MKSAP Flashcards
FDA approved SERM for genitourinary syndrome of menopause
Ospemifine
Preferred agent for GMS
Vaginal moosturizer —> vaginal estrogen
Patient with breast CA. You want to start vaginal estrogen. Is it safe?
Contact oncologist first
Most appropriate Rx of seborrhic dermatitis
Zinc pyrithion shampoo. Only use low potency steroids
SSRI not associated with ED
Bupropion
Hormonal contraception contraindicated in migraine
Estrogen. Patient can still get progesterone
Dress syndrome also called as DIHS is an example of —- hypersensitivity
Type 4 or delayed—> occurs 2-4 weeks after drug exposure
Common drugs associated with DIHS
(Dressed AAA)
Allopurinol, anticonvulsants and antibiotics (sulfonamides)
BSA in SJS
<10%
BSA in TEN
> 30%
Rapidly growing keratotic skin lesion that developed within 4-6 weeks and appears like a volcano
Keratocanthoma
What is the skin lesion of BCC
Erupted volcano
Premature ovarian failure is diagnosed before the age of -
40
Cholesterol abnormality lost menopause
Elevated LDL
HRT for vasomotor symptoms
Estrogen replacement + progestin for females who have intact uterus - either continuous or cyclical to prevent Ca
Transdermal estrogen is preferred due to low ___ risk
VTE
How frequently should HRT be assess in menopause
Every year
Risk associated with HRT in menopause that grows every year
Breast CA
Risk factors for hidradenitis supprativa
Old fat female after puberty comes smoking to the clinic, reports a family history of HS and shows painful nodular lesions in the axilla, groin, and breasts.
Rx of hidradenitis supprativa
CLeaR (clindamycin and rifampin) with Adalimumab
Algorithm for pre-operative cardiac evaluation
ACS—> no—> CAD risk factors? —> yes —> MACE >1—-> METS <4 —> Will coronary revascularization change management? —> perform functional cardiac testing —> revascularize before surgery if needed
Score to calculate pre-operative pulmonary risk
ARISCAT and. STOP-BANG
Routine CXR and spirometer for pre-op?
No
EKG for pre-op
I veryone gets it
Define erythroderma
Erythema covering >80% of BSA
Duration of DAPT for BMS
1 month
DAPT duration after PCI for ACS and DES
12 months but can be stopped after 6 months
Duration of DAPT after PCI for stable angina with DES
6 months can be stopped at 3 months of needed
Disorder associated with SCAD
FMD
Why are steroids not used for psoriasis
Can pot erythrodermic paoriasis
Electrolyte abnormality in erythoderma
HypoCa
Do you need imaging or endoscopy for diagnosis of chronic sinusitis?
Yes to demonstrate mucosal involvement and rule out mechanical obstruction
First line treatment for premature ejaculation
Paroxetine + PDE-5 inhibitor
Which drugs (including illicit) cause ED
- BB
- SSRI
- Marijuana
- Opiates
Algorithm for evaluation of ED
Early morning erections absent?—> check AM testosterone for everyone.
Rx of ED
- First line : PDE-5 inhibitors
- Second line: penile alprostadil injections
- Testosterone if confirmed hypogonadism
Contraindications/caution use of PDE-5 inhibitors with these meds
- Nitrates
- Alpha blockers
Causes of painless vision loss (all posterior etiology)
- Optic neuritis
- CRAO
- CRVO
- RD
- Vit real detachment
- Posterior uveitis
Causes of painful vision loss (mostly anterior)
- Keratitis
- Corneal a stadium
- Hyphema
- Ant uveitis
- Endopthalmitis
- Pappiledema
Most common autoimmune condition a/w vitiligo
Autoimmune thyroid Dx
Others: type 1 DM, RA, poly glandular syndrome
Rx of vitiligo
- Topical steroids and calcium Erin inhibitor
- Phototherapy
Patients who are considered high risk of clotting and should be bridged with AC pre operative
- Mechanical valve
- Valvular A.fib
- Recent VTE (3 months)
- APS or hyper coagulability
When should warfarin be restarted post surgery
Within 12-24 hours for low bleeding risk and within 7 days for high bleeding risk
Which patients should be considered for AC bridging in pre op period
- Recent PE
- Prior stroke
- CHADSVASC > 7
- Hypercoagulable
- Mechanical valve
Two form of impetigo and causative organism
- Bullous: staph aureus
- Non bullous: staph aureus and step group A
Rx of impetigo
- Localized: topical mupirocin or ratapanulin
- Systemic: oral antibiotics
What is Ecthyma
Ulcerated impetigo
Two variants of rosacea
- Papulopustular —> diff from acne due to absence of comedone
- Erythrotelengectatic —> diff from SLE due to Jason Kanika fold involvement (soared in lupus)
Rx of papulopustular rosacea
Topical metronidazole and Azeliac acid and topical ivermectin; no GC
Rx of erythrotelebgectatic rosacea
Avoid exposure to triggers, sun protection, gentle cleansers
Second line Rx of acne
Antiandrogens: spirinolactone
OCP
Why should topical antibiotics ALWAYS be combined with benzoyl peroxide in acne?
Increased antibiotic resistance with antibiotics alone
Indications for meningococcal vaccine
- HIV
- Asplenia
- First year form students
- Military recruits
- Microbiologists
- Travelers to endemic regions
Three options for emergency contraception and preferred patients for each
- Ulipristil: delays ovulation —> preferred for BMI >26
- Levonorgestrel: delays ovulation —> ineffective at BMI >26
- Copper IUD —> best if possible
Name a mast cell stabilizing agent used for allergic conjunctivitis. Why not the first line?
Cromolyn. Not used because it requires 4 times a day use and therefore has low compliance
Options for colon CA screening and their timeline
- Colonoscopy: 10
- Flex sig + annual stool occult: 10 years
- Flex sig alone: 5
- CT colonography: 5
- FIT: annual
- FIT+DNA: every 1-3 years
Rx of melasma
- Sun avoidance and protection
- Laser
- Chemical peels
- Oral tranexamic acid
Most important factor determining the viability of testes in testicular torsion
Time to surety —> should be done within 6 hours
Timing of surgeries after stroke
- Urgent : after 3 months
- Elective: at least 6 months but ideally 9 months
What is crusted scabies
1000s compared to 5-15 mites in normal scabies occurring in immunocompromised host and appears like psoriasis like lesion
Contraindications for GLP-1
- Pancreatitis
- History of MEN
- History of MTC
C/I of phentoramine-to pita mate
Nephro Litiasis
C/T for bupropion
Eating disorder, seizures, current ETOH and opiate use
Topical antibiotics associated with contact dermatitis
Bacitracin, polymyxin B, and neomycin
Duration of AC in patients undergoing abdominal or pelvic surgery for oncology issues
4 weeks
When should you touch the prostrate for culture - acute or chronic prostatitis?
Only chronic due to increased risk of bacteremia with acute proatstatis
When should females revive MMR vaccine
- Preconception and should avoid pregnancy for 4 weeks
- If preferably and non immune —> after delivery and before leaving the hospital/ after termination
Alopecia aerata typical presentation
Patch of non scarring hair loss
Classic physical exam finding in Alopecia aerata
Exclamation point hair
Women treated for trichomonas should be retested in ___ months
3
What is Bowen disease
SCC of the skin in situ which presents as red papule or plaque
What are the conditions associated with SCC
Immunosupression ( solid organ transplants, hematology), HIV, and HOV infection
What is cutaneous horn in skin malignancies?
Seen with SCC due to accusation of keratinocytes
FDA approved therapy for mastalgia which has failed conservative management with topical NSAID and supportive wear
Danazol
Systemic drugs for Rx of onychomycosis
Terbenafine and fluconazole
Older patients (>35) who are at low risk of STI have epidydymitis from uropathogens. What is the emperic Rx?
Levofloxacin x 10 days
Rx is epidydimitis for patients who practice receptive anal intervourse
IM CTX (for STI) and oral levofloxacin (to cover for empiric pathogens)
Common drugs cause in photo toxicity
Doxycycline, FQs, antimalarial, HCTZ, amiodarone
Algorithm for GAS test based on CENTOR criteria in adults
Meeting <=2: no testing
Meeting >2: rapid antigen test for GAS
***HY no guidelines recommend empiric Rx without testing
Empiric Rx of GAS pharyngitis
Penicillin or amoxicillin
Rx of SJS/TEN
D/C offending agent. IV steroid or IVIG but none supported by strong evidence.
When is topic therapy preferred over cryo for AK and which is the preferred agent
Extensive lesion (>15) and agent is 5-FU (better than imiquimod or ingenol)
What is erythrasma
Superficial skin infection caused by corynebacterium that presents as thin cigarette paper like pink brown plaques that are mildly pruritic
How is erythrasma diagnosed?
Wood lamp examination showing coral red patches
How is erythrasma treated?
Oral or topic erythromycin
When should biologics be held and started on the pre-operative period?
Withhold as close to one dosing cycle as possible and restart within 14 days if evidence of recovery
Prostrate CA screening age
55-69
55ostrate cancer screening age
55-69
Weight loss promoting antidepressant
Bupropion
Weight neutral antidepressants
Fluoxetine, venlafaxine, and nefazadone
What is a dysplastic Nevis and how to work it up?
Pigmented spot which usually has more than one shade of brown - “fried egg appearance”. Clinically cannot be different EF from melanoma and therefore excision biopsy should be performed.
Patients with dysplastic nevi are at increased risk of ___ skin cancer
Melanoma
The ONLY intervention that reduced post operative pulmonary complication in patients undergoing non cardiac surgeries
Post op prophylactic respiratory physiotherapy.
Does incentive spirometer reduce post-op pulmonary complications
NO
Organisms causing OE
Psuedomonas and Staph aureus
Treatment of uncomplicated OE
Ciprofloxacin + dexamethasone ear drops
Treatment of complicated OE (otitis external)
Systemic antibiotic
What is Ramsay Hunt syndrome (herpes zoster otitis)
Painful vescicular rash around the Travis associated with facial nerve palsy
How many lab values do you require to make a diagnosis of androgen deficiency in a male patient
2 separate testosterone values <300
You obtained two testosterone levels and conformed the diagnosis of androgen deficiency. Next step?
Obtain FSH and LH
USPTF recommends —- the use of Vitaenin E and beta carotene for CVD prevention
Against
VTE prophylaxis in hospitalized medical patients
Pharmacological only
VTE prophylaxis in surgical patients
IPC + pharmacological
Threes cores to screen for alcohol use
- AUDIT
- AUDIT-C
- SASQ (single use alcohol screening questionnaire)
Vaginal exam is consistent with candidiasis. What is the next step - treatment or testing?
Confirmatory test needs to be performed before treatment because clinically cannot distinguish different kinds of vaginitis
Rx of chronic bacterial prostatitis
4-6 week course of Bactrim or FQ
Recurrent LUTI in male patients with the same organism
Think chronic prostatitis
What are the 4 types of prostatitis
- Acute prostatitis
- Chronic prostatitis
- Pelvic pain syndrome: LUTS symptoms and pain with ejaculation with evidence of infection
- Asymptomatic unfamiliarity prostatitis: discovered on biopsy for a different reason
Breast cancer screening age recommended by USPTF
50 and older
Shared decision making regarding Brest CA screening in ages __
40-49
Pigmented lesion with rolled borders
Pigmented BCC
Melanoma typical appearance
Berry like
Name the most common INTRAEPIDERMAL bullous skin disease
Pemphigus vulgaris : defective attachment between keratinocytes of the epidermis.
How does pemphigus vulgaris present
Think bullae that rupture easily on the skin and one mucosal surface
Which is the common SUBEPIDERMAL bullous skin disease
Bullous pemphigoid that’s occurs because of defective atfcahement between dermis and epidermis
How does bullous pemphigoid present
Tense bullae that May rupture with pressure and leave a scar
Preferred antivirals and route of administration and duration for herpes zoster
Valacyclovir and Famciclovir orally within 72 hours
When can you discontinue cervical cancer screening
Age >65 with adequate screening I.e 2 negative pap with HPV screen or three normal pap within last 10 years, with most recent test occurring within 5 years.
Age to start cervical cancer screening
25
What is lichen plants
TCell medicated skin disorder commonly associated with Hep C presenting with flat topped, polygonal, purple papilla appearing on lower back, volar wrist, elbows, knees, ankle, and can involve oral mucosa.
What is Koebner phenomenon
Appearance of lichen planus in areas of trauma
When should you add low dose aspirin for primary CAD prevention
Age 40-75 with high ASCVD risk and low bleeding risk
Most effective to reduce dyspnea and improve QOL in COPD patients
Pulmonary rehab
Smoking cessation therapy recommended by ACC after ACS
During or at discharge:
1. Combination NRT: short acting no tone inhaler + nicotine patch
2. Verenecline
**bupropion or nicotine mono therapy is not preferred
Intranasal medication approved for treatment resistant depression
Esketamine
How do you define treatment resistant depression
Failed two appropriate drug trial in addition to aripirazole and psychotherapy
Atypical antipsychotic used for depression
Aripirazole
Causes of pain in bunion
Bursitis, synovitis, and mechanical weight shifting causing tarsalgia with walking
What is the HINTS test
Head impulse, nystagmus, and test of skew
Two options for treatment of suspected scaphoid fracture
- Splinting and repeat radiograph in 1-2 weeks ( not prefrred)
- Immidiate CT or MRI with cat or splinting after # confirmed
Two test to be performed for all patients with syncope
EKG and orthostsics
Medication that reduces frequency of binge eating
Lisdexamphetamine
Define the criteria for binge eating disorder:
One a week for 3 months:
1. Eating rapidly than normal
2. Eating until uncomfortably full
3. Eating large amounts when not hungry
4. Eating alone due to embarrassment
5. Remorse’s or guilt after eating
Three drug classes that reduce binge eating
- Lisdexamphetamine
- Topiramate
- SSRI
In men with persistent lower urinary tract symptoms despite treatment with an α-blocker and no evidence of bladder outlet obstruction, the addition of an anticholinergic drug is a reasonable next step.
Drug-induced acute urticaria should be treated initially with elimination of the underlying medication trigger, if possible, and with symptomatic relief with a nonsedating, long-acting second-generation H1-blocking antihistamine - fexofenadine
The only contraindication to compression therapy for venous stasis ulcer
ABI <0.5
Classic presentation of iliotibial band syndrome
A young athletes with pain the lateral knee that worsens with activity and is reproduced on noble test ( repeated extension and flexi on if supine knee with thumb on lat consuls reproduces pain)
Rx if PTSD (3 drugs)
- Serteraline
- Paroxietine
- Venlafaxine
First line therapy for premenopausal dysphoria
Serteraline
Which unusual drug is used for Chris cough that failed conventional management
6 month trial of gabapentin
Patients with unexplained chronic cough should be referred for ____
multimodality speech pathology intervention.
Which opiate is contraindicated in ESRD
Morphine
Which analgesic us cleared with HD
Hydromorphone
Chlordiazepoxide has a very long half-life and is typically preferred in the treatment of alcohol withdrawal because it is associated with less frequent changes from agitated to sedated and a lower chance for recurrent withdrawal or seizures. However, chlordiazepoxide may accumulate in patients with severe alcoholic hepatitis and cirrhosis; benzodiazepines with a shorter half-life, such as lorazepam (Option A) and oxazepam (Option B), are preferred in these patients.
Idiopathic intracranial hypertension is associated with use of tetracyclines, retinoic acid, and progesterone or estrogen supplements; discontinuation of any potential offending agent is the first step in management.
Headaches, visual symptoms, and intracranial noises (pulsatile tinnitus) are the most common presenting symptoms of IIH.
