Internal Medicine Flashcards
1
Q
What is Roflumilast?
A
A selective phosphodiesterase-4 inhibitor
2
Q
What condition does Roflumilast primarily treat?
A
Severe COPD (Chronic Obstructive Pulmonary Disease)
3
Q
In which phenotype of COPD is Roflumilast most effective?
A
Chronic bronchitis phenotype
4
Q
Fill in the blank: Roflumilast can reduce symptoms and _______ in patients with severe COPD.
A
exacerbations
5
Q
In which patients can Azithromycin be used?
A
Azithromycin can be used for patients with COPD and persistent exacerbations, especially in current nonsmokers.
6
Q
What is supplemental oxygen therapy (Option C) used for?
A
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.
7
Q
What are the adjusted thresholds for supplemental oxygen therapy in patients with COPD who have cor pulmonale, heart failure, or erythrocytosis?
A
The thresholds are lowered to a PO2 of 59 mm Hg (7.8 kPa) or less or oxygen saturation of 89% or less.
8
Q
What is neutropenia defined as?
A
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.
9
Q
What is the ANC threshold for severe neutropenia?
A
An ANC less than 500/μL (0.5 × 10^9/L)
Severe neutropenia significantly increases the risk of infections and requires careful monitoring.
10
Q
What is drug-induced neutropenia?
A
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.
11
Q
Which drugs are known to cause agranulocytosis?
A
Thionamides such as propylthiouracil and methimazole.
Agranulocytosis is a severe reduction in neutrophils, increasing the risk of infections.
12
Q
What is the overall prevalence of agranulocytosis caused by thionamides?
A
Around 0.5%.
While low, this prevalence indicates a notable risk associated with these medications.
13
Q
When is the risk of agranulocytosis highest after chemotherapy drug initiation?
A
Within the first 3 months.
Early monitoring is crucial during this period.
14
Q
Is agranulocytosis more common in men or women?
A
More common in women.
Gender differences can influence drug reactions and side effects.
15
Q
How does the dosage of methimazole relate to agranulocytosis?
A
Agranulocytosis appears to be dose related with methimazole.
Higher doses may increase the risk of developing this condition.
16
Q
In medication induced neutropenic fever - How long should it take for the ANC to recover after discontinuing the medication?
A
Within 1 to 3 weeks.
ANC stands for Absolute Neutrophil Count, an important measure in assessing neutrophil levels.
17
Q
What does DANC stand for?
A
Duffy-null associated neutrophil count
18
Q
In which demographics is DANC more common?
A
- Sub-Saharan African
- Middle Eastern descent
19
Q
Are patients with DANC usually symptomatic?
A
No, patients are asymptomatic
20
Q
Does DANC increase the risk for infections?
A
No, it does not increase risk for infections
21
Q
What degree of neutropenia is associated with DANC?
A
Mild-to-moderate degree of neutropenia
22
Q
What is cyclic neutropenia?
A
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.
23
Q
How often does cyclic neutropenia recur?
A
Every 3 weeks
This regular recurrence pattern is a key characteristic of cyclic neutropenia.
24
Q
What is the severity of neutropenia in cyclic neutropenia?
A
Severe (<200/μL [0.2 × 109/L])
This low level of neutrophils can significantly impair the body’s ability to fight infections.
25
How long does neutropenia last during each episode of cyclic neutropenia?
2 to 3 days
## Footnote
The duration of neutropenia can lead to increased vulnerability to infections during this period.
26
What symptoms are associated with cyclic neutropenia?
Recurrent fever, oral ulcerations, and infections
## Footnote
These symptoms are a result of the body's reduced ability to combat infections due to low neutrophil counts.
27
What are characteristic findings of serous cystadenomas?
Multicystic, lobulated structures with a central fibrosis scar or calcification
## Footnote
Often described as a 'bunch of grapes'
28
What is the prevalence of pancreatic cysts in individuals undergoing abdominal imaging?
15%
## Footnote
Due to increased use of imaging and improved imaging techniques
29
What are the two subcategories of cystic neoplasms of the pancreas?
* Mucin-producing cysts
* Non–mucin-producing cysts
30
What is the malignant potential of mucin-producing cysts?
Thought to have malignant potential, but many never become malignant
31
What is the malignant potential of non–mucin-producing cysts?
No malignant potential
## Footnote
Can often be identified by characteristic imaging features
32
When do non–mucin-producing cysts require further evaluation?
Unless symptomatic
33
What diagnostic procedures can be performed for unclear diagnoses in pancreatic cysts?
* Endoscopic ultrasonography
* Fine-needle aspiration
34
What can fine-needle aspiration help measure in the context of pancreatic cysts?
Cytology, carcinoembryonic antigen level, and DNA analysis
35
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
36
What is the recommended management for patients with high-risk cysts?
Surgical resection
37
What additional risk factor is associated with high-risk cysts?
Obstructive jaundice
38
What is the typical demographic for mucinous cystic neoplasms?
Occur almost exclusively in women in their fifth to seventh decades of life
39
Where are mucinous cystic neoplasms almost always located in the pancreas?
Body or tail of the pancreas
40
What is the malignant potential of mucinous cystic neoplasms?
Moderate malignant potential
41
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
42
What characterizes branch-duct IPMNs?
Cystic structures that may appear throughout the pancreas
43
What imaging characteristics are associated with main duct IPMNs?
* Main pancreatic duct dilation
* Parenchymal atrophy
44
What is the malignant potential of intraductal papillary mucinous neoplasms?
Variable malignant potential
45
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.
## Footnote
These conditions indicate serious complications that require prompt intervention.
46
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.
## Footnote
It involves using antibiotics like vancomycin and/or ceftazidime.
47
True or False: Antibiotic lock therapy is suitable for all patients with catheter-related infections.
False
## Footnote
It is only for stable patients with less virulent organisms.
48
Fill in the blank: Antibiotic lock therapy can include _______ and/or _______.
vancomycin, ceftazidime
## Footnote
These antibiotics are used to manage less virulent organisms.
49
What type of organisms are treated with antibiotic lock therapy?
Less virulent organisms such as Staphylococcus epidermitis.
## Footnote
This therapy is not indicated for more aggressive infections.
50
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.
## Footnote
This is critical to ensure early detection and management of tuberculosis in at-risk populations.
51
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.
## Footnote
This indicates that effective ART can significantly lower the risk of opportunistic infections.
52
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.
## Footnote
This suggests that other diagnostic methods may be more effective in this patient population.
53
Is it appropriate to start active tuberculosis treatment without confirmatory testing for tuberculosis infection?
No, it puts patients at risk for complications.
## Footnote
Active tuberculosis treatment should always be based on confirmed diagnosis to avoid unnecessary adverse effects.
54
What would be inappropriate without a firm diagnosis regarding latent tuberculosis?
Initiating latent tuberculosis treatment.
## Footnote
Proper diagnosis is essential to avoid complications and ensure effective management.
55
What interactions should be considered when treating latent tuberculosis in HIV patients?
Significant interactions with tenofovir alafenamide and integrase inhibitors like bictegravir or dolutegravir.
## Footnote
Awareness of drug interactions is crucial in managing HIV and tuberculosis co-infection.
56
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.
## Footnote
The choice of regimen may depend on the patient's current ART and specific health considerations.
57
What should be done before making the decision to start latent tuberculosis management?
Repeat the IGRA first.
## Footnote
This ensures that the diagnosis of latent tuberculosis is accurate before initiating treatment.
58
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
59
What type of vaccine should pregnant women receive during pregnancy?
Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine
60
True or False: Pregnant women only need to receive the vaccine once in their lifetime.
False
61
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
62
What are the two key questions prompted by the finding of an incidental adrenal mass?
1. Is the mass secreting excess hormone? 2. Is the mass benign or malignant?
63
What biochemical testing should be undertaken for patients with an incidental adrenal mass?
Testing for hypercortisolism
64
Is screening for pheochromocytoma indicated if the unenhanced CT attenuation is greater than 10 Hounsfield units?
Yes
65
What is the role of adrenal biopsy in the evaluation of incidentalomas?
Limited; reserved for lesions suspicious for metastases or infiltrative processes
66
When should adrenalectomy be considered?
For patients with a functioning pheochromocytoma, aldosterone-producing tumor, hypercortisolism, or suspicious imaging phenotype for adrenal carcinoma
67
Fill in the blank: Only patients with an incidental adrenal mass and electrolyte derangements require screening for _______.
primary hyperaldosteronism
68
What is the approximate risk percentage of a BRCA mutation in patients with high-risk prostate cancers?
Approximately 12%
## Footnote
High-risk prostate cancers include those with a high Gleason score, lymph node metastases, or distant metastatic disease.
69
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
## Footnote
This specific family history increases the likelihood of BRCA mutations.
70
True or False: Only patients with distant metastatic disease should be referred for genetic counseling regarding BRCA mutations.
False
## Footnote
High-risk prostate cancers also include those with a high Gleason score and lymph node metastases.
71
Fill in the blank: Patients with high-risk prostate cancers should be referred for _______ counseling.
genetic
72
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.
73
What increases the risk of fungemia in neutropenic patients?
Remaining neutropenic and febrile for more than 7 days.
74
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.
75
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.
76
Fill in the blank: The absolute neutrophil count considered safe is _______.
>500/μL
77
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
## Footnote
Minimal change disease is also responsible for 10% to 15% of cases in adults, especially older patients.
78
In adults, which age groups are particularly affected by minimal change disease?
Older patients (≥65 years) and elderly patients (≥80 years)
## Footnote
These age groups have a higher prevalence of minimal change disease.
79
What is the classic presentation of minimal change disease?
Sudden-onset nephrotic syndrome with abrupt appearance of edema and eventually anasarca
## Footnote
Anasarca refers to severe generalized edema.
80
What percentage of adults with minimal change disease may also experience acute kidney injury (AKI)?
Up to 25%
## Footnote
The risk increases in older patients with hypertension, low serum albumin levels, and heavy proteinuria.
81
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
## Footnote
Collapsing forms of focal segmental glomerulosclerosis can also be involved.
82
Which two conditions can cause severe AKI in elderly patients?
ANCA-associated glomerulonephritis and anti–glomerular basement membrane antibody disease
## Footnote
These conditions are characterized by both hematuria and subnephrotic-range proteinuria.
83
What is a common cause of AKI in membranous nephropathy?
Renal vein thrombosis
## Footnote
This was not observed on the patient's Doppler ultrasound.
84
In which demographic is membranous nephropathy most commonly diagnosed?
Middle-aged adults with a slight male predominance
## Footnote
It is an unusual etiology of nephrotic syndrome in patients >75 years of age unless there is an underlying malignancy.
85
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
## Footnote
This indicates a difference in clinical presentation between the two conditions.
86
What is the initial evaluation for constipation in elderly patients?
Colonoscopy
## Footnote
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.
87
At what age should a patient have a colonoscopy to evaluate for mechanical causes of constipation?
Older than 50 years
## Footnote
Specifically for patients with no previous colonoscopy.
88
What are the preferred treatments for pneumonia in healthy persons?
* Amoxicillin
* Doxycycline
## Footnote
Amoxicillin is preferred if patients are on another tetracycline like minocycline.
89
Why is amoxicillin preferred over doxycycline when treating pneumonia in certain patients?
Due to the risk of doxycycline resistance
## Footnote
This risk is heightened in patients taking another tetracycline such as minocycline for acne.
90
What is an alternative treatment option for pneumonia if local pneumococcal resistance is less than 25%?
Monotherapy with a macrolide
## Footnote
This option is viable when resistance levels are low.
91
What age is the patient mentioned in the context of colonoscopy evaluation?
52 years
92
What are the three main phenotypes of multiple sclerosis (MS)?
Primary progressive, relapsing-remitting, secondary progressive
## Footnote
Relapsing-remitting MS can be classified by activity status.
93
How is 'activity' defined in relapsing-remitting MS?
Clinical relapses or MRI evidence of new or enlarging lesions
## Footnote
Activity refers to the presence of new relapses or lesions.
94
What defines 'progression' in multiple sclerosis?
Gradual accumulation of neurologic deficits independent of relapses
## Footnote
Progression indicates a worsening of disability over time.
95
What characterizes relapsing MS?
Relapses or exacerbations
## Footnote
This form is marked by periods of symptom flare-ups.
96
What characterizes progressive MS?
Slow, progressive accumulation of disability
## Footnote
Unlike relapsing MS, there are no distinct relapses.
97
What is secondary progressive MS?
Initial relapses followed by progression
## Footnote
This status develops after relapsing MS evolves into a progressive form.
98
What is primary progressive MS?
Progression occurs from onset without initial relapses
## Footnote
This form starts with a gradual increase in disability.
99
How is the current status of MS evaluated?
Presence or absence of current relapsing activity and progression
## Footnote
This includes assessing new relapses or new lesions.
100
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
## Footnote
Mammography should begin at age 30 years.
101
What is recommended as an adjunct to mammography for breast cancer screening in Hodgkin lymphoma survivors?
Breast MRI
## Footnote
This is particularly for those who received chest irradiation.
102
Who does the ACIP recommend for pneumococcal vaccination?
All adults aged 65 years or older and individuals aged 19-64 with certain underlying conditions
## Footnote
Conditions include diabetes.
103
What pneumococcal vaccines are recommended?
15-valent, 20-valent, 21-valent pneumococcal conjugate vaccines
## Footnote
If the 15-valent is administered, a 23-valent polysaccharide vaccine should follow.
104
What is hypersensitivity vasculitis?
Cutaneous small vessel vasculitis
## Footnote
It often presents with a rash indicative of small-vessel involvement.
105
What often triggers hypersensitivity vasculitis?
Medications or infections
## Footnote
About 50% of patients have no known precipitant.
106
When does drug-induced hypersensitivity vasculitis most often occur?
7 to 10 days after the introduction of a new medication
## Footnote
Recovery is likely with discontinuation of the drug.
107
What treatments may help if symptoms of hypersensitivity vasculitis persist?
Anti-inflammatory agents, topical or low-dose systemic glucocorticoids, colchicine, or dapsone
## Footnote
These treatments can alleviate ongoing symptoms.
108
What does eosinophilic small-vessel vasculitis invariably involve?
The lungs
## Footnote
It may also affect the peripheral nervous system and skin.
109
What laboratory finding is expected in eosinophilic small-vessel vasculitis?
Presence of ANCA antibodies (myeloperoxidase subtype) and peripheral eosinophilia
## Footnote
These findings occur about half the time.
110
What can polyarteritis nodosa present with?
Palpable purpura and other skin findings indicating medium-vessel involvement
## Footnote
These include livedo reticularis and painful ulcers.
111
What features are absent in this patient that would indicate polyarteritis nodosa?
Constitutional and musculoskeletal symptoms, peripheral nervous system involvement, gastrointestinal disease
## Footnote
These features differentiate it from other conditions.
112
113
What is a significant risk associated with systemic lupus erythematosus patients who have received high cumulative doses of glucocorticoids?
Osteonecrosis, especially in the hip
## Footnote
MRI is the imaging modality of choice for suspected osteonecrosis in SLE.
114
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
115
What imaging method can remain normal for months in osteonecrosis despite symptoms?
Plain radiograph
116
What is recommended for maintenance therapy in a patient experiencing a global SLE flare?
Switch from azathioprine to mycophenolate mofetil
117
Which class of drugs is considered first-line pharmacotherapy for erectile dysfunction?
Phosphodiesterase-5 inhibitors
## Footnote
Examples include sildenafil, tadalafil, and vardenafil.
118
True or False: Phosphodiesterase-5 inhibitors can be prescribed to patients on nitrates.
False
119
When is thoracocentesis indicated for an empyema?
When the organism is known and the patient does not respond to empiric therapy
120
What is the typical presentation of alcohol intoxication due to ethanol and isopropyl alcohol?
Normal anion gap and elevated osmol gap
121
What is the treatment for methanol or ethylene glycol toxicity?
Fomepizole or IV ethanol as a second line
122
What is flumazenil used for?
Antidote for benzodiazepine toxicity
123
What is the risk for malignancy associated with benign thyroid cytopathology results?
2% to 7%
124
When should repeat ultrasonography be performed for high-suspicion thyroid nodules?
Within 12 months
125
What is aplastic anemia characterized by?
Severely decreased bone marrow cellularity and pancytopenia
126
What type of treatment is usually given to younger patients with aplastic anemia who have a suitable HLA-matched donor?
Allogeneic HSCT
127
What is the overall survival rate for young patients following HSCT with a good risk profile?
Greater than 80%
128
What is a common cause of most aplastic anemia cases?
Stem cell autoimmunity
129
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
130
What agents may be useful in managing symptomatic patients with myelodysplastic syndrome?
Azacitidine or other hypomethylating agents
131
What is the treatment for pure red cell aplasia?
IVIG
132
What results from corticospinal tract injury?
Spastic paresis or paralysis, with weakness, hyperreflexia, muscle spasticity, and extensor plantar responses
133
What is the formula for calculating the Urine Anion Gap?
Urine Anion Gap = (Urine Sodium + Urine Potassium) – Urine Chloride
134
What can cause normal anion gap metabolic acidosis?
* Gastrointestinal bicarbonate loss
* Renal loss of bicarbonate
* Inability of the kidney to excrete acid
135
What is the most common benign epithelial gastric polyp?
Fundic gland polyps
136
What should be done for symptomatic polyps or polyps larger than 1 cm?
The polyp should be completely resected rather than being biopsied
137
How many days before major surgery should warfarin be withheld?
A minimum of 5 days
138
When should warfarin be restarted after surgery?
Within 12 to 25 hours
139
What imaging technique is used to identify the extent of Paget disease of bone?
Bone scan followed by focused radiography
140
Is a bone biopsy necessary to diagnose Paget's disease?
No, radiographic imaging is sufficient
141
What symptoms suggest the diagnosis of cystic fibrosis in young adults?
Chronic productive cough, recurrent sinusitis, recurrent pulmonary infections, bronchiectasis
142
What are other complications associated with cystic fibrosis?
Liver disease, endocrine and exocrine pancreatic insufficiency, malabsorption, male infertility
143
What is the initial test for cystic fibrosis?
Sweat chloride testing
144
What confirms the diagnosis of cystic fibrosis?
Genetic testing
145
What characterizes allergic bronchopulmonary aspergillosis (ABPA)?
Persistent increased IgE levels
146
What are common symptoms of ABPA?
Difficult to control asthma, productive cough with brownish mucus
147
What will radiographic imaging show in a patient with ABPA?
Pulmonary infiltrates and bronchiectasis
148
What causes alpha-antitrypsin deficiency?
Inactivation of proteases leading to destruction of lung tissue
149
What condition is caused by alpha-antitrypsin deficiency?
Emphysema
150
What is sarcoidosis characterized by?
Formation of noncaseating granulomas
151
How is sarcoidosis best diagnosed?
Histologic assessment of a biopsy specimen
152
What is the simplified PESI score used for?
To assess inpatient vs outpatient treatment for pulmonary embolism
153
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%
154
What is the 30-day mortality rate for low-risk patients according to the PESI score?
1.1%
155
What treatments can low-risk patients be considered for?
Home anticoagulation treatment with rivaroxaban or apixaban
156
When is thrombolytic therapy indicated for pulmonary embolism?
Massive PE and shock
157
Name some medications beneficial in episodic migraine prevention.
* Venlafaxine
* Propranolol
* Timolol
* Metoprolol
* Atenolol
* Amitriptyline
* Topiramate
* Valproate
* Candesartan
* Erenumab
* Fremanezumab
* Eptinezumab
* Galcanezumab
158
What are Barter syndrome and Gitelman syndrome?
AR conditions of renal sodium and chloride transporters
159
What is the presentation of Barter syndrome and Gitelman syndrome?
Hypokalemic alkalosis with urine chloride > 15
160
What are the two types of testicular cancer?
* Seminoma
* Nonseminomatous germ cell tumors
161
What is the recommended treatment for suspected testicular cancer?
Radical inguinal orchiectomy
162
What tumor marker level is elevated in nonseminomatous germ cell tumors?
α-fetoprotein
163
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
164
When is adjuvant chemotherapy recommended in prostate cancer?
In patients with nodal involvement on RPLND
165
What indicates the need for chemotherapy in prostate cancer post-orchiectomy?
Persistence of tumor marker elevation without abnormal imaging findings
166
What imaging techniques are included in the staging of prostate cancer?
* Chest radiography
* CT of the abdomen and pelvis
* Tumor marker levels after orchiectomy
167
Is needle biopsy indicated for suspected prostate cancer?
No, due to increased risk of recurrence
168
What are the 4 core features of Lewy Body Dementia?
Parkinsonian motor features, visual hallucinations, REM sleep behavior disorder, fluctuations in attention
## Footnote
Parkinsonian motor features include gait problems and slowness of movements.
169
What is associated with Alzheimer disease dementia on MRI of the brain?
Hippocampal atrophy
## Footnote
Patients with Alzheimer disease do not typically exhibit parkinsonism, especially in the earlier stages.
170
How can Alzheimer disease be distinguished from dementia with Lewy bodies?
Other symptoms beyond cognition
## Footnote
REM sleep behavior disorder is much more common in dementia with Lewy bodies.
171
What is a common symptom in dementia with Lewy bodies that occurs at mild stages?
Delusions and hallucinations
## Footnote
These symptoms can frequently occur early in the disease.
172
What debilitating feature is often seen in dementia with Lewy bodies?
Significant sleep problems, especially daytime sleepiness
## Footnote
This can greatly affect the quality of life for patients.
173
Describe the fluctuations in memory observed in Alzheimer disease.
Days when memory is better or worse
## Footnote
Fluctuations in dementia with Lewy bodies involve decreased alertness.
174
True or False: REM sleep behavior disorder is more common in Alzheimer disease than in dementia with Lewy bodies.
False
## Footnote
REM sleep behavior disorder is much more common in dementia with Lewy bodies.
175
Fill in the blank: Patients with Lewy Body Dementia often experience _______ in attention.
fluctuations
## Footnote
This feature is one of the core symptoms of Lewy Body Dementia.
176
What is the most common cause of hyperprolactinemia?
Physiologic causes related to pregnancy and lactation
## Footnote
Other causes include physiologic stress, coitus, sleep, and nipple stimulation.
177
What is the most common pathologic non-tumor-related cause of hyperprolactinemia?
Medication
178
How does overt primary hypothyroidism cause hyperprolactinemia?
Release of thyrotropin-releasing hormone from the hypothalamus stimulates both TSH and prolactin
179
What should be treated first in a patient with both hyperprolactinemia and hypothyroidism?
Hypothyroidism
180
What is the recommended therapy for patients with macroadenomas?
Dopamine agonist therapy
181
Which dopamine agonist is preferred for lowering prolactin and tumor size?
Cabergoline
## Footnote
It has superior efficacy compared to bromocriptine.
182
What is pemphigus vulgaris?
An autoimmune blistering disorder with flaccid oral or mucosal bullae that rupture easily
183
What characterizes bullous pemphigoid?
Tense bullae with pruritus as the predominant symptom
184
What are common symptoms of SJS and TEN?
Significant skin pain, malaise, fever, and toxic appearance
185
How many mucosal surfaces are typically involved in SJS or TEN?
Two mucosal surfaces
186
What is the gold standard for diagnosing kidney stones?
Noncontrast helical CT of the abdomen and pelvis
187
What is the preferred imaging test for suspected nephrolithiasis in pregnant patients?
Ultrasonography
188
What does intravenous pyelography diagnose?
Hydronephrosis
189
What is teriparatide used for?
Treatment of osteoporosis by promoting bone formation
190
Who should not use teriparatide?
Patients with a history of irradiation
191
What is the purpose of administering a bone-modifying agent in metastatic breast cancer?
To prevent skeletal-related events
192
What are two appropriate agents for bone-modifying treatment?
* Zoledronic acid
* Denosumab
193
How often are zoledronic acid and denosumab typically administered?
Every 3 months
194
What is a contraindication for zoledronic acid?
Creatinine clearance less than 30 mL/min
195
What may both zoledronic acid and denosumab cause?
Symptomatic hypocalcemia
196
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
197
Fill in the blank: Administering urate-lowering therapy without anti-inflammatory therapy may result in _______.
Recurrent flares of acute gout
