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My notes: a small gift for you - triplehelix
#51
501. For a symptomatic patient with varicose veins without complications, appropriate initial management includes elastic compression stockings (unless there is arterial insufficiency) with leg elevation, avoidance of prolonged standing, and weight loss as appropriate.
502. Based on the Ottawa ankle rules, radiography of the ankle is not indicated in patients with ankle injury who can bear weight and have no bony tenderness over the lateral malleolus or fifth metatarsal bone.
503. Patients with moderate ankle sprains usually are not treated with cast immobilization, which can delay return to normal activities compared with functional therapy.
504. Patients with compensated, asymptomatic heart failure can generally proceed to surgery if the level of other risk factors is acceptable.
505. Effective therapies for reducing the severity of nasal congestion in patients with viral upper respiratory infections include pseudoephedrine, ipratropium nasal inhaler, cromolyn sodium nasal inhaler, and humidified air.
506. Pseudoephedrine is safe in patients with well-controlled hypertension.
507. When the plaques of psoriasis are localized and involve less than 5% of the total body area, treatment with a topical agent is appropriate.
508. Patients with acute coronary syndromes benefit from in-hospital treatment with a statin.
509. In patients who have difficulty complying with the daily use of oral contraceptive pills for symptomatic relief of dysmenorrhea, the contraceptive patch, with similar efficacy, may be an appropriate alternative.
510. The evidence-based standard is selective preoperative testing based on medical history, physical examination, and risk for surgery-specific blood loss.
511. Multiple studies have shown that indiscriminant preoperative testing rarely identifies clinically important abnormalities, delays surgery, or predicts complications.
512. The best treatment for brown recluse spider bites is ice application, wound elevation, and avoidance of strenuous exercise in the muscles surrounding the bite.
513. Blood counts should be monitored in men receiving testosterone-replacement therapy, initially within 1 to 2 months of initiating therapy, then every 3 to 6 months for the first year, and then annually.
514. Higher testosterone levels stimulate erythropoiesis, and injections are more potent stimulants than transdermal preparations.
515. The metabolic syndrome is a secondary target of therapy, after serum low-density lipoprotein level, to reduce a patient's risk for coronary artery disease.
516. Benzodiazepines are one of the most frequently implicated classes of drugs causing delirium and exacerbating pre-existing cognitive impairment in elderly patients.
517. Benzodiazepines are the class of psychotropic agents most often associated with falls and hip fractures in the elderly.
518. The standard of weight loss against which dietary interventions are compared is counseling for exercise and a balanced low-calorie diet.
519. Patients with complex regional pain syndrome respond to bisphosphonate therapy.
520. Arrhythmia should be strongly suspected in patients with syncope and coronary artery disease and bifascicular block.
521. Long-term (more than 30 days) event monitoring with external or implantable continuous-loop recorders is recommended when suspicion of arrhythmia remains after inpatient telemetry and ambulatory electrocardiographic monitoring are nondiagnostic.
522. Corneal abrasion associated with hard or soft contact lenses is especially susceptible to infectious keratitis.
523. Cauda equina syndrome is characterized by urinary retention, saddle anesthesia, and radiculopathy.
524. Cauda equina syndrome is an indication for urgent evaluation and requires definitive imaging to visualize the spinal cord and epidural space.
525. Headaches that are acute in onset, occur after age 50 years, and are associated with a history of malignancy are œred flags prompting immediate neuroradiologic evaluation.
526. The varicella vaccine is recommended for all adults with no evidence of immunity to varicella.
527. Urticaria that does not respond to usual treatment should prompt a workup for urticarial vasculitis, including erythrocyte sedimentation rate, complete blood count, and skin biopsy from the edge of the wheal.
528. In patients with a history of deep venous thrombosis (DVT), the levonorgestrel intrauterine device will not increase the risk for developing embolic disease and also sufficiently decreases the likelihood of pregnancy.
529. Both oral and topical hormonal contraception are contraindicated in patients with a history of DVT.
530. Gabapentin, approved by the Food and Drug Administration for treatment of postherpetic neuralgia, has been shown to reduce pain and improve sleep in randomized controlled trials.
531. Among patients with chronic noncardiac chest pain, randomized, placebo-controlled studies have demonstrated that tricyclic antidepressants, β-blockers, ACE inhibitors, L-arginine, statins, and exercise may relieve symptoms.
532. Causes of unexplained weight loss in the elderly include depression, cancer, benign gastrointestinal conditions, medication toxicities, and socioeconomic concerns.
533. The most common malignancies characterized by weight loss in the elderly are lung and gastrointestinal malignancies.
534. Vestibular rehabilitation is one of the few evidence-based treatments for chronic dizziness, including peripheral vestibular disorders, benign positional vertigo, multifactorial dizziness in the elderly, psychologic factors, and head injury.
535. First-line therapy for panic disorder consists of selective serotonin reuptake inhibitors, such as paroxetine.
536. œAlarm symptoms in patients with abdominal pain include hematochezia, weight loss more than 4.5 kg (10 lb), family history of colon cancer, recurring fever, anemia, or chronic severe diarrhea.
537. Rotator cuff tendonitis is characterized by subacromial tenderness and impingement; pain often occurs with overhead reaching and when lying on the side.
538. Recurrent aphthous ulcers usually begin to occur in the teenaged years and recur intermittently, and their etiology is unknown.
539. If there is no contraindication, patients with coronary artery disease or significant risk factors should take perioperative β-blockers, titrated to a resting heart rate of 60/min.
540. An absence of midline cervical tenderness on direct palpation, focal neurologic deficits, intoxication, or painful distracting injuries; and normal alertness are highly sensitive for ruling out cervical spine injury.
541. Fatigue, hypotension, bradycardia, and exacerbations of reactive airway disease and heart failure are recognized side effects of timolol eye drops.
542. Minor depression consists of the presence of either depressed mood or anhedonia (or both) with other symptoms that total more than two but less than the five total symptoms required to establish a diagnosis of major depression.
543. Although minor depression decreases functional status, several treatment trials of pharmacotherapy and psychotherapy have reported that treatment outcomes for these modalities are no better than those associated with placebo.
544. Selective serotonin reuptake inhibitors may increase the risk for surgical bleeding complications.
545. Estrogen and selective estrogen receptor modulators increase the risk for thromboembolism and should be discontinued perioperatively.
546. When hormone replacement therapy has been prescribed for vasomotor symptoms, the symptoms will recur when therapy is discontinued.
547. Hypothyroidism may be an underlying cause of elevated cholesterol levels, and thyroid replacement therapy can reverse this finding.
548. Obesity is associated with an increased risk for total mortality and chronic conditions, including coronary artery disease, stroke, type 2 diabetes, heart failure, dyslipidemia, and hypertension.
549. Weight loss of approximately 5% at 1 year decreased progression to type 2 diabetes and improved control of lipid levels and hypertension.
550. Except for acute bronchitis in patients with underlying chronic obstructive pulmonary disease, the only bacterial infection requiring antibiotic therapy is Bordetella pertussis.
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#52
551. B. pertussis infection is typically characterized by a barking or paroxysmal cough in the setting of prolonged upper respiratory infection symptoms (>2 weeks).
552. Graded exercise therapy and cognitive behavioral therapy are the nonpharmacologic therapies of choice in patients with fibromyalgia syndrome (FMS).
553. Patient education, acupuncture, hypnosis, biofeedback, and mineral baths may improve FMS symptoms.
554. Dysmenorrhea is characterized by onset of pain during the menstrual cycle and the absence of anatomic abnormalities on pelvic examination and ultrasonography.
555. NSAIDs are a generally safe and often effective initial treatment for patients with dysmenorrhea.
556. A comprehensive audiometric evaluation is appropriate in patients with subjective tinnitus to assess for hearing loss.
557. Intracavernous alprostadil injections are an effective and safe treatment for patients with erectile dysfunction.
558. Phosphodiesterase type-5 inhibitors are a first-line treatment for most men with erectile dysfunction; however, nitrate therapy is a contraindication to their use.
559. Acute shoulder pain and weakness after falling on an outstretched arm is characteristic of a rotator cuff tear.
560. The inability to smoothly lower the affected arm from full abduction (positive drop-arm test) is a highly specific finding for a rotator cuff tear.
561. An occlusive hydrocolloid dressing can increase exudate absorption, reduce pain and odor, and help debridement and reepithelialization in patients with venous ulcers.
562. Aspirin doses higher than 300 mg daily can result in faster healing in patients with venous ulcers.
563. Episodes of Meniere's disease last for several hours and involve vomiting and cochlear symptoms, and patients may develop a progressive sensorineural hearing loss.
564. Prior to identifying changes in an audiogram, the diagnosis of Meniere's disease is largely established clinically without the necessity for diagnostic testing.
565. β-Blockers, oral nitrates, and most antihypertensive drugs should be continued the morning of surgery and reinstituted when patients begin eating.
566. The anti-inflammatory and pleotrophic plaque-stabilizing effects of statins appear to reduce the risk for postoperative cardiac complications in observational studies and should be continued the morning of surgery and reinstituted when patients begin eating.
567. Screening for aortic abdominal aneurysm in men aged 65 to 75 years who have ever smoked is recommended.
568. Lesions suspicious for melanoma require an excision biopsy to prevent manipulation of the lesion and the potential for the spread of malignant cells.
569. The mainstay of treatment for primary dysmenorrhea is oral contraceptives or NSAIDs.
570. Good sleep hygiene includes avoiding strenuous exercise or alcohol close to bedtime, developing a relaxing evening routine, and avoiding afternoon caffeine.
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#53

571. Depression is a treatable underlying cause for insomnia.
572. Cholesterol monitoring is indicated once every 5 years in patients with only one risk factor for coronary heart disease.
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#54
574. Antibiotics are not indicated for allergic rhinitis or viral upper respiratory infection. Although the patient has yellowish sputum, the absence of fever, chills, and progressive illness argue against current bacterial infection.
575. The Ottawa rules suggest obtaining a knee film in patients who are older than age 55 years, have tenderness at the head of the fibula or patella, or have an inability to flex to 90 degrees or to bear weight both immediately and during evaluation.
576. Patients with acute hearing loss and an otherwise-normal neurologic examination with no mechanical obstruction usually benefit from prompt systemic corticosteroids and require emergent referral.
577. Acute angle-closure glaucoma results in rapidly increased intraocular pressure, pain, diffuse erythema, and a moderately dilated, fixed pupil.
578. Lipodermatosclerosis can occur in patients with advanced chronic venous insufficiency and involves circumferential areas of fibrosis extending proximally from above the ankles, with pitting edema above the area of fibrosis and over the feet.
579. Clonazepam is an appropriate complementary treatment choice in patients with social anxiety disorder for providing immediate relief while they await the results of psychotherapy.
580. Severe cases of poison ivy, including those with extensive involvement and associated edema, can be treated with oral prednisone.
581. Surgery is a recommended treatment option for patients with class III obesity, defined as those with a BMI of ≥40 and who cannot maintain weight loss with exercise and diet with or without drug therapy and who have obesity-related comorbid conditions.
582. Antihistamines can exacerbate lower urinary tract symptoms in men with enlarged prostates.
583. Oral decongestants can precipitate urinary retention by increasing smooth muscle tone in the prostate and bladder neck.
584. Wearing below-knee elastic compression stockings during the day for 2 years or longer reduces the risk for postphlebitic syndrome by approximately 50% in patients with symptomatic proximal deep venous thrombosis.
585. The presence of a red reflex, central opacity, and visible fundus is consistent with an immature nuclear cataract.
586. Cataract extraction is indicated when visual deficits impair quality of life.
587. The criteria for acute bacterial rhinosinusitis are duration of symptoms longer than 1 week and worsening symptoms after initial improvement, maxillary tenderness, purulent drainage, and poor response to decongestants.
588. Antibiotics should be reserved for patients who meet the criteria for acute bacterial rhinosinusitis.
589. Osteomalacia and osteoporosis are common in celiac disease and can occur even in patients who have no gastrointestinal symptoms.
590. The inactivated influenza vaccine is recommended for patients with chronic medical conditions, including heart failure, kidney disease, lung disease, diabetes, asthma, HIV/AIDS, cancer, and chronic corticosteroid therapy.
591. Hemothorax is most commonly due to trauma, either blunt or penetrating (including iatrogenic).
592. The diagnosis of cervical radiculopathy is supported by increased pain with neck flexion toward the affected side.
593. Alopecia areata is common in thyroid disease, vitiligo, diabetes, atopy, and Down's syndrome.
594. The affected skin in alopecia areata generally has no signs of inflammation, desquamation, or scarring.
595. Screening for posttraumatic stress disorder is recommended in women with chronic pelvic pain, who frequently have a history of sexual victimization.
596. Patients with progressive pain that ceases to respond to short-term pain management may require high-dose, escalating, long-acting narcotic analgesia.
597. Validated methods exist for assessing the probability of coronary artery disease using only simple clinical information, obtainable from a telephone history.
598. Symptoms atypical of angina, an absence high-risk factors for acute coronary syndrome, and the higher likelihood for musculoskeletal chest pain in the setting of recent strenuous activity allow for the outpatient management of noncardiac chest pain.
599. Sibutramine is not recommended for weight loss in patients with poorly controlled hypertension.
600. Topical ketoconazole cream is an effective therapy for patients with tinea versicolor.
601. Imaging studies are appropriate in patients with suspected chronic sinusitis who have not responded to medical treatment.
602. If dental care is immediately attained within 30 minutes of injury, successful replantation rates of avulsed teeth exceed 90%.
603. All the selective serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitors are effective for depression and generalized anxiety disorder and have Food and Drug Administration approval for these indications.
604. ¢ Depressive symptoms often respond more quickly to treatment than do anxiety symptoms, and it is not uncommon for anxiety to be œunmasked during the first few weeks of antidepressant treatment
605. Symptoms of allergic rhinitis consist of nasal congestion, rhinorrhea, postnasal drainage, and sneezing; clinical findings of pale turbinates with watery secretions; and positive results on allergen skin testing.
606. Nasal corticosteroids are more effective than either leukotriene inhibitors or oral antihistamines”both sedating and non-sedating”in treating patients with allergic rhinitis.
607. The evidence is good that routine postoperative lung expansion (for example, incentive spirometry or deep-breathing exercises) prevents postoperative pulmonary complications.
608. Cancers that most commonly spread to bone include prostate, breast, lung, thyroid, and renal cell carcinomas.
609. Benign memory loss can be distinguished from mild cognitive impairment by lack of evidence of cognitive impairment on objective tests.
610. Although approximately 12% of patients with mild cognitive impairment progress to dementia, age-related forgetfulness does not increase the risk for developing dementia.
611. Weekly oral fluconazole reduces the short-term incidence of yeast vaginitis in patients with recurrent infection.
612. It is advisable to discontinue a statin in patients with bothersome symptoms and try another statin once symptoms have resolved.
613. Some medications increase the risk for statin-associated myopathy, including fibrates, cyclosporine, macrolide antibiotics, various antifungal drugs, and cytochrome P-450 inhibitors.
614. In patients with nonspecific dyspepsia and no alarm symptoms, a œtest-and-treat approach with urea breath testing followed by Helicobacter pylori eradication in patients with positive results is the most cost-effective strategy for curing symptoms.
615. Corneal abrasions are often caused by contact lens use, particularly the soft, extended-wear type.
616. There is an increased risk for fulminant keratitis caused by pseudomonal infection in contact lens users who develop corneal abrasions.
617. Antibiotic treatment is recommended for patients with group A β-hemolytic streptococcal pharyngitis to prevent rheumatic fever, acute glomerulonephritis, and suppurative complications and to reduce contagion and symptom duration.
618. Somatization disorder criteria include several years of many physical complaints beginning before age 30 years that result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.
619. To meet the criteria for somatization disorder, the patient must have experienced two gastrointestinal tract symptoms, one sexual symptom, and one pseudoneurologic symptom, with none of these symptoms explained by another medical diagnosis.
620. The cause of urinary incontinence in most cases is intrinsic sphincteric incompetence, for which the treatment options are anticholinergic therapy, collagen injections, sling procedures, and artificial urinary sphincter implantation
621. Oral isotretinoin is Food and Drug Administration approved only for recalcitrant nodular acne and is associated with an 80% remission rate.
622. Patients with a negative mammogram in the setting of a dominant mass on clinical breast examination require further evaluation by breast ultrasonography or fine-needle aspiration.
623. Bulimia may be characterized by excoriations at the back of the throat caused by self-induced vomiting, hypertrophy of the parotid glands, and mild electrolyte abnormalities.
624. In patients with the very highest risk for coronary artery disease, lowering LDL cholesterol levels
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#55
I could not post #573 because it is blocked from posting.
This is the end of General internal medicine.
Next time, I will post Infectious disease, may be next week !
Enjoy !
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#56
up
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#57
Ok, folks !
I will post notes on Infectious diseases tonight !
Keep your 'eyes wide open", lol !!
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#58
th sir i have got keratic ulcers......my eyes are open wide...hey hey just tryin to make a bad joke...how are you sir?
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#59
Thank you very much,but please try not to post any obscene language.
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#60
lol !!! How about obscene notes ??
How are you brother basem ??

I am fine, thanks captain OF america !!
are things alright ?
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