ITE BOARD REVIEW: GENERAL INTERNAL MEDICINE
1. Diagnose domestic abuse - Answers -- definition: intentional violent/controlling
behavior towards intimate partner
- RF: h/o abuse, psych, substance, decr. age, decr. socioeconomics
- presentation: somatic symtpoms, vaginal, UTI, STI/ associated with substance abuse,
risky sexual behavior, eating disorders, limited access to health care
- no gold standard for screening but goals: assist with health, asses for safety, maintain
supportive relationship
2. Manage vasovagal syncope - Answers -- definition: neurocardiogenic syncope "faint"
prodromal phase N/V/clammy --> withdrawal of sympathetic, increase in
parasympathetic/vagal tone, decr. blood pressure, decr. HR
- if no surge in vagal tone --> then no decr. in HR --> vasodepressor syncope
- provoked: standing, dehydration, preload reduction (diuretics or vasodilators)
- risk stratification: no good tool
- management: no hospitalization, exception: old people --> risk for face/trauma or
secondary cause needs to be ruled out
- instruct on abortive/preventative strategies, isometric counter-pressure maneuvers
include leg crossing, hand grip, squatting and muscle tensing, no BB
3. Interpret Odds Ration - Answers -- post-test odds = pretest odds x LR
- likelihood ratio: probability WITH disease/ patient withOUT disease
4. Manage Eustachian tube disfunction (blockage of tube) due to allergies/cold -
Answers -- #1: nasal corticosteroids, decongestion, myringostomy
5. Diagnose at-risk drinking (14 drinks per week or 4 drinks in male/ 7 drinks per week
or 3 drinks per occasion in females) - Answers -- Risky/Hazardous - increases the risk
of harmful consequences
- Harmful - negative effects not not depend (defined by consequences not quantity)
- Dependence - desire, impaired control, increased withdrawal/tolerance despite harmful
consequences
- screening AUDIT/TWEAK (preg) --> assist
6. Manage symptomatic lumbar disc herniation - Answers -- surgery shows no clear
benefit
- shows in dermatome pattern --> MRI --> surgeon "where to put the knife"
- if asymptomatic then --> PT and exercises
7. Diagnose inappropriate drug use by medication reconciliation - Answers -...
8. Indication of pneumovax in < 65 y/o - Answers -- 23 valent
- specific risk factors
, - if vaccinated before 65, need booster at 65 or 5 years after initial if between 60-64 yo
- IMMUNOCOMPETENT: single vaccine with booster
- chronic CVD, HTN, chronic lung disease, chronic/URI disease, DM, alcoholism, CSF
leak, cochlear implant
- IMMUNOCOMPROMISED - 2 doses separated by 54
- HIV, CKD, nephrotic syndrome, malignancy, immunosuppressive meds, multiple
myeloma, congenital or acquired deficiency
- SPLENIA: 2 doses separated by 5 years
- functional asplenia (sickle cell disease, hemoglobinopathies)
- anatomic aspenia
9. Manage pharyngitis - Answers -- 4 point centor score
- 1) fever 2) absence of cough 3) anterior lymphadenopathy 4) tonsillar exudates
- 0-1 = low risk --> no additional test
- 2-3 = antigen tests or throat culture --> possible abx
- 4 = testing --> empiric abx
- PCN treatment of choice --> GAS
- 10 day oral or 1 day IM PCN G, 10 day erythromycin/azithromycin (macrolide)
- Group C and G strep = GN and RA
10. Manage ASCUS in women with HPV - Answers -- 21 yo --> PAP every 3 years
- OR
- 5 years with HPV DNA for 30-65
- ASCUS 1) colposcopy 2) HPV DNA testing then colposcopy 3) Repeat PAP in 6-12
months
11. Manage an ethical conflict - Answers -- no gifts
12. Allergic conjunctivitis management - Answers -- seasonal allergies/itching
- 1) oral antihistamines
- 2) topical antihistamines
- 3) artificial tears
- NO ABX
13. Recognize patient autonomy in medical decision making - Answers -...
14. Diet in HTN - Answers -- 1) weight loss is most effective
- 2) decrease Na intake
15. Syncope evaluation - Answers -- 1) EKG despite low diagnostic yield
- 2) echo
- 3) telemetry or ambulatory monitoring
- 4) pregnancy test
1. Diagnose domestic abuse - Answers -- definition: intentional violent/controlling
behavior towards intimate partner
- RF: h/o abuse, psych, substance, decr. age, decr. socioeconomics
- presentation: somatic symtpoms, vaginal, UTI, STI/ associated with substance abuse,
risky sexual behavior, eating disorders, limited access to health care
- no gold standard for screening but goals: assist with health, asses for safety, maintain
supportive relationship
2. Manage vasovagal syncope - Answers -- definition: neurocardiogenic syncope "faint"
prodromal phase N/V/clammy --> withdrawal of sympathetic, increase in
parasympathetic/vagal tone, decr. blood pressure, decr. HR
- if no surge in vagal tone --> then no decr. in HR --> vasodepressor syncope
- provoked: standing, dehydration, preload reduction (diuretics or vasodilators)
- risk stratification: no good tool
- management: no hospitalization, exception: old people --> risk for face/trauma or
secondary cause needs to be ruled out
- instruct on abortive/preventative strategies, isometric counter-pressure maneuvers
include leg crossing, hand grip, squatting and muscle tensing, no BB
3. Interpret Odds Ration - Answers -- post-test odds = pretest odds x LR
- likelihood ratio: probability WITH disease/ patient withOUT disease
4. Manage Eustachian tube disfunction (blockage of tube) due to allergies/cold -
Answers -- #1: nasal corticosteroids, decongestion, myringostomy
5. Diagnose at-risk drinking (14 drinks per week or 4 drinks in male/ 7 drinks per week
or 3 drinks per occasion in females) - Answers -- Risky/Hazardous - increases the risk
of harmful consequences
- Harmful - negative effects not not depend (defined by consequences not quantity)
- Dependence - desire, impaired control, increased withdrawal/tolerance despite harmful
consequences
- screening AUDIT/TWEAK (preg) --> assist
6. Manage symptomatic lumbar disc herniation - Answers -- surgery shows no clear
benefit
- shows in dermatome pattern --> MRI --> surgeon "where to put the knife"
- if asymptomatic then --> PT and exercises
7. Diagnose inappropriate drug use by medication reconciliation - Answers -...
8. Indication of pneumovax in < 65 y/o - Answers -- 23 valent
- specific risk factors
, - if vaccinated before 65, need booster at 65 or 5 years after initial if between 60-64 yo
- IMMUNOCOMPETENT: single vaccine with booster
- chronic CVD, HTN, chronic lung disease, chronic/URI disease, DM, alcoholism, CSF
leak, cochlear implant
- IMMUNOCOMPROMISED - 2 doses separated by 54
- HIV, CKD, nephrotic syndrome, malignancy, immunosuppressive meds, multiple
myeloma, congenital or acquired deficiency
- SPLENIA: 2 doses separated by 5 years
- functional asplenia (sickle cell disease, hemoglobinopathies)
- anatomic aspenia
9. Manage pharyngitis - Answers -- 4 point centor score
- 1) fever 2) absence of cough 3) anterior lymphadenopathy 4) tonsillar exudates
- 0-1 = low risk --> no additional test
- 2-3 = antigen tests or throat culture --> possible abx
- 4 = testing --> empiric abx
- PCN treatment of choice --> GAS
- 10 day oral or 1 day IM PCN G, 10 day erythromycin/azithromycin (macrolide)
- Group C and G strep = GN and RA
10. Manage ASCUS in women with HPV - Answers -- 21 yo --> PAP every 3 years
- OR
- 5 years with HPV DNA for 30-65
- ASCUS 1) colposcopy 2) HPV DNA testing then colposcopy 3) Repeat PAP in 6-12
months
11. Manage an ethical conflict - Answers -- no gifts
12. Allergic conjunctivitis management - Answers -- seasonal allergies/itching
- 1) oral antihistamines
- 2) topical antihistamines
- 3) artificial tears
- NO ABX
13. Recognize patient autonomy in medical decision making - Answers -...
14. Diet in HTN - Answers -- 1) weight loss is most effective
- 2) decrease Na intake
15. Syncope evaluation - Answers -- 1) EKG despite low diagnostic yield
- 2) echo
- 3) telemetry or ambulatory monitoring
- 4) pregnancy test
