Internal Medicine Essentials Questions: General Internal Medicine

Question 1

You need a table to know how the likelihood ratio affects post-test probability, but give the rule of thumb for an LR of 2, 5, and 10.

Answer 1

• 2 = 15%
• 5 = 30%
• 10 = 45%

Question 2

Describe the AAA screening guidelines.

Answer 2

Men ages 65 to 75 who have ever smoked should be screened with an abdominal ultrasound. This has been shown to lead to a 14% decrease in death over ten years.

Question 3

Describe the pneumococcal vaccines schedules.

Answer 3

The 23-valent and 13-valent kinds should both be given to adults older than 65 or with other risk factors. They need to be given at separate times to achieve maximum response. Repeat every five years.

Question 4

The shingles vaccine is indicated for everyone older than _________.

Answer 4

60

Question 5

Explain the screening guidelines regarding Chlamydia and HIV.

Answer 5

• HIV: all sexually active adults 13 to 64

* Chlamydia: all sexually active females younger than 25

Question 6

What ages are recommended for HPV vaccination?

Answer 6

• Boys: 11 to 21

* Girls: 9 to 26

Question 7

A patient comes in with multiple readings of prehypertension. How should you manage it?

Answer 7

Repeat BP monitoring in one year.

If you thought the patient had white coat hypertension, then you could do ambulatory monitoring. Because you wouldn’t intervene, it isn’t necessary.

Question 8

If a young patient (in his 30s) has hypertension but normal labs, what test should you do?

Answer 8

ECG

(Honestly, I think this question was kind of bogus. The most common causes of secondary hypertension are as follows: hyperthyroidism, hyperaldosteronism, hypercalcemia, aortic coarctation, renal vasculature abnormalities, pheochromocytoma, Cushing’s syndrome, and OSA. I can’t think of anything that would be revealed by ECG.)

Question 9

What are the two high-intensity statin therapies?

Answer 9

• Atorvastatin 40 mg to 80 mg QD

* Rosuvastatin 20 mg to 40 mg QD

Question 10

Fibrates are generally reserved for those with triglycerides greater than ___________.

Answer 10

500

Question 11

List two secondary causes of dyslipidemia.

Answer 11

• Diabetes

* Hypothyroidism

Question 12

Describe the safety and contraindications of each of the following weight-loss drugs:
•Lorcaserin
•Phentermine
•Orlistat

Answer 12

• Lorcaserin: serotonin receptor agonist that has been shown to be safe and effective; do not use in those taking serotonin-modifying drugs
• Phentermine: effective, but contraindicated in those with cardiovascular disease
• Orlistat: effective; only major side effect is steatorrhea

Question 13

The most effective strategy in losing weight and maintaining weight loss is ____________.

Answer 13

reduce daily calorie count by 500 to 1000 calories

Question 14

The best test in a case of suspected ankylosing spondylitis is _________________.

Answer 14

anterior-posterior radiography of the pelvis

Question 15

A patient has low back pain after an inciting event and has positive straight leg test. No numbness, weakness, or anesthesia. What is the best management?

Answer 15

Analgesics with mobility as tolerated

Question 16

Describe the progression of pertussis in adults.

Answer 16

• Incubation phase
• Catarrhal phase: rhinorrhea, cough, malaise
• Paroxysmal phase: periodic cough, can cause post-tussive emesis

Question 17

Cobblestoning of the nasopharynx is a physical exam finding of which type of chronic cough?

Answer 17

Postnasal drip

Question 18

Upper airway cough syndrome (UACS) should be treated with ______________.

Answer 18

phenylephrine and diphenhydramine

Question 19

“Throat tickle” is classic of which cough?

Answer 19

ACE inhibitors

Question 20

How should you manage new onset blood-tinged sputum in a smoker who has had a normal CXR?

Answer 20

CT

Lung cancer can be unseen on CXR. In a patient with a high pretest probability of lung cancer –such as an older person with extensive smoking history –CT needs to be done to rule out malignancy.

Question 21

What is the most common cause of nongonococcal urethritis?

Answer 21

Ureaplasma

Question 22

List three contraindications to varenicline use.

Answer 22

• Cardiovascular disease
• Psychiatric illness
• Renal failure

Question 23

If a patient does not respond to maximal doses of an antidepressant at _________, then they should be switched to a different antidepressant.

Answer 23

8 weeks

Question 24

Review the medical treatment of cocaine-induce MI.

Answer 24

• Nitroglycerin
• Aspirin
• CCB
• Lorazepam

Do not give beta-blockers!

Lorazepam is given to help slow down the HR.

Question 25

True or false: hypothalamic amenorrhea presents with low FSH.

Answer 25

False

Normal FSH is seen in hypothalamic amenorrhea. Not sure how.

Question 26

Diagnosis of PCOS requires two of the following three criteria: _________________.

Answer 26

evidence of anovulation, US showing cystic ovaries, or evidence of a hyperandrogen state (hirsutism or high androgens)

Question 27

What should you give to stabilize uterine bleeding in a woman with fibroids?

Answer 27

Medroxyprogesterone acetate daily

Question 28

A woman has secondary amenorrhea and lab shows negative b-hCG and normal FSH, LH, and prolactin. What’s the next test?

Answer 28

Progestin withdrawal

This differentiates between PCOS and anatomic problems, which would be the most likely disorders.

Question 29

An elderly person with CHF has a brief syncopal episode without a prodrome and no evidence of orthostatic changes. What is the likely etiology?

Answer 29

Arrhythmia

Most commonly, ventricular tachycardia or heart block can lead to brief syncope.

Question 30

Explain the utility of an implantable loop recorder.

Answer 30

Implantable loop recorders are long-term implants that can detect and store arrhythmias. They are useful in patients who have infrequent events that are suspicious for arrhythmia (“I have an uneasy feeling in my chest and pass out about once every six months”). They should only be used when short-term devices such as Holter monitors or event capturers have failed to detect events.

Question 31

What factors make lymphadenopathy more likely to be pathological?

Answer 31

• Advanced age (older than 40)
• Size greater than 2 cm
• Persistence for longer than 2 weeks

Question 32

Megestrol is used for ______________.

Answer 32

stimulating appetite

Question 33

List the four main causes of weight loss in an adult.

Answer 33

• Malignancy (e.g., colon cancer, lymphoma)
• Chronic infection / inflammation (e.g., tuberculosis, Crohn’s)
• Metabolic / endocrine (e.g., hyperthyroidism)
• Psychiatric / psychogenic (e.g., depression, grief)

Question 34

The best treatment for urinary incontinence among nursing home residents without worrisome signs (i.e., no suprapubic fullness, no urgency, no constant leakage) is ________________.

Answer 34

prompted voiding

Several trials have shown that having nursing home residents go to the restroom on a regular schedule can decrease incontinence.

Question 35

For elderly people at risk of falls, ___________ has been shown to increase strength and decrease falls.

Answer 35

vitamin D

You do not need to draw vitamin D levels prior to prescribing vitamin D.

Question 36

Per IME, genetic testing should be done ________________.

Answer 36

in the context of genetic counseling

Question 37

A guy has HCV and develops ulcerations in areas exposed to the sun. What is happening?

Answer 37

Acquired porphyria cutanea tarda

Chronic HCV can destroy the liver, which is where uroporphobilinogen decarboxylase is found.

This can also present with increased pigmentation and hair growth in sun-exposed areas.

Question 38

Cryoglobulinemia often affects the kidneys and _____________.

Answer 38

the legs –leading to vasculitis with resultant hyperpigmentation

Question 39

The best treatment for generalized hives is ________________.

Answer 39

systemic antihistamines, preferably second-generation to avoid sedation

Question 40

Erythema nodosum can be caused by infections, autoimmune conditions, and ______________.

Answer 40

drug reactions

Question 41

SJS affects less than ____% of the body. TEN affects more than ____% of the body.

Answer 41

10; 30

Question 42

Folliculitis can present as ______________.

Answer 42

single infections or clusters

Topical clindamycin or benzoyl peroxide can treat.