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MKSAP Flashcards

1
Q

SGLT2 inhibitor assoc with risk of lower extremity amputation

A

Canagliflozin

Most common toe and mid foot

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2
Q

Top 5 modifiable risk factors for acute MI, in order

A 
HLD
Smoking
Psychosocial
DM
HTN

Also: obesity, alcohol, physical activity, diet

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3
Q

What population is cilastazol ( PDE 3 inhibitor for claudication) contraindicated?

A

LVEF <40%

Because similar MOA to milrinone- increased mortality

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4
Q

What underlying conditions make exercise stress tests indeterminate?

A

ST segment analysis limited with LBBB, LVH, ventricular pacing, WPW

Can use Sgarbossa criteria to identify MI with LBBB or V pacing

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5
Q

When to screen for other family members for HOCM?

If < 12 yr

If 12 to 18-21

If >21

A

<12 : only if symptoms, competitive athlete, clinical early LVH, family hx of VTach

12-18/21: every 12-18 mo

> 21: symptoms or every 5 years

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6
Q

Which malignancy is most strongly assoc with pruritus?

A

Hodgkin lymphoma

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7
Q

Symptoms of DRESS

A

Drug reactions with eosinophilia and systemic symptoms

Onset 2-6 days after drug
Skin eruption
Hematologic abnormalities (eosinophilia, atypical lymphocytosis
LAD
Organ involvement (elevated liver enzymes, kidney, lungs)

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8
Q

Sweet syndrome signs and treatment

A

Aka acute febrile neutrophilic dermatosis

Juicy red papules / plaques/ nodules with sharp borders on upper trunk and prox extremities

Fever

Treat with steroids

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9
Q

How does hypoMg cause hypoCa?

A

Activates G proteins that stimulate Ca-sensing receptors and decrease PTH

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10
Q

HRS diagnostic criteria

A

Cr increase >1.5 (acute or subacute)

Lack of response to albumin challenge 1 g/kg/day for 2 days

Absence of shock, nephrotoxicity, active sediment, proteinuria >500, US evidence of kidney issues

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11
Q

Alarm features for abd pain

A 
Anemia
Dysphagia
Odynophagia
Weight loss
Fam hx of GI cancer
Hx PUD / surgery / cancer
Mass or LAD
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12
Q

What size gallbladder polyp is indication for cholecystectomy?

A

Over 1 cm, even if asymptomatic because risk of neoplasia

If less than 1 cm and no stones or symptoms, follow with serial US

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13
Q

Dx for endoscopy showing rings, longitudinal furrows I’m setting of solid food dysphagia

A

Eosinophilic esophagitis

May also have structures

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14
Q

MOA of lorcaserin (appetite suppressant)

A

Serotonin 2C agonist

Caution with other serotonin meds

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15
Q

Phentermine- topiramate combo is effective in weight loss. Who is it contraindicated for?

A

Glaucoma

Phentermine is a sympathomimetic

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16
Q

Risk factors for statin adverse effects

A

Age >75
CKD
Liver disease
Medication interactions

Use moderate intensity instead

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17
Q

What med prevents progression of dry macular degeneration?

A

High dose antioxidant vitamins (C, E, beta carotene, Zn, Cu)

Use AREDS (age related eye disease study) formulation instead of beta carotene if increased risk of lung cancer

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18
Q

Treatment for wet macular degeneration

A

VEGF - inhibits neovascularization

Use antioxidants for dry MD

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19
Q

Who to offer BRCA 1/2 testing

A

Breast cancer <45 yr

Breast cancer any age plus family hx breast or ovarian

Triple negative diagnosed before age 60

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20
Q

Health maintenance for women who received chest wall radiation between ages 10 and 30

A

High risk for breast cancer

Annual mammograms AND breast MRIs starting age 30 or 8 years after radiation

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21
Q 
Sudden high fever
Frontal/ retro orbital headache
Myalgias
Arthalgias
Severe low back pain
Rash
Thrombocytopenia
A

Dengue fever signs/symptoms

Rash appears as fever abates

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22
Q

S/s of dengue

A 
Sudden high fever
Frontal/ retro orbital headache
Myalgias
Arthalgias
Severe low back pain
Rash as fever abates
Thrombocytopenia
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23
Q

Difference between dengue and chikungunya

A

Chik has more severe arthralgias, involving small joints
Also less thrombocytopenia

Both have low back pain, fever, arthralgias

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24
Q

When to give PCV 13 and PPSV 23?

Incl immunocompromised, cochlear implant, CSF leak

A

PCV 13:
- >65, at least one year if got PPSV23

PPSV23:

  • 19-64 if comorbidities
  • 65+ one year after PCV13

HIV/ immunocompromised (CKD, asplenia):
- PCV 13 then 8 weeks later PPSV23 then 5yrs later PPSV23

Cochlear implant or CSF leak:

  • PCV13 then one year PPSV23
  • if already got both, one additional PPSV23
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25
Q

Features of Anaplasma

A

Co infects with Lyme
Ixodes tick

Fever
Leukopenia
Thrombocytopenia
Increase LFTs

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26
Q

Features of Babesia

A

Coinfects with Lyme
Ixodes tick

Fever
Hemolysis / jaundice
Splenomegaly

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27
Q

Balkin nephropathy increases risk of what malignancy?

A

Transitional cell carcinoma

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28
Q

Treat Uric acid stones

A

Hydration for UOP > 2 liters per day

Urine alkalinization with Kcitrate or Kbicarb (increased urate solubility)

Xanthine oxidase inhibitor If refractory

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29
Q

Treatment for calcium renal stones

A

Thiazides and K citrate, maybe pyridoxine if primary hyperoxaluria

Increase proximal sodium reabsorption and passive Ca reabsorption

Citrate binds Ca in tubule preventing precipitation with oxalate. Kcitrate decreases uptake of citrate from tubules

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30
Q

Treatment of choice for resistant HTN with CKD

A

Use loop over thiazide with CKD4 or worse

Thiazides lose potency

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31
Q

Treatment for struvite stones

A

Remove them when confirmed - hard to treat

Urine acidification decreases risk of formation

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32
Q

How can bowel resection cause kidney stones?

How to treat it?

A

Excess fatty acids bind Ca - Ca Not available to bind oxalate - increased oxalate absorption (enteric hyperoxaluria)

Treat with adequate Ca intake, hydration, and cholestyramine to bind oxalate

Pyridoxine only works for primary hyperoxaluria not enteric (improves glyoxylate metabolism)

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33
Q

Confusion
Aphasia
Ataxia
High anion gap

A

D lactic acidosis

Occurs in short bowel syndrome

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34
Q

Management for ischemic stroke on aspirin mono therapy

A

Add dipyridimole

Clopidogrel DAPT increases mortality without benefit

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35
Q

Personality change, psychosis, and seizures over weeks. What type of encephalitis?

A

Antibody mediated like paraneoplastic antibody syndrome

Assoc with SCLC, breast, thymoma, germ cell, Hodgkin

Can also be primary autoimmune like anti-LG1

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36
Q

Course of HHV1 encephalitis

A

Cognitive problems, psych disturbance, bitemporal seizures

Progresses acutely over days

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37
Q

What is water restriction test for and how does it work?

A

Evaluate for DI (absence or resistance to ADH)

May not have hypernatremia if access to water

Restricting water will increase plasma osmolality But urine osm doesn’t increase with DI

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38
Q

Management for Barrett esophagus with low grade dysplasia

A

Confirm with two pathologists

Endoscopic ablation or yearly endoscopic surveillance

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39
Q

Supplement for MS treatment, superior to disease modifying therapy along

A

Vitamin D

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40
Q

Best imaging to detect insulinoma

A

Endoscopic ultrasound

Often too small for CT or abdominal US

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41
Q

Clinical manifestations of eosinophilic granulomatosis with polyangiitis

A

Churg Strauss

Autoimmune small vessel vasculitis

Peripheral eosinophilia
Asthma
Purpura on hands and legs
Neuropathies (sensory or motor)

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42
Q

Allergic bronchopulmonary aspergillosis

Population?
Clinical picture?
Treatment?

A

Commonly in ppl with atopic asthma or CF

Severe asthma
Cough with production of mucous plugs
Fever/fatigue
CXR normal or infiltrates
Peripheral eosinophilia

Treat with steroids and maybe anticoagulation

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43
Q

Diagnose PCOS

A

2 of 3:

  • oligo ovulation
  • evidence of hyperandrogenism
  • polycystic morphology in ovaries on US
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44
Q

Which antiplatelet agent if giving tPA for STEMI (no cath lab available)?

A

Clopidogrel

Ticagrelor isn’t well studied

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45
Q

Treatment for cancer of rectum vs other parts of colon

A

Can irradiate rectum because it’s retroperitoneal and stationary

46
Q

Timing of colonoscopy screens after colorectal cancer

A

1 year, 3 years then every 5 yrs if those are normal

47
Q

For kidney transplants, is it better to get HLA incompatible or stay on dialysis and wait for compatible ?

A

Survival benefit to get earlier incompatible kidney than to wait

48
Q

Claudication symptoms with ABI between 0.91 and 0.99. What next?

A

Get exercise ABI if borderline resting results
Exercise ABI significant if <0.90 and decreases 20% from resting

Get CT angiography for surgical planning only after official diagnosis

49
Q

White atrophic patches with itching around vagina. Diagnose and treat.

A

Lichen sclerosis

Treat with topical high potency steroids

50
Q

1st line medication for ALS

A

Riluzole

Increases survival by 3 mo

Also edaravone is FDA approved

51
Q

Goal transferrin sats and ferritin level for CKD?

A

Transferrin >30%

Ferritin >500

52
Q

Sulfonylurea plus DPP4 inhibitor. What to think about?

A

Hypoglycemia

Decrease sulfonylurea (glipizide) when adding a DPP4 (gliptins)

53
Q

Imaging to diagnose MS?

A

Need dissemination in space and time

If only one lesion on MR brain , need to get MR spine too (cervical and thoracic)

LP with oligoclonal bands not necessary to diagnose if imaging confirms

54
Q

How to diagnose Zika

A

PCR of blood and urine

ELISA has cross reactivity with dengue and yellow fever

Should also suspect dengue and chikungunya

55
Q

When to place chest tube for parapneumonic effusion?

A

pH <7.20 with suspected infection

Or presence of pus or positive gram stain/culture

56
Q

First line management for cryptogenic stroke and PFO?

A

Aspirin

Closure of PFO not proven unless recurrent stroke on warfarin, thrombus trapped, or shunting

57
Q

Treatment for Crohn’s disease in pregnancy?

A

Anti-TNF agents

Certolizumab is preferred over infliximab and adalimumab because it’s pegylated which limits placental transfer

58
Q

Who to screen for DM if asymptomatic?

A

Age 40-70 if overweight or obese, every 3 years

59
Q

Expected compensation for metabolic acidosis?

A

Acute:
pCO2 is 1.5 x bicarb + 8

Chronic:
pCO2 is bicarb + 15

OR pCO2 is last two digits of pH

60
Q

Expected compensation for metabolic alkalosis?

A

1 increase in bicarb = 0.7 increase in CO2

61
Q

Expected compensation for respiratory acidosis?

A

Acute:
10 increase in CO2 = 1 increase in bicarb

Chronic:
10 increase in CO2 = 3.5 increase in bicarb

62
Q

Expected compensation for respiratory alkalosis?

A

Acute:
10 decrease in CO2 = 2 decrease in bicarb

Chronic:
10 decrease in CO2 = 4-5 decrease in bicarb

63
Q

What is delta delta ratio and what does it mean?

A

Use to determine if mixed or simple AGMA

Ratio of change in AG to change in bicarb

<0.8 means concurrent non AGMA

0.8-2.0 is pure AGMA

> 2 means concurrent metabolic alkalosis

64
Q

What pretest to get before starting treatment for HepC?

A

Test for prior HepB

HepC antivirals can reactivate; keep monitoring if evidence of past

65
Q

Diagnose bulla in setting of alcoholic liver disease?

A

Porphyria cutanea tarda

Assoc with extensive alcohol use, hemochromatosis, HepC infection

Fragile easily ruptured vesicles on sun exposed areas, darkened skin, hypertrichosis

66
Q

Risk factors for progression from acute to chronic pancreatitis?

A

Male, alcohol, tobacco

Not hyperTG or pseudo cysts

67
Q

Management of PMR?

A

Low dose prednisone (15 mg) plus methotrexate if high risk for relapse (ESR>40, peripheral arthritis, women, can’t tolerate steroids)

68
Q

Treatment for SCD with frequent vaso-occlusive crises despite optimal medical therapy?

A

Stem cell transplant

Best with young age

69
Q

Treatment for actinic keratoses?

A

Cryosurgical destruction if <10-15 lesions

If more, use topical fluorouracil

70
Q

What to screen for in patients with polymyositis/dermatomyositis?

A

ILD

Strong association with presence of antiJo1

71
Q

What agent to prevent GVHD in recent stem cell transplant?

A

Anti-T lymphocyte immune globulin

GVHD is T cell mediated

72
Q

First line for active seizures

A

Ativan, phenytoin, fosphenytoin (prodrug, works faster than phenytoin)

Keppra is not abortive

73
Q

Treatment for psoriatic arthritis that has failed conventional DMARDs and TNFalpha inhibitors?

A

Secukinumab (anti IL17A) if no axial disease

74
Q

What to work up if iron deficiency is resistant to supplements?

A

Malabsorption: celiac, achlorhydria, H pylori

75
Q

Pt in 2nd trimester of preg has gallstone pancreatitis. What next?

A

Take it out,safest in 2nd trimester.

Worse to wait until after delivery. Bile acid dissolution is expensive, frequent dosing, close follow up

76
Q

With liver failure, what happens to factors 5, 7, 8?

A

All factors low except for 8, which is high

Factor 8 is synthesized by all endothelial cells, not just hepatic. Also is cleared by the liver.

77
Q

How to tell between liver disease and vit K deficiency from clotting factors?

A

5 isn’t vit K dependent so will be normal with deficiency

5 will be low with liver disease

78
Q

Work up for fasting hypoglycemic episodes in non-diabetic

A

72 hour fast with hypoglycemic studies

beta hydroxybutyrate is suppressed by endogenous and exogenous insulin

If hypoglycemia <5 hours after meal, do mixed meal testing to assess metabolic response to glucose

79
Q

Degludec vs glargine in type 1 diabetes

A

Degludec preferred

Glargine more likely to cause hypoglycemia

80
Q

MOA of febuxostat

What are some drug interactions?

A

Xanthine oxidase inhibitor

It’s an alternative first line urate lowering drug

Don’t use with drugs metabolized by it: azathioprine or 6-mercatopurine

81
Q

What to work up if iron deficiency is resistant to supplements?

A

Malabsorption: celiac, achlorhydria, H pylori

82
Q

Treatment for unexplained chronic cough

A

Gabapentin - reassess at 6 months

83
Q

Obesity with proteinuria, normal serum albumin, and no edema - diagnosis and treatment?

A

Secondary FSGS, from glomerular hypertrophy (enlarged glomeruli with mild foot process effacement

Lose weight and start ACEi or ARB

84
Q

When to use anastrazole vs tamoxifen for ER/PR+ DCIS

A

After lumpectomy and radiation:

Use anastrozole for post menopausal women
- Has longer cancer free intervals and less VTEs

85
Q

Polymyositis with new fatigue and dyspnea - what to do next?

A

Rule out ACS

Poly/dermatomyositis have 4x increase of ischemic events

can have ILD too but more chronic onset

86
Q

Treatment for acromegaly

A

If evidence of mass effect (optic chiasm/vision changes), do transsphenoidal surgery

If no mass effect or contraindications to surgery, give somatostatin analogues (octreotide) to inhibit GH

87
Q

When to take drug holiday for osteoporosis

A

If taking for 3-5 years with no disease progression AND minimal risk factors for fractures

Continue if high risk

88
Q

What to use if bisphosphonate therapy fails to prevent progression with osteoporosis

A

Teriparatide (it’s also first line if T<3.0)

Denosumab, a RANK ligand inhibitor, if high risk and intolerant of bisphos

89
Q

When is TIPS contraindicated?

A

MELD over 15 or 18

Bili over 4

Existing HE

90
Q

Treatment for Sjogren keratoconjunctivitis if artificial tears doesn’t help

A

Topical cyclosporine

If that doesn’t work, topical glucocorticoids pulse therapy (can cause high IOP)

Hydroxychloroquine is reserved for systemic/extraglandular disease or failure of all topicals

91
Q

Most common cause of reduced EF in heart transplant after one year

A

Allograft vasculopathy (evaluate with LHC)

92
Q

How to diagnose gastroparesis

A

> 10% retention on gastric emptying at 4 hours

93
Q

How to give flu vaccine to solid organ transplant

A

Inactivated vaccine, two doses five weeks apart

Live vaccine is contraindicated

94
Q

How to treat hepatic adenomas assoc with OCPs

A

Resect if >5 cm or beta catenin nuclear reactivity positive or hemorrhage

OCP is reversible cause - if <5 cm surveillance CTs every 6-12 mo

95
Q

When to use epo for CKD?

A

CKD 3-5 for Hgb less than 9.5

96
Q

Things that can cause refractoriness to platelet transfusion

A

Nonimmune: sepsis, fever, DIC, splenomegaly, meds

Immune

97
Q

When to transfuse HLA matched platelets?

A

For alloimmunized patients

When platelet counts are refractory to transfusion (measured 10-60 min after) and not due to sepsis , fever, splenomeg, DIC

Washed platelets are for severe allergic reactions or IgA deficiency

98
Q

What level of coronary stenosis and fractional flow reserve (FFR) do we revascularize, if asymptomatic and no ischemia on MIBI?

A

Stenosis 50-70% and FFR <0.80

Normal is 1.0

99
Q

Dosing schedule for zoledronic acid for bone metastases

A

Every 3 mo is just as effective as monthly

Alendronate is too low potency

100
Q

What’s the risk of sub clinical hyperthyroidism?

A

Hip and other fractures

Esp with TSH <0.1

101
Q

Increased risk of what with cyclophosphamide

A

Bladder cancer

Lower risk with IV administration

102
Q

What supplement lowers the risk of nonmelanoma cancer in high risk patient?

A

Vitamin B3 - nicotinamide

High risk is two or more prior cancers

103
Q

When to refer to nephrologist for transplant evaluation

A

GFR <20

104
Q

When not to treat Shigella with cipro

A

When MIC >/= 0.12

General rule is sensitive when MIC < 1.0

105
Q

Therapy for MG without thymoma

A

Thymectomy has significant clinical benefits

106
Q

MEN 1

A

Parathyroid, pancreatic, pituitary tumors

DIAMOND

107
Q

MEN 2A

A

Medullary thyroid, pheochromocytoma, parathyroid

SQUARE

108
Q

MEN 2B

A

Medullary thyroid, pheo, neuromas (mucosal)

Marfanoid

TRIANGLE

109
Q

Measures to prevent surgical site infection

A

Perioperative hyperoxia (80% fio2 during surgery and 2-6 hr after) and 24 h abx pox

110
Q

When to use coronary artery calcium scoring?

A

To define CVD risk with moderate risk ASCVD 5-7.5%

111
Q

Relative contraindications for cholinesterase inhibitors (donepezil)

A 
Sick sinus
LBBB
Uncontrolled asthma
Close angle glaucoma
Ulcers

ABIM (1 decks)

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