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Dr. Parag H. Mehta
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Board Review · Medicine Simplified

General Medicine

9 high-yield topics. Open a topic to review its pearls.

Preventive Care and Screening

Cancer screening and immunizations

Cancer Screening

  • Breast: mammogram 40-50 (discuss), annually over 50
  • Colorectal: age 45-50, colonoscopy q10 years
  • Cervical: Pap 21-65, every 3 years
  • Prostate: PSA over 50, shared decision
  • AAA: male ex-smokers 65-75 once
  • Hepatitis C: born 1945-65

Immunizations

  • Tdap: every 10 years
  • Influenza: annual
  • Pneumococcal: over 65 or high-risk
  • Shingrix: age over 50
  • MMR/Zoster/Varicella: contraindicated in pregnancy/immunocompromised

Lipid Management

  • Very high risk (CAD + DM): LDL under 70
  • CAD/equivalent: LDL under 100
  • 2-3 risk factors: LDL under 130
  • 0-1 risk factors: LDL under 160
  • Statins if LDL over 190
  • Pravastatin least likely to cause myalgias

Medical Ethics

Autonomy, capacity, end of life

Core Principles

  • Autonomy: patient self-determination
  • Beneficence: act in best interest
  • Non-maleficence: do no harm
  • Justice: fair resource distribution

Decision-Making Capacity

  • Clinical assessment (competence is legal)
  • Psychiatric disorders do not disable capacity
  • Informed consent not required for emergencies
  • Always follow patient wishes if they have capacity

End of Life

  • Living will carries more weight than next of kin
  • Always be as literal as possible
  • No euthanasia
  • Violate confidentiality when danger to self/others, child/elder abuse

Emancipated Minors

  • No parental consent: financially independent, married, raising children, armed forces
  • No consent needed but not emancipated: contraception, pregnancy, STDs, psych, substance abuse

Preoperative Evaluation

Cardiac, pulmonary, DVT prophylaxis

Cardiac Risk

  • Active conditions: ACS, decompensated CHF, severe AS, uncontrolled arrhythmias
  • Functional capacity: 4 METs (climb stairs, walk uphill)
  • Delay elective surgery 6 months after MI
  • If on beta blocker, leave them on it

Pulmonary

  • Pre-existing chronic lung disease: most important risk factor
  • Smoking cessation 8 weeks prior
  • Incentive spirometry most likely to reduce complications
  • No routine pre-op blood gas

DVT Prophylaxis

  • Every hospitalized patient needs prophylaxis
  • Heparin, LMWH, or fondaparinux (no HIT)
  • High risk: hip/knee surgery, malignancy
  • IVC filter if anticoagulation fails or contraindicated

Endocrine

  • DM: hold sulfonylurea day of surgery, insulin drip intraop
  • Chronic steroids: stress dose, extra hydrocortisone
  • Type 1 always needs insulin even when euglycemic

Toxicology

Poisonings and antidotes

Alcohols

  • Methanol: blindness, fomepizole + folate, dialysis
  • Ethylene glycol: calcium oxalate crystals, sweet taste, fomepizole
  • Isopropyl: ketosis without acidosis

Common Antidotes

  • Acetaminophen: N-acetylcysteine (within 8h)
  • Beta blockers: glucagon
  • CCB: calcium chloride
  • Benzodiazepines: flumazenil
  • Opioids: naloxone
  • Organophosphates: atropine + pralidoxime
  • TCA/salicylates: bicarbonate
  • Iron: deferoxamine

Cocaine

  • Sympathetic activation, HTN, seizures
  • IV midazolam, labetalol/nifedipine
  • Do NOT give beta blockers alone
  • Chest pain: may need cath (vasospasm/plaque rupture)

Statistics

Sensitivity, specificity, risk

Test Characteristics

  • Sensitivity = TP/(TP+FN): good screening tests
  • Specificity = TN/(TN+FP): good confirmatory tests
  • PPV = TP/(TP+FP): probability positive has disease
  • NPV = TN/(TN+FN): probability negative is disease-free

Risk Measures

  • Relative risk: cohort studies
  • Odds ratio: case-control studies
  • Number needed to treat = 1/ARR
  • p under 0.05 significant; CI including 1.0 not significant

Allergy and Immunology

Hypersensitivity and immunodeficiency

Hypersensitivity Types

  • Type 1: IgE mediated (allergic reactions, anaphylaxis)
  • Type 2: cytotoxic IgG/IgM (hemolytic, Goodpasture)
  • Type 3: immune complex (SLE, serum sickness)
  • Type 4: delayed/cell mediated (PPD, contact dermatitis)

Anaphylaxis

  • IgE release from mast cells
  • Epinephrine, H1/H2 blockers, supportive care
  • If on beta blocker: give glucagon concurrently

Immunodeficiencies

  • IgA deficiency: most common, anaphylaxis with transfusion
  • Common variable: recurrent infections, gastric cancer risk
  • Hereditary angioedema: C1 esterase deficiency, low C4, FFP acutely

Nutrition

Vitamin and mineral deficiencies

Vitamin Deficiencies

  • B1 (thiamine): Wernicke, beriberi
  • B3 (niacin): pellagra (dementia, dermatitis, diarrhea)
  • B6 (pyridoxine): INH-induced, seizures
  • B12: megaloblastic anemia, posterior column
  • Vitamin C: scurvy, bleeding gums
  • Vitamin D: osteomalacia

Minerals and Metabolic

  • Zinc: scaly skin, alopecia, loss of taste
  • TPN deficiencies over time: water-soluble vitamins, iron, B12
  • Refeeding syndrome: hypophosphatemia
  • Bariatric surgery: B12, D, iron

Womens and Mens Health

Contraception, GU issues

Contraception

  • Rule out pregnancy first in any young female
  • 17y can consent to birth control without guardian
  • Emergency contraception within 72h (Plan B)
  • OCP contraindications: thromboembolism, CAD, migraines, smoking + age over 35

Mens Health

  • BPH: alpha blockers first line, then 5-alpha reductase
  • Testicular torsion: absent cremasteric reflex, immediate surgery
  • Erectile dysfunction: check for organic vs psychogenic

Pregnancy Drugs

  • HTN: labetalol, methyldopa, hydralazine (not ACE-I)
  • Anticoagulation: heparin (not warfarin 1st trimester)
  • Hyperthyroid: PTU 1st trimester
  • Preeclampsia + seizure = eclampsia, MgSO4, deliver

Dizziness and Syncope

Vertigo and syncope workup

Vertigo

  • Central: vertical nystagmus, direction changes, unaffected by fixation
  • Peripheral: horizontal only, inhibited by fixation
  • BPPV: positional, Dix-Hallpike, Epley maneuver
  • Meniere: episodic, tinnitus, hearing loss
  • Acoustic neuroma: progressive hearing loss, MRI with gad

Syncope

  • Vasovagal: fear/pain trigger, no further workup
  • Neurally mediated: recurrent, tilt table test
  • Arrhythmia: no prodrome, telemetry/Holter
  • Structural: exertional, echo (HOCM, aortic stenosis)