ITE Board Review: General Internal Medicine (with Complete Solutions)

1. Diagnose domestic abuse correct 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 correct 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 correct 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 correct 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) correct 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 correct 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 correct answers ... 8. Indication of pneumovax in 65 y/o correct answers - 23 valent - specific risk factors