General internal medicine

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General internal medicine
2013-10-31 21:06:03
medicine shelf

mksap, internal medicine
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  1. post-test probability
    = post-test odds / (post-test odds +1)

    post-test odds =  pretest odds x positive likelihood ratio
  2. abdominal US screen
    one-time screen for abdominal aortic aneurism is recommended for men ages 65 to 79 years
  3. influenza prevention in immunosuppressed
    • oseltamivir
    • active against influenza A and B
  4. inactivated vs live influenza vaccine
    inactivated is recommended for patients with chronic medical conditions
  5. midsystolic murmur in elderly patient
    right sternal border
    Aortic sclerosis is present in approximately 25% of persons between the ages of 65 and 74 years and in 48% of persons older than 84 years.
  6. PSA
    in patients with no symptoms of prostate disease, PSA testing has positive predictive value of only 30%
  7. Orlistat
    • Lipase inhibitor that increases fecal fat loss
    • tx of patients to aid in weight loss
    • efficacy: 2.8kg at 12 months
  8. Depression
    weight loss
    • Depression accounts for 9 to 15% of all cases of involuntary weight loss
    • most common psychiatric cause
  9. Most common cause of irregular menstrual bleeding
    • polycystic ovary syndrome
    • early onset: key part of history (usually within 1 year)
    • evidence of androgen excess
    • ovulatory dysfunction
  10. Abx for inflammatory acne
  11. comedone acne
    • blackheads/whiteheads
    • tx: topical retinoids
  12. Apthous ulcers
    • paiful lesions that are localized, shallow, round, often with whitish appearance
    • cause: unknown
  13. Becet's disease
    • connective tissue disease characterized by recurrent oral and genital ulcers
    • systemic manifestations
  14. atopic dermatitis
    • ezcema
    • allergic disorder
    • 1. involvement of skin creases
    • 2. history of asthma or hay fever
    • 3. history of dry skin during the past year
    • 4. onset in a child <2yo
    • 5. Visible dermatitis of skin flexures
  15. poison ivy
    topical corticosteroids cannot be used on the face, neck, intertrigenous areas
  16. painful, erythematous nodules on anterior surface of legs
    • erythema noduosum
    • causes: IBS, fungal or streptococcal infections, lymphomas, medications...
  17. Erythema plus arthritis or periarthritis -->
    suspicion for acute sarcoidosis
  18. Herepes zoster
    Tx: famciclovir
  19. Itching at night, papules, excoriations
    • scabies
    • sarcoptes scarbieli var hominis
    • most commonly in school chilgren, nusring-home residents, institutionalized patients
    • transmission: close physical contact
  20. tinea versicolor
    • area of hypopigmentation
    • hyperpigmented form
    • large, blunt hyphae and thick-walled budding spores in spaghetti and meatballs
    • Tx: topical ketoconazole cream or shampoo
  21. coarctation of the aorta
    associated with bicuspid aortic valve
  22. NSAIDs in elderly patients
    can raise blood pressures considerably
  23. CKD progression
    • hypertension
    • diabetes mellitus
    • proteinuria
    • cigarette smoking
  24. dissecting aortic aneurysm
    • hypertension
    • back pain
    • diastolic murmur
  25. hemophilia A
    deficiency of factor VIII
  26. Hemophilia B
    Factor IX deficiency
  27. ABO mismatch transfusion
    • rapid hemolysis
    • fever
    • flank pain
    • dark urine
    • DIC
  28. HIV kidney damage
    • most common: collapsing focal and segmental glomerulosclerosis
    • "HIV-related nephropathy"
    • Presentation: proteinuria
  29. primary hyperaldosteronism
    • Conn's syndrome
    • hypertension
    • hypokalemia
    • metabolic alkalosis
    • mild hypernatremia
    • suppressed plasma renin activity
    • elevated plasma aldosterone levels
  30. glucagonoma
    clinical features
    • Necrolytic migratory erythema: papules/plaques on face, perineum, extremities
    • Diabetes mellitus: mild hyperglycemia easily controlled with oral agents
    • Gastointestinal symptoms: diarrhea, anorexia, abdominal pain, occasional constipation
    • Other findings: weight loss, neuropsychiatric, associated with venous thrombosis
  31. Glucagonoma
    • hyperglycemia with elevated glucagon >500pg/mL
    • NOrmocytic, normochromic anemia (ACD)
    • Abdominal imaging (CT or MRI) to localize tumor