MKSAP Book

Question 1

AL Amyloidosis

Answer 1

Due to plasma cell dyscrasias like MM, MGUS, Waldenstrom’s

Question 2

Hereditary Amyloidosis

Answer 2

Due to mutated transythyretin (TTR) gene

Question 3

AA Amyloidosis

Answer 3

Assoc. w/ RA, IBDs, Chronic infection; consists of serum amyloid A protein

Question 4

Dialysis-related amyloidosis

Answer 4

Consists of B2-microglobulin

Question 5

Clinical manifestations of Amyloid

Answer 5

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

Question 6

Treatment for hyperviscosity syndrome

Answer 6

Emergent plasmapheresis

Should simultaneously start rituxan, steroids, and chemotherapy

Question 7

Drop arm test

Answer 7

Painful shoulder is abducted then patient must slowly lower arm; sudden drop = Positive

Indicates tear of the supraspinatus

Question 8

Hawkins Test

Answer 8

Arm is flexed to 90 degrees w/ elbow flexed as well; examiner internally rotates arm producing pain

Indicates impingement of supraspinatus muscle

Question 9

Beer can test tests what muscle

Answer 9

Full tear of supraspinatus

Question 10

Resisted external rotation of arm

Answer 10

Indicates infraspinatus damage; limitation of ROM suggests adhesive capsulitis

Question 11

Internal rotation lag sign (Winged scapula)

Answer 11

Tests for subscap tear

Question 12

Meralgia paresthetica

Answer 12

Distal anterolateral thigh parasthesia and pain associated w/ tight fitting pants and obesity

Question 13

Caveat to Anterior drawer test

Answer 13

you should be sitting on the patient’s foot to stabilize the leg

Question 14

McMurray Test

Answer 14

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

Question 15

medial-lateral grind knee test

Answer 15

Have patient flex and extend knee while you provide medial and lateral stress to the knee

Grinding= Meniscal tear

Question 16

Lorcaserin

Answer 16

Selective serotonergic receptor antagonist that suppresses appetite but is associated w/ anticholinergic ADRs and hypoglycemia in DM pts

Low rate of discontinuation otherwise

Question 17

Medication given to patients w/ concurrent chronic bronchitis and recurrent COPD exacerbation

Answer 17

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

Question 18

Patient’s with hidradenitis should be screened with what?

Answer 18

PCOS and vice versa

From The Curbsiders

Question 19

Initial diagnostic workup for PCOS

Answer 19

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)

Question 20

Kasabach-Merritt Syndrome

Answer 20

Large, hepatic hemangioma that causes consumptive coagulopathy w/ DIC and thrombocytopenia

Question 21

Referral for MELD occurs at what score

Answer 21

15 or greater

Question 22

Where do you auscultate for renal artery bruits?

Answer 22

ANTERIORLY

Question 23

Immune Mediated Necrotizing Myopathy (IMNM)

Answer 23

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

Question 24

Tuberous xanthoma

Answer 24

Yellow/red 3mm papules that appear on extensor surfaces of elbows and knees; associated w/ elevated LDL (familial hypercholesterolemia) and IDL (familial dysbetalipoproteinemia)

Question 25

Patient with infection and history of seizure

Answer 25

Try to avoid meds that low seizure threshold

Question 26

Treating BB overdose

Answer 26

Glucagon 3mg bolus followed by IV infusion

-If no response, milrinone gtt will increase CO

Question 27

Workup for Seizure while it is happening

Answer 27

GLUCOSE

CMP, CBC, Lactate, Mg, Phosphorus, UDS, AED levels

Treat fever AGGRESSIVELY

Question 28

Meds if seizure doesn’t stop with Ativan

Answer 28

Fosphenytoin 100mg/min
Keppra 1g
Phenobarbital 15mg/kg at 50mg/min
-Simultaneously prepare Versed and propofol drips

Question 29

Reasons to get CT after fall (8)

Answer 29

1. GCS <15 2hrs after injury or <13 at any time
2. Suspected fracture
3. Signs of basilar skull fracture (racoon eyes, Battle sign, CSF rhinorrhea/otorrhea)
4. Vomiting
5. Age > 65
6. Amnesia >30 mins
7. Dangerous mechanism (high elevation)
8. On blood thinners

Question 30

First line treatments for ischemic priaprism

Answer 30

1. Aspiration

2. Phenylephrine injection

Question 31

Medication used to prevent recurrent episodes of priaprism

Answer 31

Oral ketoconazole; decreases androgen production from the adrenals and testes

-Patients need continued LFT and androgen monitoring

Question 32

Maddrey’s Discriminant Function Score

Answer 32

Grades severity of alcoholic hepatitis

PT - PT(control) + total bilirubin

Score >32 =» Administer prednisolone (discontinue with no improvement in bilirubin by Day 7)

Question 33

Initial presentation of Wilson’s Disease

Answer 33

Sometimes a Coombs negative hemolytic anemia due to sudden release of copper from hepatocytes; labs would show high urinary copper and low ceruloplasmin

Question 34

Bleeding from an isolated gastric varix in a patient w/o liver failure

Answer 34

Suspect splenic vein thrombosis

Question 35

Reasons gastric varices are banded

Answer 35

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

Question 36

KHORANA score

Answer 36

Scoring system to establish risk of VTE in malignancy

Question 37

Clue to the presence of APLS

Answer 37

Increased aPTT in a patient not on heparin; represents presence of lupus anticoagulant

Question 38

PESI

Answer 38

Pulmonary Embolism Severity Index

Patient’s with a score of I or II can be considered for outpatient management

Question 39

Patient who can’t continue indefinite anticoagulation although it would be continued if they could

Answer 39

2021 CHEST guidelines suggest aspirin in patients with an unprovoked proximal DVT or PE who are stopping anticoagulation therapy; however, continued anticoagulation is preferred.

Question 40

Post thrombotic syndrome

Answer 40

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

Question 41

How to diagnose ABPA

Answer 41

Measurement of serum IgE against Aspergillus fumigatus

Question 42

Abnormal finding on a stress test

Answer 42

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.