logging in or signing up ITE 2008 General Medicine umdnjchiefs Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 526 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: October 08, 2008 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: tawfik61 (4 month(s) ago) Very nice presentation,if you can send me one copy,tawfik61@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript General Internal Medicine : General Internal Medicine ITE-2008 High Yield Review Sudden Visual LossPainless : Sudden Visual LossPainless Retinal Detatchment Flashes of light, floaters, curtain Fundoscope: folded retina Retinal Artery occlusion Sudden painless visual loss- a.fib Fundoscope: cherry red spot on macula Retinal Vein occlusion Sudden painless visual loss- Waldenstrom’s Dilated retinal veins/hemorrhages Diabetic Eye : Diabetic Eye Non-proliferative Aneurysms Hemorrhages (retinal) Exudates Tx: glycemic control Proliferative Neovascularization Complications: Retinal detachment Vitreous hemorrhage Tx: Laser Eye Findings : Eye Findings Roth’s spots: Endocarditis Hollenhorst Plaques Cholesterol emboli- post cath Eye Inflammation : Eye Inflammation Autoimmune Optic Neuritis: MS- transient, other neurologic deficits Temporal arteritis HA, jaw claudictation, PMR, ESR, High dose steroids Infectious CMV retinitis: AIDS, cheese/ketchup appearance Tx: Gancyclovir HSV Keratitis: Red eye, foreign body Dendritic Pattern No steroids! Tx: triflouridine drops Pseudomonas Keratitis: Contact lense or intubated. Red eye/white cornea Tx: topical and IV Abx Glaucoma : Glaucoma Open Angle Peripheral visual loss Cup: Disc > 50% Tx: Adrenergic agonist B-blockers Carbonic anhydrase inhibitors Closed Angle Acute onset PAIN Red eye, mid-fixed dilated pupil Tx: Pilocarpine B- blocker Opthalmologist Now Visual Loss : Visual Loss Peripheral First Pseudotumor Cerebri Open angle Glaucoma Central First Macular degeneration Retinitis pigmentosa Red Eye : Red Eye Painless Conjunctivitis- itchy Allergic Bacterial Viral Painful Closed Angle Uveitis (+) photophobia Mid-constricted Ciliary Flush Causes Reiters, Ankylosing spondylitis, Bechet’s, Sarcoid, toxo Eye Inflammation (External) : Eye Inflammation (External) Stye Pustule on lid margin Blepharitis: Eye lid inflammation Pterygium: Membrane on conjunctiva Chalazion Obstructed medbonium gland Nodule under tarsus Cellulitis: Pre-septal: EOMI, pupil nl Septal: cavernous thrombosis, diplopia from CN6 palsy, IV antibiotics CT to diagnose Hearing Loss : Hearing Loss Presbyacusis Bilateral symmetrical sensorineural Aging Otosclerosis AD Young Overgrowth/Fixed stapes Otitis Externa : Otitis Externa Non- malignant External auditory canal Tx: Topical antipseudomonals Malignant Erythematous, purulent Tx: 2 antipseudomonals (ceftazadime + aminoglyco) Ramsey Hunt Vessicles in auditory canal, CN 7 involved Tx: Acyclovir + prednisone Bullous Myringitis Vessicles in ear from mycoplasma, concomittant PNA Vertigo : Vertigo Central Horizontal or Vertical nystagmus Can’t inhibit Basilar infarcts MS Brainstem/cerebeller Dz Peripheral Horizontal Nystagmus only Visual fixation inhibits nystagmus Acoustic neuroma Labrynthitis Benign Positional Menierre’s Dz Vertigo + Hearing loss : Vertigo + Hearing loss Menierre’s disease Fluctuating hearing loss Acoustic Neuroma Progressive hearing loss Get MRI VertigoNo hearing loss : VertigoNo hearing loss Benign Positional Exacerbated by position changes 2º otolith settling in cupula of post semicircular canal Epley otolith maneuver Labrynthitis Post URI Tx: meclizine +/- steroids MigrainesDiagnostic Criteria : MigrainesDiagnostic Criteria 1. Lasts 4-72 hours 2. Need 2 of the following: Unilateral - Pulsatile Intensity (Mod-sev) - Activity worsens it 3. Need 1 of the following: Nausea and vomiting Photophobia Phonophobia Migraine Treatment : Migraine Treatment Acute episode: OTC anti-inflammatory Triptans Do not use if CAD (use prochlorperazine) Prophylaxis B-blockers TCA Ca channel blockers Cluster : Cluster Male > Female Orbital- Excruciating 15 min, multiple episodes Rhinorrhea Lacrimation Ipsilateral Horner’s Tx: High flow intranasal O2 Tension : Tension Females > Males Not disabling Band-Like Location: Diffuse analgesics Pseudotumor Cerebri : Pseudotumor Cerebri Obese Females, steroids, Vit A intox Peripheral visual loss first CN 6 palsy Horizontal diplopia Papilledemia, increased ICP Tx: LP, Acetazolamide, shunts “Worst HA of my life” : “Worst HA of my life” Subarachnoid HTN CT misses 15% Xanthochromia seen in CSF LP Nimodopine • Vasospasm Pituitary Apoplexy Hypotension, adrenal insufficiency EtOH : EtOH Screen: CAGE DT’s > 72 hours Hyperadrenergic State Tx: AA, support groups Naltrexone EtOH deficiencies : EtOH deficiencies Thiamine Give thiamine then glucose Wernicke’s Triad: Confusion Opthalmoplegia Ataxia Magnesium Low, ECG changes, hypo Ca, K Anxiety Disorders : Anxiety Disorders Use SSRI Panic Disorder OCD PTSD No SSRI GAD- use buspirone Phobia Fakers : Fakers Aware Factitious -Health care workers Munchausen Sick role Malingering: Secondary gain Unaware Somatization > 8 organ systems, No findings Frequent appointments Conversion Neurologic complaints DepressionSIGECAPS : DepressionSIGECAPS > 2 weeks: MDD Normal Bereavement Traumatic event, Sx < 2 mos Dysthymia Sx > 2 yrs Sleep Interests Guilt Energy Concentration Appetite Psychomotor Suicidal Ideation Depression Tx : Depression Tx 1st episode: SSRI: 6-9 mos Takes 4-6 weeks to work, if no response by 6 weeks, switch meds Watch for increased enerygy and suicide attempt Second episode SSRI for at least 2 years Bipolar = Lithium : Bipolar = Lithium Hypothyroid (add synthroid) Hypercalcemia Nephrogenic DI (stop the Li) Schizophrenia = Antipsychotics : Schizophrenia = Antipsychotics Acute Dystonic RXN Torticollis, eyes fixed Tx: Benadryl Akathesia Motor Restlessness Tardive Dyskinesia Lip smacking Drug Intoxication : Drug Intoxication AMS, Autonomic instability, Neuromuscular problems (rigidity) Seratonin Syndrome SSRI + Buproprion Neuroleptic Malignant syndrome Phenothiazines + Haldol Eating Disorders : Eating Disorders Anorexia < 15% of ideal body weight SCD 2º to arrythmia 2º amenorrhea Still r/o pregnancy Bulemia Normal weight Dieting Callus on knuckles, dental enamel erosions Parotid enlargement Amylase Mallory Weiss tear Tx: SSRI Geriatrics : Geriatrics Best intervention to decrease falls: Stop Benzos, TCA, neuroleptics Tai Chi Best intervention to prevent Fractures: External hip protector Best predictor of fracture: osteoporosis Incontinence : Incontinence Look at sex and age of patient Look at Medications (anticholinergics, opiates) Look at PMHx (DM, BPH, MS) Physical Exam: Sphincter tone, prostate size Labs: U/A for infection Incontinence : Incontinence Elevated Post void residual (smells like urine) Obstruction: BPH- alpha blockers Detruser underactivity: Neuro problems (DM, MS, Anticholinergics, opiates) Tx: Bethanachol Decreased Sphincter tone • stress Multiple pregancies, cough- Kegals, pessaries Urge incontinence (detrusor overactivity) Anticholinergic (timed voiding, bladder training, oxybutnyn) Functional Incontinence – “Somebody help me!” Pregnancy : Pregnancy Safe Hydralazine Methyl-dopa Nifedipine labetalol PTU Heparin Nitrofurantoin amoxicillin Avoid ACE-I & ARB Methimazole Ciprofloxacin Bactrim Doxycycline Coumadin in 1st trimester Contraindications to Pregnancy : Contraindications to Pregnancy Pulmonary HTN Eisenmenger’s Marfan’s with dilated Aortic Root Severe AS NHA Class III DementiaMMSE < 23 : DementiaMMSE < 23 Alzheimers- MCC Anticholinesterase- Donepezil Memantine- mod/sev Multi-infarct History of patient Picks Fronto-Temporal lobes < 65 y/o CJD Startle myoclonus Lewy Body Parkinson’s Hallucinations Smoking Cessation : Smoking Cessation Nicotine replacement + behavior modification- 16% quit rate Nicotine patch alone is useless Buproprion alone- 30% quit rate Nicotine replacement + buproprion- 35% quit rate Contraindicated if hx of seizures New option: Chantix (Varenicline) SinusitisWhen to start empiric Abx : SinusitisWhen to start empiric Abx Fever Sinusitus symptoms > 7 days Tooth Pain Failure to improve after decongestant trial Otherwise: Tx with decongestants and analgesics Allergic SinusitisWhen to use anihistamines and nasal steroids : Allergic SinusitisWhen to use anihistamines and nasal steroids Rhinorrhea Tearing Sneezing Sore throatCriteria to start empiric Abx : Sore throatCriteria to start empiric Abx Must have all 4 of these: 1. Fever 2. Pharyngeal Exudates 3. Anterior cervical LAD 4. No cough If 2 or more Order rapid strep test Vaccinations : Vaccinations Influenza Age 50, then yearly Pneumococcal Age 65, then Q 5yrs (if received before 65) Start after splenectomy Tetanus Booster Q 10 yrs Multiple Sclerosis : Multiple Sclerosis Symptoms exacerbated by increased temp Warm climates or fever MC presentation – parasthesias No HA or Seizures MRI brain – increased T2 signals Carbamazepine for spasticity Optic neuritis means good prognosis Motor symptoms and late onset (age > 40) means bad prognosis Favorite Medications : Favorite Medications Lithium ACE-I Methotrexate Metformin Tamoxifen Alendronate Contraception : Contraception OCP Contraindications: smoking, DVT/PE, CAD, hypercoag states Depot medroxyprogesterone- causes weight gain Contraindications to Meds : Contraindications to Meds NSAIDS: hx of GIB, PUD, elevated Cr Triptans: hx of CAD B-Blockers: Psoriasis, Raynaud’s, wheezing Meds that don’t cause weight gain : Meds that don’t cause weight gain Metformin Buproprion You do not have the permission to view this presentation. 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ITE 2008 General Medicine umdnjchiefs Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 526 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: October 08, 2008 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: tawfik61 (4 month(s) ago) Very nice presentation,if you can send me one copy,tawfik61@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript General Internal Medicine : General Internal Medicine ITE-2008 High Yield Review Sudden Visual LossPainless : Sudden Visual LossPainless Retinal Detatchment Flashes of light, floaters, curtain Fundoscope: folded retina Retinal Artery occlusion Sudden painless visual loss- a.fib Fundoscope: cherry red spot on macula Retinal Vein occlusion Sudden painless visual loss- Waldenstrom’s Dilated retinal veins/hemorrhages Diabetic Eye : Diabetic Eye Non-proliferative Aneurysms Hemorrhages (retinal) Exudates Tx: glycemic control Proliferative Neovascularization Complications: Retinal detachment Vitreous hemorrhage Tx: Laser Eye Findings : Eye Findings Roth’s spots: Endocarditis Hollenhorst Plaques Cholesterol emboli- post cath Eye Inflammation : Eye Inflammation Autoimmune Optic Neuritis: MS- transient, other neurologic deficits Temporal arteritis HA, jaw claudictation, PMR, ESR, High dose steroids Infectious CMV retinitis: AIDS, cheese/ketchup appearance Tx: Gancyclovir HSV Keratitis: Red eye, foreign body Dendritic Pattern No steroids! Tx: triflouridine drops Pseudomonas Keratitis: Contact lense or intubated. Red eye/white cornea Tx: topical and IV Abx Glaucoma : Glaucoma Open Angle Peripheral visual loss Cup: Disc > 50% Tx: Adrenergic agonist B-blockers Carbonic anhydrase inhibitors Closed Angle Acute onset PAIN Red eye, mid-fixed dilated pupil Tx: Pilocarpine B- blocker Opthalmologist Now Visual Loss : Visual Loss Peripheral First Pseudotumor Cerebri Open angle Glaucoma Central First Macular degeneration Retinitis pigmentosa Red Eye : Red Eye Painless Conjunctivitis- itchy Allergic Bacterial Viral Painful Closed Angle Uveitis (+) photophobia Mid-constricted Ciliary Flush Causes Reiters, Ankylosing spondylitis, Bechet’s, Sarcoid, toxo Eye Inflammation (External) : Eye Inflammation (External) Stye Pustule on lid margin Blepharitis: Eye lid inflammation Pterygium: Membrane on conjunctiva Chalazion Obstructed medbonium gland Nodule under tarsus Cellulitis: Pre-septal: EOMI, pupil nl Septal: cavernous thrombosis, diplopia from CN6 palsy, IV antibiotics CT to diagnose Hearing Loss : Hearing Loss Presbyacusis Bilateral symmetrical sensorineural Aging Otosclerosis AD Young Overgrowth/Fixed stapes Otitis Externa : Otitis Externa Non- malignant External auditory canal Tx: Topical antipseudomonals Malignant Erythematous, purulent Tx: 2 antipseudomonals (ceftazadime + aminoglyco) Ramsey Hunt Vessicles in auditory canal, CN 7 involved Tx: Acyclovir + prednisone Bullous Myringitis Vessicles in ear from mycoplasma, concomittant PNA Vertigo : Vertigo Central Horizontal or Vertical nystagmus Can’t inhibit Basilar infarcts MS Brainstem/cerebeller Dz Peripheral Horizontal Nystagmus only Visual fixation inhibits nystagmus Acoustic neuroma Labrynthitis Benign Positional Menierre’s Dz Vertigo + Hearing loss : Vertigo + Hearing loss Menierre’s disease Fluctuating hearing loss Acoustic Neuroma Progressive hearing loss Get MRI VertigoNo hearing loss : VertigoNo hearing loss Benign Positional Exacerbated by position changes 2º otolith settling in cupula of post semicircular canal Epley otolith maneuver Labrynthitis Post URI Tx: meclizine +/- steroids MigrainesDiagnostic Criteria : MigrainesDiagnostic Criteria 1. Lasts 4-72 hours 2. Need 2 of the following: Unilateral - Pulsatile Intensity (Mod-sev) - Activity worsens it 3. Need 1 of the following: Nausea and vomiting Photophobia Phonophobia Migraine Treatment : Migraine Treatment Acute episode: OTC anti-inflammatory Triptans Do not use if CAD (use prochlorperazine) Prophylaxis B-blockers TCA Ca channel blockers Cluster : Cluster Male > Female Orbital- Excruciating 15 min, multiple episodes Rhinorrhea Lacrimation Ipsilateral Horner’s Tx: High flow intranasal O2 Tension : Tension Females > Males Not disabling Band-Like Location: Diffuse analgesics Pseudotumor Cerebri : Pseudotumor Cerebri Obese Females, steroids, Vit A intox Peripheral visual loss first CN 6 palsy Horizontal diplopia Papilledemia, increased ICP Tx: LP, Acetazolamide, shunts “Worst HA of my life” : “Worst HA of my life” Subarachnoid HTN CT misses 15% Xanthochromia seen in CSF LP Nimodopine • Vasospasm Pituitary Apoplexy Hypotension, adrenal insufficiency EtOH : EtOH Screen: CAGE DT’s > 72 hours Hyperadrenergic State Tx: AA, support groups Naltrexone EtOH deficiencies : EtOH deficiencies Thiamine Give thiamine then glucose Wernicke’s Triad: Confusion Opthalmoplegia Ataxia Magnesium Low, ECG changes, hypo Ca, K Anxiety Disorders : Anxiety Disorders Use SSRI Panic Disorder OCD PTSD No SSRI GAD- use buspirone Phobia Fakers : Fakers Aware Factitious -Health care workers Munchausen Sick role Malingering: Secondary gain Unaware Somatization > 8 organ systems, No findings Frequent appointments Conversion Neurologic complaints DepressionSIGECAPS : DepressionSIGECAPS > 2 weeks: MDD Normal Bereavement Traumatic event, Sx < 2 mos Dysthymia Sx > 2 yrs Sleep Interests Guilt Energy Concentration Appetite Psychomotor Suicidal Ideation Depression Tx : Depression Tx 1st episode: SSRI: 6-9 mos Takes 4-6 weeks to work, if no response by 6 weeks, switch meds Watch for increased enerygy and suicide attempt Second episode SSRI for at least 2 years Bipolar = Lithium : Bipolar = Lithium Hypothyroid (add synthroid) Hypercalcemia Nephrogenic DI (stop the Li) Schizophrenia = Antipsychotics : Schizophrenia = Antipsychotics Acute Dystonic RXN Torticollis, eyes fixed Tx: Benadryl Akathesia Motor Restlessness Tardive Dyskinesia Lip smacking Drug Intoxication : Drug Intoxication AMS, Autonomic instability, Neuromuscular problems (rigidity) Seratonin Syndrome SSRI + Buproprion Neuroleptic Malignant syndrome Phenothiazines + Haldol Eating Disorders : Eating Disorders Anorexia < 15% of ideal body weight SCD 2º to arrythmia 2º amenorrhea Still r/o pregnancy Bulemia Normal weight Dieting Callus on knuckles, dental enamel erosions Parotid enlargement Amylase Mallory Weiss tear Tx: SSRI Geriatrics : Geriatrics Best intervention to decrease falls: Stop Benzos, TCA, neuroleptics Tai Chi Best intervention to prevent Fractures: External hip protector Best predictor of fracture: osteoporosis Incontinence : Incontinence Look at sex and age of patient Look at Medications (anticholinergics, opiates) Look at PMHx (DM, BPH, MS) Physical Exam: Sphincter tone, prostate size Labs: U/A for infection Incontinence : Incontinence Elevated Post void residual (smells like urine) Obstruction: BPH- alpha blockers Detruser underactivity: Neuro problems (DM, MS, Anticholinergics, opiates) Tx: Bethanachol Decreased Sphincter tone • stress Multiple pregancies, cough- Kegals, pessaries Urge incontinence (detrusor overactivity) Anticholinergic (timed voiding, bladder training, oxybutnyn) Functional Incontinence – “Somebody help me!” Pregnancy : Pregnancy Safe Hydralazine Methyl-dopa Nifedipine labetalol PTU Heparin Nitrofurantoin amoxicillin Avoid ACE-I & ARB Methimazole Ciprofloxacin Bactrim Doxycycline Coumadin in 1st trimester Contraindications to Pregnancy : Contraindications to Pregnancy Pulmonary HTN Eisenmenger’s Marfan’s with dilated Aortic Root Severe AS NHA Class III DementiaMMSE < 23 : DementiaMMSE < 23 Alzheimers- MCC Anticholinesterase- Donepezil Memantine- mod/sev Multi-infarct History of patient Picks Fronto-Temporal lobes < 65 y/o CJD Startle myoclonus Lewy Body Parkinson’s Hallucinations Smoking Cessation : Smoking Cessation Nicotine replacement + behavior modification- 16% quit rate Nicotine patch alone is useless Buproprion alone- 30% quit rate Nicotine replacement + buproprion- 35% quit rate Contraindicated if hx of seizures New option: Chantix (Varenicline) SinusitisWhen to start empiric Abx : SinusitisWhen to start empiric Abx Fever Sinusitus symptoms > 7 days Tooth Pain Failure to improve after decongestant trial Otherwise: Tx with decongestants and analgesics Allergic SinusitisWhen to use anihistamines and nasal steroids : Allergic SinusitisWhen to use anihistamines and nasal steroids Rhinorrhea Tearing Sneezing Sore throatCriteria to start empiric Abx : Sore throatCriteria to start empiric Abx Must have all 4 of these: 1. Fever 2. Pharyngeal Exudates 3. Anterior cervical LAD 4. No cough If 2 or more Order rapid strep test Vaccinations : Vaccinations Influenza Age 50, then yearly Pneumococcal Age 65, then Q 5yrs (if received before 65) Start after splenectomy Tetanus Booster Q 10 yrs Multiple Sclerosis : Multiple Sclerosis Symptoms exacerbated by increased temp Warm climates or fever MC presentation – parasthesias No HA or Seizures MRI brain – increased T2 signals Carbamazepine for spasticity Optic neuritis means good prognosis Motor symptoms and late onset (age > 40) means bad prognosis Favorite Medications : Favorite Medications Lithium ACE-I Methotrexate Metformin Tamoxifen Alendronate Contraception : Contraception OCP Contraindications: smoking, DVT/PE, CAD, hypercoag states Depot medroxyprogesterone- causes weight gain Contraindications to Meds : Contraindications to Meds NSAIDS: hx of GIB, PUD, elevated Cr Triptans: hx of CAD B-Blockers: Psoriasis, Raynaud’s, wheezing Meds that don’t cause weight gain : Meds that don’t cause weight gain Metformin Buproprion