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General Internal Medicine > GIM > Flashcards

GIM Flashcards

1
Q

Plan-Do-Study-Act

A

quality improvement: plan intervention, apply on limited small scale, analyze, broader scale

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2
Q

Floaters, squiggly lines, flashes of light, sudden peripheral vision defect, progressive curtain

A

Retinal detachment

tx: surgery

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3
Q

Painless loss of vision

A

central retinal artery occlusion
elderly people
pale fundus with cherry red fovea

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4
Q

abrupt monocular vision loss, cloudy vision

A

central retinal vein occlusion
congested tortuous veins
retinal hemorrhage, cotton wool spots

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5
Q

post op vte prophylaxis in high risk patients (previous vte, ortho surgery, cancer)

A

28 days of lovenox if abdominal surgery
35 days of warfarin/aspirin for ortho surgeries
only use compression devices in patients with low risk / high risk of bleeding (antiplatelet therapy)

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6
Q

tenderness to palpation of acromioclavicular joint (superior shoulder) and pain with adduction and abduction above 120

A

acromioclavicular joint degeneration
tx: NSAIDs, activity modification
bilateral-rheumatoid arthritis

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7
Q

pain between 60 and 120 degrees of abduction, limited rotation, pain with full flexion, pain with Hawkins sign

pain with active shoulder abduction, painful arc, not passive motion

A

rotator cuff tendinitis
tx : steroid injection

supraspinatus tendinitis-conservative therapy

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8
Q

adhesive capsulitis

A

thickening of capsule around glenohumeral joint
gradual pain
avoid lying on affected side
no active/passive ROM

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9
Q

Rotator cuff tear

A

supraspinatus weakness, external rotation weakness, impingement, positive drop arm test (can’t slowly and steadily lower arm), can’t abduct above 60 degrees
get MRI

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10
Q

vaginal atrophy treatment

A

mild to moderate: lubricants and moisturizers

severe: vaginal estradiol tablets/ring

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11
Q

Bacterial vaginosis

A

vaginal discharge, increased ph, clue cells, positive whiff test
tx: metronidazole

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12
Q

thick, white potassium hydroxide positive vaginal discharge

A

yeast

tx: vaginal clotrimazole

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13
Q

Dependent bilateral symmetric lower extremity edema only (worsening with day)

A

Venous stasis
Tx: weight reduction, sodium restriction, leg elevation, compression stockings
no testing
*different from drug induced lower extremity edema-CCBs

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14
Q

palpitations then syncope

A

Arrhythmogenic syncope

episodal

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15
Q

Sensorineural hearing loss

A

Weber-heard better on unaffected side
Rinne-heard better through air than on mastoid
If no Meniere (hearing loss, vertigo, tinnitus) Get MRI to r/o meningioma, neuroma
If sudden-give steroids

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16
Q

Uncontrolled pain in cancer

A

Long acting morphine (30-50% of 24 hr dose) plus PO for breakthrough

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17
Q

Suspected BPH

A

r/o UTI, get U/A

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18
Q

Stage III ulcer

Stage IV ulcer

A

subq tissue-debridement
bone, tendons, muscle-debridement
Refractory-surgery

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19
Q

Pancytopenia (macrocytic anemia) low rec count

A

Vitamin B12 deficiency

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20
Q

Dizziness

A

Vertigo-spinning, peripheral (bppv, vestibular neuronitis, Meniere disease, aminoglycosides, herpes zoster, diagnosed with Dix-hallpike, vestibular suppressant trial) vs. central (other neuro symptoms, prolonged vertical nystagmus-get MRA)
Presyncope
Dysequilibrium

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21
Q

Cough, sore throat, coryza, rhinorrhea, nasal congestion, myalgia, fatigue, afebrile, conjunctival injection, nasal drainage, lungs clear

A

Rhinosinusitis (cold)
tx: chlorpheniramine (antihisUntamine), no abx
If > 10 days and bacterial is suspected-amoxicillin clavulanate

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22
Q

Unilateral conjunctivitis

Recurrent, seasonal, conjunctival edema, cobblestoning under eyelid

A

Viral
Allergic conjunctivitis
*no topical steroids

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23
Q

Pulsatile tinnitus

A

Listen
stenosis, AV malformation, glomus tumor
bruit-Doppler/MRA

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24
Q

Preop testing

A

Only test what you suspect is abnormal

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25
Q

Dyspnea in hospice patients with cardiopulm disease

A

morphine

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26
Q

Anterior nosebleeds

Posterior

A

Hold pressure for 15 to 30 mins

ENT

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27
Q

OCD treatment

A

SSRI + therapy (CBT)

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28
Q

Tingling first, second and third digits, pain in thenar eminence, pain with palmar flexion at wrist with elbow extended, pain with percussion over median nerve, intact strength

A

Dx: Carpal tunnel syndrome
Tx: wrist splinting and avoidance of repetitive wrist emotions
*no steroids if acute, weakness or sensory loss
Drugs/surgery only if refractive, sensory/motor loss, moderate-severe findings on electrodiagnostic studies

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29
Q

Recurrent syncope without heart disease

A

Tilt table test-neurocardiogenic vs orthostatic vs psych

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30
Q

Hypertension tx in diabetic with proteinuria

A

ARB

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31
Q

Hypertension in preg tx

Diabetes in preg tx

A

Labetalol, methyldopa (if htn before 20 weeks, it’s chronic htn)
Insulin preferred, metformin acceptable
ACEI, statin, ARBs contraindicated Aspirin may interfere with implantation

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32
Q

Urge incontinence tx

A

Tolterodine

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33
Q

Mild cognitive impairment

A

one or two domains (such as memory)
MMSE score of 24-25
<24-dementia

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34
Q

Start palliative care early

A

Along with even life prolonging therapy

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35
Q

Acute cervical radiculopathy without trauma/weakness/ myelopathy

A

Conservative-analgesics, avoidance of provocation

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36
Q

PPI trial for chronic cough secondary to GERD

A

3 months

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37
Q

Drugs that cause low testosterone

A

Opioids, steroids, hormones

Check morning level of testosterone

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38
Q

hypertriglyceridemia (>500) treatment

A

fenofibrate
Nicotinic acid (increases HDL, decreases LDL also) but increases gout
Omega 3 fatty acids-third line
colesevelam for decreasing LDL

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39
Q

Pain in superior and posterior testicle, high fevers, leukocytosis, dysuria, urgency, frequency

A

Epididymitis
gonorrhea, chlamydia
pain with direct palpation of the testicle, enlargement-orchitis

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40
Q

pelvic pain, UTI symptoms, tender prostate

A

acute prostatitis

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41
Q

xerophthalmia (dry eyes), xerostomia (dry mouth) + anti Ro SSA, anti La SSB, abnormal Schimer (tears)
polyarthritis, vasculitis, peripheral neuropathy, interstitial nephritis

A

Primary Sjogren syndrome

  • just dry eyes-meibomianitis*
  • secondary sjogren syndrome to RA/lupus*
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42
Q

Palpable breast mass

A

Evaluate even if unlikely to be cancer
in young woman: u/s-cyst (aspirate, cytology if bloody/recurrent), solid (biopsy)
If biopsy is benign-still follow up

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43
Q

Prevention of periop pulm complications

A

Pre and post op incentive spirometry

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44
Q

> 40 years with hematochezia

hemorrhoids

A 
colonoscopy
conservative treatment (no banding, etc.) unless refractory
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45
Q

prostate cancer screening

A

talk with patient, patient decides

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46
Q

obesity treatment

A

diet

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47
Q

Lower LDL with

Athesclerosis-goal LDL <100

A

Statin
lower drug-drug interactions with pravastatin (renally cleared)
do not combine atorvastatin, lovastatin, simvastatin with diltiazem/ rosuvastatin with warfarin

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48
Q

Excessive menstrual bleeding treatment

A

Moderate-medroxyprogesterone acetate for 21 days
Monophasic OCP 4x daily for 5 to 7 days, then qd
Orthostatic/dizzy-IV estrogen

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49
Q

Anterior knee pain worsened by sitting or stairs, pressure to patella with knee in extension and moving patella medially and laterally

A

palletofemoral pain syndrome-no testing

anterior knee pain+swelling+erythema-prepatellar bursitis due to recurrent trauma-aspirate fluid-no imaging needed

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50
Q

pain in anteromedial proximal tibia, swelling

A

pes anserine bursitis

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51
Q

chronic dizziness in elderly

A

multifactorial, disequilibrium
PT for gait training
vestibular rehab is for BPPV

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52
Q

> 60 yrs, menopausal vasomotor symptoms (hot flashes)

A

venlafaxine, paroxetine

  • if using estrogen, add progesterone to prevent cancer*-still get clots
  • if no uterus-estrogen only*
  • systemic therapy reasonable in healthy <60yo, time since menopause <10 years
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53
Q

DEXA

A

> 65 yo / >9.3% risk of fracture (FRAX)

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54
Q

Lipid screening

A

40-75 years q 5 years

10 year cardiovascular event risk of >10% + dyslipidemia/diabetes/htn/smoking-statin

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55
Q

Glucose screening

A

40-70 years who are obese or overweight q 3 years

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56
Q

Pre op cardiothoracic surgery

A

Spirometry for everyone

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57
Q

Lateral epicondylitis

A

repetitive wrist motion, pain over lateral elbow, pain with resisted wrist extension
tx: avoidance of pain inducing activities
refractory-surgery
clinical diagnosis

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58
Q

Quality improvement-Eliminating waste
-quality control of particular step

Root cause analysis results

A

Lean model-system inefficiencies
DMAIC (six sigma)-perfection

fishbone/ishikawa diagram

  • spaghetti diagram-workflow*
  • pareto chart-improvement initiatives*
  • control chart-effect of intervention*
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59
Q

Primary dysmenorrhea tx

A

NSAIDs/ COX 2 inhibitors

combined estrogen progestin pill

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60
Q

PMS/PMDD treatment

A

SSRI

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61
Q

Severe menstrual bleeding treatment

A

tranexamic acid

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62
Q

Most important measure to prevent pressure ulcers

A

Advanced static mattresses or overlays

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63
Q

Age to stop breast cancer screening

breast MRI+mammography

A 
75 yo (consider if life expectancy >10 years)
lifetime risk> 20%
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64
Q

Anorexia vs bulimia vs binge eating disorder

A

BMI <18.5 vs normal/overweight BMI vs. no compensatory behaviors

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65
Q

Aural fullness, hearing loss, fluid behind tympanic membrane, post URI or allergies
+evidence of infection

A

Otitis media with effusion
self-resolves in 12 weeks, refractory-miringotomy with tympanostomy tubes
acute otitis media-amoxicillin
otitis externa (external ear canal inflammation)-neomycin, polymyxin B, hydrocortisone

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66
Q

Postherpetic neuralgia tx

A

Lidocaine patch
Localized therapies such as lidocaine, capsaicin cream, preferable for neuropathies
Systemic neuropathic pain-gabapentin

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67
Q

eye pain, redness, photophobia, circumferential redness around the border of the sclera and cornea, pupillary miosis, flare cells in anterior chamber

A

uveitis
inflamed iris, body and choroid
may be associated with ankylosing spondylitis

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68
Q

redness, irritation, tearing in eyes, no pain

bilateral redness across entire sclera

A

episcleritis

scleritis

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69
Q

Drugs for weight

A

BMI>/30, 27 with comorbidities
Orlistat
Lorcaserin-appetite suppressant-do not use in increased serotonin pts
phentermine-topiramate: CI in glaucoma

70
Q

medically unexplained symptoms treatment

A

cognitive behavioral therapy, regularly scheduled visits

71
Q

Palpable breast mass with negative mammography (postmenopausal)

A

still biopsy

72
Q

Disequilibrium

A

unsteadiness with walking/standing
multifactorial including sensory (visual, auditory) deficits
physical therapy
CT not adequate for cerebellum-MRI instead

73
Q

postop anemia + cardiovascular disease

A

observe

transfuse only if symptomatic or hgb <7

74
Q

delivering bad news

A

SPIKES-setting, perception, invitation, knowledge, empathy, strategize
Be blunt

75
Q

Former smoker screening

A

55-80 years with >/30 pack year smoking history
quit in the last 15 years
low dose CT
reasonable life expectancy, willing to undergo surgery

76
Q

AAA screening

A

once by u/s in men 65-75 yo who have smoked 100 cigs/ first degree relative who required repair

77
Q

Cauda equina syndrome

A

Acute low back pain, radiculopathy, saddle anesthesia, urinary retention, areflexia, decreased anal tone
compression and ischemia of nerve roots
imaging and surgery

78
Q

Erectile dysfunction treatment

A

Lifestyle modification, then PDE 5 inhibitors

79
Q

Statin guidelines regarding clinical ASCVD (PAD, MI, Stroke, angina)

A

High intensity statin therapy regardless of LDL level unless >75 yo, CKD or use of interacting drug such as diltiazem-then moderate intensity

80
Q

Give niacin when

A

severe triglyceridemia, no response/tolerance to statin

81
Q

Cohort study outcome measure

A

Similar patients exposed to different risks or exposures
Relative risk
>1-more likely with exposure

82
Q

Case control study outcome measure

A

patients with disease vs. patients without a disease, retrospective
odds ratio

83
Q

Sacroiliitis

A

stepping off a curb, leg length discrepancies, pregnancy, scoliosis, lumbar fixation
positive FABER test, pain in posterior hip
rest, NSAID, PT

84
Q

Hip joint OA

A

Pain radiates to groin, limited ROM

85
Q

Piriformis syndrome

Trochanteric bursitis

A

Trapped sciatic-pain, tingling and numbness down leg

Lateral hip pain

86
Q

Direct to consumer DNA testing positive results only

A

Without family history or symptoms, don’t test

87
Q

Insulin in perioperative period

A

Stress-hyperglycemia
Give long acting (glargine, detemir), hold short acting as there will be no PO esp for short procedures
iv insulin for cardiac surgery

88
Q

bipolar tx-depressive phase

manic phase

maintenance phase

A

quetiapine (hypersomnolence, weight gain, tardive dyskinesia, hyperglycemia), olanzapine-fluoxetine

lithium, antipsychotics, antiepileptics

lamotrigine

89
Q

Obstructive sleep apnea post op management

A

nonsupine positioning, continuous pulse ox, be careful about opioids/sedatives
If hypoxic/apneic-CPAP

90
Q

Chronic fatigue syndrome (systemic exertion intolerance) tx

A

CBT, graded exercise program

91
Q

OCP in migraine patient

A

No estrogen

minimize bleeding by not using progestin only methods

92
Q

Screening test bias-aggressive disease in non screened cohort vs less aggressive in screened cohort

A

Length time bias

93
Q

Stress dosing of steroids

A

<10mg prednisone-not needed, take usual dose on morning of surgery
>10-IV hydrocortisone q8h for 48 hours post op

94
Q

Automatic statin

A

40-75 yo, >/7.5% 10 yr ASCVD risk
clinical ASCVD (MI, stroke, angina, PAD, TIA, revascularization)
>/21 yo w/ LDL >/190
DM 40-75 yo, LDL 70-189

95
Q

boggy testicle, lower urinary tract symptoms, superolateral tenderness relieved by elevation

A

epididymitis

96
Q

stress incontinence treatment

overactive bladder

A

pelvic floor muscle training, weight loss

oxybutynin

97
Q

drugs which affect statin metabolism

A

CCBs, fibrates, protease inhibitors, amiodarone. macrolides

98
Q

fall prevention vitamin D

mineralocorticoid supplement

A

neuromuscular benefits

orthostasis

99
Q

depression vs anticipatory grief

A

guilt, hopelessness, helplessness, worthlessness vs none

100
Q

Hypogonadism

A

test AM testosterone twice
Primary vs secondary-get LH and FSH levels
Secondary (if low)-brain MRI

101
Q

Sharp pain in foot with first few steps

Posterior burning heel pain, stiffness and tenderness after rapid increase in exercise, improves with rest

pain in middle of heel, barefoot on hard surfaces

Midfoot pain with radiation into medial arch, extensive exercise

A

Plantar fasciitis
pain with palpation of medial calcaneal tubercle and passive dorsiflexion of toes

Achilles tendinopathy

heel pad syndrome

Stress fracture of tarsal navicular bone

102
Q

colon cancer screening

A 
50 to 75yo
annual gFOBT or FIT (preferred)
flex sig q5years
ct colonography q5years
flex sig q10years+annual gFOBT
colonoscopy q 10 years
103
Q

Image neck pain if

A

trauma/compression fracture/weakness/neuro/infection/cancer (point tenderness to palpation)

104
Q

Anovulatory bleeding
in premenopausal woman

Confirm menopause with

A

Unpredictable
endometrial biopsy
if<35 yo with no risk factors-hormonal therapy

FSH (if amenorrheic for 12 months)
postmenopausal bleeding-transvag u/s

105
Q

Blepharitis
Orbital cellulitis
Endophthalmitis
Preseptal cellulitis vs orbital

A

eyelid/lash
EOM, recent sinus/dental infection, get CT brain
vision changes
no proptosis/pain with eye movement

106
Q

cardiac risk factors+good functional capacity preop

A

just get an EKG

107
Q 
AR
ARR
NNT
RR
RRR
A

patients with event/total number of patients
difference between two groups
1/ARR
experimental event rate/control event rate
1-RR

108
Q

bupropion positive profile

A

no weight gain, minimal sexual side effects,effective

109
Q

If good sleep hygiene doesn’t work

A

try sleep restriction, then drugs

110
Q

For reducing ASCVD risk/controlling cholesterol, combined therapy (statin+something else) is unnecessary unless

A

no response/tolerance to statins

111
Q

centor criteria

A

fever, no cough, anterior cervical LAD, tonsillar exudate
4-group a strep-treat
2-3-test
1-dont test/treat

112
Q

Tdap vaccine during pregnancy

A

between 27 and 36 weeks during each pregnancy

113
Q

otosclerosis

presbycusis

A

conductive hearing loss, side on Weber-tx; amplification/surgical stapedectomy
sensorineural hearing loss, symmetric

114
Q

Do not use anticholinergics in elderly

A

ex. loratidine, oxybutynin

115
Q

scheduled opioids should also be on

if laxatives fail

A

scheduled senna or bisacodyl +miralax/sorbitol/lactulose

methylnaltrexone

116
Q

Specialized rehab hospital

A

have to tolerate 3 hours, 5 days a week

117
Q

Dry age-related macular degeneration (loss of central vision, drusen deposits, atrophy of retinal pigment epithelium) treatment

Wet AMD
treatment

A

high dose antioxidants, zinc

neovascularization in subretina
VEGF inhibitors

118
Q

Tarsal tunnel syndrome

painful squeeze/ cross-legged test

A

compression of posterior tibial nerve, pain and paresthesia in medial ankle
high ankle sprain

119
Q

Continuous high pitched tinnitus
Rinne test

Weber-louder in affected ear
louder in normal ear

A

sensorineural hearing loss
should be heard better through air-otherwise conductive hearing loss
conductive hearing loss
sensorineural hearing loss

120
Q

bilateral and painless gradual peripheral vision loss

treatment

A

primary open angle glaucoma
increased cup to disk ratio, vertical extension of central cup, disc hemorrhages, increased IOP
beta blockers, prostaglandins, laser therapy, surgery

121
Q

alcohol withdrawal in patient with liver disease

A

do not use long acting benzos (chlordiazepozide)

use short term (lorazepam)

122
Q

Back pain with no neuro/systemic findings

A

acute (<4 weeks), subacute (4-12 weeks), chronic (more)
activity, heat, NSAIDs within 6 weeks
spinal manipulation/massage therapy if unresolving

123
Q

Metformin side effect

A

lactic acidosis

124
Q

Knee meniscal tear

A

weight bearing, locking/catching sensation

abnormal Thessaly and medial-lateral grind test

125
Q

Acute sinusitis

Bacterial if

A

usually viral, symptomatic treatment
persistent and severe, high fever, failure to improve after 10 days-amoxicillin clavulanate, doxy
no imaging needed

126
Q

syncope with prodrome of warmth, nausea and lightheadedness

syncope triggered by standing, high risk setting, no organic heart disease

A 
neurally mediated (vasovagal) syncope 
get orthostatics and EKG 
*EKG in all syncope cases*

tilt-table testing
MRI if seizure-like or neuro symptoms

127
Q

Elective noncardiac surgery with recent coronary stent

A

Delay surgery at least 6 months (drug eluting stent), 30 days (bare metal)
if surgery is needed-continue antiplatelet therapy

128
Q

Panic disorder must have fear of another attack. Tx

Buspirone

A

SSRI +therapy

generalized anxiety tx

129
Q

Pre OCP use testing

A

Pregnancy test if more than 1 week since last menstrual period
Blood pressure

130
Q

Full thickness rotator cuff tear

A

cant abduct above 90 degrees, surgery

131
Q

Olanzapine

A

Antipsychotic, may be used in combination therapy (+ fluoxetine) for depression, not alone

  • aripiprazole, quetiapine+ any antidepressant*
  • refractory depression-switch drugs after 6 weeks*
132
Q

Palpate pulse in 65yo/older to find

A

afib

133
Q

trichomonas

A

copious malodorous frothy yellow discharge w/ itching, burning, bleeding
metronidazole
test for other STDs and treat partner

134
Q

Metabolic syndrome (waist circ, triglyceride of 150, hdl <40, htn, diabetes) + 10 year risk of ASCVD>10%

A

aspirin

135
Q

Teratogenic drugs

A

statins, ACEIs, ARBs

136
Q

Lifestyle intervention for weight loss
Drugs BMI
Surgery BMI

A

behavioral therapy, diet changes, exercise
>/30 or >/27 with comorbidities
>/40 or >/35 with comorbidities

137
Q

Somatic symptom disorder

conversion disorder
illness anxiety disorder

A

at least one symptom interfering with life, excessive behavior, at least 6 months
abnormal sensation/motor function
general health, minimal to no symptoms

138
Q

CBT useful in chronic systemic pain.

Lidocaine patch for

A

localized pain

139
Q

reduce fall risk in cognitively impaired with no reversible risk factors

A

continue current cure

140
Q

Live flu vaccine vs inactivated

Recombinant flu vaccine

A

49 yo and immunocompetent w/ no egg allergies

only in severe (anaphylaxis) egg allergy

141
Q

Most effective smoking cessation therapy

A

combination nicotine replacement (rapid onset-gum+ extended release-patch> varenicline> bupropion/single agent nicotine

142
Q

Central vertigo imaging

A

MRI, not CT cos CT can’t properly image posterior fossa

carotid artery distribution would be monocular vision loss+ hemisensory/hemimotor+ apraxia+speech

143
Q

Breast cancer screening in patient with high breast density

A

Digital screening mammography

144
Q

Urinary incontinence+ dementia

A

prompted voiding

145
Q

Unstageable pressure ulcer

A

base covered by slough/eschar

debridement (surgical or wet-to-dry dressings)

146
Q

drugs that cause extrapyramidal symptoms

A

1st gen antipsychotics-chlorpromazine, haloperidol, thioridazine
use 2nd gen-clozapine

147
Q

Acute severe pain at end of life

A

Opioids, no morphine in kidney failure

148
Q

Interrupted vaccine series

A

Resume, do not restart

149
Q

Noninfectious olecranon bursitis tx

A

physical protection+NSAID, if refractory-steroids

if suspected to be infectious or crystalline-aspirate

150
Q

HIV testing

A

15-65 yo, just once

  • lipid levels 40-75 yo every 5 years*
  • blood glucose 40-70 years+overweight q 3 years*
151
Q

Cancer patients with cachexia

A

appetite stimulants/ TPN do not improve M&M or quality of life

152
Q

Central pain syndrome

nociceptive pain

A

dysregulation of sensory pathways, constant with bursts, exacerbated by movement, emotions, etc.
Fibromyalgia, post stroke pain, post spinal cord injury pain

dull, aching, throbbing, localized, caused by tissue injury

153
Q

pneumococcal vaccination in asplenia

A

PCV13 (prevnar), then PPSV 23 in 8 weeks

  • PPSV 23 again five years after first dose, if 19-64.
  • again at 65
154
Q

Preop echo

A

if more than a year or change in clinical status

155
Q

Cyclic mastalgia

A

support bra, education, reassurance

156
Q

Suspected arrhythmogenic syncope (no prodrome) with risk factors

Recurrent syncope

A

inpatient cardiac monitoring

loop recorder

157
Q

Acute nonspecific low back pain with negative exam

A

no imaging

image if no improvement after 4-6 weeks

158
Q

BPH treatment

A

Get urinalysis-treat UTI if present

AUASI score: 1-7 (mild-observe), 8-19 (moderate-tamsulosin), 20-35/ 40ml prostate (severe-finasteride)

159
Q

Chronic neurogenic pain (may be due to space narrowing around nerve, OA ) treatment

A

gabapentin, TCAs

no epidural steroids

160
Q

vestibular neuronitis vs. labyrynthitis

A

no hearing loss

161
Q

bilateral severe boring radiating ocular pain, worse at night and with movement, redness, photophobia, tearing

blotchy redness

painless redness, irritation, tearing

A

scleritis
underlying systemic disease
refer to ophtho
subconjunctival hemorrhage

episcleritis

162
Q

bilateral severe boring radiating ocular pain, worse at night and with movement, redness, photophobia, tearing

blotchy redness

painless redness, irritation, tearing

A

scleritis
underlying systemic disease
refer to ophtho
subconjunctival hemorrhage

episcleritis

163
Q

tamsulosin+ PDE-5inhibitor

A

profound hypotension

cardiac stress test before viagra

164
Q

Recurrent (>/4 times a year) vulvovaginal candida treatment

A

extended course antifungal

165
Q

hypertrophic cardiomyopathy murmur

A

systolic crescendo-decrescendo @ left lower sternal border

increases with valsalva, decreases with increased preload (leg elevation)/afterload (handgrip)

166
Q

surveillance of long term opioid therapy for noncancer pain

A

assess risk, baseline and periodic urine drug tests (doesn’t have to be at every visit), signed agreement, prescription drug monitoring program

167
Q

Hyperlipidemia w/o ASCVD, diabetes, LDL>190, risk >7.5%

A

lifestyle modification

168
Q

Asymptomatic cerumen impaction

A

observe

if symptomatic-ceruminolysis, irrigation, manual removal

169
Q

Upper airway cough syndrome

A

due to allergic rhinitis, >8 weeks
excess mucus, postnasal drip
tx: intranasal glucocorticoid

170
Q

Upper airway cough syndrome

A

due to allergic rhinitis, >8 weeks
excess mucus, postnasal drip
tx: intranasal glucocorticoid

171
Q

Pre-invasive procedure anticoagulation in patient on chronic warfarin w/ low risk of clot
intermediate/high risk

A

stop 5 days before, no bridging, continue aspirin

lovenox

General Internal Medicine (1 decks)

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