General Medicine Lecture Notes

Key Points

• Importance of General Medicine and its relevance in exams.
• Discussion on various medical conditions and their management.

Peripheral Artery Disease (PAD)

• Diagnosis: Ankle Brachial Index (ABI)

  • Normal: BP in lower extremity = upper extremity (ABI = 1)
  • PAD: BP in lower extremity < upper extremity (ABI < 0.9)
  • Measurement: Highest systolic BP in upper and lower extremities
  • Example: BP in upper arm = 138 mmHg, lower extremity = 128 mmHg, ABI = 128/138 = 0.92 (equivocal)
  • Further Test: Exercise ABI if initial ABI is equivocal

• Management: Supervised exercise program, high-intensity exercise to point of claudication, cilostazol + statin

Critical Limb Ischemia

• Marginally Threatened Limb: Decreased sensation in toes, absent pedal pulses; management with heparin, angiogram, tPA
• Immediately Threatened Limb: Decreased sensation and power in the foot, absent pulses; management with heparin, surgical revascularization
• Embolization: Sudden onset of black and blue toes, blood pressure control to prevent further plaque rupture

Metabolic Syndrome

• Criteria: Waist circumference (Men: >102 cm, Women: >88 cm), triglycerides >150 mg/dL, low HDL (Men: <40 mg/dL, Women: <50 mg/dL), BP >130/85 mmHg, fasting blood sugar >100 mg/dL
• Management: Diet, exercise, medications if BMI >30, bariatric surgery if BMI >35 with uncontrolled diabetes
• Complications: Type 2 diabetes, cardiovascular diseases, osteoarthritis, sleep apnea

Obesity

• BMI Categories:
  • Normal: 19-25
  • Overweight: 25-30
  • Obesity: >30
• Management: Caloric intake reduction, exercise, medications (if BMI >30), bariatric surgery (if BMI >35 with comorbidities or >40 without)
• Complications: Type 2 diabetes, cardiovascular diseases, osteoarthritis, non-alcoholic steatohepatitis, sleep apnea
• Behavioral Tips: Small incremental changes, building habits, setting strategies for exercise and diet

Bariatric Surgery

• Indications: BMI >35 with comorbidities, >40 without
• Complications: Thiamine deficiency, rhabdomyolysis, PE, staple leaks, long-term deficiencies (vitamins D, B12, copper, selenium)
• Types of Procedures: Roux-en-Y (highest nutritional deficiencies), gastric sleeve, gastric band (least complications but least effective)

Cardiovascular Disease and Screening

• Screening for CAD: Increased waist-to-hip ratio, especially in older adults
• Exercise: One hour/day, five days/week to decrease mortality
• Retinal Detachment: Flashes of light, shower of black dots, cobwebs; emergent ophthalmology evaluation
• Retinal Artery Occlusion: Sudden visual loss, cherry red spot on fundoscopy
• Retinal Vein Occlusion: Multiple hemorrhages, thunder and lightning appearance
• Macular Degeneration: Blurred edges of objects, yellow spots on fundoscopy

Ophthalmology

• Conjunctivitis:
  • Bacterial: Whitish/yellowish discharge, lid margin involvement
  • Viral: Watery discharge, handwashing to prevent spread
  • Allergic: Itching, watery discharge, cool compresses
• Glaucoma: Cup-to-disc ratio >50%, management with eye drops
• Corneal Abrasions and Ulcers: Fluorescein staining, management based on etiology
• Endophthalmitis: Post-cataract surgery complication, intraocular WBCs

General Notes

• Miscellaneous Tips:
  • Importance of gratitude and contentment for overall well-being
  • Encouragement of incremental changes for habit building
  • Discussion on the relevance of understanding patient perspectives and empathy in clinical practice

Summary

This lecture covered a wide range of topics crucial for general medicine, including the diagnosis and management of peripheral artery disease, metabolic syndrome, obesity, bariatric surgery, cardiovascular disease screening, and key ophthalmological conditions. Emphasis was placed on practical approaches to patient management, the importance of incremental habit changes, and the role of empathy in clinical practice.