MKSAP19 Flashcards
What is an S3? What conditions would it be present in?
Low frequency, early diastolic sound. Best heard at the cardiac apex. Heard in heart failure with reduced ejection fraction or volume overload states
Patient with blood pressure of 200/110 and in acute heart failure exacerbation. What is IV medication of choice, in addition to lasix, to help with blood pressure? What medication class should be avoided in these cases?
IV nitroglycerin
Avoid beta blockers in decompensated heart failure
Who should get hepatitis b vaccine?
Anyone aged 15-59 or older than 60 who are at increased risk of hepatitis b, such as diabetics (exposed to needles), HIV, chronic liver disease, incarceration, travel to endemic areas, IV drug usage, sexual exposure
Which live vaccine is contraindicated in HIV, regardless of CD4 count?
Live influenza vaccine
Patient with autoimmune hepatitis, started on immunosuppressive therapy. How long would you be on therapy before making decision to taper?
Must be on therapy for 2-3 years prior to tapering because of high rate of relapse.
Patient presents with exertional dyspnea. Physical exam reveals fixed splitting of S2, a parasternal impulse at the left sternal border.
Most likely diagnosis?
Atrial septal defect
Patient who is an agricultural worker presents with progressive worsening of kidney disease after undergoing treatment for cellulitis with antibiotics. UA with no casts or leukocytes. Most likely diagnosis?
Chronic interstitial nephritis
Patient with aortic stenosis on physical exam. Echo shows severe stenosis, but hemodynamic eval on echo shows more moderate. When there is a discrepancy between the clinical evaluation and the echocardiogram, what’s best next test to further evaluate?
Cardiac catheterization
Pregnant patient at 16w develops gingival bleeding. Platelets noted to be at 60K. Most likely diagnosis? What if at 32w and platelets at 100K?
Immune thrombocytopenic purpura
Gestational thrombocytopenia
Patient with fatigue, abdominal pain and weight loss over past month. The patient has intensely tanned skin and hyperpigmented buccal mucosa and palmar creases. Labs significant for hyponatremia, hyperkalemia, low morning cortisol, high ACTH level. Most likely diagnosis and treatment step?
Primary adrenal insufficiency
Hydrocortisone and fludricortisone
Recs for those taking vitamin E, fish oil, beta carotene?
In patients taking anticoagulants, vitamin E and fish oil increase the risk for bleeding; β-carotene increases the risk for lung cancer in cigarette smokers
HSV type that’s associated with viral meningitis?
HSV type 2
How big of a rise would you expect with transfusion of 1 unit of platelets?
One unit of platelets should raise the platelet count by around 20,000 to 30,000/μL
Patient comes in with concerns for bacterial meningitis. Platelets are at 38K. What should be done first prior to LP?
Platelets up to above 50K
Patient that comes in with microangiopathic hemolytic anemia, thrombocytopenia and purpura. Most likely diagnosis and treatment?
thrombotic thrombocytopenic purpura
Plasma exchange, prednisone and rituximab
Patient who comes in with syncope, ekg shows dropped beat with no change in PR interval. Diagnosis and most appropriate management?
Mobitz type 2 AV block
Pacemaker placement
Is warfarin teratogenic?
In patient with mitral valve prostheses, on warfarin 4mg daily, what is safest anticoagulation option in 1st trimester is? What if they were on 6mg daily?
Yes
Warfarin if dose is less than 5mg per day in all three trimesters
If greater than 5mg, then would recommend IV unfractionated heparin in first trimester, followed by warfarin in 2nd and 3rd
Wanting to start patient on thyroid replacement therapy for hypothyroidism. Normal starting dose is based on weight. What is the conversion for dose?
What if they were older and had history of heart disease?
1.6ug/KG/day
25ug-50ug per day due to cardiotropic effects of thyroid hormone
In patient with alcoholic hepatitis with Maddrey discrimination function score greater than 32, what’s the most appropriate management? How long do you stay on this?
Prednisolone
28 days. If not responding in 7 days, should discontinue
Patient with epigastric pain that is more severe with eating, progressively worsening. Trial of PPI has been ineffective. Upper endoscopy is normal. Abdominal exam is normal. PPI is discontinued. Diagnosis and next step in treatment?
Functional dyspepsia
Trial of tricyclic antidepressant
Nortriptyline
Patient with binge eating disorder, started in CBT and citalopram with improvement in symptoms but not complete resolution. What can be added in adjunct to help with this?
Lisdexamfetamine
Patient with CKD4 who presents for routine follow up. Hg 10.1, Cr 3.3, K 4.2, Bicarb 19.
Most appropriate treatment?
Sodium bicarbonate supplementation
If serum bicarb is less than 22, should start
Tremor that worsens with action but disappears at rest?
Often affects bilateral hands and arms, head and voice
Essential tremor
Patient with progressive SOB and dry cough for 7 months. Physical exam reveals Velcro-like crackles at bilateral lung base and clubbing. Most likely diagnosis? Most appropriate treatment?
Idiopathic pulmonary fibrosis
Antifibrotic therapy, pirfenidone
Patient with year long worsening dementia. MRI brain shows no hippocampus involvement, and diffuse confluence white matter hyperintensities. Most likely diagnosis?
What if there was hippocampal involvement?
Vascular cognitive impairment
Alzheimer disease
Patients who has family history of colon cancer, who presents with new found ovarian cancer. What genetic testing should be done?
BRCA and Lynch syndrome mutations
45 year old woman being worked up for elevated alk phos. She has mild pruritus. No liver disease or other LFT abnormalities. Most likely diagnosis? Next best lab test to obtain to confirm diagnosis?
Primary biliary cholangitis
Antimitochondrial antibody
Which test would help predict responsiveness to inhaled glucocorticoids in a patient that has asthma?
Fractional exhaled nitric oxide
What imaging modality should be used when working up a breast mass in women aged 30 or more? What if less than 30?
Mammography
Ultrasound
Patient with acute bacterial conjunctivitis. They do not wear contacts. What is best pharmacological treatment option? What if they do wear contacts?
Trimethoprim - polymyxin ophthalmic solution
Ofloxacin ophthalmic solution
Female Patient with signs of hyperandrogenism who has DHEAS level greater than 700. Most appropriate diagnostics test.
CT abdomen
Opioid of choice for an admitted patient with history of ESRD on HD?
Hydromorphone
Recommended treatment for guillan barre syndrome?
Plasma exchange or IVIG
Patient of African descent who has nephrotic range proteinuria. Most likely diagnosis?
Focal segmental glomerulosclerosis
In a patient with newly diagnosed atrial fibrillation, what should always be considered with regards to appropriate treatment/management?
Rhythm control, such as ablation or anti-arrhythmic drugs
Patient with COPD who quit smoking, takes his appropriate meds, good inhaler technique, and participates in pulm rehab. He continues to have diminished quality of life. Chest imaging shows predominantly upper lobe emphysema. FEV1 and DLCO are greater than 20% of predicted. What’s the most appropriate treatment?
Lung lobe reduction surgery
Hearing loss associated with ear pain and discharge?
Conductive hearing loss
Hearing loss associated with tinnitus and vertigo?
Sensorineural hearing loss
AKI with UA that shows muddy brown casts. Most likely diagnosis?
Acute tubular necrosis
Patent ductus arteriosus is found in 40y/o who is asymptomatic
Echo has moderate left atrial and ventricular enlargement.
Most appropriate management?
PDA device closure
Patient with giant cell arteritis who responds well to steroids but has bad side effects from it. Apart from prednisone taper, what is best additional therapy?
Tocilizumab
Vasculitis that affects large vessels, most commonly the aorta?
Takayasu arteritis
Hepatic adenoma found in men is managed how? In women?
Surgical resection
If on OCPs, stop them and follow up imaging 6 months later
If >5cm worrisome and should be taken out
