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ABIM > MKSAP2 > Flashcards

MKSAP2 Flashcards

1
Q

What effect does aldosterone have on the DCT?

A

Increased sodium and K exchange (i.e. hypokalemia with hypernatremia; aldosterone antagonists cause hyperkalemia)

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2
Q

What is the preferred drug for campylobacter jejuni gastroenteritis?

A

Azithromycin (recall, Campy can be assoc. with small bowel MALT lymphoma)

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3
Q

What is the term used to describe dry eyes in Sjogren’s?

A

Keratoconjunctivitis Sicca

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4
Q

What is concern for OSA in the post-op setting?

A

Post-operative hypoxia or frank respiratory failure

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5
Q

What sort of diagnostic workup needs to be included in a patient with newly diagnosed heart failure

A

Ischemic workup either stress test (exercise or pharm if normal QRS; perfusion if LBBB or QRS morphology weird) vs. Cardiac catheterization

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6
Q

After giving tPA for a stroke where should the person go? What is the BP goal? How long should anticoagulation and antiplatelet agents be held for?

A

To an ICU, BP goal is <180/105, and antiplatelets and anticoagulation should be held for 24 hours (don’t place NGT, A-lines, or Foleys for first 24h unless critically needed)

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7
Q

What sorts of diseases lead to Microvascular Cardiomyopathy typified by patchy myocardial fibrosis?

A

Diseases such as systemic sclerosis as they can lead to coronary vasospasm with microvascular disease and therefore patchy myocardial fibrosis

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8
Q

What are the Centor Criteria?

A

Fever, Absence of Cough, Tonsillar exudates, and tender anterior cervical LAD (rapid strep if 2-3); If 4 then just treat

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9
Q

What is the preferred way to replace a bicuspid aortic valve, SAVR or TAVR?

A

SAVR; used to say that TAVR had no role but now that is coming into question

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10
Q

Differentiate use of SAVR vs. TAVR

A

SAVR is indicated in all pt with symptomatic severe AS who are low surgical risk; TAVR is indicated mainly for pt with intermediate risk

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11
Q

Explain pseudohypokalemia and pseudohyperkalemia in leukemias

A

Pseudohypokalemia can be due to increased uptake of K by the tumor cells in the test tube; pseudohyperkalemia can be due to lysis of the tumor cells in the test tube; both are relative diagnoses of exclusion

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12
Q

What is the major clinical difference between vestibular neuronitis and labyrinthitis?

A

In labyrinthitis the patient will also have hearing loss because the cochlea is affected as well

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13
Q

Why does immune complex deposition lead to glomerulonephritis?

A

Because immune complexes can activate complement (IgG and IgM i.e. GM is a classic car; activate classic complement cascade) which leads to calling in of inflammatory cells

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14
Q

What is the best step for a patient with what appears to be early ovarian CA on imaging?

A

Surgery as there is survival benefit following intact removal of an adnexal mass

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15
Q

What are the management options for dry eyes in Sjogren’s syndrome?

A

Can start with artificial tears, then punctal plugs, then cyclosporine eye drops (Restasis)

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16
Q

What asthma meds are safe in pregnancy?

A

Inhaled glucocorticoids, albuterol, and montelukast (leukotriene inhibitor)

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17
Q

What is a Halo Nevus and why does it look that way?

A

Benign melanocytic nevus with area of depigmentation around it which indicates regression of the nevus

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18
Q

Why is the diagnosis of ovarian CA usually best made by exploratory surgery rather than bx?

A

Because, for early ovarian CA, there is a survival benefit following intact removal of an adnexal mass

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19
Q

When is a CRT-D indicated in the mgmt of heart failure?

A

If a patient has severe conduction system disease with QRS >150 ms

20
Q

When should you use cyclosporine eye drops in Sjogren syndrome?

A

After failing artificial tears and maybe punctal plugs

21
Q

How do you manage non-typhoidal Salmonella gastroenteritis in healthy patients?

A

You should withold antibiotics as it may prolong viral shedding

22
Q

What is Triage Cueing?

A

A type of bias in which a patient gets managed based on where they are triaged (probably bc you have a mental heuristic for how to manage floor vs. ICU vs. heme onc vs. GI)

23
Q

Differentiate urine chloride in vomiting vs. Barter syndrome?

A

In vomiting, urine chloride is low because of the GI losses that leads to increased chloride reabsorption; in Bartter syndrome, urine chloride is high

24
Q

What drugs are used for IBS-C after failure of standard laxative therapy?

A

Linaclotide and Lubiprostone

25
Q

How long after giving TPA should you wait to place NGT, Foley, or A-lines?

A

At least 24 hours

26
Q

What type of metastatic breast lesion cannot be assessed for Her2 status when biopsied?

A

Bone lesions

27
Q

In a patient who no longer has parathyroid function after surgery what are the serum and urine calcium goals for supplementation?

A

Serum calcium goals is 8-8.5; urine calcium goal is <300 mg/24h

28
Q

What provides a more realistic estimate of risk: absolute risk reduction or relative risk reduction?

A

Absolute Risk Reduction (i.e. the classic example is that if relative risk is 50% that sounds like a lot but if the risk in population is 1 in 1000 the absolute risk is now 1.5 in 1000)

29
Q

What medications have been shown to alter the progression of aortic stenosis?

A

None

30
Q

What direct cardiac pathology may a patient with systemic sclerosis experience that leads to heart failure?

A

Microvascular Cardiomyopathy- can have systemic sclerosis-induced vasospasm with microvascular dz and patchy myocardial fibrosis

31
Q

What is the most common psoriatic nail finding?

A

Subungual Hyperkeratosis (not nail pitting, though that is more specific probs)

32
Q

What sorts of labs might you see in a patient with hypokalemia associated with vomiting?

A

Metabolic alkalosis, increased urine potassium excretion, and decreased urine chloride excretion; this is bc vomiting leads to increased loss of hydrogen chloride; hypovolemia activates RAAS and leads to inccrease in H/Na exchange and increased bicarb resorption in the PCT

33
Q

If you need an anti-epileptic drug in pregnancy what is the best one to go with?

A

Levetiracem (Keppra)

34
Q

How is the heart disease of SLE different from that of systemic sclerosis?

A

SLE is associated with accelerated coronary artery disease which could lead to ischemic CMO; systemic sclerosis is associated with microvascular cardiomyopathy due to small vessel vasospasm; of note, systemic sclerosis could also cause pulmonary HTN and lead to R heart failure indirectly

35
Q

What autoimmune disease is typified by inflammation of exocrine glands?

A

Sjogren Syndrome (i.e. salivary, lacrimal, and pancreas)

36
Q

If a newly diagnosed person w/ EF of 35% should you place an ICD?

A

No, would first need to optimize their heart failure meds and reassess; then, if on maximal therapy with EF <35% and NYHA II-III sx would have Class I indication

37
Q

How is vaginitis different from cervicitis?

A

Cervicitis often has friable cervix whereas vaginitis does not; cervicitis often STD and tx w/ CTX and azithro whereas vaginitis often fungal or trichomoniasis

38
Q

How do you treat cervicitis?

A

CTX 250 mg IM x1, azithromycin 1g x1; often caused by C. trachomatis or N. gonorrhea; friable cervix differentiates from vaginitis

39
Q

In a pt with hx of breast CA with findings of a new metastasis what is the next best step

A

Biopsy to confirm and to assess receptor status as it may have changed from the original tumor; particularly Her2 (a tyrosine kinase; trastuzumab induces rapid removal of Her2 from cell surface)

40
Q

What is the management of Infection-Related Glomerulonephritis? Proposed pathophys?

A

Treating the underlying infection; it is an immune complex disease often assoc. with non-streptococcal infections; suspect if nephritic urine sediment in an azotemic patient who has an active infection

41
Q

What has the greatest influence on prognosis in a patient with DLBCL?

A

The r-IPI score

42
Q

What is a punctal plug?

A

They are placed in the tear ducts of patients with dry eyes to keep moisture on the eye itself

43
Q

How do you treat vitamin K antagonist toxicity w/ INR >9 in a patient who has no bleeding?

A

Hold the medicine and give vitamin K

44
Q

What has a class I indication in pt w/ HFrEF w/ EF <35% and NYHA II-III sx while on maximal therapy?

A

ICD (if QRS >150 ms then would include a CRT-D)

45
Q

What effect on morbidity and mortality does revascularization (cardiac cath) have on patients with stable angina who are medically refractory?

A

None but improves sx

ABIM (18 decks)

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