[Music] retinal artery occlusion cherry-red macula retinal vein occlusion blood and thunder retina um some pediatric cherry red macula to remember tay-sachs disease and niemann-pick but niemann-pick also has hepatomegaly CKD or diabetes mellitus with proteinuria first line is ace inhibitor remember angiotensin likes to constrict the efferent arteriole which increases glomerular pressure which increases glomerular filtration so when you use the ACE inhibitor you get vasodilation of the efferent arteriole which reduces pressure over the group lemare ulis which reduces proteinuria so it's considered renal protective best at lowering triglycerides as fibrates only want to use fibrates when the triglycerides are over a thousand also hypertriglyceridemia associated as one of the causes of pancreatitis beste increasing HDL is niacin but even though i say this remember that first line for hyperlipidemia statins and remember that there's four people who get statins those who have current atherosclerosis clear disease anyone with a coronary artery disease or peripheral vascular disease the second is diabetics over 40 with the LDL over of 70 the third is healthy people with the LDL of over 190 and the last person is a person who is over 40 with the ASC VD risk of greater than 7.5% with the LDL greater than 70 these are the four people who get statins first-line for cluster headache remember cluster headache is the person who has a one-sided I discharged one-sided I pain described as very sharp unilateral and extremely sharp pain behind the eye this is a cluster headache the number one treatment is oxygen prophylaxis is a calcium channel blocker for such as for a panel versus tension headache which is bilateral and band like this is actually just musculoskeletal headache due to death neck or bad posture and this is just treated supportively migraine headache is the unilateral pounding can cause nausea and vomiting can be debilitating worsened with noise can also have auras which can be strange neurological deficits sometimes can even present like a stroke and that can be tricky but the key here is to look at the age if there's a young person with a bad headache and just are threa or like hemiparesis that resolves and they're like 20 years old this is most likely a migraine with aura and the migraines you want to treat if it's severe or refractory with sumatriptan which is a serotonin agonist or prophylaxis beta blockers or TCA post nasal drip which can cause upper airway reactive syndrome which can is a post nasal drip that causes a cough first lion is antihistamine someone who has allergic rhinitis though which is just constantly runny nose due to allergies the first line is intranasal steroids bloody stool plus fever next step is stool white blood cells if the white blood cells are positive the next step is stool culture if negative symptomatic treatment if you suspect c-diff next step is CF toxin bowel obstruction next best step x-ray of the abdomen anything with an acute abdomen you always do x-ray of the abdomen because it gives you a more information but most importantly it rules out pneumoperitoneum which presents with free air under the diaphragm which is an indication for surgery irritable bowel syndrome think of alternating to patient and diarrhea and the kicker is it's alleviated with defecation interstitial cystitis the patient has all the symptoms of UTI dysuria increased frequency increased urgency but the urinalysis is basically has no markers of a UTI and/or the antibiotics did not work this is interstitial cystitis and the kicker is alleviated with urination desk herniation versus spinal stenosis position with disk herniation bending over hurts extending feels better with spinal stenosis extending feels worse and bending over feels better don't just think oh shoot and áown the legs Oh slam dunk for disc herniation no make sure to confirm the positional changes and what makes it better or worse remember someone with disc herniation the best next step symptomatic treatment such as physiotherapy and analgesics and you don't do an MRI quite yet until later on because a lot of times disk herniation symptoms will resolve if it stays for like six weeks or if now they have scary neurologic deficits like incontinence or paralysis then you do an MRI but usually the correct answer for someone who has disc herniation is first recommend supportive treatment before them were indications for MRI of the spine is if you fear cauda equina syndrome right which is lower motor neuron deficits rate hyporeflexia flaccid paralysis fasciculations urinary incontinence decreased famous finger tone or like saddle anesthesia those are indications for an immediate MRI or someone who has epidural abscess due to sieving from an infection that will also cause fever point tenderness and neurologic deficits that's also an indication for an MRI of splain versus metastatic back pain due to a cancer that person will have point tenderness to the back and it'll be back pain that is really bad especially at night that points towards metastatic cancer to the spine the first line for that is an x-ray and spine metastasis cancer you want to treat with opioids and radiation if the opioids don't work osteoarthritis the number one risk factor is obesity so in most osteoarthritis vignettes the person's BMI will be over 30 and it gets worse and with use throughout the day versus rheumatoid arthritis which is improved throughout the day treatment for osteoarthritis is analgesics and to lose weight osteoporosis remember DEXA scan happens at age 65 if it's less than negative two point five that's osteoporosis and first line treatment is bisphosphonates in addition to weight-bearing exercises plus vitamin D plus calcium supplementation but the answer will be bisphosphonates you can have open-angle glaucoma or closed angle glaucoma and it can be the dangerous one is acute closed angle glaucoma this presents with the rock-hard eye with non reactive pupils the person will see halos they'll have very painful red eye and with angle closure glaucoma remember that meiosis helps why because when you stretch out the IRS that opens up the trabecular meshwork which allows for aqueous humor outflow so you want to give any drug that would promote meiosis such as pillow carmine which is a muscarinic agonist which promotes meiosis in addition to beta blockers which decrease aqueous humor production blepharitis is inflammation of the eyelid its will present with crusting over the eyelids in the morning usually in a kid it's most likely caused by staph aureus and treatment is scrubbing the eye in the morning with warm water and a warm compress where it verses bacterial conjunctivitis which is purulent discharge out of the eye this is also caused by staph aureus but in this case it needs to be treated with antibiotics and think if there's pus then you treat it with a macrolide such as erythromycin um first-line treatment for obesity is lifestyle modification but if that doesn't work then second line is orlistat which is a pancreatic lipase inhibitor also what indications what are some indications for bariatric surgery if the BMI is greater than 40 or greater than 35 with comorbidities such as like debilitating osteoarthritis so you have stress incontinence overflow incontinence and urge incontinence so stress incontinence is associated with multiple pregnancies and older age and this is due to the internal urethral sphincter falling below the pelvic diaphragm muscles and so anytime they valsalva like cough or sneeze then that increases pressure over the bladder but the internal urethral sphincter won't compress like it normally does because usually it's above the diaphragm so the bladder and the internal urethral sphincter both compressed so nothing happens but in this case the internal urethral sphincter will have less pressure verses the bladder which causes leakage of urine in this case the q-tip test will show you referral hypermobility so the q-tip angle changes a lot and then also the first-line treatment for this is Kegel exercises and if that doesn't work the second line treatment is a pessary which is a plastic device which is inserted through the vagina which helps hold the black up higher and then the third my treatment is the mid urethral swing versus urge incontinence which is caused by sporadic spasming of the bladder and then this person will have the urge to pee and they won't be able to control it because it comes out of nowhere and then the treatment for this is bladder training exercises and the second line is something that will relax the detrusor such as oxybutynin which is a muscarinic antagonist and then there is the final one is overflow incontinence which is seen which is also known as neurogenic bladder which is seen in patients with severe diabetes with neuropathic complications or people who have spinal cord injuries or people who have had recent surgery and the anesthesia has stunned their bladder and so basically the first-line treatment for this is intermittent soft catheterization and if that doesn't work then the second line treatment would be a sanic haul which is a muscarinic agonist and then treatment of alcoholics is naltrexone or a camper say treatment of smoking cessation first-line treatment is nicotine gum and patch and then other possible treatments are varenicline and bupropion varenicline is a partial nicotinic acetylcholine receptor agonist it's famous side effect of suicidality and bupropion is famous for its contraindication which is it's contraindicated in people who have seizures eating disorders or alcoholics because it lowers the seizure threshold bupropion is also an antidepressant that's famous for not having the side effects of weight gain or sexual side effects colon cancer screaming start at age 50 every 10 years you stop by age 75 if you find a polyp the worst is of the list adenoma then you read to Pete the screen in three years if someone in the family less than sixty had colon cancer then you do it at age forty or ten years before the family member was diagnosed whichever one comes first pap smears started at age 21 and at age 65 and happen every three years HIV testing happens in anyone who's sexually active with it between ages of 15 to 65 mammograms start at 40 years old and happen every year DEXA scans happen at 65 years old Triple A screening happens at 65 years old and any male who has ever smoked a Pneumovax vaccine happens at 60 years old as well Oscar vaccine also happens at 60 years old lung cancer screening starts at 55 years old for anyone who's ever had a 30-pack year smoking history who currently smokes or who has quit within 15 years chlamydia and gonorrhea screening happens in all women less than 24 years old hepatitis A B vaccines happen for men who have sex with men IV drug users people with hepatitis C or a chronic liver disease why because hepatitis A or B infection superimposed on pre-existing liver disease is catastrophic and can require liver transplant having a cold or fever is not a contraindication for getting a vaccine breastfeeding is okay if you have gotten a vaccine don't breastfeed if you have HIV or if you're on chemotherapy or if you're a drug user all military and college people should get a man in Chicago vaccine cephalosporins are lame they can't treat Listeria atypical pneumonias EMRs a or Enterococcus metronidazole get gap on the metro all right guys and that wraps it up for high-yield internal medicine I hope this is really helpful for you and helps you succeed in your shelf exam or for your step to seek a preparations if you have any other ideas or if there's anything else you would like me to expand on or talk about then please let me know in the comments below and all the best in your studies guys good luck