Internal Medicine Flashcards
The American Heart Association and American College of Cardiology recommend that patients aged 20 years or older with an LDL cholesterol level of 190 mg/dL (4.92 mmol/L) or higher should receive
high-intensity statin therapy for primary prevention of atherosclerotic cardiovascular disease.
The decision to initiate breast cancer screening in women aged 40 to 49 years
should be an individualized one based on patient context and values regarding specific benefits and harms.
For patients undergoing orthopedic surgery without increased bleeding risk, postoperative dual venous thromboembolism prophylaxis with intermittent pneumatic compression and low-molecular-weight heparin is recommended during hospitalization; low-molecular-weight heparin should be continued for
up to 35 days.
first-line therapy for neuropathic pain syndromes are
Gabapentinoids and serotonin-norepinephrine reuptake inhibitors
the treatment of depression at the end of life; results can be seen as quickly as 24 to 48 hours after initiation
Methylphenidate is a rapid-acting psychostimulant that is well tolerated and effective
Bacterial conjunctivitis is characterized by redness of the conjunctival membrane obscuring the tarsal vessels, matting of both eyes in the morning, and thin mucopurulent discharge; treatment may include
topical antibiotics, such as trimethoprim–polymyxin B or erythromycin.
The acceptability of the number needed to treat as a means of comparing one treatment with another depends on
the risks associated with the condition, the cost and side effects of the treatment, and other treatments available.
The most common infectious cause of acute bacterial prostatitis is Escherichia coli or other gram-negative bacilli; the treatment of choice is a
prolonged course of trimethoprim-sulfamethoxazole or ciprofloxacin.
Health care workers are at increased risk for acquiring and transmitting measles, mumps, and rubella and should receive
a second dose of the MMR (measles, mumps, and rubella) vaccine.
Manage an in-flight medical emergency by
connecting to the ground-based physician.
The more risk factors for a motor vehicle accident that an older driver has, the higher the risk for an adverse event while driving. Thus,
Counsel an older patient with risk factors for a motor vehicle accident.
Evaluate a patient with symptoms of systemic exertion intolerance disease.
In patients with fatigue without a clear cause, it is reasonable to obtain a
complete blood count, electrolyte panel, thyroid-stimulating hormone level, fasting glucose level, and kidney and liver chemistry tests; unnecessary laboratory, imaging, and invasive studies should be avoided.
Nerve root involvement of the cauda equina requires immediate imaging,
preferably with MRI, and surgical intervention to prevent permanent neurologic damage.
For women younger than 30 years with a low-risk breast mass,
ultrasonography is usually the only imaging required.
initially present with a depressive episode; however, recognition of previous manic or hypomanic episodes is crucial
Bipolar disorder
Treatment of bipolar disorder requires mood stabilizers, either alone or in combination with antidepressants.
This should be considered in patients who do not lose weight with lifestyle modifications and have a BMI of 40 or greater, or a BMI of 35 or greater with obesity-related comorbid conditions, such as type 2 diabetes mellitus, coronary artery disease, obstructive sleep apnea, or osteoarthritis.
Bariatric Surgery
In patients with chronic cough who have a normal chest radiograph and are taking an ACE inhibitor, the first intervention is
Discontinuation of the ACE inhibitor
Patients who undergo direct-to-consumer genetic testing should be advised of the
risks and limitations of these tests, including the possibility for misinterpretation.
Tinnitus associated with unilateral sensorineural hearing loss suggests
acoustic neuroma and requires advanced imaging with MRI.
can provide significant benefits for patients with chronic lung disease and has been shown to improve subjective dyspnea in patients with severe COPD and following an acute exacerbation of COPD
Pulmonary rehabilitation
Patients with decompensated liver disease should
avoid elective surgery and be referred for liver transplant evaluation.
Irrespective of gender presentation, physicians should provide
culturally sensitive care for all patients in a sensitive, respectful, and affirming manner (e.g. a transgender patient)
an important tool in the communication between the hospital and the follow-up clinician
A discharge summary that includes the evaluations performed, medication reconciliation, pending test results, required follow-up tests
Characterized by loss of shoulder movement accompanied by pain; examination discloses significant loss of both active and passive range of motion
Adhesive capsulitis
The most effective pharmacologic options for premature ejaculation is the combination of
a selective serotonin reuptake inhibitor plus a phosphodiesterase-5 inhibitor and topical anesthetics e.g. lidocaine
Stress urinary incontinence is characterized by urine leakage associated with activities that cause increased intra-abdominal pressure, such as coughing, laughing, or sneezing; it is best managed
with pelvic floor muscle training exercises
when the physician and the patient (or family members) have conflicting goals of care
an ethics consultation may be beneficial.
A physician should not provide treatment that conflicts with professional obligations and will not meet the goals of care
appropriate treatment for patients with moderate to severe genitourinary syndrome of menopause that has not responded to moisturizers and lubricants.
Vaginal estrogen therapy
Treatment options for generalized anxiety disorder include cognitive behavioral therapy and
SSRI or SNRI
Physicians should consider offering ______ to patients receiving long-term opioid therapy with a high risk for overdose (history of overdose or substance use disorder, other mental health disorder, high opioid dosage [≥50 morphine milligram equivalents/day], concurrent benzodiazepine use, COPD, or obstructive sleep apnea).
Naloxone
What are the preferred nonstatin drugs for patients with clinical atherosclerotic cardiovascular disease who do not achieve goal LDL cholesterol reduction with maximally tolerated statin therapy?
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and ezetimibe.
Note: New guidelines just recommend a moderate or high intensity statin.
High-intensity statin:
- therapy for an LDL >190 mg/dL (4.92 mmol/L) or higher
- for patients with 10-year ASCVD risk of 20% or higher.
Moderate-intensity statin therapy:
- patients aged 40 to 75 years with DM
- 40 to 75 years with risk-enhancing factors and 10-year ASCVD risk of 7.5% to less than 20% (Updated May 2019)
USPSTF recommends screening for colorectal cancer
asymptomatic adults aged 50 to 75 years; the choice of screening test should be guided by evidence, patient preferences, and local availability.
Dietary and herbal supplements have questionable efficacy and may be associated with considerable harms
physicians must inform patients of harmful supplements and suggest safer alternatives.
for patients with known atherosclerotic cardiovascular disease, including coronary artery disease, arrhythmia, peripheral artery disease, cerebrovascular disease, or significant structural heart disease, who are undergoing moderate- to high-risk surgeries; cardiac stress testing should generally be reserved for patients at elevated risk for major adverse cardiac event with a functional capacity less than 4 metabolic equivalents, but only if the results of the test will change perioperative management.
Preoperative electrocardiography (ECG) is reasonable
caused by impingement of the ulnar nerve at the elbow by bone spurs, fibrous tissue, ganglion cysts, or ulnar nerve subluxation; characteristics include pain at the elbow that worsens with flexion, paresthesias and numbness of the fourth and fifth fingers, and weakness of the interosseous muscles.
Ulnar nerve entrapment, also known as cubital tunnel syndrome
In patients with syncope, the physical examination should include
an in-depth cardiovascular evaluation, including orthostatic (postural) blood pressure measurements, as well as a basic neurologic examination to evaluate for focal defects; electrocardiography is the only diagnostic study that is routinely recommended in patients with syncope.
In women older than 35 years who smoke more than 15 cigarettes a day because of an increased risk for venous thromboembolism, which birth control are contraindicated?
Estrogen-containing hormonal contraceptives are contraindicated
when a trial of comprehensive lifestyle modification, including reduced dietary intake, exercise, and behavioral therapy, fails to achieve a 5% to 10% reduction in weight after 3 to 6 months.
Weight-loss medications (e.g. liraglutide) are recommended
Palliative medicine, with its focus on reducing pain, nonpain symptoms, and psychosocial stress associated with advanced disease, improves quality of life for patients and their caregivers and should be initiated?
early initiation of palliative medicine during a life-threatening illness has substantial advantages
__________ for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and colorectal cancer is recommended for adults aged 50 to 59 years with a 10-year ASCVD risk of 10% or higher who do not have an increased risk for bleeding.
Low-dose aspirin
Note: guidelines published by the ADA in 2020 state that the use of aspirin for primary prevention may be considered in this patient group, thus indicating that not using aspirin may also be appropriate.
The initial evaluation of chronic insomnia involves obtaining
a sleep diary to identify adverse environmental factors, inappropriate exposure to electronic screens before bedtime, and sleep patterns.
Telemedicine, or the use of electronic communication and technologies to provide health care to patients at a distance, may increase access to care, improve outcomes, enhance physician-patient collaboration, and reduce costs; however,
a valid patient-physician relationship must be established for professionally responsible telemedicine services to occur.
acute vision loss, eye pain with movement, color perception change, and afferent pupillary defect; results of a funduscopic examination may be normal
Optic neuritis
The validity of cross-sectional studies is particularly susceptible to
recall bias and confounding
Patients with postoperative urinary retention and residual bladder volume of 800 mL or more should be treated
with bladder decompression and urinary catheterization
The decision to discontinue cervical cancer screening at age 65 years should be made only
after confirming that the patient has received adequate prior screening.
In patients with chronic noncancer pain
physical therapy reduces pain and improves function.
Cognitive impairment is a progressive decline that impairs function in at least two areas, including attention, executive function, language, memory, and visual-spatial function; it is best measured with
assessment examinations, such as the Mini-Cog and the Mini–Mental State Examination, rather than laboratory testing or imaging.
aching sensation that is isolated to the neck but can radiate to the posterior head or shoulders; physical examination usually shows decreased range of motion, tenderness to palpation, and reproduction of the pain with flexion or extension, but no neurologic findings
cervical sprain
Following diagnosis and treatment of a woman with Trichomonas vaginalis infection
the sexual partner should be treated and both individuals should be screened for other sexually transmitted infections; retesting of women for T. vaginalis infection within 3 months of treatment is also recommended
are diagnosed according to the presence of symptoms that cannot be attributed to a specific medical cause after a thorough medical evaluation.
Medically unexplained symptoms
In patients with drug-induced peripheral edema
removal of the offending agent is the treatment of choice. Not adding compression stockings.
diagnosed by the presence of at least five cardinal symptoms, at least one of which is depressed mood or anhedonia, during the same 2-week period
Major depressive disorder
the presence of fatigue of at least 6 months’ duration with substantial reduction in preillness activities, postexertional malaise, unrefreshing sleep, and either cognitive impairment or orthostatic intolerance
systemic exertion intolerance disease
A positive Prehn sign (relief of pain with scrotal elevation) suggests a diagnosis of
epididymitis, although it does not rule out other possibilities, such as testicular torsion.
For patients with chronic low back pain, clinicians and patients should initially select non-pharmacologic treatment; ______ can be considered in patients who have had an inadequate response to non-pharmacologic therapy.
NSAIDs
Recurrent unilateral epistaxis may be a sign of neoplasm and warrants
referral for nasal endoscopy
Note: Low-dose aspirin may be associated with a slight increase in the risk for epistaxis, although data have not been conclusive and do not support routine discontinuation in otherwise healthy patients with epistaxis
a four-step process involving a rapid cycle of change in which baseline data are collected, an intervention is planned and then implemented on a small scale, the results are analyzed, and an action plan is made
A Plan-Do-Study-Act cycle
Frequent review of patient medications to verify their necessity and proper dosing is an essential aspect of optimal _______ care.
geriatric
the character of their pain may change during the course of opioid therapy, pain may worsen with increased opioid dosages, and pain may decrease when opioid dosages are reduced.
opioid-induced hyperalgesia
In patients taking dual antiplatelet therapy, if the risk of surgical delay exceeds the risk for stent thrombosis, discontinuation of the P2Y12 inhibitor can be considered after a minimum of
30 days in the case of bare metal stent placement or 3 months after drug-eluting stent placement.
Note: Aspirin should be continued, if at all possible, along with restarting of DAPT as soon as bleeding risk has sufficiently diminished.
The decision to pursue prostate cancer screening
should be individualized so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision.
Audible posterior oropharyngeal secretions (“death rattle”) are common at the end of life and are best managed with
family education and reassurance.
This vaccine should be administered to select immunocompetent patients aged 19 to 64 years, including those with chronic heart, liver, or lung disease; diabetes mellitus; cochlear implants; cerebrospinal fluid leak; alcoholism; or cigarette smoking.
23-valent pneumococcal polysaccharide vaccine
requires at least three of the following characteristics occurring at least once weekly for 3 months: abnormally rapid consumption, consuming large amounts of food when not hungry, eating alone due to embarrassment, eating until uncomfortably full, and feelings of guilt related to overconsumption.
The diagnosis of binge eating disorder
Cyclic mastalgia is often related to hormonal changes that occur with ovulation, resulting in diffuse premenstrual breast pain that resolves with the menstrual cycle; the most appropriate management is education, reassurance, and
appropriate breast support with a well-fitting bra
In patients with central vertigo, the Dix-Hallpike maneuver produces nystagmus with an:
immediate onset (no latency), longer duration (>1 minute), no fatigability, and vertical or horizontal directionality without a torsional component.
Prepatellar bursitis (e.g knee swelling seen with carpet layers) can be caused by repetitive trauma, infection, or gout; & so these patients should have
fluid aspiration and subsequent analysis
the best protection against the development of pressure injuries in hospitalized patients.
An advanced static mattress or mattress overlay made of specialized sheepskin, foam, or gel
Sexually active gay, bisexual, and other men who have sex with men and injection drug users should be screened for HIV infection
at least annually
In patients aged 40 to 75 years with no atherosclerotic cardiovascular disease (ASCVD) or diabetes mellitus and with a 10-year ASCVD risk of 7.5% or higher accompanied by the presence of ASCVD risk enhancers, the American Heart Association and American College of Cardiology recommend
moderate-intensity statin therapy for primary prevention of ASCVD
Error disclosure should include
an explanation of the course of events and how the error occurred, an apology by the physician, a description of how the effects of the error will be minimized or rectified, and steps the physician or system will take to reduce recurrences.
How do you confirm a suspected case of overflow urinary incontinence?
A postvoid residual urine volume, determined by ultrasonography
Treatment of chronic pelvic pain syndrome demands a multimodal approach, with options including both pharmacologic and nonpharmacologic strategies; among the pharmacologic options are
neuromodulatory agents, such as pregablin, gabapentin, and nortriptyline.
Treatment of somatic symptom disorder focuses on acknowledging the patient’s symptoms, building a therapeutic relationship with the patient through frequent scheduled visits and
implementing cognitive behavioral therapy, and avoiding further testing
presents as acute, profound, and painless loss of monocular vision associated with an afferent pupillary defect and cherry red fovea.
Central retinal artery occlusion (CRAO)
In patients with severe refractory dyspnea
appropriately dosed oral opioids are first-line therapy for symptomatic relief
In the primary and secondary prevention of cardiovascular events, the addition of aspirin to long-term anticoagulation
is associated with significantly increased bleeding events and is not routinely recommended
Acute onset of pain proximal to the ankle, accompanied by swelling and ecchymosis
High ankle sprains
treatment for uncomplicated vulvovaginal candidiasis, which is usually caused by Candida albicans
Topical antifungal imidazole therapy, such as intravaginal clotrimazole
In patients in whom opioid therapy is being considered for the treatment of chronic pain, what should be done next?
urine drug screening should be performed before opioid prescription and at least yearly during therapy to evaluate for adherence to therapy and to identify the presence of other controlled drugs.
______________________ to evaluate preoperative cardiac risk is appropriate for patients with moderate to severe valvular stenosis or regurgitation in the absence of an assessment in the previous year or for those whose clinical status has changed or who have referable symptoms.
Transthoracic echocardiography
Management guidelines for patients with overweight or obesity recommend measurement of height and weight; calculation of BMI; measurement of waist circumference; and measurement of cardiovascular disease risk factors, including blood pressure, fasting blood glucose (or hemoglobin A1c), and
serum lipid levels.
Recommended treatments for unexplained chronic cough include
multimodality speech pathology therapy and neuromodulators, such as gabapentin.
Selective serotonin reuptake inhibitors are generally well tolerated among patients with major depressive disorder, but sexual side effects (such as anorgasmia, delayed orgasm, and reduced libido) are common; for these patients,
bupropion is an appropriate alternative, as is cognitive behavioral therapy.
Patients with medically unexplained symptoms may benefit from
cognitive behavioral therapy, physical therapy, occupational therapy, individual or group psychotherapy, social support, biofeedback, graded exercise therapy, stress management activities, and training in coping mechanisms.
_____________ should not be routinely obtained in patients with nonspecific low back pain; such testing should be reserved for patients with severe or progressive neurologic deficits and patients for whom a serious underlying condition is suspected.
Diagnostic studies
All patients for whom genetic testing is being considered should undergo
genetic counseling
In the clinical setting, physicians must determine a patient’s ____________ capacity by assessing the patient’s ability to understand the relevant information, appreciate the medical consequences of the situation, consider various treatment options, and communicate a choice.
decision-making capacity
an effective therapy for smoking cessation and should be considered in smokers with a recent cardiac event.
Varenicline
All men aged 65 to 75 years who have ever smoked should undergo one-time?
abdominal ultrasonography to screen for abdominal aortic aneurysm
should occur at all transitions of care to prevent medication errors
Medication reconciliation
________is a quantifiable geriatric syndrome that may predict a patient’s response to medical treatment.
Fraility
First-line pharmacologic therapy for attention-deficit/hyperactivity disorder
Stimulants, such as methylphenidate and when stimulants are contraindicated, atomoxetine, bupropion, and tricyclic antidepressants can be used.
Patients with diffuse, poorly localized lateral knee and distal thigh pain; there is often tenderness to palpation 2 to 3 cm proximal to the lateral femoral condyle.
iliotibial band syndrome
Patients with noncyclic mastalgia with focal breast pain but no palpable mass should undergo
targeted breast ultrasonography because approximately 1% of such patients may have breast cancer at the site of pain.
Likelihood ratios (LRs) are a statistical indicator of how much the result of a diagnostic test will increase or decrease the pretest probability of a disease in a specific patient; a clinical rule of thumb is that positive LRs of 2, 5, and 10
correspond to an increase in disease probability of 15%, 30%, and 45%, respectively. If the stress test result had been negative, LR− values of 0.5, 0.2, and 0.1 correspond to a decrease in disease probability of 15%, 30%, and 45%, respectively.
For patients undergoing non-orthopedic surgery who are at high risk for postoperative venous thromboembolism as defined by the Caprini score, what is the most appropriate postoperative venous thromboembolism prophylaxis?
pharmacologic prophylaxis with low-molecular-weight heparin or low-dose unfractionated heparin and the addition of mechanical prophylaxis
preferred initial agent for radiation-induced nausea and vomiting
A 5-hydroxytryptamine-3 (5-HT3) antagonist, such as ondansetron
Hallmark signs of viral pharyngitis include
conjunctivitis, cough, nasal congestion, and rhinorrhea; viral pharyngitis should be treated symptomatically.
Most common form of syncope and is seen primarily in younger adults; prodromal symptoms (nausea, diaphoresis) are classically present before the syncopal event, and fatigue and generalized weakness are typically present afterward.
Neurally mediated syncope
Male patients with urgency urinary incontinence who have not achieved satisfactory relief of symptoms with behavioral therapy may benefit from the use of
anticholinergic agents or mirabegron
Routine cervical cancer screening with cytology alone is indicated in women aged
21 to 29 years, including those vaccinated against human papillomavirus.
Note: guidelines published by the American Cancer Society in 2020 recommend high-risk human papilloma virus detection as the preferred cervical cancer screening strategy for women age 25 to 65 years.
In adult patients, first-line therapy for symptomatic left-sided varicocele that is not associated with testicular atrophy or infertility is
analgesic agents and scrotal support
Initial therapy for carpal tunnel syndrome consists of
avoiding repetitive hand and wrist motions and neutral-position wrist splinting.
2-day history of deep boring pain in the right eye. She also describes eye redness and photophobia but no recent trauma to the eye. She has a 10-year history of rheumatoid arthritis. What is the diagnosis?
Scleritis, which can be vision-threatening and lead to thinning of the sclera and perforation.
Note: Episcleritis is an abrupt inflammation of the superficial vessels of the episclera, a thin membrane that lies just beneath the conjunctiva. Typically resolves spontaneously & presents without pain or decreased visual acuity.
In preopertive patients with kidney disease and those who are taking medications that may affect kidney function or predispose them to electrolyte abnormalities
Preoperative measurement of serum electrolyte and creatinine levels is recommended
The use of what medication should be discontinued/avoided in patients who have undergone bariatric surgery?
NSAIDs
Ibuprofen and other NSAIDs should be avoided after bariatric surgery because their use is associated with increased risk for internal bleeding.
These patients have chaotic interpersonal relationships, emotional lability, impulsive and self-destructive behaviors (such as suicide attempts), and exaggerated responses to social stressors; comorbidity with other psychiatric illnesses is high.
Borderline personality disorder
The treatment of systemic exertion intolerance disease (SEID) involves
a structured, multimodal, nonpharmacologic approach that includes regularly scheduled office visits, cognitive behavioral therapy, and sleep hygiene education.
Before initiating hormonal contraception,
a negative pregnancy test result must be documented if 7 days have passed since the onset of the last menstrual period
First-line treatment of acute low back pain is:
nonpharmacologic therapy, including acupuncture, massage, spinal manipulation, and superficial heat; most patients will improve over time, regardless of the treatment chosen.
Patients with diabetes mellitus are at significantly increased lifetime risk for cardiovascular events and should receive
moderate- or high-intensity statin therapy for primary prevention
First-line therapy for insomnia
Cognitive behavioral therapy for insomnia, which combines components of sleep hygiene with cognitive therapy and behavioral interventions,
If the physician-patient relationship becomes irreparably compromised because of lack of trust, lack of mutual goals, or failure to maintain an effective working relationship despite efforts to resolve differences, the relationship can be
terminated
Symptoms of neurogenic thoracic outlet syndrome include paresthesias and pain that typically worsen with activities that involve continued use of the arm or hand, especially those that include elevation of the arm; first-line therapy includes
improving posture and strengthening the shoulder girdle muscles
All patients with sudden sensorineural hearing loss should undergo
audiometric evaluation, and most patients will require MRI
The treatment of Stage 3 pressure injuries include: protein supplements, the use of electrical stimulation to accelerate wound healing &
Hydrocolloid or foam dressings, which are superior to standard gauze dressings
Obsessive-compulsive disorder should be treated with
cognitive behavioral therapy (CBT); a combination of CBT and selective serotonin reuptake inhibitor therapy is useful for patients with severe symptoms or inadequate response to CBT.
In older men (older than 55) and persons who practice insertive anal intercourse, infectious epididymitis should be treated with
Ceftriaxone and a fluoroquinolone, such as levofloxacin.
NOTE: In younger patients (<35 years), the most common infectious etiologies include Chlamydia trachomatis & Neisseria gonorrhoeae. Treat with ceftriaxone and doxycycline (or azithromycin, if the patient is intolerant to doxycycline).
For evaluation of palpable breast abnormalities in women aged 40 years or older,
mammography, followed in most cases by ultrasonography, is recommended.
Antihypertensive medications absolutely contraindicated during pregnancy include
ACE inhibitors, angiotensin receptor blockers, and, likely, renin inhibitors.
In patients on warfarin who are undergoing surgery, bridging anticoagulation
is typically reserved for patients at highest risk for thromboembolism.
The Centers for Disease Control and Prevention recommends that men who have sex with men should be
screened at least annually for genital and extragenital chlamydial and gonorrheal infections, syphilis, and HIV infection.
Note: Based on the 2020 Centers for Disease Control and Prevention recommendations for hepatitis C screening among adults in the United States, one-time screening for hepatitis C virus should be completed in all patients aged 18 years and older. Therefore, options B and C are both correct.
For patients with three or more episodes of major depressive disorder, persistent depressive disorder, or residual depressive symptoms, how long should you treat?
The American Psychiatric Association recommends long-term maintenance therapy for patients; the antidepressant dosage that was effective in acute treatment should be continued for long-term maintenance.
In patients with medically unexplained symptoms, clinicians must
approach each symptom in a focused manner and diligently review any previous diagnostic evaluations.
Cervical radiculopathy, caused by nerve root compression, usually resolves within 2 to 3 months by using
conservative measures; stretching and strengthening exercises of the neck muscles provide the best intermediate-term relief.
Note: Electrodiagnostic testing is not indicated.
Vaccination against human papillomavirus is recommended for all patients aged
11 or 12 years or between the ages of 13 and 26 years if not previously vaccinated.
Hormone therapy is an option for women with moderate to severe vasomotor symptoms of menopause who are
younger than 60 years and within 10 years of menopause onset, provided they are at low risk for breast cancer, coronary heart disease, stroke, and thromboembolic disease.
Characterized by sudden-onset, severe, persistent peripheral vertigo accompanied by hearing loss; it is most often preceded by a viral infection affecting both branches of the vestibulocochlear nerve (cranial nerve VIII)?
Labyrinthitis
Note: BPPV = no auditory changes
Meniere disease = tinnitus, vertigo & hearing loss.
Vestibualr neuronitis =Preceded by a viral infection too, but no auditory symptoms
Acute rhinosinusitis may be treated symptomatically with analgesics and
intranasal glucocorticoids; antibiotics are not recommended without clearly established bacterial infection.
Preferred opioid to treat cancer-related pain in patients with chronic kidney disease?
Hydromorphone
In preoperative patients at elevated risk for a major adverse cardiac event or if functional capacity cannot be determined?
Preoperative cardiac stress testing should be considered, but only if the results of stress testing will change perioperative management.
Every physician is responsible for protecting patients from an impaired colleague and for assisting an impaired colleague by
identifying appropriate sources of help.
Erectile dysfunction in a patient who experiences nocturnal penile tumescence is most likely situational or mood related
cognitive behavioral therapy, biofeedback, or sensory awareness exercises with a psychotherapist are first-line therapies.
Pain between the metatarsal heads, the sensation of walking on a pebble, and no obvious abnormalities of the foot upon clinical examination or palpation
Hallmarks of a Morton neuroma
The ______________________ relies on identifying a goal to be accomplished with a change, determining how the results of a change will be measured, and deciding on the changes that will bring about an improvement.
The Model of Improvement
Functional incontinence, which occurs in patients who cannot reach and use the toilet in a timely manner, is treated with
prompted voiding
Treatment of posttraumatic stress disorder requires
psychotherapy from a specialist with experience in treating the disorder; antidepressants are useful adjunctive therapies.
The sudden onset of headache, nausea, vomiting, and vision changes; the appearance of halos around lights; and the presence of a mid-dilated, nonreactive pupil
Acute angle-closure glaucoma
an inexpensive and important risk assessment tool that allows clinicians to identify persons at increased risk for developing certain conditions, especially genetic conditions.
Three-generation family history
For women with anovulatory abnormal uterine bleeding and contraindications to combination oral contraceptive use,
a progestin-containing intrauterine device will likely reduce blood loss and maintain the stability of the endometrium, thereby reducing the risk for uterine cancer.
The treatments of choice for persistent postural-perceptual dizziness (PPPD) are
vestibular and balance rehabilitation therapy and medical therapy with selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.
These facilities provide longer-term, higher-intensity medical treatment, such as complex wound care, mechanical ventilation weaning, and treatment with intravenous medications; such facilities also provide physical rehabilitation services
Long-term acute care hospitals
occurs when early detection of a disease with a screening test leads to an increase in measured survival but not overall survival time.
Lead-time bias
Treatment for alcohol dependence at the time of hospital discharge.
Naltrexone, which is available in both oral and long-acting injectable forms, is associated with a substantial decrease in 30-day readmission and emergency department visits
For seriously ill patients, understanding of their health and prognosis must be assessed before
a conversation regarding care preferences and pathways can occur.
In patients in whom statin therapy is being considered,
an alanine aminotransferase level should be obtained at baseline to evaluate for liver dysfunction; further hepatic monitoring is unnecessary if the baseline level is normal.
Screening for diabetes mellitus is recommended for patients
with overweight or obesity and other risk factors for diabetes.
a heterogeneous disorder characterized by at least two of the following symptoms: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms; the typical age of onset is early adulthood.
Schizophrenia
Clinical diagnosis of bacterial vaginosis requires three of the following four features:
vaginal pH greater than 4.5, thin and homogenous vaginal discharge, positive whiff test result, and CLUE CELLS comprising at least 20% of all squamous cells on SALINE MICROSCOPY; culture is not a reasonable test to confirm the diagnosis of bacterial vaginosis and would also be costly and inefficient compared with an office-based diagnosis.
For patients with concomitant benign prostatic hyperplasia and erectile dysfunction
a trial of TADALAFIL (a phosphodiesterase-5 inhibitor) has been shown to be effective and is the only FDA-approved option to treat both conditions.
Which of the following is the most appropriate management of this patient’s medications: Amlodipine, Metoprolol, Atorvastatin & aspirin before surgery?
In patients undergoing noncardiac surgery, β-blockers and statins should be continued in those who have been taking the drugs long term, and aspirin generally should be continued in patients with coronary stents unless the bleeding risk is prohibitively high.
High breast density alone does not necessitate
adjunctive breast imaging other than routine screening mammography.
has demonstrated some efficacy in the treatment of chronic noncancer pain.
Medical cannabis
Asymptomatic popliteal cysts
Do NOT REQUIRE TREATMENT; in symptomatic cases, treatment is usually directed at the underlying cause.
The diagnosis of a female sexual disorder requires both
significant distress and the persistence of symptoms not explained by a nonsexual mental disorder.
In patients with findings concerning for centrally mediated vertigo or patients with acute sustained vertigo and risk factors for vertebrobasilar stroke, urgent evaluation with
MRI and posterior circulation magnetic resonance angiography are strongly recommended.
Weight loss is best achieved with
a high-intensity behavioral therapy program (≥14 sessions of ≥6 months’ duration) delivered by a trained interventionist and including regular self-monitoring of weight and calorie intake.
When decisions are made on behalf of a patient who lacks decision-making capacity, they should be based on
previously expressed oral or written statements of preferences or values, also known as substituted judgment.
If maximal medical therapy has failed to achieve laxation in patients taking opioids
peripheral opioid antagonists, such as METHYLNATREXONE, can be considered; this med does not reverse the analgesic or antidyspneic effects of systemically administered opioids.
a heterogeneous group of disorders that share two diagnostic features: (1) repetitive, nonpurposeful behaviors and (2) deficiencies in communication and social interaction.
Autism spectrum disorder
Treat hyperlipidemia in a patient at low risk for atherosclerotic cardiovascular disease.
Therapeutic lifestyle changes, including dietary modification, regular physical activity, weight loss, and smoking cessation, are the initial treatment for hyperlipidemia.
Patients with greater trochanteric pain syndrome (trochanteric bursitis) typically have pain localized to the greater trochanter, which may radiate down the lateral leg to the knee, and pain to palpation over the greater trochanter; treatment includes
avoiding painful activities, acetaminophen or NSAIDs, and muscle strengthening
Is a clinical diagnosis characterized by vulvar itching, vaginal dryness, and dyspareunia; pelvic examination findings include pale, shiny vaginal walls; decreased rugae; and petechiae.
Genitourinary syndrome of menopause
In patients with chronic pain
risk assessment should be performed before initiating or continuing opioid therapy
When it is necessary to discontinue anticoagulant therapy for surgery, non–vitamin K antagonist oral anticoagulants can be stopped
2 to 3 days preoperatively because of their short half-lives.
Treatment of major depressive disorder?
Cognitive behavioral therapy and second-generation antidepressants have proved equally effective for treatment of major depressive disorder, with similar rates of discontinuation; treatment selection should be made after discussion of adverse effect profiles, accessibility, cost, and preferences with the patient.
