Dr. High Yield- IM Ambulatory Key Topics Overview

Feb 4, 2025

High-Yield Internal Medicine Topics

Ophthalmology

  • Retinal Artery Occlusion: Cherry-red macula.
  • Retinal Vein Occlusion: Blood and thunder retina.
  • Pediatric Cherry Red Macula: Associated with Tay-Sachs disease and Niemann-Pick. Niemann-Pick also has hepatomegaly.

Nephrology

  • CKD or Diabetes Mellitus with Proteinuria:
    • First-line treatment is ACE inhibitor.
    • Reduces proteinuria by vasodilation of the efferent arteriole.

Cardiovascular and Lipid Disorders

  • Best at Lowering Triglycerides: Fibrates, used when triglycerides are over 1000.
  • Hypertriglyceridemia: Can cause pancreatitis.
  • Best at Increasing HDL: Niacin.
  • First-Line for Hyperlipidemia: Statins, indicated for:
    • Current atherosclerosis.
    • Diabetics over 40 with LDL >70.
    • Healthy individuals with LDL >190.
    • Individuals over 40 with ASCVD risk >7.5% and LDL >70.

Headaches

  • Cluster Headache: Sharp unilateral eye pain. Treatment: Oxygen; prophylaxis: calcium channel blocker.
  • Tension Headache: Bilateral band-like pain; treated supportively.
  • Migraine: Unilateral, pounding, can cause nausea and aura. Treatment: Sumatriptan; prophylaxis: beta blockers or TCA.

Respiratory

  • Post Nasal Drip: Causes cough; first line is antihistamine.
  • Allergic Rhinitis: First line is intranasal steroids.

Gastroenterology

  • Bloody Stool with Fever: Check stool white blood cells.
  • C-Diff: Check toxin.
  • Bowel Obstruction: X-ray of abdomen.
  • Irritable Bowel Syndrome: Alternating constipation and diarrhea alleviated with defecation.

Urology

  • Interstitial Cystitis: UTI-like symptoms but negative urinalysis; alleviated with urination.

Neurology

  • Disc Herniation vs. Spinal Stenosis:
    • Disc Herniation: Bending over hurts; treat with physiotherapy and analgesics.
    • Spinal Stenosis: Extending hurts.
  • Indications for MRI: Suspect cauda equina syndrome or epidural abscess.

Rheumatology

  • Osteoarthritis: Risk factor obesity. Treatment: Analgesics, weight loss.
  • Osteoporosis: DEXA at 65, bisphosphonates first line.

Ophthalmology

  • Glaucoma:
    • Open vs. Closed Angle.
    • Acute Closed Angle: Painful red eye, treated with drugs promoting miosis and beta blockers.

Dermatology

  • Blepharitis: Inflammation of the eyelid; treated with warm compress.
  • Bacterial Conjunctivitis: Purulent discharge; treated with antibiotics.

Obesity

  • First-Line: Lifestyle modification.
  • Second-Line: Orlistat or bariatric surgery based on BMI criteria.

Incontinence

  • Stress Incontinence: Treat with Kegel exercises; pessary second line.
  • Urge Incontinence: Bladder training; oxybutynin second line.
  • Overflow Incontinence: Intermittent catheterization; bethanechol second line.

Substance Abuse

  • Alcoholism: Naltrexone or acamprosate.
  • Smoking Cessation: Nicotine gum/patch; varenicline or bupropion.

Cancer Screening

  • Colon Cancer: Starts at 50; repeat based on polyp type or family history.
  • Pap Smears: Start at 21, end at 65.
  • Mammograms: Start at 40, annually.
  • DEXA and AAA Screening: At 65.
  • Lung Cancer: Starts at 55 with smoking history.
  • Chlamydia/Gonorrhea Screening: Women <24.

Vaccinations

  • Hepatitis Vaccines: For at-risk groups.
  • Breastfeeding & Vaccines: Generally safe unless HIV or chemotherapy.
  • Meningococcal Vaccine: Required for certain groups.

Antibiotics

  • Cephalosporins: Ineffective against Listeria, atypical pneumonias, MRSA, or Enterococcus.
  • Metronidazole: For specific infections.

This lecture provided a comprehensive overview of high-yield internal medicine topics essential for exams. Use these notes as a study guide, and refer to additional sources for clarification on complex topics.