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.
