Internal Medicine

Front 1

When should surgical intervention be considered in patients with low back pain?

Back 1

if symptoms persist for more than 6 weeks or if progressive neurologic deficits develop

Front 2

What provides short term relief for patients with low back pain with or without sciatica?

Back 2

NSAIDs

Front 3

What two types of nonpharmacologic treatments have proven beneficial in BPPV?

Back 3

- habituation exercises and
- the canalolith repositioning (Epley's) maneuver

Front 4

Where does epistaxis commonly occur?

Back 4

anteriorly, Kiesselbach's plexus

Front 5

What are indications for emergent or urgent referral to ENT for epistaxis?

Back 5

- suspicion of posterior bleeding
- need for electrocautery
- uncontrolled bleeding with packing
- recurrent bleeding within 1 to 2 days requiring possible arterial ligation or embolization

Front 6

What medication improves pain in patients with trigeminal neuralgia?

Back 6

carbamazepine

Front 7

Which drugs can act on cholinergic receptors to cause symptoms of incontinence?

Back 7

- nortiptyline (anticholinergic effects)
- antihistamines
- tricyclic antidepressants
- antipsychotic agents

Front 8

What should sexually active women aged 25 years and younger be screened for?

Back 8

Chlamydia trachomatis

Front 9

What medication is a good option for patients experiencing sexual dysfunction while on a SSRI?

Back 9

Buproprion (& doesn't cause weight gain)

Front 10

Which antidepressants stimulates appetite and may be good for anorexic patients?

Back 10

mirtazapine

Front 11

Which antidepressant should be used cautiously in patients with less than ideally controlled blood pressure?

Back 11

venlafaxine

Front 12

What are symptoms associated with Seborrheic blepharitis?

Back 12

- pain with blinking
- burning eye irritation with watering.
- scale is visible around the lashes, and sometimes there is crusting at the medial canthus.
-Occasionally, decreased vision or photophobia

Front 13

What are risk factors for postop delirium?

Back 13

- increasing age
- cognitive impairment, and
- benzodiazepine use

Front 14

What are potential causes of postoperative delirium?

Back 14

- hyponatremia
- severe hyperglycemia
- marked decline in hemoglobin
- hypoxemia
- infection
- unstable coronary syndrome,
- pneumonia
- opiate medications

Front 15

What suggests rhinitis medicamentosa?

Back 15

Persistent rhinitis symptoms in the setting of nasal decongestant

Front 16

How can rhinitis medicamentosa be treated?

Back 16

Stop use of nasal decongestant and use nasal corticosteroid spray

Front 17

What is the gold standard evaluation for diagnosis of abnormal uterine bleeding?

Back 17

endometrial biopsy

Front 18

What antibiotics can be used empirically for MRSA?

Back 18

- doxycycline
- trimethoprim–sulfamethoxazole
- minocycline
- clindamycin

Front 19

What is the most common cause of heel pain?

Back 19

plantar fasciitis

Front 20

What are risk factors for plantar fasciitis?

Back 20

- Obesity
- prolonged standing, and
- running (repetitive microtrauma)

Front 21

What does conservative treatment for plantar fasciitis consist of?

Back 21

- rest
- icing
- exercises
- NSAIDs
- orthotics and cushioned soles

Front 22

What symptoms are characteristic of Achilles tendonitis?

Back 22

Diffuse or focal posterior heel pain, tenderness, and swelling at the insertion site of the Achilles tendon on the calcaneus

Front 23

What is a useful therapy for the treatment of dry eyes unresponsive to moisture-replacement therapy?

Back 23

Cevimeline is a cholinergic agent with muscarinic agonist activity prominently affecting the M1 and M3 receptors prevalent in exocrine glands

Front 24

What is a common cause of dry eyes?

Back 24

Keratoconjunctivitis sicca (KCS)

Front 25

What are the oral treatments for onychomycosis?

Back 25

- terbinafine
- itraconazole
- griseofulvin

Front 26

What score on the Five-Item Geriatric Depression Screen is considered a negative depression screening result?

Back 26

less than 2

Front 27

How is the diagnosis of metabolic syndrome established?

Back 27

Any 3 of the following:
- increased waist circumference (> 40 in men & 35 in women)
- triglycerides > 150 or on meds
- HDL < 40 men or < 50 women or on medication to increase
- blood pressure > 130 systolic or >85 diastolic or on medication
- fasting plasma glucose > 100 or on drug treatment

Front 28

What testing should be performed in patients with nonspecific urinary tract symptoms?

Back 28

urinalysis and serum creatinine measurement

Front 29

What are Waddell's signs? How should they be evaluated?

Back 29

- when signs and symptoms are inconsistent and don't make physiologic sense with hypochondriasis and hysteria
- psychological evaluation

Front 30

Besides cognitive behavioral therapy, how can posttraumatic stress disorder be treated?

Back 30

- paroxetine and sertraline

Front 31

What is the most appropriate treatment of microbial otitis externa?

Back 31

combination of
- physical evacuation of the ear canal
- topical antibiotic treatment
- and efforts to decrease inflammation to allow sufficient drainage of the ear canal
(Topical corticosteroid drops plus acetic acid drops, which has antimicrobial effect)

Front 32

Where is the skin rash with Gonococcal arthritis?

Back 32

extensor surfaces

Front 33

What is a useful therapy for the treatment of dry eyes unresponsive to moisture-replacement therapy?

Back 33

Cevimeline is a cholinergic agent with muscarinic agonist activity prominently affecting the M1 and M3 receptors prevalent in exocrine glands

Front 34

What is a useful therapy for the treatment of dry eyes unresponsive to moisture-replacement therapy?

Back 34

Cevimeline is a cholinergic agent with muscarinic agonist activity prominently affecting the M1 and M3 receptors prevalent in exocrine glands

Front 35

What is a common cause of dry eyes?

Back 35

Keratoconjunctivitis sicca (KCS)

Front 36

What is a common cause of dry eyes?

Back 36

Keratoconjunctivitis sicca (KCS)

Front 37

What are the oral treatments for onychomycosis?

Back 37

- terbinafine
- itraconazole
- griseofulvin

Front 38

What are the oral treatments for onychomycosis?

Back 38

- terbinafine
- itraconazole
- griseofulvin

Front 39

What score on the Five-Item Geriatric Depression Screen is considered a negative depression screening result?

Back 39

less than 2

Front 40

What score on the Five-Item Geriatric Depression Screen is considered a negative depression screening result?

Back 40

less than 2

Front 41

How is the diagnosis of metabolic syndrome established?

Back 41

Any 3 of the following:
- increased waist circumference (> 40 in men & 35 in women)
- triglycerides > 150 or on meds
- HDL < 40 men or < 50 women or on medication to increase
- blood pressure > 130 systolic or >85 diastolic or on medication
- fasting plasma glucose > 100 or on drug treatment

Front 42

How is the diagnosis of metabolic syndrome established?

Back 42

Any 3 of the following:
- increased waist circumference (> 40 in men & 35 in women)
- triglycerides > 150 or on meds
- HDL < 40 men or < 50 women or on medication to increase
- blood pressure > 130 systolic or >85 diastolic or on medication
- fasting plasma glucose > 100 or on drug treatment

Front 43

What testing should be performed in patients with nonspecific urinary tract symptoms?

Back 43

urinalysis and serum creatinine measurement

Front 44

What testing should be performed in patients with nonspecific urinary tract symptoms?

Back 44

urinalysis and serum creatinine measurement

Front 45

What are Waddell's signs? How should they be evaluated?

Back 45

- when signs and symptoms are inconsistent and don't make physiologic sense with hypochondriasis and hysteria
- psychological evaluation

Front 46

What are Waddell's signs? How should they be evaluated?

Back 46

- when signs and symptoms are inconsistent and don't make physiologic sense with hypochondriasis and hysteria
- psychological evaluation

Front 47

Besides cognitive behavioral therapy, how can posttraumatic stress disorder be treated?

Back 47

- paroxetine and sertraline

Front 48

Besides cognitive behavioral therapy, how can posttraumatic stress disorder be treated?

Back 48

- paroxetine and sertraline

Front 49

What is the most appropriate treatment of microbial otitis externa?

Back 49

combination of
- physical evacuation of the ear canal
- topical antibiotic treatment
- and efforts to decrease inflammation to allow sufficient drainage of the ear canal
(Topical corticosteroid drops plus acetic acid drops, which has antimicrobial effect)

Front 50

What is the most appropriate treatment of microbial otitis externa?

Back 50

combination of
- physical evacuation of the ear canal
- topical antibiotic treatment
- and efforts to decrease inflammation to allow sufficient drainage of the ear canal
(Topical corticosteroid drops plus acetic acid drops, which has antimicrobial effect)

Front 51

Where is the skin rash with Gonococcal arthritis?

Back 51

extensor surfaces

Front 52

Where is the skin rash with Gonococcal arthritis?

Back 52

extensor surfaces

Front 53

What is the leading cause of legal blindness among people aged 65 years or older in the United States?

Back 53

age-related macular degeneration

Front 54

What is seen on opthalmoscopic exam in dry age-related macular degeneration?

Back 54

- soft drusen
- pigmentary abnormalities
- geographic atrophy (well-defined areas of retinal pigment epithelium loss)

Front 55

What is seen on opthalmoscopic exam in wet age-related macular degeneration?

Back 55

exudative process consisting of choroidal neovascularization

Front 56

How is proliferative diabetic retinopathy is characterized?

Back 56

microaneurysms, cotton wool spots, dilated retinal vessels, and new formation of retinal vessels

Front 57

What are contraindications to estrogen use?

Back 57

- undiagnosed vaginal bleeding
- breast cancer
- other estrogen-sensitive cancers,
- current or previous history of venous or arterial thrombosis, or
- liver dysfunction or disease

Front 58

What is an effective and safe initial therapy for common warts?

Back 58

- Simple topical treatment containing salicylic acid
- may take 6 -12 weeks to treat

Front 59

What test can be performed if suspecting a diagnosis of endometriosis?

Back 59

transvaginal ultrasound

Front 60

What are the criteria for hospitalization of patients with anorexia nervosa?

Back 60

- severe malnutrition or dehydration
- electrolyte disturbances
- cardiac arrhythmias
- physiologic instability
- failure of outpatient treatment
- acute food refusal
- uncontrollable bingeing and purging
- acute medical complication of malnutrition
- suicidal ideation
- the presence of comorbid problems interfering with treatment

Front 61

What is acute bacterial epididymitis usually caused by?

Back 61

Chlamydia trachomatis or Neisseria gonorrhoeae

Front 62

What does treatment of acute bacterial epididymitis include?

Back 62

- bed rest
- scrotal elevation
- oral antibiotics

Front 63

In patients with urge incontinence and intolerance to oxybutynin, what medication can be used?

Back 63

Tolterodine - lower risk for dry mouth and crosses the blood-brain barrier in only negligible amounts so less CNS symptoms

Front 64

What interventions have been found to be beneficial in chronic fatigue syndrome?

Back 64

cognitive behavioral therapy and graded exercise

Front 65

What medication can be used for migraines when allodynia is present?

Back 65

Metoclopramide
(Triptans are effective abortive therapy for most migraines, but are much less effective in the setting of allodynia during a migraine attack)

Front 66

When should patients with varicose veins be considered for surgery, such as vein stripping or ligation, or sclerotherapy?

Back 66

When they do not respond to 3 to 6 months of conservative treatment or who are very bothered by the cosmetic appearance of the varicose veins

Front 67

What are effective therapies for viral URIs?

Back 67

- pseudoephedrine
- ipratropium nasal inhaler,
- cromolyn sodium nasal inhaler
- humidified air.

Front 68

When is phototherapy used for psoriasis treatment?

Back 68

When larger body area involved

Front 69

How is psoriasis treated when plaques of psoriasis are localized and involve less than 5% of the total body area?

Back 69

high-potency corticosteroids

Front 70

What is used to treat psoriasis of the face and intertriginous areas?

Back 70

Topical tacrolimus (a nonsteroidal agent with topical anti-inflammatory activity)

Front 71

What are potential side effects of Methotrexate?

Back 71

- bone marrow toxicity
- stomatitis
- gastrointestinal intolerance,
- fever
- alopecia
- chronic hepatotoxicity and requires monitoring of liver function,

Front 72

When is electrocardiography indicated as preoperative evaluation?

Back 72

- men > 40 yr
- women > 50 yr
- pts with CAD, DM or other significant risk factors for CAD (HLP, family history, HTN)

Front 73

What is best treatment for brown recluse spider bites?

Back 73

ice application, wound elevation, and avoidance of strenuous exercise in the muscles surrounding the bite

Front 74

How is pain related to complex regional pain syndrome best treated?

Back 74

bisphosphonates

Front 75

How is complex regional pain syndrome characterized?

Back 75

chronic pain of the extremities, often characterized by swelling, vasomotor instability, skin changes, and patchy bone demineralization

Front 76

When is tilt table testing indicated?

Back 76

patients with unexplained syncope in the absence of coronary artery disease or after a cardiac cause has been excluded

Front 77

What are corneal abrasion associated with hard or soft contact lenses is especially susceptible to?

Back 77

infectious keratitis

Front 78

How does anterior uveitis present?

Back 78

, painful eye, blurred vision, and vision loss, usually in young or middle-aged persons, but is not associated with contact lens use, corneal abrasion, or foreign-body sensation
-erythema prominent at the limbus, light reflex is sluggish to unreactive, and the pupil is constricted

Front 79

What is seen with herpetic keratitis?

Back 79

watery discharge and dendritic, or branching, pattern on fluorescein staining, and may have branching opacities

Front 80

Which eye conditions require emergency referral to an ophthalmologist?

Back 80

- Hypopyon
- infectious keratitis associated with corneal abrasion
- anterior uveitis

Front 81

Who should receive the varicella vaccine?

Back 81

all adults with no evidence of immunity to varicella.

Front 82

Is varicella vaccine safe in patients on prednisone therapy?

Back 82

yes, if daily dose is < 20 mg

Front 83

How should varicella vaccine be given to adults?

Back 83

- Two-dose vaccination series over 6 weeks, delay work for 4 weeks (there is viral sheeding in the 4 weeks after giving vaccine)
- should avoid aspirin due to risk of Reye's syndrome

Front 84

What are typical laboratory abnormalities with hereditary angioedema?

Back 84

- C1 esterase inhibitor deficiency
- Decreased C4 and CH50 levels are typical during attacks

Front 85

How should a patient be evaluated if they have urticaria not responding to normal therapy?

Back 85

- workup for urticarial vasculitis, including erythrocyte sedimentation rate, complete blood count, and skin biopsy from the edge of the wheal

Front 86

What can be used to treat chronic noncardiac chest pain?

Back 86

- tricyclic antidepressants
- β-blockers
- ACE inhibitors
- L-arginine
- statins
- exercise may relieve symptoms

Front 87

What is one of the few evidence-based treatments for chronic dizziness of various causes?

Back 87

Vestibular rehabilitation - can improve symptoms, postural stability and dizziness-related challenges

Front 88

What is first-line therapy for panic disorder?

Back 88

serotonin reuptake inhibitors, such as paroxetine
- partial responders should also get CBT & benzodiazepiens
- non-responders should have SSRI switched, SNRI and may need atypical neuroleptics (risperidone, 1 to 2 mg; olanzapine, 5 to 10 mg; or quetiapine, 25 to 50 mg)

Front 89

How is rotator cuff tendonitis characterized?

Back 89

- subacromial tenderness and impingement
- pain often occurs with overhead reaching and when lying on the side

Front 90

What is a specific finding for rotator cuff tendonitis?

Back 90

Pain with resisted midarc abduction

Front 91

Why should SSRIs be discontinued 1 week before surgery?

Back 91

can increase bleeding risk because of depletion of intraplatelet serotonin stores

Front 92

Why should gingko and garlic be discontinued 1 week before surgery?

Back 92

can cause bleeding problems

Front 93

What does weight loss of approximately 5% at 1 year decreased progression to?

Back 93

- diabetes
- improved lipid control
- improved hypertension control

Front 94

What is the preferred choice of antibiotics for Bordetella pertussis?

Back 94

macrolides

Front 95

Which antiplatelet drug is associated with tinnitus?

Back 95

aspirin

Front 96

What history is characteristic of a rotator cuff tear?

Back 96

acute shoulder pain and weakness after falling on an outstretched arm

Front 97

What physical exam findings is a highly specific finding for a rotator cuff tear?

Back 97

inability to smoothly lower the affected arm from full abduction (positive drop arm test)

Front 98

How can you differentiate between rotator cuff tear and tendonitis?

Back 98

there will be weakness with tear and not tendonitis

Front 99

What is the most common cause of recurrent, disabling attacks of vertigo?

Back 99

Meniere's disease

Front 100

What will you see clincially with Meniere's disease?

Back 100

- vertigo that last for several hours and associated wth vomiting and cochlear symptoms (tinnitus, ear fullness and/or hearing loss)
- may develop progressive sensotineural hearing loss

Front 101

How do you treat Meniere's disease?

Back 101

- meclizine
- benzodiazepines
- antiemetics
- if frequent, prophylactic diuretics and low-sodium diet

Front 102

How do you differentiate vestibular neuritis from labyrinthitis?

Back 102

Labyrinthitis will have unilateral hearing loss

Front 103

How do you differentiate vestibular neuritis from Meniere's disease?

Back 103

vestibular neuritis is usually a single episode that resolved in a few days to week

Front 104

Which antihypertensive medications should be held the morning of surgery?

Back 104

ACEI & ARBs

Front 105

When should men be screened for aortic abdominal aneurysm?

Back 105

age 65-75 if they ever smoked

Front 106

What is the mainstay of treatment for primary dysmenorrhea?

Back 106

oral contraceptives and NSAIDs

Front 107

How often should patients undergo cholesterol screening if they have only one risk factor for heart disease?

Back 107

once every 5 years

Front 108

What will you see with acute angle-closure glaucoma?

Back 108

- rapidly increased intraocular pressure
- pain
- diffuse erythema, and a
- moderately dilated, fixed pupil

Front 109

Pateint presents with lower extremity edema, without signs of overt heart failure. What is the diagnosis?

Back 109

Lipodermatosclerosis
(involves circumferential areas of fibrosis extending proximally from above the ankles, with pitting edema above the area of fibrosis and over the feet)

Front 110

What is first line treatment for poison ivy?

Back 110

oral corticosteroids for 2 weeks

Front 111

What is the treatment option for patients with class III obesity, defined as those with a BMI of ≥40?

Back 111

surgery

Front 112

What class of medications can exacerbate lower urinary tract symptoms in men with enlarged prostates?

Back 112

antihistamines (decrease bladder contractility)

Front 113

What reduces the risk for postphlebitic syndrome by approximately 50% in patients with symptomatic proximal deep venous thrombosis?

Back 113

elastic compression stockings

Front 114

What is the presence of a red reflex, central opacity, and visible fundus is consistent with?

Back 114

immature nuclear cataract (do not need to extract)

Front 115

What is the preferred initial treatment for bacterial rhinosinusitis?

Back 115

- amoxicillin
- trimethoprim-sulfamethoxazole
- doxycycline
(cover strep and Haemophilus)

Front 116

What is chylothorax associated with?

Back 116

- Malignancy (Non-Hodgkin's lymphoma - 60%)
- cardiothoracic procedures (25% of time)
- cirrhosis
- tuberculosis
- filariasis

Front 117

What is appropriate therapy for cervical radiculopathy?

Back 117

anti-inflammatories and moist heat

Front 118

In what other conditions is Alopecia areata common?

Back 118

- diabetes
- thyroid disease
- vitiligo
- atopy
- Down's syndrome

Front 119

What are "exclamation point" hairs pathognomonic for?

Back 119

alopecia areata

Front 120

What test indicates active disease in alopecia areata?

Back 120

A "pull test" with 25-50 hairs removed

Front 121

What is Telogen effluvium?

Back 121

- Nonpermanent hair loss that can be related to drug effect, acute illness, or stress.
- Microscopy demonstrates a white bulb on the shaft
- Self-limited

Front 122

How is tinea capitus treated?

Back 122

griseofulvin or an antifungal “azole” medication.

Front 123

Which weight loss medication should be avoided in patients with poorly controlled blood pressure?

Back 123

Sibutramine (SSRI/SNRI)

Front 124

What is an effective therapy for patients with tinea versicolor?

Back 124

- topical keoconazole
- oral itraconazole (contraindicated in patients using statins)

Front 125

what organism causes tinea versicolor?

Back 125

Malassezia furfur

Front 126

What does microscopic examination of scale with 10% potassium hydroxide show in patients with tinea versicolor?

Back 126

large, blunt hyphae and thick-walled budding spores in a “spaghetti and meatballs” pattern

Front 127

How should an evulsed tooth be transported if can get to a dentist within 30 min?

Back 127

in the socket
(milk is second best)

Front 128

Which class of medications are appropriate for the treatment of depression and generalized anxiety disorder?

Back 128

SSRI/SNRIs

Front 129

Which cancers most commonly spread to bone?

Back 129

- renal cell
- breast
- lung
- prostate
- thyroid

Front 130

What should patients with a history of cancer and new skeletal complaints should be evaluated for?

Back 130

metastasis - can perform a bone scan (picks up small lesions)

Front 131

What are reversible causes of memory problems?

Back 131

- depression
- hyper- or hypothyroidism,
- liver or renal dysfunction
- hypercalcemia
- B12/folate deficiency

Front 132

How can benign memory loss can be distinguished from mild cognitive impairment?

Back 132

lack of evidence of cognitive impairment on objective tests (ex. Mini-Mental exam)

Front 133

What can be done to reduce the short-term incidence of yeast vaginitis in patients with recurrent infection?

Back 133

weekly oral fluconazole

Front 134

Which medications increase the risk for statin-associated myopathy?

Back 134

- fibrates
- cyclosporine
- macrolide antibiotics
- various antifungal drugs
- cytochrome P-450 inhibitors.

Front 135

What are signs & symptoms of group A β-hemolytic streptococcus pharyngitis?

Back 135

- fever
- tender lymphadenopathy (anterior cervical)
- absence of cough
- tonsillar exudates

Front 136

What needs to be met to diagnose somatization disorder?

Back 136

- 2 GI complaints, 1 sexual symptom and 1 pseudoneurological complaint,none of which can be explainable by another medical diagnosis

Front 137

What is one of the most serious adverse outcomes of radical prostatectomy? How is it treated?

Back 137

- severe urinary incontinence
- anticholinergic therapy, collagen injections, sling procedures, and artificial urinary sphincter implantation

Front 138

What can be used for for recalcitrant nodular acne?

Back 138

oral isotretinoin

Front 139

In what infection do you see 'Clue cells' and how is it treated?

Back 139

- Bacterial vaginosis
- metronidazole or clindamysin (orally or vaginally)

Front 140

What MMSE score isconsidered to be a positive screening result for dementia?

Back 140

score of less than 23 (of 30)

Front 141

What is most commonly associated with a rash in the creases of the skin and on the hands? How is it treated?

Back 141

- atopic dermatitis
- topical moisturizers (emollients) or topical corticosteroids, if not responding to emollients

Front 142

What is the criteria for the diagnosis of atopic dermatitis?

Back 142

1) involvement of the skin creases, including areas around the neck or eyes, elbows, knees, and ankles
2) history of asthma or hay fever
3) history of dry skin during the past year
4) onset in a child younger than 2 years of age; and
5) visible dermatitis of skin flexures.

Front 143

What nonprescription treatment is available for hot flushes?

Back 143

black cohash (should use for less than 6 months)

Front 144

What can you see on opthalmologic exam with diabetic retinopathy?

Back 144

- microaneurysms
- cotton-wool spot
- dilated retinal vessels, and
- new formation of retinal vessels

Front 145

What is the treatment for comedonal-only acne?

Back 145

topical retinoid medication

Front 146

What is the recommended prophylaxis for elective total knee replacement?

Back 146

high-dose low-molecular weight heparin (subQ enoxaparin 30 mg BID)