GIM Flashcards
Unilateral then bilateral Purulent discharge without pain or visual disturbance. Dx?
Bacterial conjunctivitis
Conjunctivitis associated with rash involving ophtho division of fifth cranial n, Dx?
Herpes zoster conjunctivitis
Acute hyperpurulent ocular discharge in a sexually active adult. Dx?
Neisseria gonorrhea conjunctivitis
Unilateral then bilateral conjunctivitis with Daytime watery or mucoid discharge. Dx?
Viral conjunctivitis
Itching and tearing of the eyes, nasal congestion. Dx?
Allergic conjunctivitis
Anaphylaxis reaction is an example of which type of hypersensitivity reaction?
Type 1 hypersensitivity reaction
Back pain that improves with leaning forward is the classic presentation of what musculoskeletal condition?
Spinal stenosis
Before starting a patient on TNF-alpha inhibitors, what test should be performed?
Purified protein derivative(PPD) tuberculin skin test
Best next step after pt has tried NSAIDs /OCPs for primary dysmenorrhea but symptoms persist >3 months?
Ultrasound to rule out uterine abnormalities like fibroids
Name the supplement: Sleep aid also used for stress/anxiety relief. If combined withEtOH, can oversedate.
Kava
Finasteride, used to assist patients with benign prostatic hyperplasia, acts on which enzyme to inhibit conversion of testosterone to dihydrotestosterone?
5 alpha reductase
Excessive ingestion of licorice can lead to which electrolyte abnormality?
Hypokalemia
Name the supplement: Used against dementia. Can increase the risk of bleeding.
Ginkgo Biloba
Name the supplement: Used for benign prostatic hyperplasia. Can cause headaches and/or abdominal pain/nausea.
Saw Palmetto
Name the supplement: Used as an anti-depressant. Can potentially induce cytochrome P450 drug metabolism.
St. John’s Wort
Name the supplement: Used against the common cold. Can cause nausea, rash and itchiness.
Echinacea
Name three conditions that are very often associated with hypogammaglobulinemia
CLL, nephrotic syndrome, bronchiectasis
On fundoscopic examination, which condition is associated with cherry red spots on the macula?
Retinal artery occlusion
1-3% with 1 long bone fracture 33% with bilateral femur fractures - acute neurological abnormalities, hypoxemia and petechial rash. Dx?
Fat Embolism Syndrome
On a DEXA scan, what T score will indicate osteoporosis?
T score of less than -2.5
Digestion of which toxin from reef fish can cause for peri-oral paresthesias to occur?
Ciguatera toxin (found in barracuda, grouper, red snapper, moray eel, sea bass)
Loss of passive flexion of the foot when the calf is squeezed with achilles tendon tears is known as what test?
Positive Thompson test
During exercise, what is the formula used to determine the maximum heart rate an individual should achieve?
(220 - age in years) X 85%
Rapid fire txt: Bipolar disorder
Mood stabilizers (eg, lithium, valproic acid, carbamazepine), atypical antipsychotics
Rapid fire txt: Anorexia
Nutrition, psychotherapy, antidepressants not helpful (?olanzapine)
Rapid fire txt: Alcohol withdrawal
Long-acting benzodiazepines
chlordiazepoxide, clonazepam, Diazepam
Rapid fire txt: Alcoholism
Disulfiram, acamprosate, naltrexone, supportive care
Rapid fire txt: Bulimia nervosa
CBT, SSRIs
Rapid fire txt: ADHD
Methylphenidate, CBT, atomoxetine, guanfacine, clonidine
Rapid fire txt: Depression
SSRIs or CBT
What are the possible agents for treating hypertension in pregnant women?
Hydralazine, Labetalol, Alpha Methyldopa
Rapid fire txt: Benign prostatic hyperplasia
α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors
HLA-DR4assoc w/?
Diabetes mellitus type 1, rheumatoid arthritis, Addison disease
Rapid fire txt: Ethylene glycol/methanol intoxication
Fomepizole (alcohol dehydrogenase inhibitor)
Rapid fire txt: Drug of choice for anticoagulation during pregnancy
1st trimester: warfarin if <5mg, LMWH, UFH 2nd trimester: warfarin
Rapid fire assoc: Mammary gland (“blue domed”) cyst
Fibrocystic change of the breast
Rapid fire txt: Buerger disease
Smoking cessation
HLA-B27 assoc w/? 4 things
Psoriatic arthritis, ankylosing spondylitis, IBD-associated arthritis, reactive arthritis (formerly Reiter syndrome)
HLA-DR3assoc w/?
Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis, Addison disease
Rapid fire assoc:”Thumb sign” on lateral neck x-ray
Epiglottitis (Haemophilus influenzae) Medical emergency
What are the two most common nerve root impingements in lower back pain?
L5 and S1
What blood test is the initial screening test for suspected systemic mastocytosis?
Serum tryptase level
What environmental exposure can lead to acute vitamin B12 deficiency?
Nitrous oxide (Nitrous oxide inactivates vitamin B12.)
What is the enzyme that converts testosterone to estradiol?
Aromatase
What class of anti-depressants can be used for patients who are suffering from urge incontinence?
TCAs (Tricyclic anti-depressants)
What is the anti-depressant category of choice in patients with bulimia?
SSRIs
What is the fundoscopic exam finding often seen with idiopathic intracranial hypertension (Pseudotumor cerebri)?
Papilledema
Which vitamin toxicity may lead to idiopathic intracranial hypertension(Pseudotumor cerebri)?
Vitamin A
Which vitamin is used to enhance iron absorption?
Vitamin C (Ascorbic acid)
Which pain medication should be avoided in patients who are taking SSRIs for depression?
Tramadol (concurrent use of SSRI with tramadol can cause serotonin syndrome)
Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener syndrome (dynein arm defect affecting cilia)
Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria
Osler-Weber-Rendu syndrome
Which knee test can indicate that patient has a lateral collateral ligament tear?
Positive varus test
Swollen gums, mucosal bleeding, poor wound healing, petechiae
Scurvy (vitamin C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)
Which statin is the drug of choice in HIV patients?
Pravastatin
Rapid fire assoc: “Chocolate cyst” of ovary
Endometriosis (frequently involves both ovaries)
What is the most common presenting symptom of an individual with acute altitude sickness?
Headaches
What is the laboratory screening test for chronic alcohol abuse?
Carbohydrate free transferrin level elevated
What is the most common symptom of Hereditary Hemorrhagic Telangiectasia(HHT)?
Epistaxis (nose bleeding)
What is the most commonly used agent in the treatment of Familial Mediterranean Fever?
Colchicine
What is the main anti-depressant to be avoided in patients with seizure disorder?
Bupropion
Slow, progressive muscle weakness in boys
Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne)
Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema
Turner syndrome (45,XO)
Dermatitis, dementia, diarrhea
Pellagra (niacin [vitamin B3] deficiency)
Dilated cardiomyopathy, edema, alcoholism, or malnutrition
Wet beriberi (thiamine B1] deficiency)
Enlarged, hard left supraclavicular node
Virchow node (abdominal metastasis)
Episodic vertigo, tinnitus, hearing loss
Meniere disease
Unilateral deep regular pain, nausea, vomiting, fixed non-reactive pupil, Shallow anterior chamber
Acute angle closure glaucoma
Severe ocular pain that worsens with eye Movement and light exposure; A raised hyperemic lesion that may be localized or diffuse and obscures the underlying vasculature
Scleritis
Red eye with scales and crusts around the eyelashes or dandruff like skin changes and greasy scales around the eyelashes
Blepharitis
Non-painful red, flat, superficial lesion that allows visualization of the underlying vasculature
Episcleritis
Facial muscle spasm upon tapping
Chvostek sign (hypocalcemia)
Bluish line on gingiva
Burton line (lead poisoning)
Bone pain, bone enlargement, arthritis
Paget disease of bone (increased osteoblastic and osteoclastic activity)
What vitamin deficiency can occur with use of Isoniazid (INH)?
Vitamin B6 (Pyridoxine)
What vitamin or mineral deficiency is associated with rash and alopecia in patients on TPN feeding?
Zinc deficiency
What is the most likely diagnosis in diabetic pt with diarrhea, weight loss, flatulence and vitamin A, D, B12 deficiencies?
Small intestinal bacterial overgrowth
What will be the folate and vitamin B12 Levels in patients with Caribbean tropical sprue?
Normal folate, decreased vitamin b12 levels
What are the five major medications that can cause folate deficiency?
Phenytoin, MTX, tmp, sulfasalazine, metformin
Aspirin exacerbated respiratory disease (triad asthma or samter syndrome) TX?
Aspirin desensitization
Chronic non-allergic rhinitis (vasomotor rhinitis) tx?
Intranasal glucocorticoids, intranasal antihistamines, topical ipratropium bromide
Absolute risk (event rate) equation?
Patients with event in group/Total patients in Group
Relative risk equation?
Experimental event rate/ Control event rate
Absolute risk reduction equation?
|ERR-CER|
Relative risk reduction equation?
|ERR-CER|/CER
NNT or NNH equation?
1/ARR
Pos Likelihood ratio equation?
Sensitivity/(1-specificity)
Neg Likelihood ratio equation?
(1-sensitivity)/specificity
Pos likelihood ratio of 2,5,10 increase probability of dz by?
15, 30, 45%
Neg likelihood ratio of 0.5, 0.2, 1 decrease probability of dz by?
15, 30, 45%
Nasal polyposis, asthma, eosinophilia, mononeuritis, petechial skin lesions
Eosinophilic granulomatosis with polyangiitis
Systemic illness with saddle nose deformity, nasal ulceration, chronic sinusitis
Granulomatosis with polyangiitis
Young person, nasal polyposis, chronic sinusitis, malnourishment, infertility, recurrent bronchitis
Cystic fibrosis
Non-seasonal rhinitis with negative skin test. Dx?
Chronic non-allergic rhinitis (vasomotor rhinitis)
Refractory congestion after chronic use of topical nasal decongestants
Rhinitis medicamentosa
Nasal congestion in the last six or more weeks of pregnancy
Pregnancy rhinitis
Rhinitis, nasal polyps, asthma, aspirin intolerance
Aspirin exacerbated respiratory disease (triad asthma or samter syndrome)
Pain, photophobia, inflammation Confined to corneal limbus, corneal irregularity, pupillary irregularity
Keratitis or iridocyclitis (iritis, anterior uveitis)
transient Impairment in anterograde memory. Self awareness, motor, And social skills are preserved
Transient global amnesia
Urinary urgency and Increasing pelvic pain and pressure relief with voiding in women is due to what diagnosis? Usually patients have fibromyalgia
Interstitial cystitis
What are three treatments for Interstitial cystitis? (Treatment is not curative and typically focuses on improving quality of life and avoidance of triggers)
Amitriptyline (use limited due to side effects), pentosan Polysulfate sodium, bladder instillation
In patients with multiple sclerosis, eye pain w/central vision loss suggest what diagnosis? What is the treatment?
Optic neuritis, methylprednisolone (oral prednisone leads to higher rate of recurrence)
What 4 main drugs interfere with folic acid metabolism?
Methotrexate, phenytoin, pyrimethamine, trimethoprim
What are 1st line treatments for alcohol use disorder?
Naltrexone and acamprosate
What are the 2 main contraindications for naltrexone?
Patients currently taking opioids and acute hepatitis or liver failure
what serum lithium levels are indications for dialysis.
> 4 or >2.5 with significant lithium toxicity (seizures, depressed mental status)
Symptomatic vertebral compression fractures are managed how acutely? And if this fails, what’s another option for txt?
NSAIDs, acetaminophen, opioids. Intranasal calcitonin if the others don’t work
What is the triad of serotonin syndrome?
Mental status change, autonomic hyperactivity (hyperreflexia), neuromuscular abnormalities. (Clonus)
What are the findings in neuroleptic malignant syndrome?
Very high fever typically greater than 104゚, delirium, lead pipe rigidity, autonomic instability