MKSAP

Question 1

Malignant melanoma follow up

Answer 1

1. Bresblow depth of <1mm and successful resection - follow up in 12 months
2. metastatic melanoma- for BRAF mutations can use BRAF inhibitors, such as vemurafenib and dabrafenib, otherwise can use check point inhibitors

Question 2

Hydroxiurea compliance

Answer 2

Check for macrocytosis

Question 3

Metastatic lung adenocarcinoma

Answer 3

Can check for PDL-1 mutation for pembro

Question 4

Metastatic prostate cancer therapy

Answer 4

for patients with new bone leasions, start therapu=y with an antiandrogen such as biclutatide prior to GnRH agonist luprolide because luprolide can transiently worsen symptoms

Question 5

Erlotinib

Answer 5

Erlotinib is indicated for treatment of metastatic non–small cell lung cancer in patients with an EGFR mutation.

Question 6

crizotinib.

Answer 6

ALK translocations and ROS1 mutations derive similar benefit from crizotinib in metastatic NSCLC

Question 7

SLE refractory to all traditional treatments

Answer 7

add Belimumab - B lymphocyte stimulator protein antagonist

Question 8

Double posative ANCA

Answer 8

Think drug induced

Question 9

changes to lamotrogine when starting a oral contraceptive

Answer 9

increase it, oral contraceptives increase the metabolism

Question 10

cutaneous abscess

Answer 10

incision and drainage. No antibiotic treatment unless there are systemic signs of illness

Question 11

mild TBI

Answer 11

neuropsych testing before return to play

Question 12

indications for aortic valve replacement

Answer 12

For patients with severe aortic regurgitation, surgical aortic valve replacement is recommended in the presence of symptoms attributable to regurgitation, left ventricular ejection fraction less than 50%, or another indication for cardiac surgery. In addition, surgical aortic valve replacement can be beneficial in asymptomatic patients with significant left ventricular dilatation (end-systolic dimension >50 mm or indexed end-systolic dimension >25 mm/m2). In the absence of these findings, clinical evaluation and surveillance echocardiography every 6 to 12 months is recommended.

Question 13

Therapy for MS mobility impairments

Answer 13

dalfampridine, a voltage-gated potassium channel antagonist, significantly improved timed 25-foot walking speeds in patients with multiple sclerosis and gait impairment.

Question 14

alcoholic ketoacidosis

Answer 14

don’t necessarily have to have ketones in urine

Question 15

Hemochromotosis with elevated liver chemistries

Answer 15

get a biopsy

Question 16

premature ejactulation

Answer 16

SSRI

Question 17

Vaccienes needed prior to starting TNF alpha inhibitors

Answer 17

Herpies zoster to prevent disseminated disease and post herpatic neuroalgia

Question 18

voriconazole complications

Answer 18

skin cancer with prolonged use

Question 19

subepithelial collagen band on colon biopsy

Answer 19

microscopic colitis, treat with budesonide

Question 20

Medications that need to be discontinued prior to secondary causes of hypertension workup

Answer 20

Spiro/epleronone, amitriptoline (causes falsely elevated metanephrines)

Question 21

work up of breast mass in pt’s >30y/o

Answer 21

mammo and US despite breast density

Question 22

D-lactic acidosis

Answer 22

Think in people wit anion gap and hx of malabsorption or small bowel resection

Pt’s will present with confusion and ataxia

Question 23

chrons flare despite previous pred tapers

Answer 23

infliximab

Question 24

which antiepileptic does not cause bone loss

Answer 24

lamotrogine

Question 25

hypoparathyroid maagement

Answer 25

have to monitor urine calcium because this can often limit therapy

Question 26

mirabegron

Answer 26

anticolenergic used to treat BPH

Question 27

status epilepticus in a patient allergic to phenytoin

Answer 27

Valproic acid

Question 28

murmurs that warrant echos

Answer 28

(1) a systolic murmur grade 3/6 or higher (grade 3, moderately loud murmur; grade 4, loud murmur associated with a palpable thrill; grade 5, very loud murmur but cannot be heard without the stethoscope; and grade 6, can be heard without a stethoscope); (2) late or holosystolic murmurs; (3) diastolic or continuous murmurs; or (4) murmurs with accompanying symptoms. This patient with a holosystolic murmur that radiates to the axilla needs further evaluation with TTE.