Hold plavix 5-7 days before surgery (assuming minimum of 30 days if bare metal or 3 months after drug-eluting)

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46
Q

Pneumovax indicatinos

A

Age 19-64 w/ chronic heart, liver, or lung disease, **DM2, CSF leak, *alcoholic, or cigarette smoking

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47
Q

Zoster indication

A

All adults 50 or older

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48
Q

PCV13 indications

A

19-64 w/ immunocompromise, cochlear implants, or history of CSF leaks + all adults 65 or older

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49
Q

difference between bulimia and binging subtype of anorexia nervosa

A

Patients with anorexia nervosa have a low BMI

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50
Q

Management of cyclic mastalgia

A

Wear well-fitting bra

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51
Q

How to determine if vertigo is central (ie vertebrobasilar ischemia, infarction, hemorrhage)

A
  • Dix-Hallpike, which produces nystagmus with immediate onset + nystagmus of long duration + nystagmus direction varies depending on direction of patient’s gaze
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52
Q

Knee condition caused by repetitive stress on anterior knee

A

prepatellar bursitis

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53
Q

Management of prepatellar bursitis

A

Fluid aspiration w/ gram stain and culture (can also be caused by gout and infection)

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54
Q

how to prevent pressure ulcers

A
  • advanced static mattress (made of specialized sheepskin, foam or gel)
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55
Q

USPSTF recommendation on screening for HIV

A

One-time of anyone over age 15 + repeat for high-risk people

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56
Q

indication for fibrates

A

fasting triglyceride level of 500 or higher (to prevent pancreatitis)

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57
Q

workup of suspected overflow incontinence

A

PVR

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58
Q

Term for continence due to neurogenic bladder + presentation

A
  • (overflow incontinence)

- constant urine leaking and dribbling

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59
Q

common causes of overflow incontinence

A

*BPH (outflow obstruction)

DM2 (neurogenic bladder)

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60
Q

clinical features of chronic pelvic pain syndrome

A

chronic pelvic/perineal pain + intermittent voiding symptoms + no evidence of infection

61
Q

treatment of chronic pelvic pain syndrome

A

Neuromodulatory meds (pregabalin, gabapentin, nortriptyline)

62
Q

Management of somatic symptom disorder

A

CBT

63
Q

central retinal artery occlusion clinical features

A

painless
acute loss of vision
APD
*cherry red spot

64
Q

acute angle-closure glaucoma presentation

A

severe eye pain + vision loss

65
Q

New term for pseudotumor cerebri

A

idiopathic intracranial hypertension

66
Q

idiopathic intracranial hypertension clinical features

A

diplopia + headache + bilateral visual symptoms + papilledema

67
Q

retinal detachment clinical features

A
  • photopsias (flashes of light)
  • floaters
  • progressive vision compromise that my involve partial visual fields
68
Q

management of patient with severe refractory dyspnea/end stage COPD who doesn’t want further medical therapy

A

low dose oral opioids

69
Q

High ankle sprain exam features

A
  • pain elicited by compressing the leg at mid-calf (squeeze test)
  • pain elicited by having patient cross the legs with the lateral malleolus of the injured leg resting on the other knee (Crossed-leg test)
70
Q

Treatment of vulvovaginal candidiasis

A

Intravaginal azole

71
Q

Evaluation of obesity

A

BP
Fasting blood glucose or A1c
Lipid panel
*TSH not needed, prevalence of endocrine cause of obesity is very low, should be reserved for patients with symptoms of thyroid disease.

72
Q

Treatment of unexplained chronic cough

A

Multimodal speech therapy (teaches you how to suppress cough, breathing exercises)

73
Q

Treatment of medically unexplained symptoms

A

CBT

74
Q

Imaging for nonspecific low back pain?

A
  • not indicated

- only indicated if neuro deficits,

75
Q

Function of APC gene

A

Tumor suppressor gene

76
Q

Clinical presentation of patients with APC gene mutations

A

High penetrance (almost all develop colon cancer with most developing colon cancer before age 40)

77
Q

Particular NSAID that has been shown to cause regression of colorectal adenomas in FAP

A

Sulindac

78
Q

AAA screening guideline

A

65-75

+ EVER smoker (even if quite greater than 15 years ago)

79
Q

Osteoporosis screening in men

A
  • INSUFFICIENT evidence per USPSTF
80
Q

lung cancer screening guidelines

A

Age 55-80 years + **20 pack year smoking history + have quit within past 15 years

81
Q

Score for determining patients response to medical treatment

A

FRAIL

82
Q

Meralgia paresthetica presentation

A

Paresthesias on anterolateral thigh

83
Q

Noncyclic mastalgia clinical features

A

Focal breast pain but no palpable mass

Umbrella term for trauma, cysts, duct ectasias, mastitis,

84
Q

Noncyclic mastalgia management

A

Breast US (despite absence of mass, 1% have cancer at the site of pain)

85
Q

Rule of thumb for correlation of likelihood ratios to increase in disease probability

A

LRs of 2,5,10 correspond to 15,30,45 percent increase in probability (add this percentage to pretest)

86
Q

What is an LR in general?

A

Indicator of how much the result of a diagnostic test will increase or decrease the pretest probability of a disease

87
Q

How to prevent post op VTE in pt at high risk for VTE

A

LMWH + SCDs

88
Q

Management of radiation induced nausea on cancer patients + why

A

Zofran (radiation is thought to cause mucosal injury and subsequent serotonin release)

89
Q

Cause of most pharyngitis

A

Typically all viral

90
Q

Approach to pharyngitis/strep testing

A

Determine CENTOR criteria (fever, tonsillar exudates, tender anterior cervical LAD, absence of cough)
*3 or more = test for strep

91
Q

other term for neurocardiogenic syncope

A

neurally mediated syncope

92
Q

management of urgency urinary incontinence

A

First line = behavioral therapy (bladder training and scheduled voiding)
second line = anticholinergic agents or mirabegron

93
Q

Cervical cancer screening in woman vaccinated against HPV

A

same as typical screening

94
Q

HPV testing and age

A

Not indicated in women younger than 30 years (high prevalence of transient HPV in this age group)

95
Q

varicocele treatment

A

Ibuprofen and scrotal support

96
Q

scleritis clinical features

A

patient with RA
eye pain
pain w/ gentle palpation of the globe
photophobia

97
Q

NSAIDs and bariatric surgery

A

Avoid (increased bleeding risk due to anastomoses and staple or suture lines and increased risk for marginal or gastric ulceration)

98
Q

Antihypertensives safe for pregnancy

A

Methyldopa
Labetalol
CCB’s

99
Q

patients with AF who need bridging prior to surgery

A

Only patients with mechanical valves

100
Q

Management of recurrent major depression (3 or more episodes or persistent depression)

A

Long-term maintenance therapy with an SSRI

101
Q

Management of cervical radiculopathy

A

Conservative – stretching and strengthening exercises of neck muscles w/ neck exercises (usually resolves within 2-3 months)
*only image if history of malignancy, progressive neuro symptoms, or myelopathy findings

102
Q

HPV vaccination age range

A

11-12

13-26

103
Q

Tdap vaccination indication if unknown

A

Indicated for all adults aged 19 years and older

104
Q

Treatment of menopause

A

IF moderate to severe vasomotor symptoms (hot flashes, night sweats) + at low risk for breast cancer, coronary artery disease, stroke, or VTE –>

105
Q

Labyrinthitis clinical features

A
  • severe, persistent peripheral vertigo + hearing loss + preceded by a viral infection
106
Q

Vestibular neuronitis clinical features

A
  • preceded by a viral infection + NO hearing loss (unlike labyrinthitis)
107
Q

Indications for antibiotics with sinusitis

A
  • symptoms lasting more than 10 days, severe, high fever, purulent nasal discharge for at least 3 consecutive days
108
Q

Preferred opioid for patients with cancer-related pain and CKD

A

hydromorphone

IF not opioid naive –> fentanyl patch

109
Q

When preoperative cardiac stress testing is needed

A

1) Patients at elevated risk for a major cardiac event

2) Functional capacity can’t be determined

110
Q

How to manage impairment (cognitive or substance use) in a physician colleague

A

Directly approach the colleague with concerns of impairment

- Unless patient harm seems likely, in which place you need to refer to state medical board

111
Q

Management of ED in a patient who experiences nocturnal penile tumescence per boards

A

Psychotherapy or CBT (most likely situational or mood related)

112
Q

Sildenafil contraindication

A

Nitrates

113
Q

Management of patient with ED and symptomatic androgen deficiency

A

testosterone supplementation

114
Q

Clinical features of morton neuroma

A
  • pain between metatarsal heads
  • sensation of walking on a pebble
  • paresthesias
115
Q

Plantar fasciitis features

A

Pain improves with walking

116
Q

Model used for PDSA cycle

A

Model for Improvement

117
Q

Management of functional incontinence in dementia patients

A

Prompted voiding every 2-3 hours

118
Q

What is functional incontinence

A

Patient who can’t reach and use toilet in time (eg demented patients)

119
Q

Management of abnormal uterine bleeding (without secondary cause) in woman with contraindication to combined OCP

A

first line = Progestin-containing IUD (levonorgestrel-containing IUD)
second line = endometrial ablation or hysterectomy

120
Q

Persistent postural perceptual dizziness clinical features

A

Dizziness or imbalance that worsens with motion or upright positioning or movement of objects in surrounding environment + precipitated by another vestibular process (eg. trauma, BPPV, psych conditions)

121
Q

Treatment for persistent postural perceptual dizziness

A

Vestibular therapy

SSRI or SNRI’s

122
Q

Lead-time bias concept

A

Early detection of a disease with a screening test leads to an increase in measured survival but not overall survival time (patient is diagnosed earlier during preclinical phase but intervention doesn’t enable patient to live any longer)

123
Q

selection bias concept

A

Study participants don’t accurately reflect population being studied

124
Q

First line therapy for alcohol use disorder

A

Naltrexone

125
Q

Step before initiating statin therapy always

A

CMP (ALT)

126
Q

When to screen for diabetes

A

Overweight + one other RF for DM2 (loosely defined)

*IF over age 45 –> everyone

127
Q

Criteria for BV diagnosis

A
  • Clue cells
  • positive whiff test (can be negative
  • pH greater than 4.5 (loss of hydrogen-producing lactobacilli and subsequent overgrowth of g vaginalis, mycoplasma)
  • thin and homogenous vaginal discharge
128
Q

BV treatment

A

Metronidazole or clindamycin

129
Q

Management of BPH if patient also has ED

A

Tadalafil

130
Q

Diagnosis of BPH

A

Enlarged prostate on rectal exam + LUTS

131
Q

Perioperative management of aspirin in patient with stent

A

Continue unless bleeding risk is prohibitively high

132
Q

Management of high breast density in mammogram

A

IF no additional breast cancer RF’s –> no additional screening (although breast density is an RF for breast cancer, further imaging with MRI has not been shown to have a survival benefit)
IF additional breast cancer RF’s –> breast MRI in addition to mammogram

133
Q

What is digital breast tomosynthesis?

A

Imaging technology that creates a three-dimensional image of the breast. Has been found to have sensitivity equal to or exceeding sensitivity of mammogram in detection of breast cancer in women with dense breasts but there isn’t enough RCTs or long term data to support it.

134
Q

Management of chronic pain when alternative methods have failed and patient has ESRD

A

cannabis oil

135
Q

management of baker cyst

A

no treatment

136
Q

Next step after determining peripheral vs central vertigo

A

MRI brain (rule out stroke) + MRA

137
Q

Presentation of central vertigo

A
  • usually have concomitant neurologic findings (eg ataxia, nystagmus, dysphagia, dysarthria, diplopia, postural instability, hemiparesis)
138
Q

Initial step for weight loss

A

First line = high-intensity behavioral therapy program (regular self monitoring of weight and calorie intake). Must be long term and require monthly contact.
Second line = pharmacologic therapy (phentermine, low dose topamax)

139
Q

medication used to reverse opioid-induced constipation

A

Methylnaltrexone

140
Q

Greater trochanteric pain syndrome (trochanteric bursitis) clinical presentation

A

Lateral hip pain + radiating down lateral leg to knee + pain over palpation of trochanter

141
Q

trochanteric bursitis treatment

A

Activity modification
APAP or NSAIDs
PT

142
Q

Term for pale dry vaginal mucosa + vaginal pain following menopause + vulvar itching

A

Genitourinary syndrome of menopause

143
Q

Vulvar lichen sclerosus clinical features

A
  • white, atrophic patches on skin + patches circumferentially involve vaginal introitus and perianal area (“figure 8” appearance)
144
Q

First step before prescribing long term opioids for pain

A

Opioid risk assessment

- IF high risk for opioid overdose –> prescribe naloxone

145
Q

When to hold NOACs before surgery

A

2 (low bleeding risk) or 3 (high bleeding risk) days

146
Q

Pes anserine bursitis location + clinical features

A

…

147
Q

Indications for bisphosphonates on chronic steroids

A

1) ALL men over 50 and postmenopausal women taking 7.5 mg/day or more of pred for anticipated course of 3 months
2) 10-year fracture risk greater than 20% regardless of dose or duration

148
Q

Treatment duration of SSRI for single episode of major depressive disorder + multiple episodes

A

6 months following acute response (continuation phase treatment) – then gradually taper and discontinue
IF 2 episodes – 1-3 following remission

149
Q

Management of UC flare

A

Systemic steroids + high dose 5-aminosalicylic acid compounds
IF signs of severe systemic toxicity Or toxic megacolon OR peritonitis – empiric abx

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