MKSAP Book Flashcards
AL Amyloidosis
Due to plasma cell dyscrasias like MM, MGUS, Waldenstrom’s
Hereditary Amyloidosis
Due to mutated transythyretin (TTR) gene
AA Amyloidosis
Assoc. w/ RA, IBDs, Chronic infection; consists of serum amyloid A protein
Dialysis-related amyloidosis
Consists of B2-microglobulin
Clinical manifestations of Amyloid
Nephrotic range proteinuria w/ anasaraca, LE edema, foamy urine
GI bleeding, anemia, intestinal pseudo-obstruction and distention
Chronic liver disease, portal HTN
Distal numbness, paresthesia, autonomic dysfnxn
CHF and arrhythmias
Bleeding diasthesis
Macroglossia, muscular pseudohypertrophy, carpal tunnel syndrome
Treatment for hyperviscosity syndrome
Emergent plasmapheresis
Should simultaneously start rituxan, steroids, and chemotherapy
Drop arm test
Painful shoulder is abducted then patient must slowly lower arm; sudden drop = Positive
Indicates tear of the supraspinatus
Hawkins Test
Arm is flexed to 90 degrees w/ elbow flexed as well; examiner internally rotates arm producing pain
Indicates impingement of supraspinatus muscle
Beer can test tests what muscle
Full tear of supraspinatus
Resisted external rotation of arm
Indicates infraspinatus damage; limitation of ROM suggests adhesive capsulitis
Internal rotation lag sign (Winged scapula)
Tests for subscap tear
Meralgia paresthetica
Distal anterolateral thigh parasthesia and pain associated w/ tight fitting pants and obesity
Caveat to Anterior drawer test
you should be sitting on the patient’s foot to stabilize the leg
McMurray Test
with patient supine, examiner fully flexes knee and rotates tibia externally; knee is then extended with the hand over the medial joint line
Positive= SNapping detected over joint line
medial-lateral grind knee test
Have patient flex and extend knee while you provide medial and lateral stress to the knee
Grinding= Meniscal tear
Lorcaserin
Selective serotonergic receptor antagonist that suppresses appetite but is associated w/ anticholinergic ADRs and hypoglycemia in DM pts
Low rate of discontinuation otherwise
Medication given to patients w/ concurrent chronic bronchitis and recurrent COPD exacerbation
Roflumilast; PDE-4 inhibitor shown to improve lung function and decrease COPD exacerbation rate in these
individuals
ADRs: HA, N/V/D
CI’d w/ liver impairment; also has significant drug-drug interactions
Patient’s with hidradenitis should be screened with what?
PCOS and vice versa
From The Curbsiders
Initial diagnostic workup for PCOS
Signs of hyperandrogenism (acne, alopecia, hirsutism, acanthosis nigricans, manlike features)
Irregular periods
Prolactin
TSH
17-OH or DNA test for 21a-hydroxylase deficiency
AMH (tests for ovarian follicles)
Kasabach-Merritt Syndrome
Large, hepatic hemangioma that causes consumptive coagulopathy w/ DIC and thrombocytopenia
Referral for MELD occurs at what score
15 or greater
Where do you auscultate for renal artery bruits?
ANTERIORLY
Immune Mediated Necrotizing Myopathy (IMNM)
Abnormal immune response associated w/ anti-HMGCR antibodies; can be seen in paraneoplastic syndromes or after initiation of statins
Patients w/ have progressive myopathy associated w/ CK elevation even after discontinuation of statin therapy
Dx: Biopsy showing muscle fiber necrosis w/ minimal inflammatory cells
Tx: Immunosuppressive therapy
Tuberous xanthoma
Yellow/red 3mm papules that appear on extensor surfaces of elbows and knees; associated w/ elevated LDL (familial hypercholesterolemia) and IDL (familial dysbetalipoproteinemia)
Patient with infection and history of seizure
Try to avoid meds that low seizure threshold
Treating BB overdose
Glucagon 3mg bolus followed by IV infusion
-If no response, milrinone gtt will increase CO
Workup for Seizure while it is happening
GLUCOSE
CMP, CBC, Lactate, Mg, Phosphorus, UDS, AED levels
Treat fever AGGRESSIVELY
Meds if seizure doesn’t stop with Ativan
Fosphenytoin 100mg/min
Keppra 1g
Phenobarbital 15mg/kg at 50mg/min
-Simultaneously prepare Versed and propofol drips
Reasons to get CT after fall (8)
- GCS <15 2hrs after injury or <13 at any time
- Suspected fracture
- Signs of basilar skull fracture (racoon eyes, Battle sign, CSF rhinorrhea/otorrhea)
- Vomiting
- Age > 65
- Amnesia >30 mins
- Dangerous mechanism (high elevation)
- On blood thinners
First line treatments for ischemic priaprism
- Aspiration
2. Phenylephrine injection
Medication used to prevent recurrent episodes of priaprism
Oral ketoconazole; decreases androgen production from the adrenals and testes
-Patients need continued LFT and androgen monitoring
Maddrey’s Discriminant Function Score
Grades severity of alcoholic hepatitis
PT - PT(control) + total bilirubin
Score >32 =» Administer prednisolone (discontinue with no improvement in bilirubin by Day 7)
Initial presentation of Wilson’s Disease
Sometimes a Coombs negative hemolytic anemia due to sudden release of copper from hepatocytes; labs would show high urinary copper and low ceruloplasmin
Bleeding from an isolated gastric varix in a patient w/o liver failure
Suspect splenic vein thrombosis
Reasons gastric varices are banded
If they extend from the esophagus to the cardia of the stomach; howver, if they are in the gastric fundus, they are treated w/ IVF, abx, and octreotide
KHORANA score
Scoring system to establish risk of VTE in malignancy
Clue to the presence of APLS
Increased aPTT in a patient not on heparin; represents presence of lupus anticoagulant
PESI
Pulmonary Embolism Severity Index
Patient’s with a score of I or II can be considered for outpatient management
Patient who can’t continue indefinite anticoagulation although it would be continued if they could
2021 CHEST guidelines suggest aspirin in patients with an unprovoked proximal DVT or PE who are stopping anticoagulation therapy; however, continued anticoagulation is preferred.
Post thrombotic syndrome
Approximately 25% to 40% of patients with symptomatic DVT develop aspects of postthrombotic syndrome and chronic venous insufficiency, which often develop within 2 years of VTE. Symptoms of postthrombotic syndrome include pain, heaviness, swelling, stasis dermatitis, and ulceration in the affected limb. Treatment includes leg exercises, avoiding dependent positions for lengthy periods, and using compression stockings. Emollients and a low-moderate potency topical glucocorticoid may be used for stasis dermatitis
How to diagnose ABPA
Measurement of serum IgE against Aspergillus fumigatus
Abnormal finding on a stress test
If there are several areas of hypoperfusion, the differential in perfusion between regions might not be adequate to highlight a focal area of ischemia. Reduction or lack of augmentation in poststress ejection fraction and transient cavity dilatation, as in this patient, are indicators of global hypoperfusion and are high-risk features in MPI. Prompt evaluation for coronary disease with cardiac catheterization is indicated.
