General internal medicine (memo from NEJM knowledge plus and MKSAP)
<general medicine>
・management of patient with general weakness, slow gait, recent fall
prescribe vitamin D without obtaining level
・dumping syndrome
avoid refined carbohydrate
・zoster vaccine
live vaccine
・linezolid toxicity
type B lactic acidosis
・bisphosphonate to patient with CKD
contraindication to patient with GFR<30
・diagnosis of patient with one week history of sore throat, fever, neck pain, sign of pharyngitis, no cervical lymphadenopathy, CXR show multiple densities
septic thrombosis of the jugular vein (Lemierre syndrome)
・medical Tx for urinary incontinence
anti-cholinergic (tolterodine)
・isolated elevation of ALP with normal γGTP in asymptomatic elderly person
bone scintigraphy for suspected Paget disease
・management of patient with opioid-induced delirium
switch to different opioid
・interval of blood pressure screening for healthy person
every 2 years for person older than 18 yo, with blood pressure < 120/80
・preoperative test for young healthy female
only pregnancy test
・sleep-maintenance insomnia
temazepam
・management of patient with cancer-related pain which is persistent throughout the day
sustained-release morphine
・thrombophilia work-up for patient with recent DVT on enoxaparin and warfarin
factor V Leiden and prothrombin gene-mutation
(acute thrombosis reduce protein S, protein C, antitrhombin III, heparin reduce antithrombin III, warfarin reduce protein S, protein C)
・management of patient with functional incontinence due to limited mobility or significant cognitive impairment
prompt voiding (periodically ask and remind patient to go to toilet)
・phenoxybenzamine
alfa blocker
・management of patient with GERD-related cough whose cough and heart burn don't change 2 weeks after patient started omeprazole
continue omeprazole for 8 to 12 weeks
・antiemetic Tx for patient receiving chemotherapy
ondansetron, dexamathasone, fosaprepitant (neurokinin-1 inhibitor)
・medication causing low testosterone level (erectile dysfunction, decreased energy)
opioid, high-dose corticosteroid, hormonal therapy
・management of 28 yo female with breast mass, 1.5cm, mobile, tender, without nipple discharge or overlying skin change
ultrasonography (aspirate if cyst, biopsy if solid)
・most successful long-term and safe weight loss strategy
consistent reduction of caloric intake by 500-1000kcal/day
・cirrhotic patient with Child-Pugh C who undergo preoperative evaluation for elective total hip replacement
avoid elective surgery (mortality 80% with Child-Pugh C)
・next diagnostic step for patient with 6 months chronic non-productive cough, without apparent sign or cause, negative CXR, PFT, methachollin challenge test
sputum testing for eosinophil (for nonasthmatic eosinophilic bronchitis)
・first-line treatment of stress urinary incontinence
pelvic floor muscle training
・management of temporomandibular joint disorder
jaw relaxation, heat and therapeutic exercise
・DDx of patient with chronic pelvic pain with unexplained urinary symptoms
interstitial cystitis (no pyuria)
・management of patient with neuropathic pain secondary to DM who doesn't respond to NSAIDs, gabapentin, oxycodone-acetaminophen
sustained-release morphine
・management of perioperative warfarin for patient with atrial fibrillation with CHADS2 score of 5 and TIA 2 months ago
discontinue warfarin 5 days prior to surgery with enoxaparin bridge until the morning of surgery
・first-line medication for elderly patient with chronic non-cancer pain
acetaminophen (325mg)
・indication of rapid antigen detecting test for patient suspected with streptococcal pharyngitis
all patients (Centor criteria 1-4)
・management of patient with prolonged interval since the previous dose of multiple-dose vaccine
series should be resumed rather than restarted from the beginning
・DDx from pityriasis rosea (pink, scaly, christmas-tree pattern)
syphilis
<orthopedic surgery>
・initial management of carpal tunnerl syndrome
wrist splinting
・difficulty with arm abduction and positive drop-arm test
rorator cuff tear
・most common cause of knee pain in younger than 45 yo, worse with prolonged sitting and with walking up and down stairs
patellofemoral pain syndrome
・maneuver eliciting lateral epicondylitis
resisted wrist extension with elbow fully extended
・indication of x-ray for ankle injury
unable to bear weight or bony tenderness to palpation
・pain along anteromedial aspect of proximal tibia distal to the joint line of knee, in the setting of overuse
pes anserine bursitis
・burning pain on the plantar surface in the space between third and fourth toes, in the setting of wearing high heels
morton neuroma
・management of acute back pain with positive straight leg raise test, diminished ankle refelx without motor or sensory deficit
analgesics and mobilization as tolerated (no imaging study)
・Dx of patient with burning sensation on the lateral aspect of thigh with sensory deficit
melargia paresthetica (entrapment of lateral femoral cutaneous nerve beneath inguinal ligament)
・management of patient with plantar fasciitis refractory to initial Tx with NSAIDs
arch support
・management of osteoarthritis of trapeziometacarpal joint (pain at base of thumb)
wrist splint with thumb post
・hip pain in young athlete with femoroacetabular dysplasia
labrum tear
・management of symptomatic popliteal cyst
glucocorticoid injection
・diagnosis of knee osteoarthritis
weight-bearing x-ray
<dermatology>
・Tx for psoriasis and psoriatic arthritis
TNF-alfa blocking agents
・V-shaped rash on upper chest
dermatomyositis
・molluscum contagiosum in adults
possible sign of HIV progression
・ecthyma gangrenosum (purpuric patch with ulceration)
pseudomonas aeruginosa bacteremia
・actinic keratoses
5-fluorouracil cream
・most common identifiable cause of erythema nodosum
streptococcal infection
・dyshidrotic eczema (pruritic vesicular eruption, due to repeated water exposure or sweating)
potent topical glucocorticoid (triamcinolone ointment)
・symmetric target-shaped lesions on palms
erythema multiforme, associated with herpes simplex infection
・bedbug bite
steroid cream (triamcinolone acetonide cream)
・venous stasis ulcer
unna boot compression
・allergic contact dermatitis on face
hydrocortisone valerate (lower potency)
・treatment for impetigo
topical mupirocin
・ulcerative skin disease associatd with inflammatory bowel disease
pyoderma gangrenosum
・management of atypical urticaria, lasting for more than 24 hours, not pruritic
skin biopsy (to evaluate urticarial vasculitis)
・acne medication which is contraindicated during pregnancy
tazarotene
・pigmentation extending onto the proximal nail fold
subungual melanoma
・management of suspected toxic epidermal necrolysis
skin biopsy to confirm diagnosis and supportive care (systemic corticosteroid is controversial)
・DDx of red plaque on lip that is covered with scale, crust
squamous cell carcinoma
・crateriform pitted lesion on the sole of feet
pitted keratolysis
・flesh-colored smooth bump on face that occur by shaving
verruca plane (HPV)
・management of miliaria
cooling
(small papulovesicle associated with itching, caused by blockage and rupture of eccrine sweat duct, occur when skin is hot and occluded)
・slow-growing type of melanoma commonly seen on face of older fair-skinned patient
lentigo maligna
・pruritic blister on chest, abdomen, lower extremities, draining clear yellow fluid and crusting over before healing
bullous pemphigoid
・pruritic eruption that topical corticosteroid temporarily reduce inflammation, but recur after discontinuation
tinea corporis
・red papules on the chest, topped by vesicle or scale, waxing and waning, exacerbated by heat and sweating
Grover disease (achantholytic dermatosis)
・ulcer on the feet under metatarsal heads in DM patient
neuropathic ulcer
・management of intensly itchy small papulovesicle on scalp, elbow, knee, skin biopsy shows deposition of granular IgA
gluten-free diet for dermatitis herpetiformis associated with celiac disease
・Tx for seborrheic dermatitis (itchy, scaly rash in eyebrow, nose, ear)
ketoconazole cream
・acne that is widespread or that is inflammatory and refractory to topical medication
doxycycline
<ophthalmology>
・corneal abrasion from fingernail
fluoroquinolone eyedrop (covering pseudomonas)
・Sx of uveitis
photophobia, eye pain, decreased vision
・bacterial VS viral conjunctivitis
viral conjunctivitis lacks morning gluing
・bothered by glare from oncoming headlights when driving
cataracts
・pseudodendrite
herpse zoster
・uveitis and lacrimal gland enlargement
sarcoidosis
・management of viral conjunctivitis
cool compression
・central retinal artery occlusion vs central retinal vein occlusion
CRAO: cherry red spot
CRVO: flame-shaped retinal hemorrhage, cotton-whool spots
・foreign body sensation and vascular growth over conjunctiva
pterygium
<OBGYN>
・reversible, highly effective contraception
levonorgestrel intrauterine device, etonogestrel implant
・medroxyprogesterone acetate IM injection every 3 months
not for long-term use, risk for osteoporosis
・prophylaxis Tx after sexual assault
azithromycin, ceftriaxone, HIV prophylaxis, HBV vaccine, metronidazole, levonorgestrel
・inhaled glucocorticoid Tx for pregnant female with mild persistent asthma
budesonide
・uncomplicated mastitis
continue breast feeding and dicloxacillin (staphylococcal coverage)
・Tx for postpartum endometritis
clindamycin and gentamicin
・management of Graves disease during pregnancy
propylthiouracil in 1st tremester and methimazole in 2nd and 3rd tremester
・opioid addiction during pregnancy
methadone / buprenorphine
・persistent lack of desire for sexual activity
hypoactive sexual desire disorder
・management of female who is planning to attempt conception, found to have HbA1c 7.5
metformin (class B, switch to insulin during pregnancy)
・next step for patient with heavy menstrual bleeding secondary to fibroid which is scheduled for surgery in 2 weeks
oral medroxyprogesterone acetate
・management of hot flush in patient with h/o cardiovascular disease or VTE
venlafaxine (serotonin norepinephrine reuptake inhibitor)
・first-line treatment of dysmenorrhea
NSAIDs
・recommended contraception for 38 yo female without PMH, smoking a pack daily
progesterone contraceptive
(women older than 35 yo smoking more than 15 cigarettes daily shoud not be prescribed estrogen-containing preparations)
<otolaryngology>
・central cause of vertigo
direction-changing nystagmus, severe trunchal instability, negative head-thrust test
・Dix-Hallpike maneuver to BPPV
vertical-torsional nystagmus toward affected side
・Tx for acute otitis extema
almost always due to bacterial infection -> topical ABX covering pseudomonas and staphylococcus
・Tx for vestibular neuritis
meclizine and hydration
・Tx for nasal polyposis
intranasal glucocorticoid
・idiopathic sudden sensorineural hearing loss
high-dose prednisone
・cerumen impaction
cerumenolytics (hydrogen peroxide, carbamino peroxide, mineral oil)
・whistling or swishing sound in ear, faster and louder when exercise
pulsatile tinnitus -> evaluate for bruit for possible vascular anomaly
・Tx for rhinosinusitis
anti-histamine (chlorpheniramine)
・Dx of patient with h/o allergic rhinitis who has intractable nasal congestion and rhinorrhea on oxymetazoline
rhinitis medicamentosa
(continued use of vasoconstictor (oxymetazoline) cause withdrawal congestion)
・erythematous patches with white hyperkeratotic rim on the tongue
georgraphic tongue (benign migratory glossitis)
・unilateral ulcerative tonsillar lesion with cervical lymphadenopathy
squamous cell carcinoma until proven otherwise
<psychiatry>
・medication for prevention of alcohol dependence relapse in patient with cirrhosis
acamprosate
・initial treatment for alcohol-use disorder
naltrexone
・dementia with visual hallucination
dementia with Lewy bodies
・bulimia nervosa
Na in urine elevated when diuretic abuse, and decreased when self-induced vomiting
・first choice for panic disorder
SSRI
・major depressive disorder with sexual dysfunction
bupropion
・monotherapy for bipolar depression
quetiapine
・psychosis, purpuric skin lesion, neutropenia
intravenous cocaine use
・indication for depression screening
all adults