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ABIM > MKSAP16 > Flashcards

MKSAP16 Flashcards

1
Q

The presence of this antibody increases the risk of lupus glomerulonephritis

A

Anti-dsDNA

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2
Q

What is the deal with adjuvant radioactive iodine in thyroid CA? What is the TSH goal with thyroid replacement?

A

In pts s/p total thyroidectomy with high risk dz or intermediate (+LNs >5, ETE, and lymphovascular invasion) want adjuvant radioactive iodine and synthroid with goal TSH <0.1

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3
Q

Pt with recent influenza PNA now with cavitary lesion

A

MRSA pneumonia

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4
Q

In what setting is the diagnosis of portopulmonary HTN made?

A

When there is evidence of pulmonary HTN in the presence of portal HTN (still rule out other stuff though like HIV, drugs or connective tissue dz b/c it is WHO 1)

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5
Q

What is the first line tx for symptomatic prolactinomas? What is the difference between a microprolactinoma and a macroprolactinoma?

A

Dopamine agonists such as cabergoline; Micro <10 mm; macro is >10 mm; can give even if mild compressive sx because DA agonists can shrink the size of the tumor; recall octreotide is for GH secreting tumors (Acromegaly)

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6
Q

What sorts of blood products should be used in treating BMT patients?

A

Leukoreduced and irradiated

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7
Q

At what frequency of UTIs is low-dose antimicrobial ppx useful?

A

3 UTIs in 12 months or 2 UTIs in 6 months

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8
Q

How does RLL collapse appear on CXR? Mechanism of hypoxia?

A

Triangular opacity over the R hemidiaphragm; forms a functional shunt (R–>L intrapulmonary shunt)

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9
Q

Most patients with Class III/IV Lupus Nephritis benefit from combo treatment of what?

A

Steroids + either MMF or Cyclophosphamide

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10
Q

What is the main treatment of high altitude pulmonary edema? Preventitive tx?

A

Supplemental O2 (to decrease PVR- pulm vasc resistance), descent and possibly vasodilators (short acting CCB); prevent with nifedipine

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11
Q

What should you do for a pt with MS who is on disease modifying meds that are teratogenic and she wishes to become pregnant?

A

Can stop the medicine; there is a common misconception that there is an adverse risk when getting pregnant

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12
Q

What is the primary mgmt of dysmenorrhea?

A

NSAIDS first then OCPs

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13
Q

What can you say about glucose intolerance and peripheral neuropathy in the absence of frank DM?

A

Glucose intolerance can cause neuropathy too; so even if normal A1C can do a glucose tolerance test

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14
Q

This phenomenon, also seen in Behcet’s disease, may explain why Crohn’s patients can develop peristomal pyoderma gangrenosum

A

Pathergy; irritation at the site can cause the PG; tx is with topical steroid such as clobetasol

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15
Q

How can STARI and early lyme present? Difference in Tx?

A

Southern Tick Associated Rash Illness (STARI) and Lyme dz both present with erythema migrans; both can be tx with Doxycycline; only Lyme can get the alternative Amoxicillin/Cefuroxime

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16
Q

What is the initial mgmt of ITP?

A

Can observe if platelet count >30-40k without evidence of bleeding; if bleeding or if platelet <30 then start PO prednisone

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17
Q

What is the standard of care for an MS relapse? What if refractory?

A

IV glucocorticoid i.e. methylprednisolone 1 mg/kg (oral glucocorticoids have worse outcome); if refractory then PLEX

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18
Q

How would the presentation of cryptococcal CNS dz differ from toxoplasmosis?

A

Crypto may be preceded by lung infection since that is usually the first place but crypto more likely to have meningitis type picture that is subacute with high CSF pressures; toxo more likely to have mass lesions though cryptococcomas are possible

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19
Q

What is the acting out of dreams in PD called?

A

RBD- REM Behavioral Disorder

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20
Q

A young man with solid food dysphagia may have this diagnosis _________

A

Eosinophilic Esophagitis; endoscopy will reveal trachealization of the esophagus and Bx will show >15 eos/hpf; Tx is with swallowed glucocorticoids

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21
Q

What can you say about the use of aspirin for primary prevention of MI etc. in pt with >10% ASCVD risk?

A

While it was in the guidelines, the ASPIREE and ASCEND trials showed an actual increase in mortality in patients on this for primary prevention as well as increased bleeding risk

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22
Q

What are the classic signs of a fixed drug eruption?

A

Painful purple rash that occurs in the same area repeatedly (lips, genitals, and hands are MC)

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23
Q

Both Felty Syndrome and LGL are associated with this HLA marker

A

HLA-DR4

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24
Q

What test can facilitate the diagnosis of primary CNS lymphoma? Where do they tend to occur?

A

EBV PCR from the CSF; usually only if very immunosuppressed i.e. CD4 <50 and often periventricular and only one lesion whereas Toxo often multiple but not always

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25
Q

This is a common cause of hypogonadotrophic hypogonadism and azoospermia?

A

Klinefelter Syndrome (XXY)

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26
Q

What underlies humoral hypercalcemia of malignancy?

A

PTHrP as in breast CA and SCC of the lung

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27
Q

What infection are solid organ transplant pts at increased risk of within 6 months of an episode of acute rejection?

A

PCP because acute rejection requires intensification of their immunosuppression (affects cell-mediated immunity); of note things like aspergillosis are more common when someone is neutropenic

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28
Q

If a lung nodule is stable for _____ amount of time, then no further monitoring is needed

A

24 months

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29
Q

In whom is omalizumab useful?

A

Moderate to severe asthma with Sx inadequately controlled with inhaled glucocorticoid and LABA, evidence of allergies to pereniall aeroallergens, and IgE leves between 30-700

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30
Q

What should be on the DDx for a pt with Wegeners who is being treated with cyclophosphamide who develops bloody urine?

A

Would always be concerned about a pauci-immune glomerulonephritis due to the Wegeners but could also be bladder CA due to Cyclo

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31
Q

What is the malignancy most commonly associated with generalized pruritis, often without a primary rash?

A

Hodgkin Lymphoma; consider obtaining a CXR in these pts to evaluate

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32
Q

What is the basic approach to treating MDS?

A

Based on risk stratification some can be observed (based on IPI), azacitidine (and other HMAs) for high risk dz and short life expectancy; allo-HSCT for high risk dz and longer life expectancy

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33
Q

Immediate administration of this is indicated to prevent early mortality in suspected APML? Translocation?

A

ATRA; t(15;17)

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34
Q

What are 6 indications for AICD in HOCM?

A

Massive Myocardial Hypertrophy (>30 mm), Previous Cardiac Arrest, Blunted BP response or HoTN during exercise, Unexplained Syncope, NSVT, and FMHx of sudden cardiac death

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35
Q

When a pt has panhypopit such as after pituitary surgery, how do you make adjustments in hydrocortisone dosing?

A

Based on sx such as orthostasis, weight loss, N/V, light headedness as the ACTH and cortisol levels will be low so you cannot base off that

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36
Q

Where are target cells commonly seen?

A

In thalassemias, i.e. imbalance of globin chain synthesis with impaired production of hemoglobin and intramedullary hemolysis

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37
Q

In whom does primary thyroid lymphoma MC occur? Typical presentation?

A

In elderly women with underlying Hashimoto (due to the chronic inflammation); often presents as an enlarging goiter rapidly, night sweats, and weight loss; tx is chemo often do not need thyroidectomy

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38
Q

This disorder (sometimes associated with malignancy) often has “juicy” well demarcated borders

A

Sweet Syndrome

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39
Q

What GI disorder is identified in 9% of patients with otherwise unexplained elevations in transaminases?

A

Celiac Dz; LFTs may improve with the treatment of the Celiac

40
Q

What disease will have trachealization of the esophagus on endoscopy? Tx?

A

Eosinophilic Esophagitis then a bx would show >15 eos/hpf; tx is with swallowed aerosolized glucocorticoids

41
Q

What is NODAT?

A

New-Onset DM After Transplant; implicated meds are s/p solid organ xplant due to steroids and tacro

42
Q

What is associated with Anti-phospholipase-2-Receptor antibodies (Anti-PLA2R)?

A

Primary Membranous Glomerulonephritis; PLA2R is located on podocyte membrane so antibody against it causes nephrotic syndrome by causing podocyte damage

43
Q

A painful purple rash that occurs in the same area repeatedly may be a ____

A

Fixed Drug Eruption

44
Q

What should be considered in patients with parkonsonianism, cerebellar ataxia, and early postural instability?

A

Multiple System Atrophy; the Shy-Drager subtype has significant autonomic instability

45
Q

What is a major difference (usually) of stasis dermatitis and cellulitis?

A

Cellulitis often has leukocytosis and fever, possibly LAD; Stasis dermatitis often has overlying scale/serum crust and more often bilateral

46
Q

What is the basic management of microscopic colitis (lymphocytic or collagenous)?

A

Withdrawal of any known offending med, antimotility agent; if worse then can do bismuth and budesonide

47
Q

This occurs when there is cutaneous involvement of Gottron papule, shawl sign, and lilac lids but negative Bx and EMG evidence of myositis

A

Amyopathic Dermatomyositis

48
Q

Lymphangitic spread in the lungs of a cancer is best identified by what modality?

A

HRCT

49
Q

What drug is indicated in all patients who have had an aneurysmal subarachnoid hemorrhage?

A

Oral nimodipine x21 days

50
Q

What disorder presents with small pits in the skin and hyperhidrosis? Tx?

A

Pitted Keratolysis; tx is with clindamycin topical

51
Q

In a patient with breast CA who has developed peripheral interstitial abnormality identified on CT likely has ___________

A

Lymphangitic spread of cancer

52
Q

What are some secondary causes of membranous glomerulonephritis?

A

Solid organ cancers (minimal change = Hodgkin), infections such as HBV and HCV (note HCV more often MPGN; HBV often PAN which causes renal artery aneurysms but not GN), and NSAIDS

53
Q

What is the appropriate mgmt of a complicated parapneumonic effusion?

A

Should be suspected in all patients who do not respond to appropriate abx; place a small bore chest tube (<14 French)

54
Q

What drug is often used in glomerulonephritis due to ANCA or SLE?

A

Often times cyclophosphamide is used upfront; in ANCA vasculitides rituximab can also be used

55
Q

What noninflammatory condition is defined by the presence of “flowing osteophytes” involving the anterolateral aspect of the spine at 4-5 contiguous vertebrae?

A

Diffuse Idiopathic Skeletal Hyperostosis (DISH); this is different than ankylosing spondylitis in that it occurs in older ppl and is non-inflammatory

56
Q

How is otosclerosis different from presbycusis?

A

Otosclerosis is a loss of low pitched sounds (conductive hearing loss) due to abnormal hardening of bones in middle ear tx is with amplification or stapedectomy with prosthetic stapes; presbycusis affects high pitched sounds and is a dz of elderly

57
Q

What are the GOLD stage I-IV based on? ABCD groups?

A

Stages by FEV1; ABCD group by symptoms

58
Q

In whom is lung transplantation used? Lung volume reduction surgery?

A

FEV1 <20%, DLCO <20% and HOMOGENOUS distribution of emphysema; Lung volume reduction surgery in pt with upper lobe emphysema and low post-rehab exercise capacity

59
Q

What is an important diagnostic test in patients suspected of having VAP?

A

Should undergo deep respiratory sampling with BAL to identify the organism

60
Q

Under what circumstance is a CSF study for EBV by PCR most likely to be helpful?

A

In an immunosuppressed pt with a lesion concerning for primary CNS lymphoma; EBV is a driver tumor virus

61
Q

What is STARI and what is the treatment?

A

Southern Tick Associated Rash Illness; Doxycycline. Note that doxycycline is good for both early Lyme and STARI but amoxicillin and cefuroxime are only good for Lyme

62
Q

What studies are important to perform in a patient who presents with optic neuritis?

A

MRI of brain to evaluate for lesions consistent with a diagnosis of MS; of note the presence of oligoclonal bands in CSF is NOT part of any MS diagnostic criteria

63
Q

Mgmt of AAA <5.5 cm in men or <5.0 cm in women

A

Conservatively with abdominal US q6-12 months

64
Q

A woman 65 or older with a FRAX > ______ should be screened for osteoporosis

A

>9.5% and if >20% should be treated as osteoporosis

65
Q

In what patients with HSP are steroids used?

A

In patients with severe symptoms of Henoch Schonlein purpura especially if involving multiple systems; of note more severe in adults than kids; Deposition of IgA in skin confirms dz

66
Q

What is the scientific name for bedbugs? How can you recognize?

A

Cimex lectularius; often painless and itchy lesions in a linear pattern

67
Q

What is the first line tx of central sleep apnea in patients on opiates?

A

Reduction in opiate dosage (normally it is ASV)

68
Q

Best test for mild hyperthyroidism that is thought to be likely due to a toxic adenoma?

A

Radioactive Iodine Uptake scan; presence of hot nodule obviates need for Bx

69
Q

What drug is approved for fatigue in multiple sclerosis?

A

Modafanil and Armodafanil; can also be used in refractory pts with OSA as well as in Narcolepsy

70
Q

What is the treatment of peristomal pyoderma gangrenosum? Theorized mechanism?

A

Topical steroid such as clobetasol; can be due to pathergy

71
Q

This is an overlap syndrome that includes features of SLE, systemic sclerosis and/or polymyositis __________. Assoc with this antibody ____________

A

Mixed Connective Tissue Disease; Anti-U1-RNP

72
Q

How would bronchiolitis obliterans organizing pneumonia differ from lymphangitic spread of cancer to the lungs?

A

BOOP tends to show up more as a consolidation (it can be assoc with CA); lymphangitic spread tends to show up as a peripheral interstitial abnormality

73
Q

What disorder can have sx of chest tightness and dyspnea with lack of improvement with asthma tx and a monophasic wheeze and stridor?

A

Vocal Cord Dysfunction (flattening of inspiratory limb)

74
Q

What can you say about the use of bicarbonate in the treatment of DKA?

A

No benefit if the pH is >6.9 and a 2011 systematic review noted that bicarb can worsen ketonemia

75
Q

A STOP-BANG score of > __________ suggests increased risk of OSA

A

5

76
Q

What is the preferred initial diagnostic test to evaluate for ILD?

A

HRCT as the pattern seen on CT correlates well with pathology (so transbronchial Bx often not helpful, would need surgical lung bx)

77
Q

What antibodies is primary membranous glomerulonephritis associated with? What malignancy can it be due to?

A

Anti-phospholipase2-Receptor (Anti-PLA2R); possibly due to solid organ CA–phospholipase A2-Receptor is located on the podocyte surface so the antibody causes nephrotic syndrome

78
Q

What is the MOA of teriflunomide?

A

This is the active metabolite of leflunomide and inhibits pyrimidine synthesis which therefore interferes with interaction between T cells and APCs

79
Q

How should FSGS in obese patients be treated?

A

Should be on an ACE inhibitor but since FSGS can be secondary to obesity, should lose weight which can decrease the proteinuria

80
Q

What is Cough Variant Asthma?

A

A type where the primary symptoms are nonproductive cough especially in a patient with hx of allergies

81
Q

What biomarkers define severe C. diff (may be out of date)

A

WBC >15k and sCr >1.5x baseline

82
Q

In what population should asymptomatic bacteriuria be treated in? Tx?

A

Pregnant women as there is high risk for pyelo given the physiologic hydronephrosis; amoxicillin or nitrofurantoin but nitrofurantoin is class B

83
Q

What test can help clarify the diagnosis of asthma in a patient with sx but normal spirometry?

A

Methacholine challenge

84
Q

What is the MOA of fingolimod?

A

A sphingosine-1-receptor modulator that restricts activated lymphocytes to LNs (preg category C)

85
Q

When should you perform a brain MRI in Bell Palsy?

A

If there is incomplete recovery after 3 months (hyperacusis and impaired taste are suggestive of peripheral nerve)

86
Q

What disease can present with multiple thunderclap headaches that recur over several days to weeks? Tx?

A

Reversible Cerebral Vasoconstriction Syndrome; kind of like the Prinzmetal angina of the brain and angiography will show multiple areas of vasoconstriction; BP control is tx

87
Q

Abrupt onset of abdominal pain, emesis, and forceful bowel evacuation with severe hypotension and an unremarkable abdominal exam is consistent with ________

A

Acute mesenteric ischemia especially if associated with atrial fibrillation

88
Q

When is mechanical stone removal indicated for patients with kidney stones?

A

If the stone is >10 mm or smaller stones with refractory pain, AKI, or urosepsis

89
Q

Trigeminal neuralgia is often sporadic but may complicate this disease _____

A

Multiple Sclerosis; of note should get MRI in Tic patients because can be due to mass lesion at the CP angle

90
Q

What is the best treatment of frequent, forceful closure of the eyes?

A

i.e. Blepharospasm (tx with Botulinum toxin injection)

91
Q

What is essential treatment of patients with Takotsubo cardiomyopathy?

A

Beta Blockers and ACE inhibitors (essentially GDMT)

92
Q

What are some general AEDs to be used in the setting of generalized seizures?

A

Topiramate, Lamotrigine, Levetiracem, Valproate, and Zonisamide; ones that are more for partial seizures are Carbamazepine, gabapentin, and phenytoin

93
Q

How do you manage allopurinol and febuxostat in patients on azathioprine?

A

Allpurinol requires dose-adjustment and febuxostat is contraindicated; can get dangerously high levels of azathioprine as it is metabolized by xanthine oxidase

94
Q

What should be corrected prior to starting IV insulin for DKA?

A

Hypokalemia; the IVF is important and one should correct the hypokalemia then start the insulin; should start giving KCl if K <5.2 but ok to give insulin unless the K is <3.3 then you need to replete first then start the insulin

95
Q

Explain how peak and plateau pressures would differ between Auto-PEEP and tube obstruction

A

Both are high in Auto-PEEP; however, in tube obstruction pressure is only high when there is flow so only peak pressure is high; plateau pressure is measured when there is no flow

96
Q

What is undifferentiated connective tissue disease?

A

NOT an overlap syndrome (as in mixed connective tissue dz) but rather a series of nonspecific clinical features of Raynaud and Arthralgia with nonspecific autoantibodies such as ANA

ABIM (18 decks)

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