General Medicine Flashcards
If nystagmus with Dix-Hallpike maneuver is vertical what type of vertigo is it? Peripheral or central?
Central
What is the triad for Meniere Disease?
- Vertigo
- Low frequency hearing loss
- Tinnitus
What is cause of shoulder pain if Apley scratch test (touch superior and inferior aspects of opposite scapula) is positive?
Rotator cuff problem
What is cause of shoulder pain is Neer test is positive (forced flexion of pronated arm)?
Subacromial impingement
What is cause of shoulder pain if Hawkins test is positive (forward flexion of the shoulder to 90 degrees and internal rotation)?
Supraspinatous tendon impingement
What is cause of shoulder pain if patient has positive drop-arm test (attempted slow lowering of arm to waist)?
Rotator cuff tear
What is the cause of shoulder pain if positive cross-arm test (forward elevation to 90 degrees and active adduction)?
Acromioclavicular joint arthritis
What is the cause of shoulder pain if positive Spurling test (spine extended with head rotated to affected shoulder while axially loaded)?
Cranial nerve root disorder
What is the cause of shoulder pain if positive apprehension test (anterior pressure on the humerus with external rotation)?
Anterior glenohumeral instability
What is the cause of shoulder pain if positive relocation test (posterior force on the humerus while externally rotating the arm)?
Anterior glenohumeral instability
What is the cause of shoulder pain if positive sulcus sign (pulling down on elbow or wrist)?
Inferior glenohumeral instability
What is the cause of shoulder pain if positive yergason sign (elbow flexed to 90 degrees with forearm pronated)?
Biceps tendonitis or instability
What is the cause of shoulder pain if positive speed maneuver (elbow flexed to 20 to 30 degrees and forearm supinated)?
Biceps tendonitis or instability
What is the cause of shoulder pain if positive “clunk” sign (rotation of loaded shoulder from extension to forward flexion)?
Label tear/disorder
Do testicular torsion or epididymal pain improve with raising the affected testicle?
Epididymitis
What is the length of treatment for epididymitis?
21 days
Do varicoceles occur more on the right or left?
Left
What is diagnostic test of choice for breast mass if age
Ultrasound
What is diagnostic test of choice for breast mass if woman > age 35?
Diagnostic mammogram
What form of biopsy is best for solid breast lesions?
Core needle biopsy
What is only medication approved for treatment of cyclic mastalgia?
Danazol
What are contraindications to using OCPs?
H/o thrombosis Liver disease Breast cancer Migraine with aura Uncontrolled hypertension
A copper IUD can be implanted within how many days to act as emergency contraception?
5 days
How far after intercourse can Plan b (levonorgestrel) be taken for emergency contraception?
72 hrs, may be efficacious up to 5 days
How long after sexual intercourse call Ella (ulipristal) be used for emergency contraception?
120 hrs (5 days)
Which SSRIs are potentially teratogenic?
Fluoxetine
Paroxetine
How long should a person have amenorrhea to be considered to have gone through menopause?
12 months
What are absolute contraindications to hormonal therapy for menopausal symptoms?
Pregnancy Thrombosis CVA Coronary artery disease Unexplained vaginal bleeding Breast or endometrial cancer Hypertriglyceridemia Immobilization
What defines oligomenorrhea?
> every 35 days
What defines polymenorrhagia?
Bleeding more frequent that every 24 days
What endometrial stripe thickened requires further eval for endometrial cancer?
5 mm
How many candidal vaginitis infections in a year is considered recurrent?
> 4 in a year - treat with topical imidazole x 7-14 days or PO fluconazole q3 days x 3 followed by weekly x 6 months
What is the most common viral etiology of conjunctivitis?
Adenovirus
What is the most common bacterial etiology of conjunctivitis?
S aureus
What is severe complication of Neisseria gonorrhea conjunctivitis?
Corneal perforation
What underlying conditions are associated with scleritis?
Rheumatoid arthritis
Tuberculosis
Syphilis
What antibiotic should be used for blepharitis with associated rosacea?
Oral tetracycline
What eye condition has deposits of drusen?
Dry macular degeneration
What type of macular degeneration is more vision threatening - wet or dry?
Wet
What is treatment of dry macular degeneration?
Antioxidants - vit C or E and beta carotene
Zinc
Laser therapy
VEGF inhibitor
What is leading cause of irreversible blindness in the world?
Primary open angle glaucoma
What cup to disc ratio is a finding of glaucoma?
> 0.5
What complication occurs if acute angle closure glaucoma is not treated?
Optic nerve atrophy
What is leading cause of blindness globally (reversible)?
Cataracts
What is epiphora?
Excessive tearing of eyes due to impaired drainage of the lacrimal duct system
What eye disorder presents with sudden unilateral vision loss, cotton wool spots, tortuous retinal veins?
Central retinal vein occlusion (CRVO)
What eye condition presents with sudden loss of vision in one eye, pale retina, cherry red fovea and afferent pupillary defect?
Central retinal artery occlusion
What is endophthalmitis?
Inflammation of the aqueous and vitreous humors - usually from infection or after eye surgery
What is Hutchinson sign?
Herpes zoster infection that involves the tip of the nose - usually indicates corneal involvement
What dietary change can precipitate worsening of Ménière’s disease?
High salt intake
Which tuning fork is used for Rinne test - 256 or 512 hz?
512 Hz
Which hearing test places a 512 hz running fork against the mastoid?
Rinne test - if sound can be heard better on the mastoid then likely conductive hearing loss
Which type of hearing loss (conductive vs sensorineural) in the Weber test be louder in the affected ear?
Conductive
What conditions can cause pulsatile tinnitus?
AV malformation
Carotid artery stenosis
Paraganglioma (glomus tumor)
What are the 2 most common bacterial causes of acute otitis externa?
Pseudomonas
Staph aureus
Acute otitis externa with presence of white or black fungal balls indicate what organism?
Aspergillus
What post strep complication can NOT be caused by group C or G streptococci?
Acute rheumatic fever
What bacteria is know to cause lemierre syndrome (septic thrombosis of IJ)?
Fusobacterium necrophorum
What vitamin deficiency is associated with atropic glossitis?
B12
Which type of vertigo, central or peripheral, habituates with Dix-Halpike maneuver?
Peripheral
What is Russell sign?
Scarring on dorsum of the hand from recurrent purging in bulimia
What MMSE score is mild dementia?
19-24
What pharmacological therapy can help with stress incontinence if pelvic floor exercises don’t work?
Duloxetine
What pressure ulcer stage has full thickness breakdown with visible subq fat but no tendons, bone or ligament seen?
Stage 3
Which lipid lowering agent needs to be held prior to surgery?
Cholestyramine
What dose of steroids a patient is taking requires stress dosing?
If taking >10 mg/day for 3 weeks or more
When should estrogen be discontinued before surgery?
Several weeks- increased risk of thrombosis
What psychiatric medication class needs to be discontinued prior to surgery?
MAOIs
Which patients require DVT prophylaxis for 5 weeks after surgery?
Orthopedic surgeries
Abdominal or gynecological surgery for malignancy
History of VTE
What CHADS2 score for a fib requires bridging therapy for surgery?
> 4
What medication can be given for platelet dysfunction due to underlying kidney/liver disease prior to surgery to decrease bleeding?
Desmopressin 1 hr prior to surgery
Which hormone LH or FSH is responsible for ovulation?
LH
What vitamin deficiency presents with skin pigmentation cracking and crusting?
Niacin
What vitamin deficiencies present with glossitis?
Niacin folate and vitamin b12
What condition should be considered if a person faints while doing upper extremity exercise?
Subclavian steal syndrome
What is Ramsey hunt syndrome?
Zoster infection of the external ear canal of facial nerve. May also have facial paralysis and sensorineural hearing loss
What cause of conjunctivitis is associated with giant papillary conjunctivitis with itchy, watery discharge and preauricular LAD?
Chlamydial conjunctivitis
