IM Essentials Flashcards
What are risk factors for seizure recurrence after a first seizure?
The risk of recurrence is greatest in patients who have status epilepticus on presentation, an identifiable underlying neurologic cause, or abnormal results on an electroencephalogram (EEG). Patients with a partial seizure who are age 65 years or older or who have a family history of epilepsy may also be in a higher-risk category.
What does MRI of brain in FTD show?
Magnetic resonance imaging of the brain shows disproportionate atrophy of the frontal and anterior temporal regions.
What is the main modifiable RF for rheumatoid arthritis?
The duration and intensity of smoking correlate with the risk of developing rheumatoid arthritis.
What should you do once the diagnosis of myasthenia gravis is confirmed?
CT of the chest to rule out thymoma as this is present in 15% of MG pts.
What is the characteristic finding of fibromuscular dysplasia on renal artery angiogram?
On angiogram, the characteristic finding of fibromuscular dysplasia is the “string of beads” appearance of the involved artery
Why can hypercalcemia lead to dehydration?
High calcium levels impair the ability of the nephron to concentrate urine, which results in inappropriate water loss from the kidney.
When is bariatric surgery for weight reduction indicated?
Bariatric surgery is recommended as a treatment option for patients who have been unable to maintain weight loss with diet and exercise with or without drug therapy with class III obesity, defined as patients who have a body mass index (BMI) ≥40, or those with BMIs of 35 to 39.9 (class II) who have obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea.
What is lorcaserin and what is it used for?
It is a serotonin 2C agonist and is used for weight loss w/ similar efficacy as orlistat although it lacks long term safety data.
Avoid using in combo w/ other serotonergic drugs like SSRIs.
What is the definition of subclinical hypothyroidism?
A serum thyroid-stimulating hormone (TSH) level greater than the reference range, with a concomitant serum free thyroxine (T4) level in the reference range. Patients typically have mild or no symptoms of hypothyroidism.
What is the optimal glucose management approach for an a severely ill (i.e. ICU) pt?
The optimal glucose management for this critically ill patient is an insulin drip with a target plasma glucose level of 140-200 mg/dL (7.8-11.1 mmol/L).
What classifies moderately persistent asthma per guidelines? What do guidelines recommend for “step-up” treatment at this point?
Daily symptoms of asthma and nocturnal awakenings more than once per week
Guidelines recommend the addition of a long-acting β2-agonist to medium-dose corticosteroids in patients with moderate persistent asthma.
What is the appropriate follow up for patients w/ average risk prostate cancer who achieve remission after radiation therapy?
Patients with average-risk prostate cancer who achieve remission after radiation therapy should receive follow-up with serial digital rectal examinations and serum PSA measurement every 6 to 12 months.
What is Asherman syndrome?
It is intrauterine adhesions. Asherman syndrome is caused by endometrial scarring after a uterine procedure (usually repeated dilation and curettage) and should be considered in any woman with amenorrhea and past exposure to uterine instrumentation.
What is Lemierre syndrome? When should you suspect it?
It is septic thrombus of the jugular vein. The diagnosis of septic thrombosis of the jugular vein (Lemierre syndrome) should be suspected in patients with pharyngitis, persistent fever, neck pain, and septic pulmonary emboli.
What sorts of medications should be avoided in HFpEF?
Those that decrease preload.
What malignancies are Henoch-Schönlein purpura associated with?
Onset of Henoch-Schönlein purpura may occur in adults and can be associated with solid tumors or the myelodysplastic syndrome.
When is DEXA scanning for osteoporosis screening recommended in women?
The U.S. Preventive Services Task Force recommends screening for osteoporosis with DEXA in all women age 65 years or older and also in younger women with an elevated fracture risk.
What are the modifiable risk factors for osteoporosis?
Among the modifiable risk factors for osteoporosis are adequate amounts of both calcium and vitamin D, regular exercise, cessation of cigarette smoking, and avoidance of alcohol abuse.
What is the best treatment for asymptomatic pancreatic pseudocysts following pancreatitis?
Asymptomatic pancreatic pseudocysts following acute pancreatitis typically resolve spontaneously and do not require treatment.
When is EPO indicated in CKD?
ESAs are indicated for patients with CKD who have hemoglobin levels less than 10 g/dL (100 g/L), but other causes of anemia, including iron deficiency, hemoglobinopathies, vitamin B12 deficiency, and gastrointestinal blood loss, should be considered before beginning this therapy.
Don’t initiate ESAs in Hgb > 12g/dL as EPO is associated w/ increased CV outcomes.
What are the criteria for diagnosing osteoarthritis?
Knee osteoarthritis can be diagnosed if knee pain is accompanied by at least three of the following features: age greater than 50 years, stiffness lasting less than 30 minutes, crepitus, bone tenderness, bone enlargement, and no palpable warmth. These criteria are 95% sensitive and 69% specific for diagnosis.
What are effective treatments for acute gout attacks?
Effective treatment of acute attacks of gout involves therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, or colchicine.
True or false, eosinophilia can be seen in adrenal insufficiency?
True!
What are the screening guidelines for cervical cancer?
Although the typical Pap smear screening interval for women ages 21 to 65 years is every 3 years, the USPSTF now recommends that women 30 to 65 years old may have a Pap smear with HPV testing every 5 years if they wish to extend the time in between tests
What are the screening guidelines for osteoporosis?
The USPSTF recommends routine screening for osteoporosis in all women aged ≥65 years and in younger women who are at increased risk for osteoporotic fractures.
Women at increased risk for low bone density include those with a smoking history, physical inactivity, secondary osteoporosis, prolonged glucocorticoid use, prolonged hyperthyroidism, celiac disease, a family history of osteoporosis, and inadequate calcium intake.
How do likelihood ratio results correlate to the increase or decrease in likelihood of a disease being present?
LR(+) values of 2, 5, and 10 correspond to an increase in disease probability by 15%, 30%, and 45%, respectively; LR(-) values of 0.5, 0.2, and 0.1 correspond to a decrease in disease probability by 15%, 30%, and 45%, respectively.
(Note this is general rule of thumb type logic)
How does the pain of pes anserine bursitis present?
The pain of pes anserine bursitis is typically located along the anteromedial aspect of the proximal tibia distal to the joint line of the knee and characteristically worsens with stair climbing and at night.
True or false, the diagnosis of ITP is made by anti-platelet antibody testing?
Flase! Antiplatelet antibody testing is found to have little predictive value in the diagnosis of ITP and is not recommended.
Why is initial urate lowering therapy for gout prevention in people who have had recurrent attacks both allopurinol and colchicine?
Because the addition of urate-lowering therapy transiently increases the risk for acute gout attacks for at least 3 to 6 months; accordingly, prophylaxis with an anti-inflammatory agent such as colchicine, at least during that period, is indicated concurrent with urate-lowering therapy.
What is the pathophysiology of hepatorenal syndrome?
Intense renal vasoconstriction (due to portal hypertension) leads to a syndrome of acute kidney dysfunction characterized by increased renal sodium avidity, a relatively normal urine sediment, and oliguria in some patients.
What are things that may precipitate hepatorenal syndrome?
Spontaneous bacterial peritonitis, vigorous diuretic therapy, paracentesis without volume expansion, and gastrointestinal bleeding also may precipitate hepatorenal syndrome.
