Internal Medicine Flashcards
What is Roflumilast?
A selective phosphodiesterase-4 inhibitor
What condition does Roflumilast primarily treat?
Severe COPD (Chronic Obstructive Pulmonary Disease)
In which phenotype of COPD is Roflumilast most effective?
Chronic bronchitis phenotype
Fill in the blank: Roflumilast can reduce symptoms and _______ in patients with severe COPD.
exacerbations
In which patients can Azithromycin be used?
Azithromycin can be used for patients with COPD and persistent exacerbations, especially in current nonsmokers.
What is supplemental oxygen therapy (Option C) used for?
It improves quality of life and decreases mortality in patients with an arterial PO2 of 55 mm Hg (7.3 kPa) or less or an oxygen saturation of 88% or less.
What are the adjusted thresholds for supplemental oxygen therapy in patients with COPD who have cor pulmonale, heart failure, or erythrocytosis?
The thresholds are lowered to a PO2 of 59 mm Hg (7.8 kPa) or less or oxygen saturation of 89% or less.
What is neutropenia defined as?
A circulating absolute neutrophil count (ANC) less than 1500/μL (1.5 × 10^9/L)
Neutropenia indicates a lower than normal level of neutrophils, a type of white blood cell essential for fighting infections.
What is the ANC threshold for severe neutropenia?
An ANC less than 500/μL (0.5 × 10^9/L)
Severe neutropenia significantly increases the risk of infections and requires careful monitoring.
What is drug-induced neutropenia?
Impairment of normal granulopoiesis in the bone marrow or drug-dependent, antibody-mediated immune destruction of circulating neutrophils.
Granulopoiesis is the production of neutrophils in the bone marrow.
Which drugs are known to cause agranulocytosis?
Thionamides such as propylthiouracil and methimazole.
Agranulocytosis is a severe reduction in neutrophils, increasing the risk of infections.
What is the overall prevalence of agranulocytosis caused by thionamides?
Around 0.5%.
While low, this prevalence indicates a notable risk associated with these medications.
When is the risk of agranulocytosis highest after chemotherapy drug initiation?
Within the first 3 months.
Early monitoring is crucial during this period.
Is agranulocytosis more common in men or women?
More common in women.
Gender differences can influence drug reactions and side effects.
How does the dosage of methimazole relate to agranulocytosis?
Agranulocytosis appears to be dose related with methimazole.
Higher doses may increase the risk of developing this condition.
In medication induced neutropenic fever - How long should it take for the ANC to recover after discontinuing the medication?
Within 1 to 3 weeks.
ANC stands for Absolute Neutrophil Count, an important measure in assessing neutrophil levels.
What does DANC stand for?
Duffy-null associated neutrophil count
In which demographics is DANC more common?
- Sub-Saharan African
- Middle Eastern descent
Are patients with DANC usually symptomatic?
No, patients are asymptomatic
Does DANC increase the risk for infections?
No, it does not increase risk for infections
What degree of neutropenia is associated with DANC?
Mild-to-moderate degree of neutropenia
What is cyclic neutropenia?
A rare genetic cause of symptomatic neutropenia that recurs every 3 weeks
Neutropenia is a condition characterized by an abnormally low number of neutrophils, which are a type of white blood cell important for fighting infections.
How often does cyclic neutropenia recur?
Every 3 weeks
This regular recurrence pattern is a key characteristic of cyclic neutropenia.
What is the severity of neutropenia in cyclic neutropenia?
Severe (<200/μL [0.2 × 109/L])
This low level of neutrophils can significantly impair the body’s ability to fight infections.
How long does neutropenia last during each episode of cyclic neutropenia?
2 to 3 days
The duration of neutropenia can lead to increased vulnerability to infections during this period.
What symptoms are associated with cyclic neutropenia?
Recurrent fever, oral ulcerations, and infections
These symptoms are a result of the body’s reduced ability to combat infections due to low neutrophil counts.
What are characteristic findings of serous cystadenomas?
Multicystic, lobulated structures with a central fibrosis scar or calcification
Often described as a ‘bunch of grapes’
What is the prevalence of pancreatic cysts in individuals undergoing abdominal imaging?
15%
Due to increased use of imaging and improved imaging techniques
What are the two subcategories of cystic neoplasms of the pancreas?
- Mucin-producing cysts
- Non–mucin-producing cysts
What is the malignant potential of mucin-producing cysts?
Thought to have malignant potential, but many never become malignant
What is the malignant potential of non–mucin-producing cysts?
No malignant potential
Can often be identified by characteristic imaging features
When do non–mucin-producing cysts require further evaluation?
Unless symptomatic
What diagnostic procedures can be performed for unclear diagnoses in pancreatic cysts?
- Endoscopic ultrasonography
- Fine-needle aspiration
What can fine-needle aspiration help measure in the context of pancreatic cysts?
Cytology, carcinoembryonic antigen level, and DNA analysis
What are high-risk features for patients with mucinous cysts?
- Main pancreatic duct dilation
- Cysts 3 cm or larger
- Change in main duct diameter with distal parenchymal atrophy
- Association with a solid mass
What is the recommended management for patients with high-risk cysts?
Surgical resection
What additional risk factor is associated with high-risk cysts?
Obstructive jaundice
What is the typical demographic for mucinous cystic neoplasms?
Occur almost exclusively in women in their fifth to seventh decades of life
Where are mucinous cystic neoplasms almost always located in the pancreas?
Body or tail of the pancreas
What is the malignant potential of mucinous cystic neoplasms?
Moderate malignant potential
In which demographic are intraductal papillary mucinous neoplasms (IPMNs) prevalent?
Equally prevalent in men and women, usually in their fifth to seventh decades of life
What characterizes branch-duct IPMNs?
Cystic structures that may appear throughout the pancreas
What imaging characteristics are associated with main duct IPMNs?
- Main pancreatic duct dilation
- Parenchymal atrophy
What is the malignant potential of intraductal papillary mucinous neoplasms?
Variable malignant potential
When should tunneled catheters be removed?
Immediately for severe sepsis, evidence of metastatic infection, evidence of an exit-site or tunnel infection, persistent fever, or bacteremia despite administration of antibiotics.
These conditions indicate serious complications that require prompt intervention.
What is antibiotic lock therapy?
An alternative option to treat catheter-related bloodstream infections in stable patients with less virulent organisms such as Staphylococcus epidermitis.
It involves using antibiotics like vancomycin and/or ceftazidime.
True or False: Antibiotic lock therapy is suitable for all patients with catheter-related infections.
False
It is only for stable patients with less virulent organisms.
Fill in the blank: Antibiotic lock therapy can include _______ and/or _______.
vancomycin, ceftazidime
These antibiotics are used to manage less virulent organisms.
What type of organisms are treated with antibiotic lock therapy?
Less virulent organisms such as Staphylococcus epidermitis.
This therapy is not indicated for more aggressive infections.
When should tuberculosis screening be repeated in persons with HIV?
When the CD4 cell count rises to 200/µL, especially if previous testing was negative and the patient has significant risk factors.
This is critical to ensure early detection and management of tuberculosis in at-risk populations.
What is the risk for Mycobacterium avium complex (MAC) infection in persons with advanced HIV?
Low, if the pretreatment CD4 cell count is more than 50/µL and there is a remarkable increase following effective ART.
This indicates that effective ART can significantly lower the risk of opportunistic infections.
What is the utility of performing acid-fast bacilli blood cultures for evaluating disseminated MAC infection in patients with advanced HIV?
Little to no utility.
This suggests that other diagnostic methods may be more effective in this patient population.
Is it appropriate to start active tuberculosis treatment without confirmatory testing for tuberculosis infection?
No, it puts patients at risk for complications.
Active tuberculosis treatment should always be based on confirmed diagnosis to avoid unnecessary adverse effects.
What would be inappropriate without a firm diagnosis regarding latent tuberculosis?
Initiating latent tuberculosis treatment.
Proper diagnosis is essential to avoid complications and ensure effective management.
What interactions should be considered when treating latent tuberculosis in HIV patients?
Significant interactions with tenofovir alafenamide and integrase inhibitors like bictegravir or dolutegravir.
Awareness of drug interactions is crucial in managing HIV and tuberculosis co-infection.
What is the treatment regimen for latent tuberculosis if diagnosed?
Isoniazid for 6 to 9 months or a weekly isoniazid and rifapentine-based regimen for 12 weeks.
The choice of regimen may depend on the patient’s current ART and specific health considerations.
What should be done before making the decision to start latent tuberculosis management?
Repeat the IGRA first.
This ensures that the diagnosis of latent tuberculosis is accurate before initiating treatment.
When should pregnant women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine?
Between 27 weeks’ and 36 weeks’ gestation with every pregnancy
What type of vaccine should pregnant women receive during pregnancy?
Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine
True or False: Pregnant women only need to receive the vaccine once in their lifetime.
False
Fill in the blank: Pregnant women should receive one dose of the _______ vaccine between 27 weeks’ and 36 weeks’ gestation.
tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis
What are the two key questions prompted by the finding of an incidental adrenal mass?
- Is the mass secreting excess hormone? 2. Is the mass benign or malignant?
What biochemical testing should be undertaken for patients with an incidental adrenal mass?
Testing for hypercortisolism
Is screening for pheochromocytoma indicated if the unenhanced CT attenuation is greater than 10 Hounsfield units?
Yes
What is the role of adrenal biopsy in the evaluation of incidentalomas?
Limited; reserved for lesions suspicious for metastases or infiltrative processes
When should adrenalectomy be considered?
For patients with a functioning pheochromocytoma, aldosterone-producing tumor, hypercortisolism, or suspicious imaging phenotype for adrenal carcinoma
Fill in the blank: Only patients with an incidental adrenal mass and electrolyte derangements require screening for _______.
primary hyperaldosteronism
What is the approximate risk percentage of a BRCA mutation in patients with high-risk prostate cancers?
Approximately 12%
High-risk prostate cancers include those with a high Gleason score, lymph node metastases, or distant metastatic disease.
What family history is an indication for BRCA-related genetic counseling in men with prostate cancer?
A first-degree relative diagnosed with breast cancer before the age of 50 years
This specific family history increases the likelihood of BRCA mutations.
True or False: Only patients with distant metastatic disease should be referred for genetic counseling regarding BRCA mutations.
False
High-risk prostate cancers also include those with a high Gleason score and lymph node metastases.
Fill in the blank: Patients with high-risk prostate cancers should be referred for _______ counseling.
genetic
Until when should antibiotics be continued in patients with neutropenic fever?
Until either the absolute neutrophil count recovers (>500/μL) or the patient has completed a full course of antibiotic therapy, whichever is longest.
What increases the risk of fungemia in neutropenic patients?
Remaining neutropenic and febrile for more than 7 days.
In a patient with neutropenic fever, If a patient remains febrile for more than 4 days, initiation of what therapy is warranted?
Addition of an antifungal agent such as voriconazole.
Under what condition should an antifungal agent be added in febrile neutropenic patients?
If the patient’s neutropenia is expected to last beyond 7 days and no alternative source for the infection has been identified.
Fill in the blank: The absolute neutrophil count considered safe is _______.
> 500/μL
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
Minimal change disease is also responsible for 10% to 15% of cases in adults, especially older patients.
In adults, which age groups are particularly affected by minimal change disease?
Older patients (≥65 years) and elderly patients (≥80 years)
These age groups have a higher prevalence of minimal change disease.
What is the classic presentation of minimal change disease?
Sudden-onset nephrotic syndrome with abrupt appearance of edema and eventually anasarca
Anasarca refers to severe generalized edema.
What percentage of adults with minimal change disease may also experience acute kidney injury (AKI)?
Up to 25%
The risk increases in older patients with hypertension, low serum albumin levels, and heavy proteinuria.
What can be a concomitant cause of nephrotic syndrome with AKI related to minimal change disease?
MCG with concomitant interstitial nephritis due to NSAID use
Collapsing forms of focal segmental glomerulosclerosis can also be involved.
Which two conditions can cause severe AKI in elderly patients?
ANCA-associated glomerulonephritis and anti–glomerular basement membrane antibody disease
These conditions are characterized by both hematuria and subnephrotic-range proteinuria.
What is a common cause of AKI in membranous nephropathy?
Renal vein thrombosis
This was not observed on the patient’s Doppler ultrasound.
In which demographic is membranous nephropathy most commonly diagnosed?
Middle-aged adults with a slight male predominance
It is an unusual etiology of nephrotic syndrome in patients >75 years of age unless there is an underlying malignancy.
How does the onset of edema in membranous nephropathy compare to minimal change disease?
The onset of edema in membranous nephropathy is usually slower than in minimal change disease
This indicates a difference in clinical presentation between the two conditions.
What is the initial evaluation for constipation in elderly patients?
Colonoscopy
Considered for patients with acute constipation, unintentional weight loss, family history of colorectal cancer, unexplained anemia, and those older than 50 years with no previous colonoscopy.
At what age should a patient have a colonoscopy to evaluate for mechanical causes of constipation?
Older than 50 years
Specifically for patients with no previous colonoscopy.
What are the preferred treatments for pneumonia in healthy persons?
- Amoxicillin
- Doxycycline
Amoxicillin is preferred if patients are on another tetracycline like minocycline.
Why is amoxicillin preferred over doxycycline when treating pneumonia in certain patients?
Due to the risk of doxycycline resistance
This risk is heightened in patients taking another tetracycline such as minocycline for acne.
What is an alternative treatment option for pneumonia if local pneumococcal resistance is less than 25%?
Monotherapy with a macrolide
This option is viable when resistance levels are low.
What age is the patient mentioned in the context of colonoscopy evaluation?
52 years
What are the three main phenotypes of multiple sclerosis (MS)?
Primary progressive, relapsing-remitting, secondary progressive
Relapsing-remitting MS can be classified by activity status.
How is ‘activity’ defined in relapsing-remitting MS?
Clinical relapses or MRI evidence of new or enlarging lesions
Activity refers to the presence of new relapses or lesions.
What defines ‘progression’ in multiple sclerosis?
Gradual accumulation of neurologic deficits independent of relapses
Progression indicates a worsening of disability over time.
What characterizes relapsing MS?
Relapses or exacerbations
This form is marked by periods of symptom flare-ups.
What characterizes progressive MS?
Slow, progressive accumulation of disability
Unlike relapsing MS, there are no distinct relapses.
What is secondary progressive MS?
Initial relapses followed by progression
This status develops after relapsing MS evolves into a progressive form.
What is primary progressive MS?
Progression occurs from onset without initial relapses
This form starts with a gradual increase in disability.
How is the current status of MS evaluated?
Presence or absence of current relapsing activity and progression
This includes assessing new relapses or new lesions.
When should annual breast cancer screening with MRI begin for women survivors of Hodgkin lymphoma treated with chest irradiation?
8 to 10 years post-therapy or at age 25 years, whichever comes last
Mammography should begin at age 30 years.
What is recommended as an adjunct to mammography for breast cancer screening in Hodgkin lymphoma survivors?
Breast MRI
This is particularly for those who received chest irradiation.
Who does the ACIP recommend for pneumococcal vaccination?
All adults aged 65 years or older and individuals aged 19-64 with certain underlying conditions
Conditions include diabetes.
What pneumococcal vaccines are recommended?
15-valent, 20-valent, 21-valent pneumococcal conjugate vaccines
If the 15-valent is administered, a 23-valent polysaccharide vaccine should follow.
What is hypersensitivity vasculitis?
Cutaneous small vessel vasculitis
It often presents with a rash indicative of small-vessel involvement.
What often triggers hypersensitivity vasculitis?
Medications or infections
About 50% of patients have no known precipitant.
When does drug-induced hypersensitivity vasculitis most often occur?
7 to 10 days after the introduction of a new medication
Recovery is likely with discontinuation of the drug.
What treatments may help if symptoms of hypersensitivity vasculitis persist?
Anti-inflammatory agents, topical or low-dose systemic glucocorticoids, colchicine, or dapsone
These treatments can alleviate ongoing symptoms.
What does eosinophilic small-vessel vasculitis invariably involve?
The lungs
It may also affect the peripheral nervous system and skin.
What laboratory finding is expected in eosinophilic small-vessel vasculitis?
Presence of ANCA antibodies (myeloperoxidase subtype) and peripheral eosinophilia
These findings occur about half the time.
What can polyarteritis nodosa present with?
Palpable purpura and other skin findings indicating medium-vessel involvement
These include livedo reticularis and painful ulcers.
What features are absent in this patient that would indicate polyarteritis nodosa?
Constitutional and musculoskeletal symptoms, peripheral nervous system involvement, gastrointestinal disease
These features differentiate it from other conditions.
What is a significant risk associated with systemic lupus erythematosus patients who have received high cumulative doses of glucocorticoids?
Osteonecrosis, especially in the hip
MRI is the imaging modality of choice for suspected osteonecrosis in SLE.
What factors are associated with an increased risk of osteonecrosis in patients with systemic lupus erythematosus?
- Long-term and high prednisone dosages (>20 mg/d)
- Severe/active SLE
- Vasculitis
What imaging method can remain normal for months in osteonecrosis despite symptoms?
Plain radiograph
What is recommended for maintenance therapy in a patient experiencing a global SLE flare?
Switch from azathioprine to mycophenolate mofetil
Which class of drugs is considered first-line pharmacotherapy for erectile dysfunction?
Phosphodiesterase-5 inhibitors
Examples include sildenafil, tadalafil, and vardenafil.
True or False: Phosphodiesterase-5 inhibitors can be prescribed to patients on nitrates.
False
When is thoracocentesis indicated for an empyema?
When the organism is known and the patient does not respond to empiric therapy
What is the typical presentation of alcohol intoxication due to ethanol and isopropyl alcohol?
Normal anion gap and elevated osmol gap
What is the treatment for methanol or ethylene glycol toxicity?
Fomepizole or IV ethanol as a second line
What is flumazenil used for?
Antidote for benzodiazepine toxicity
What is the risk for malignancy associated with benign thyroid cytopathology results?
2% to 7%
When should repeat ultrasonography be performed for high-suspicion thyroid nodules?
Within 12 months
What is aplastic anemia characterized by?
Severely decreased bone marrow cellularity and pancytopenia
What type of treatment is usually given to younger patients with aplastic anemia who have a suitable HLA-matched donor?
Allogeneic HSCT
What is the overall survival rate for young patients following HSCT with a good risk profile?
Greater than 80%
What is a common cause of most aplastic anemia cases?
Stem cell autoimmunity
How is autoimmune aplastic anemia treated in patients older than 50 years without a suitable stem cell donor?
Immunosuppression with antithymocyte globulin, cyclosporine, and prednisone
What agents may be useful in managing symptomatic patients with myelodysplastic syndrome?
Azacitidine or other hypomethylating agents
What is the treatment for pure red cell aplasia?
IVIG
What results from corticospinal tract injury?
Spastic paresis or paralysis, with weakness, hyperreflexia, muscle spasticity, and extensor plantar responses
What is the formula for calculating the Urine Anion Gap?
Urine Anion Gap = (Urine Sodium + Urine Potassium) – Urine Chloride
What can cause normal anion gap metabolic acidosis?
- Gastrointestinal bicarbonate loss
- Renal loss of bicarbonate
- Inability of the kidney to excrete acid
What is the most common benign epithelial gastric polyp?
Fundic gland polyps
What should be done for symptomatic polyps or polyps larger than 1 cm?
The polyp should be completely resected rather than being biopsied
How many days before major surgery should warfarin be withheld?
A minimum of 5 days
When should warfarin be restarted after surgery?
Within 12 to 25 hours
What imaging technique is used to identify the extent of Paget disease of bone?
Bone scan followed by focused radiography
Is a bone biopsy necessary to diagnose Paget’s disease?
No, radiographic imaging is sufficient
What symptoms suggest the diagnosis of cystic fibrosis in young adults?
Chronic productive cough, recurrent sinusitis, recurrent pulmonary infections, bronchiectasis
What are other complications associated with cystic fibrosis?
Liver disease, endocrine and exocrine pancreatic insufficiency, malabsorption, male infertility
What is the initial test for cystic fibrosis?
Sweat chloride testing
What confirms the diagnosis of cystic fibrosis?
Genetic testing
What characterizes allergic bronchopulmonary aspergillosis (ABPA)?
Persistent increased IgE levels
What are common symptoms of ABPA?
Difficult to control asthma, productive cough with brownish mucus
What will radiographic imaging show in a patient with ABPA?
Pulmonary infiltrates and bronchiectasis
What causes alpha-antitrypsin deficiency?
Inactivation of proteases leading to destruction of lung tissue
What condition is caused by alpha-antitrypsin deficiency?
Emphysema
What is sarcoidosis characterized by?
Formation of noncaseating granulomas
How is sarcoidosis best diagnosed?
Histologic assessment of a biopsy specimen
What is the simplified PESI score used for?
To assess inpatient vs outpatient treatment for pulmonary embolism
What criteria are included in the simplified PESI score?
- Age older than 80 years
- History of cardiopulmonary disease
- History of cancer
- Pulse rate 110/min or greater
- Systolic blood pressure less than 100 mm Hg
- Oxygen saturation less than 90%
What is the 30-day mortality rate for low-risk patients according to the PESI score?
1.1%
What treatments can low-risk patients be considered for?
Home anticoagulation treatment with rivaroxaban or apixaban
When is thrombolytic therapy indicated for pulmonary embolism?
Massive PE and shock
Name some medications beneficial in episodic migraine prevention.
- Venlafaxine
- Propranolol
- Timolol
- Metoprolol
- Atenolol
- Amitriptyline
- Topiramate
- Valproate
- Candesartan
- Erenumab
- Fremanezumab
- Eptinezumab
- Galcanezumab
What are Barter syndrome and Gitelman syndrome?
AR conditions of renal sodium and chloride transporters
What is the presentation of Barter syndrome and Gitelman syndrome?
Hypokalemic alkalosis with urine chloride > 15
What are the two types of testicular cancer?
- Seminoma
- Nonseminomatous germ cell tumors
What is the recommended treatment for suspected testicular cancer?
Radical inguinal orchiectomy
What tumor marker level is elevated in nonseminomatous germ cell tumors?
α-fetoprotein
What are the management options for early-stage nonseminomatous germ cell tumors after resection?
- Active surveillance (in selected patients)
- Retroperitoneal lymph node dissection (RPLND)
- Limited chemotherapy
When is adjuvant chemotherapy recommended in prostate cancer?
In patients with nodal involvement on RPLND
What indicates the need for chemotherapy in prostate cancer post-orchiectomy?
Persistence of tumor marker elevation without abnormal imaging findings
What imaging techniques are included in the staging of prostate cancer?
- Chest radiography
- CT of the abdomen and pelvis
- Tumor marker levels after orchiectomy
Is needle biopsy indicated for suspected prostate cancer?
No, due to increased risk of recurrence
What are the 4 core features of Lewy Body Dementia?
Parkinsonian motor features, visual hallucinations, REM sleep behavior disorder, fluctuations in attention
Parkinsonian motor features include gait problems and slowness of movements.
What is associated with Alzheimer disease dementia on MRI of the brain?
Hippocampal atrophy
Patients with Alzheimer disease do not typically exhibit parkinsonism, especially in the earlier stages.
How can Alzheimer disease be distinguished from dementia with Lewy bodies?
Other symptoms beyond cognition
REM sleep behavior disorder is much more common in dementia with Lewy bodies.
What is a common symptom in dementia with Lewy bodies that occurs at mild stages?
Delusions and hallucinations
These symptoms can frequently occur early in the disease.
What debilitating feature is often seen in dementia with Lewy bodies?
Significant sleep problems, especially daytime sleepiness
This can greatly affect the quality of life for patients.
Describe the fluctuations in memory observed in Alzheimer disease.
Days when memory is better or worse
Fluctuations in dementia with Lewy bodies involve decreased alertness.
True or False: REM sleep behavior disorder is more common in Alzheimer disease than in dementia with Lewy bodies.
False
REM sleep behavior disorder is much more common in dementia with Lewy bodies.
Fill in the blank: Patients with Lewy Body Dementia often experience _______ in attention.
fluctuations
This feature is one of the core symptoms of Lewy Body Dementia.
What is the most common cause of hyperprolactinemia?
Physiologic causes related to pregnancy and lactation
Other causes include physiologic stress, coitus, sleep, and nipple stimulation.
What is the most common pathologic non-tumor-related cause of hyperprolactinemia?
Medication
How does overt primary hypothyroidism cause hyperprolactinemia?
Release of thyrotropin-releasing hormone from the hypothalamus stimulates both TSH and prolactin
What should be treated first in a patient with both hyperprolactinemia and hypothyroidism?
Hypothyroidism
What is the recommended therapy for patients with macroadenomas?
Dopamine agonist therapy
Which dopamine agonist is preferred for lowering prolactin and tumor size?
Cabergoline
It has superior efficacy compared to bromocriptine.
What is pemphigus vulgaris?
An autoimmune blistering disorder with flaccid oral or mucosal bullae that rupture easily
What characterizes bullous pemphigoid?
Tense bullae with pruritus as the predominant symptom
What are common symptoms of SJS and TEN?
Significant skin pain, malaise, fever, and toxic appearance
How many mucosal surfaces are typically involved in SJS or TEN?
Two mucosal surfaces
What is the gold standard for diagnosing kidney stones?
Noncontrast helical CT of the abdomen and pelvis
What is the preferred imaging test for suspected nephrolithiasis in pregnant patients?
Ultrasonography
What does intravenous pyelography diagnose?
Hydronephrosis
What is teriparatide used for?
Treatment of osteoporosis by promoting bone formation
Who should not use teriparatide?
Patients with a history of irradiation
What is the purpose of administering a bone-modifying agent in metastatic breast cancer?
To prevent skeletal-related events
What are two appropriate agents for bone-modifying treatment?
- Zoledronic acid
- Denosumab
How often are zoledronic acid and denosumab typically administered?
Every 3 months
What is a contraindication for zoledronic acid?
Creatinine clearance less than 30 mL/min
What may both zoledronic acid and denosumab cause?
Symptomatic hypocalcemia
What is an effective treatment for acute gout within the first 24 hours?
Colchicine, 1.2 mg followed by a 0.6-mg dose in 1 hour
Fill in the blank: Administering urate-lowering therapy without anti-inflammatory therapy may result in _______.
Recurrent flares of acute gout
