GenMed HY Pearls:

1) [Misc]
a) Lean Model = quality improvement method focused on eliminating non-value added activities, or waste, within
a system.
b) DMAIC Process = Focus on quality control in Each step of the process, rather than on optimizing the overall
efficiency.
c) Plan, do, study, act (PDSA) = Focus on specific points in the system and are not typically used for studying
overall system function and efficiency.
d) When delivering bad news, the short concise, do not use jargon or euphemisms.
e) Metabolic Syndrome Is Defined As Having 3 Or More of the Following 5 Criteria: 1. Increased Waist
Circumference. 2. Triglyceride >149 Or Currently Taking Medication for Hyper-Triglyceride. 3. HDL <40 in
men, <50 and Women. 4. Hypertension. 5. FPG >100.
f) Artificial Nutrition, Pharmacological Agents Do Not Improve Morbidity, Mortality, or Quality of Life in
Cancer Patients with Cachexia.
g) BMI And Waist Circumference Are the 2 Most Important Variables For Stratifying Cardiovascular Risk in obese
patients.
h) Give Opioid Therapy with Stimulant Laxative-Senna. Colace = Stool Softener, Not Appropriate.
i) DVT Prophylaxis In Patients Who Have Undergone Cancer Surgery = Prophylactic Dose Of LMWH For up to 28 Days
after Surgery.
j) Centor Criteria = 1) Fever, 2) Absence of Cough, 3) Tonsillar Exudate, 4) Tender Anterior Cervical
Lymphadenopathy. + 1 Criteria = Reassurance and Symptomatic Management. + 2/3 Criteria = RSA/Throat Culture
To Confirm Diagnosis. +4 Criteria = Initiate Empiric Antibiotic Therapy.
k) Advanced Static mattresses or Overlays reduce the risk of pressure ulcers. While, Frequent repositioning and
Alternating air mattresses have not been shown to decrease pressure ulcer risk.
l) Management of localized neuropathic pain in the elderly = Topical Lidocaine or Topical Capsaicin. Gabapentin
is 2nd line secondary to Advanced age, and also not systemic neuropathic pain.
m) Continue Long-Acting Insulin Before Surgery, However Stop Oral And Short-Acting Insulin.
n) Drug-Induced Hypersensitivity Syndrome Present As: Fever, Rash, Lymphadenopathy, Eosinophilia, Increase LFT.
o) Salicylate Overdose = Tinnitus, Fever, Vertigo, Nausea, Vomiting, Diarrhea, Hypothermia, Pulmonary Edema, Altered Mental
Status. Respiratory Alkalosis + Anion Gap Metabolic Acidosis. Treatment = Urine Alkalinization.
2) [PreOp]
a) Patients with Mechanical Aortic Valve On Chronic Warfarin Therapy Without Any Cardiac Symptoms/Signs Has
Noncardiac Surgeries Planed: Anticoagulation Management = Stop Warfarin 5 Day before Surgery, No Need for
Bridging Anticoagulation, Continuation of Aspirin Is Case-By-Case.
b) Patients with Asymptomatic Severe Aortic Stenosis Can Proceed to Elective Noncardiac Surgery Without Any
Further Preop Evaluation If the Patient Has Had Cardiac Stress Test With the 1 Year.
c) Conservative postoperative measures that reduce the risk of pulmonary complications from suspected
obstructive sleep apnea include elevate the head of the bed, careful use of sedatives and opioids, and
continuous pulse oximetry. Remember, Nocturnal CPAP Ventilation Is Not Needed.
d) For Patients Taking Low-Dose Glucocorticoids, This Should Be Continued on the Morning of Surgery.
e) Noninvasive Pharmacologic Cardiac Stress Test Is Not Recommended If the Patient Is Asymptomatic And at Low
Risk Of Cardiac Complications.
f) Wait 12 Months For Surgery After Drug Eluting Stent. Wait 14 Days After PCI Without Any Stent Placement.
Wait 30 Days For Surgery After CABG Or BMS Placement.
g) In Patients with Less Than 4 METs, Coronary Evaluation Is Needed Before Surgery.
3) [Incontinence]
a) Management of Urge Incontinence 2/2 BPH = Consider Anti-Muscarinic Agents Such As Oxybutynin.
b) Urge Incontinence = Involuntary Leakage with Urgency, Sudden Desire to Pass Urine, Provoked by Running Water,
Handwashing, Cold Weather. Increased Detrusor Activity.
c) Stress Incontinence = Involuntary Leakage with Increased Intra-Abdominal Pressure (Sneezing, Coughing, Exertion) Most
Common in Young Women.
d) Overflow Incontinence = dribbling, Continuous Leakage With Incomplete Bladder Empty, Associated with Bladder Outlet
Obstruction, Increase Frequency, Decrease Urinary Stream, Nocturnal Urination.
e) Mixed Incontinence = Mix of Stress and Urge Incontinence, Most Common in Women.
4) [Ear & Nose]
a) Management of Uncomplicated NonInflammatory Otitis Media with effusion <12 wk = Observe and Supportive Care.
>12 wk = Ear Tubes.
b) Management of Allergic Rhinitis = Nasal Corticosteroids.
5) [Psych/Misc]
a) Consider Changing Medication Class For Pt On Full Dose Antidepressant Tx That Is Not Responding After 6 wk.
b) When Discontinuing SSRIs, and Switching to Another Antidepressant, REMEMBER: Taper the SSRI.
c) CIWA Score <15 = Outpatient Detox with Fixed Dose BZD.
d) Diagnosis of anorexia, Remember, BMI MUST be less than 18.5. If BMI is normal, then it's Bulimia.
e) Management of Anorexia = CBT, Then For Medication = Olanzapine. REMEMBER: SSRIs Are Ineffective for
Anorexia. They Are Effective for Bulimia.
f) Somatic Symptom Disorder Defined As Having: At Least 1 Somatic Symptom Causing Distress or Interference with
Daily Life; Excessive Thoughts, Feelings, and Behaviors Related to the Somatic Symptoms; Persistent of
Somatic Symptoms For At Least 6 Months.
g) 1st line Management of Somatic Disorders = Regularly Scheduled Office Visits.
h) 1st Line Screening for Unhealthy Alcohol Use = Either: Single Item Screening Test, or, AUDIT-C Screen Tests. CAGE Is No
Longer First-Line Screening.
i) SSRIs And SNRIs Are Okay in Pregnancy for Depression.
j) 1st line management For Insomnia 2/2 Time zone Shifts = Behavioral Modifications + Melatonin.
6) [HLD]
 a) High Intensity Statin Therapy = 1) Atorvastatin 40-80 Mg. 2) Simvastatin 80 Mg. 3) Rosuvastatin 20-40 Mg.
7) [Women's Health]
a) Management of Primary Dysmenorrhea = NSAIDs/Cox 2 inhibitors are first-line, for those who cannot tolerate
NSAIDs or NSAIDs are ineffective, use Combine Estrogen-Progestin contraceptive pill.
b) SSRI = first-line treatment for PMS.
c) Biopsy is required for a Palpable breast mass even if mammogram is negative/nondiagnostic.
d) It Is Okay to Give Systemic Estrogen Therapy Without Progestin In Patients without a Uterus.
e) Women with Heterogeneously Dense Breast Tissue, or, Extremely Dense Breast Tissue Should Undergo Routine
Digital Screening Mammogram. Even If Analog Mammogram Is Normal.
f) Patients in Menopause With ONLY Urogenital Symptoms Not Responding to Vaginal Lubricant Should Be Treated
with Topical Low-Dose Vaginal Estradiol.
g) In Patients with Heavy Vaginal Bleeding And Irregular/AnOvulatory Menses Will Require Endometrial Biopsy.
Regardless of the Last Pap Smear.
h) Management of Recurrent Vulvovaginal Candidiasis = Extended Course Antifungal Therapy.
i) Cyclic Mastalgia = Bilateral Breast Pain Developing and Worsening Days before Menses And Then Resolving.
Best Management = Support Bra.
j) Consider Asherman Syndrome and Female Patients with Amenorrhea and History of Uterine Instrumentation (D&C)
Presenting with Amenorrhea and Cyclic Pelvic Pain.
k) Diagnosis of Asherman Syndrome = 1st Step = Transvaginal Ultrasound, Confirm Diagnosis with
Hysterosalpingogram.
l) Treatment of Asherman Syndrome = Hysteroscopic Resection Of the Lesions.
m) Galactocele = Painless Lumps Postpartum.
n) Plugged Milk Ducts = Postpartum Breast Pain With Multiple Small Tender Lumps, (-) Fever, (-) Erythema of the Skin.
o) Diagnostic Approach to Postmenopausal Bleeding = Pregnancy Test, Pap Smear, Transvaginal Ultrasound, Endometrial
Biopsy.
p) Pap Smear + HPV Testing = Every 5 Years.
q) Management of Pelvic Inflammatory Disease = Cefoxitin/Cefotetan + IV Doxycycline.
8) [Screening]
a) Screening for lung cancer with annual low-dose chest CT is recommended for high-risk patients: adults 55-80
with smoking history of 30-pack-years or more, including former smokers with quit in the last 15 years.
b) All Patients Between 15-65 Should Have One Time Screening for HIV.
c) Colonoscopy Screening For Normal Risk Patients: Flex-Sig q5 yr, or Flex-Sig q5yr + FOBT q3yr,or hs-FOBT/FIT
(Fecal Immunochemical Testing) q1yr, or Colonoscopy q10yr.
d) After Starting Statin Therapy, Check Repeat Fasting Lipid Panel Within 1-3 Months. Afterwards Normal Regular
Monitoring At 3-12 Months Intervals.
e) Indications for Moderate-Intensity Statin therapy = Age >75, CKD, use of medication known to interact with
statins (Cardizem), History of Statin intolerance, severe liver disease.
f) Do not trust Commercial Genetic testing, do not order excessive tests.
9) [Statistics]
a) Sensitivity = TP/(TP+FN)
b) Specificity = TN/(TN+FP)
c) Positive Likelihood Ratio = Sensitivity/(1 - Specificity).
d) Negative Likelihood Ratio = (1 - Sensitivity)/Specificity.
10) [Ophtho]
a) Scleritis = Bilateral Eye Pain And Redness, Photophobia, Sparing of the Eyelids and Iris, Worse at Night,
Pain Is Worse with Eye Movement. Normal Vision. 50% of Patients Will Have Underlying Systemic Inflammatory
Disease.
b) Primary Open Angle Glaucoma = Gradual Decrease in Peripheral Vision, No Eye Pain, No Redness, Increased
Intraocular Pressure-Normal = <22 mmHg. First-Line Management = Beta-Blockers.
c) Ophthalmic Artery Occlusion = Common Cause Of Permanent Vision Loss in Patients with Giant Cell Arteritis.
d) Blepharitis = Diffuse Inflammation of the Sebaceous Glands Or Lash Follicles of the Eyelids. Common Causes =
Staph Aureus Infection, Rosacea, Seborrheic Dermatitis.
e) Treatment of Moderate Dry Age-Related Macular Degeneration = High-Dose Antioxidant Vitamins-This Will Slow
Progression To Advance Disease.
f) Retinal Detachment = Myopia, Floaters, Photopsia, Squiggly Lines, Peripheral Visual Field Defect-Described
As A Black Curtain.
g) Central Retinal Artery Occlusion: Common among Elderly, Profound and Sudden Vision Loss. Funduscopic Exam =
Affaire Pupillary Defect, Cherry Red Fovea.
h) Episcleritis = Less Commonly Associated with Pain or Photophobia, Redness, Irritation, Tearing.
i) Keratoconjunctivitis Sicca = Dry Eyes = Dryness, Irritation, Burning.
j) Subconjunctival Hemorrhage = Painless, Blotchy Redness Confined to One Area of the Conjunctiva. Usually
Resolves within Several Weeks.
k) Orbital Cellulitis = Eye Pain, Eye Swelling, Redness. Preceded by Recent Dental/Sinus Infection. Eyelid
Swelling, Pain with Eye Movement, Usually Unilateral.
l) Pre-Septal Cellulitis = Inflammation of The Eyelid And Facial Tissue That Are Anterior to the Orbital
Septum, No Eye Involvement.
m) Endophthalmitis = Vision Loss, Photophobia, Ocular Pain, Discharge. Usually Due to Bacterial/Fungal
Infection Following Eye Surgery.
n) Medications of Drug Induced Optic Neuropathy: Ethambutol, Sildenafil, Linezolid, Infliximab, Bevacizumab,
+/- Amiodarone.
o) Management of Traumatic/Foreign Body Corneal Abrasion = Prophylactic Topical Antibiotics.
p) Retinal Detachment = Floaters, Flashing Lights, Occasional Vision Loss, Painless. No Obvious Abnormalities On Funduscopic
Exam.
q) Central Retinal Artery Occlusion = Mark Vision Loss, Amaurosis Fugax. Pale Fundus w/ Cherry Red Spot In the Macula on
Funduscopic Exam.
r) Yellow Drusen Deposits In the Macular Area On Funduscopic Exam = 100% Age-Related Macular Degeneration.