General Medicine

Question 1

When to Screen for Barretts

Answer 1

1. GERD X 5 YEARS
2. AGE >50Y0
   Plus >/= 2 of the following:
   - Obesity
   - Smoking
   - Nocturnal Sx
   - Hiatal Hernia

Question 2

Copper Deficiency

Answer 2

Fragile Hair, ataxia, neuropathy, muscle weakness, osteoporosis

Question 3

Zinc Deficiency

Answer 3

Alopecia, Poor wound healing, Night blindness

Question 4

Vitamin A deficiency

Answer 4

Skin rash, night vision problems, poor bone growth

Question 5

Breaking Bad News (SPIKES)

Answer 5

SETTING- WHERE
PERCEPTION- WHAT DO THEY KNOW 
INVITATION- HOW MUCH WOULD THEY LIKE TO KNOW 
KNOWLEDGE- TELL THEM 
EMPATHY
STRATEGIZE 
"SPIKE"

Question 6

Proteinuria on UA

1. dipstick- albumin
2. Prot/Creatine Ratio
3. Albumin/Cr Ratio

Answer 6

Dipstick: 
trace <30
1+ 30
2+ 100
3+ 300
4+ >1000

Prot/Cr >150 = proteinuria

Albumin/Cr >30= proteinuria (mild), >300 (severe)

Question 7

CI to testosterone replacement

Answer 7

1. CAD
2. Untreated HF
3. PSA >4.0
4. untreated OSA
5. Polycythemia
6. Breast/Prostate Cancer
7. LUTS

Question 8

Erythema multiforme

Answer 8

Target shaped lesions with dark center lesion
mucosal erosions

caused by HSV, disseminated drug reactions, mycoplasma

Question 9

GERD Treatment

Answer 9

*** only applicable for GERD not dyspepsia

1. Trial of PPI
2. BID PPI, then
3. EGD
4. pH testing to ensure true reflux disorder,
5. Manometry to ensure no motility disorder
6. Surgery (does not protect against barretts or adenocarcinoma)

Question 10

Drugs that elevate BP

Answer 10

NSAIDS
Antidepressants (TCA, doxepin) 
Steroids 
OCP 
Decongestants
Pseudoephedrine
Migraine 
EPO

Question 11

Renovascular Hypertension Clues

Answer 11

1. malignant HTN (end organ)
2. Resistant HTN
3. Onset of HTN after age 55yo
4. Onset of HTN in known athlerosclerosis
5. ** recurrent flash pulmonary edema

• Increase in Cr >30% with initiation of ACE/ARB
• Atrophic Kidney

Dx: Doppler US

Tx: treat cause for stenosis (lipid lowering meds ex. )

Question 12

Treatment of HPV

Answer 12

Clinical Diagnosis
Examine Cervix, anal canal, and urethra for lesions

Tx:

• Podophyllotoxin, for trichloroacetic acid
• Surgery if fails topical