MKSAP4 Flashcards
Conjunctival edema with cobblestoning under the eyelid commonly occur in what disease process?
Allergic conjunctivitis
What two labs do you need to help with diagnosing DRESS and why?
CBC for eosinophilia and CMP for looking at liver involvement
What should be done in patients with dermatomyositis with AST elevations?
(Not evidence based here) but would probably pursue liver workup but keep in mind that it may be due to muscle breakdown as AST is present in muscle
During what time fram is the risk of malignancy the highest with respect to time of diagnosis of dermatomyositis?
Within the first 2 years, particular concern is for ovarian CA
What is pathergy?
Description for an erythematous papule or pustular lesion that appears around 48 hours after skin prick with a sterile needle (Commonly occurs in Behcets disease)
How should you manage a symptomatic spontaneous pneumothorax?
Initial mgmt with hiflow supplemental O2 to facilitate absorption; can do a needle aspiration and if it is secondary PTX put in a small bore chest tube
Explain the management of severe mitral valve stenosis in planned pregnancy
Pregnancy is a CLASS ONE indication for mitral valve intervention in patients with severe MS REGARDLESS of whether or not they are symptomatic; most young patients are treated with MITRAL BALLOON VALVULOPLASTY
What rare, cystic lung disease occurs sporadically in women of childbearing age? What is it associated with?
Lymphangioleiomyomatosis; it is sporadic, as noted but it is associated with tuberous sclerosis; typical CT findings are diffuse, thin walled small cysts on CT
When is a TTE appropriate in the setting of known valvular disease?
Whenever a patient is experiencing new symptoms; especially for myxomatous mitral valves; the rupture of chordae can lead to acute changes
What is the optimal perioperative management of patients with von-willebrand disease undergoing minor surgery vs. major surgery?
Desmopressin is ok for minor surgery; Factor VIII concentrates is good for major surgery
What is seen on histopathology of lymphangioleiomyomatosis?
Infiltration of ATYPICAL SMOOTH MUSCLE CELLS into the pulmonary interstitium and is related to the mTOR pathway and w/ elevated levels of VEGF; sirolimus shown to stabilize dz
What do you do for a patient with mitral stenosis who develops new atrial fibrillation with controlled ventricular response?
Anticoagulate w/ coumadin and INR goal of 2.5-3.5
What sorts of drugs may be helpful for a patient with severe mitral stenosis?
Negative inotropes such as beta-blockers as they increase diastolic filling time
What infectious disease may have cortical ribboning on MRI?
Crutzfeld Jakob - often w/ hyperintensities in the cerebral cortex or basal ganglia and thalamus on DWI
What is first line treatment for localized impetigo? What is it called when a bug bite turns into impetigo?
Topical antibiotic like mupirocin; impetiginized insect bite
What is lymphangioleiomyomatosis? Treatment?
A rare cystic lung disease w/ diffuse thin-walled cysts on CT that occurs sporadically in women of child-bearing age and is associated with tuberous sclerosis; Tx can be with sirolimus as mTOR implicated and has been shown to stabilize dz
What type of virus is MERS?
It was first described in 2012 and is a novel B-coronavirus that is similar to but distinct from SARS (Severe Acute Respiratory Syndrome); suspect in anyone with respiratory illness coming from the arabian peninsula
What vasculitic disease is commonly associated with pathergy?
Behcets disease
What are the Sokolow-Lyon criteria for LVH
R wave in aVL is 11 mm or more, sum of the deepest S-wave in V1 or V2 and the tallest R-wave in V5 or V6 is 35 mm or more
Drug Hypersensitivity Syndrome is otherwise known as ______
DRESS- Drug Reaction with Eosinophilia and Systemic Symptoms
What should be on the differential for anyone coming from the Arabian peninsula with a respiratory illness?
MERS- Middle East Respiratory Syndrome
What should you suspect if you see a morbilliform rash in association with a new drug?
DRESS- Drug Reaction with Eosinophilia and Systemic Symptoms
What is the treatment of trichomoniasis? What else do ya do?
Single 2g Metronidazole dose; treat patient; can have copious discharge, vulvar itching and post-coital bleeding
At what eGFR do you start considering transplantation?
<20, all G4 or G5 patients should be referred to a nephrologist; those w/ eGFR <20 should be considered for transplant evaluation
What must be avoided in women with migraine with aura?
Estrogen-containing OCPs; progestin-only is ok otherwise condoms and other IUDs i.e. non-hormone containing
The diagnosis of dermatomyositis significantly increases the risk for what cancer in particular?
Ovarian cancer
What inflammatory molecules are implicated in inflammatory anemia/anemia of chronic disease?
TNF-alpha, IL-6, and IL-1; in particular, IL-6 induces the production of hepcidin; Hepcidin causes decreased absorption of iron from the GI tract as well as decreased iron release from macrophages by inducing internalization and proteolysis of ferroportin
Why do liver metastases tend to be hypodense on CT scan?
They are hypovascular with respect to the surrounding liver
What is the management of secondary hypogonadism in a man secondary hyperprolactinemia?
If the adenoma is small enough can give cabergoline which is a dopamin agonist; since dopamine is prolactin-inhibiting factor this will help
