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Internal Outpatient Flashcards

1
Q 
deHTN treatment if 
diabetes?
stroke?
CAD?
CHF?
pregnant?
A

diabetes, stroke –> ACEI
CAD, CHF –> BB
preg –> CCB

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2
Q

side effects of niacin and fibrates?

A

niacin: flushing, hyperglycemia, hyperuricemia (check CK, LFTs)
fibrates: hepatoxicity, rhabdo, cholesterol gallstones (check CK, LFTs)

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3
Q

de quervian disease

A

pain at radial wrist with thumb gripping
Dx: finkerstein test (clench thumb under other fingers then ulnar deviate wrist)
tx: thumb spica splint + NSAIDs

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4
Q

age related macular degeneration

A

degeneration of macula –> loss of central vision, scotoma (blind spot)
wet: sudden onset
dry: gradual onset
Dx: drusen (yellow-white deposits under pigmented epithelium)
Tx for wet: ranibizumab dec rate of vision loss

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5
Q

glaucoma

A

inc intraocular pressure –> optic nerve damage –> loss of peripheral vision, blindness
open angle: gradual onset, usually asx for years
closed angle: sudden onset w/ severe eye pain, tearing, N/V
Dx: check CNII damage, visual field defects, tonometry to measure IOP
Tx open angle: BB, alpha agonists, acetazolamide, prostaglandins
Tx closed angle: pilocarpine + emergent iridectomy

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6
Q

blepharitis

A

eyelid inflammation due to staph aureus

tx warm compress

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7
Q

complication of giant cell arteritis

A

aortic aneurysm

tx: follow patients with serial Xrays

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8
Q

treatment for torsades

A

if hemo unstable: defibrillator

if hemo stable and conscious: IV Mg

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9
Q

Common causes of aortic aneurysms

A

ascending: cystic medial necrosis (occurs w/ aging) or CT d/o
descending: atherosclerosis

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10
Q

clinical clues of renal parenchymal dz (3)

A
  1. HTN
  2. elev Cr
  3. abnorm urinalysis
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11
Q

indications for carotid endarterectomy

A

females: 70+ % stenosis
males sxs: 50+ stenosis
males asx: 60+ stenosis

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12
Q

acute aortic dissection tx

A

pain control (morphine)
IV BB (esmolol)
Na nitroprusside if SBP >120
surgery if ascending

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13
Q

complications of acute aortic dissection (8)

A
  1. stroke
  2. acute aortic regurg
  3. Horner syn
  4. acute MI
  5. pericardial effusion
  6. hemothorax
  7. LE weakness/ischemia
  8. abdominal pain
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14
Q

cholesterol crystal embolism

A

risk factors: HLD, HTN, DM II, cardiac Cath, vascular procedure
sxs: livedo reticular, ulcers, gangrene, blue toe syndrome); kidney injury; CNA prob; hollenhorst plaques on eye; GI issue
lab: elev Cr, elev Eos, low C’; urinalysis usually benign
skin/renal biopsy: biconvex, needle shaped clefts w/in occluded vessels, perivasc inflammatory w/ eos

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15
Q

indications for statin therapy

A

CV event
LDL>190
40-75 w/ DM
ASCVD risk >7.5%

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16
Q

presentation of constrictive pericarditis (8)

A 
exertion dyspnea, fatigue
periph edema and ascites
inc JVP
pericardial knock
pulses paradoxus
kussmauls sign
pericardial thickening and calcification on imaging
prominent X and Y descent
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17
Q

lights criteria for exudative effusion

only need 1

A

pleural fluid protein/serum protein ratio >0.5
pleural fluid LDH/serum LDH >0.6
pleural fluid LDH >2/3 upper limit of normal for serum LDH

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18
Q

Wells criteria for PE

A

> 4 PE likely
+3 if clinical signs of DVT, other dx less likely
+1.5 if previous PE/DVT, HR >100, recent surgery or immobilization
+1 if hemoptysis, cancer

19
Q

renal calculi tx

A

inc fluid intake
dec Na intake
norm Ca intake

20
Q

hyposthenuria

A

impaired ability of kidney to [ ] urine due to RBC sickling in the vasa rectae of the inner medulla

found in patients with sickle cell dz or trait

21
Q

management of uncomplicated ureteral stones <1 cm

A

hydration
analgesics
alpha blockers

22
Q

milk alkali syndrome

A

pathophys: excess intake of Ca and alkali; renal vasoconstriction and dec GFR; renal loss of Na and water, reabsorption of bicarb
sxs: NV, constipation; polyuria/dipsia; neuropsych sxs
lab: hyperCa, meta aka, AKI, suppressed PTH
tx: d/c cause agent; isotonic saline then furosemide

23
Q 
clinical ass'n
FSGS
membranous nephropathy
MPGN
minimal change
IgA
A

FSGS: AA & hispanic, obesity, HIV, heroin
membranous nephropathy: adenoCA, NSAIDs, Hep B, SLE
MPGN: Hep C & B, lipodystrophy
min change: NSAIDs, lymphoma
IgA: URI

24
Q

indications for cystoscopy (6)

A
  1. gross hematuria w/ no evidence of glomerular dz or infection
  2. microscopic hematuria w/ no evidence of glomerular dz or infection but inc risk of CA
  3. recurrent UTI
  4. obstructive sxs w/ suspicion for stricture, stone
  5. irritative sxs w/o UTI
  6. abnormal bladder imaging or urine cytology
25
chronic prostatitis/pelvic pain syndrome
pain in pelvis, perineum, genitals, w/ urination, w/ ejaculation no prostate tenderness sterile urine culture tx: alpha blockers (tamsulosin); abx; 5 alpha reductase inh (finasteride)
26
central cord syndrome
often in hyperextension injury in older person w/ DJD of cervical spine weakness in UE>LE
27
prevention test for patients w/ MG?
chest CT to check for thyoma | thymectomy can have long term improvement
28
vertigo causes (5)
1. meunière dz: recurrent episodes, sensoneural hearing loss, tinnitus, ear fullness 2. BPPV: triggered by head mvmt, nystagmus w/ dix-hallpike maneuver 3. vestibular neuritis: single episodes, can last days, follows viral syndrome, abnormal head thrust test 4. migraine 5. BS/cerebellar stroke: sudden onset, persistent
29
management of cirrhosis decompensated complications - varies bleed, ascites, encephalopathy
varices - nonselective BB, repeat EGD yearly ascites - Na restriction, diuretics, paracentesis encephalopathy - lactulose, fix underlying cause
30
outpatient empiric treatment of CAP
macrolide or doxycycline if healhty | fluoroquinolone or beta lactam + macrolide if comorbidities
31
AAA screening
one time for smokers 65-75
32
should live attenuated vaccines be avoided in patients taking anti-TNF meds?
YES
33
screening for average risk - breast CA - cervical CA - colon CA - HIV - HLD - HTN - osteoporosis
``` breast CA: mammoth every 2 yrs 50-75 cervical CA: pap every 3 yrs 21-65 colon CA: colonoscopy every 10 years or annual fecal occult test 50-75 HIV: 1 time Ab screen 15-65 HLD: lipid panel every 5 years men 35+ HTN: BP every 2 years 18+ osteoporosis: DEXA 65+ ```
34
meningococcal vaccination
regular: primary vaccination at age 11-18 **11-12; booster at 16-21 if 1* vaccine given <16 high risk patients (C' deficiency, asplenia, college dorms, military recruits, travel to endemic area, exposure to community outbreak) --> vaccinate even if 18+
35
felty syndrome
RA + neutropenia + splenomegaly +Anti-CCP, RF elev ESR
36
screening for HIV
initial: age 15-65, tx for TB, tx for STD annual: IVDU + sex partners, MSM, sex for $/drugs, HIV+ partner, >1 partner since last HIV test, homeless, in jail other: preg, occupation exposure, new STD sxs, prior to new sex relation
37
sxs of chromium, selenium deficiency
chromium: impaired glucose control in diabetes selenium: thyroid dysfunction, cardiomyopathy, immune dysfunction
38
copper deficiency
``` brittle hair skin depigmentation neuro dysfonctionnement (ataxia, peripheral neuropathy) sideroblastic anemia osteoporosis ```
39
zinc deficiency
``` alopecia pustular skin rash hypogonadism impaired wound healhing impaired taste immune dysfunciton ```
40
dx for CO poisoning
carboxyhemoglobin level on ABG
41
WegCners granulomatosis
necrotizing vasculitis, granulomas in lung, and glomerulonephritis **hemoptysis + hematuria dx=c-ANCA, tissue biopsy tx = cyclophosphamide
42
churg strauss syndrome
asthma + Eos + necrotizing vasculitis dx : p ANCA tx: steroids
43
Goodpasture syndrome
anti GBM Ab --> hemoptysis + hematuria | tx: steroids + cyclophosphamide + plasmapharesis

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