MKSAP4

Question 1

Conjunctival edema with cobblestoning under the eyelid commonly occur in what disease process?

Answer 1

Allergic conjunctivitis

Question 2

What two labs do you need to help with diagnosing DRESS and why?

Answer 2

CBC for eosinophilia and CMP for looking at liver involvement

Question 3

What should be done in patients with dermatomyositis with AST elevations?

Answer 3

(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

Question 4

During what time fram is the risk of malignancy the highest with respect to time of diagnosis of dermatomyositis?

Answer 4

Within the first 2 years, particular concern is for ovarian CA

Question 5

What is pathergy?

Answer 5

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)

Question 6

How should you manage a symptomatic spontaneous pneumothorax?

Answer 6

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

Question 7

Explain the management of severe mitral valve stenosis in planned pregnancy

Answer 7

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

Question 8

What rare, cystic lung disease occurs sporadically in women of childbearing age? What is it associated with?

Answer 8

Lymphangioleiomyomatosis; it is sporadic, as noted but it is associated with tuberous sclerosis; typical CT findings are diffuse, thin walled small cysts on CT

Question 9

When is a TTE appropriate in the setting of known valvular disease?

Answer 9

Whenever a patient is experiencing new symptoms; especially for myxomatous mitral valves; the rupture of chordae can lead to acute changes

Question 10

What is the optimal perioperative management of patients with von-willebrand disease undergoing minor surgery vs. major surgery?

Answer 10

Desmopressin is ok for minor surgery; Factor VIII concentrates is good for major surgery

Question 11

What is seen on histopathology of lymphangioleiomyomatosis?

Answer 11

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

Question 12

What do you do for a patient with mitral stenosis who develops new atrial fibrillation with controlled ventricular response?

Answer 12

Anticoagulate w/ coumadin and INR goal of 2.5-3.5

Question 13

What sorts of drugs may be helpful for a patient with severe mitral stenosis?

Answer 13

Negative inotropes such as beta-blockers as they increase diastolic filling time

Question 14

What infectious disease may have cortical ribboning on MRI?

Answer 14

Crutzfeld Jakob - often w/ hyperintensities in the cerebral cortex or basal ganglia and thalamus on DWI

Question 15

What is first line treatment for localized impetigo? What is it called when a bug bite turns into impetigo?

Answer 15

Topical antibiotic like mupirocin; impetiginized insect bite

Question 16

What is lymphangioleiomyomatosis? Treatment?

Answer 16

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

Question 17

What type of virus is MERS?

Answer 17

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

Question 18

What vasculitic disease is commonly associated with pathergy?

Answer 18

Behcets disease

Question 19

What are the Sokolow-Lyon criteria for LVH

Answer 19

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

Question 20

Drug Hypersensitivity Syndrome is otherwise known as ______

Answer 20

DRESS- Drug Reaction with Eosinophilia and Systemic Symptoms

Question 21

What should be on the differential for anyone coming from the Arabian peninsula with a respiratory illness?

Answer 21

MERS- Middle East Respiratory Syndrome

Question 22

What should you suspect if you see a morbilliform rash in association with a new drug?

Answer 22

DRESS- Drug Reaction with Eosinophilia and Systemic Symptoms

Question 23

What is the treatment of trichomoniasis? What else do ya do?

Answer 23

Single 2g Metronidazole dose; treat patient; can have copious discharge, vulvar itching and post-coital bleeding

Question 24

At what eGFR do you start considering transplantation?

Answer 24

<20, all G4 or G5 patients should be referred to a nephrologist; those w/ eGFR <20 should be considered for transplant evaluation

Question 25

What must be avoided in women with migraine with aura?

Answer 25

Estrogen-containing OCPs; progestin-only is ok otherwise condoms and other IUDs i.e. non-hormone containing

Question 26

The diagnosis of dermatomyositis significantly increases the risk for what cancer in particular?

Answer 26

Ovarian cancer

Question 27

What inflammatory molecules are implicated in inflammatory anemia/anemia of chronic disease?

Answer 27

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

Question 28

Why do liver metastases tend to be hypodense on CT scan?

Answer 28

They are hypovascular with respect to the surrounding liver

Question 29

What is the management of secondary hypogonadism in a man secondary hyperprolactinemia?

Answer 29

If the adenoma is small enough can give cabergoline which is a dopamin agonist; since dopamine is prolactin-inhibiting factor this will help