MKSAP5 Flashcards
What drug can be used in patients with inappropriate sinus tachycardia assuming all else has been excluded? What other reason can it be used?
Ivabradine; can also be used in patients w/ CHF who are intolerant to or maximally dosed on BB w/o having achieved goal HR
What should you be concerned about in patients with SLE who have pain or limitation of a large joint (i.e. hip or knee)?
Be concerned for osteonecrosis of the joint; check XR first then MRI
What is the most common complication of E. coli 0157:H7 dysentery?
HUS; can be made worse if abx or antimotility agents used
What may be a reasonable option for a person with pyoderma gangrenosum who has severe DM and osteoporosis?
Cyclosporine; there was a study that showed that prednisolone and cyclosporine were equally efficacious so if someone would need a steroid-sparing agent, cyclo might be good
What is the general tx of superficial bladder CA?
TURBT followed by intravesical BCG or by mitomycin then follow w/ serial cystoscopy
This term refers to inflammation of the fibrous layer of the eye that is underlying the conjunctiva and episclera ________. What types of conditions are associated?
Scleritis; Autoimmune conditions like rheumatoid arthritis, relapsing polychondritis, IBD, and vasculitis; should always consider ANCA vasculitis
A 2016 study suggests adding radiotherapy to the prostate even in metastatic prostate CA, why is this?
There is preclinical data suggesting that the primary tumor has a direct effect on metastatic growth; They found a 16% OS benefit with addition of RT to ADT compared to ADT alone
What are the two types of microscopic colitis?
Collagenous colitis and Lymphocytic colitis
What should you do with statins, ACE/ARBs in pregnant patients?
discontinue both as they are teratogenic; dyslipidemia can best be managed by lifestyle modification and diet
When is cystectomy indicated for recurrent superficial bladder CA?
If they develop recurrence within 6-12 months of initial TURBT OR after receiving 1-2 courses of intravesical BCG; always indicated if muscle-invasive dz
How long after radiation does radiation pneumonitis typically take to take effect?
6-12 weeks
What is the most common pulmonary neuroendocrine tumor? How does it present radiographically?
Small Cell Lung Cancer; often with large hilar mass and bulky mediastinal LAD; can be associated with LEMS
How can you discern radiation pneumonitis on CT imaging?
The presence of a nonanatomic straight line on imaging demarcating involved vs. uninvolved lung is pathognomonic
What is the only FDA approved drug for gastroparesis?
Metoclopromide; but is acquired with hyperprolactinemia and galactorrhea as well as tardive dyskinesia
What is the best way to diagnose Occupational Asthma?
spirometry before and after workplace exposures
What should you think in a patient with fever, petechial rash, and meningitis with possible tick exposure?
RMSF and should tx with doxycycline (100 bid)– SEROLOGIC TESTING may NEGATIVE in the acute setting.
What is the best dopamine agonist is the best for RLS? What is the “risk of augmentation”?
Ropinirole; Augmentation is the worsening of symptoms over time with dopamine supplementation
When should you suspect occupational asthma?
Suspect in patients with asthma-like symptoms that vary with exposure to the workplace
What multiple sclerosis drug can lead to autoimmune hepatitis? What is the recommended screening?
Interferon B; should monitor serum aminotransferases
What is the most common presenting symptom for esophageal cancer?
Progressive solid food dysphagia
What should you do in a patient with CAP who is not responding within 2-3 days of standard abx?
Order a chest CT; this is the best to evaluate a nonresponsive pneumonia for things like parapneumonic effusion, lung abscess, cavitary lesion
What are oval fat bodies on a UA? What appearance do they usually have?
They are seen in nephrotic syndrome; they look like maltese crosses under plane polarized light
What does the finding of “maltese crosses” on UA suggest?
Oval fat bodies seen on UA (have “maltese cross” under plane-polarized light) is assoc with nephrotic syndrome
If a person with gastroparesis on metoclopromide starts to get tardive dyskinesia what would be the next step aside from stopping the med
Metoclopromide is the only FDA approved drug but in this case would have to stop and start scheduled promethazine and small scheduled meals
What kind of imaging should be done for patients slated to undergo thyroid surgery with suspected or confirmed thyroid CA?
Cervical US to evaluate lymph nodes and biopsy any that appear abnormal (>8-10 mm in short axis)
What chemotherapy drug is associated with pneumonitis as well as increased risk of radiation pneumonitis?
Gemcitabine
What (occasionally wide complex) tachycardia can occur within 24 hours after reperfusion from an MI?
Accelerated Idioventricular Rhythm (AIVR); postulated to result from abnormal automaticity in the subendothelial Purkinje fibers
Why does ascending aortic dilation occur in patients with bicuspid AoV? How should you follow them?
Due to abnormal connective tissue; originally thought to be related to the valve itself but now recognized to be bc of connective tissue; follow the ascending aortic diameter on TTE especially once it is >4.5 cm. If TTE cannot assess then get CT Angio or MRA
Why does hypomagnesemia cause hypocalcemia?
Low serum magnesium levels impair PTH secretion which can lead to low Ca
Why should you check K-RAS and N-RAS mutations in patients with metastatic colorectal cancer?
Because their presence predicts for resistance to EGFR inhibitors
According to a recent RCT taking HTN meds at what time may help prevent new-onset DMII
Taking them at night time
What can you say about the relationship of S. aureus nasal colonization and risk of surgical site infection?
Increases the risk of surgical site infection; can tx w/ 5 day course intranasal mupirocin apparently found to decrease the risk
What bisphosphonates are good for newly diagnosed multiple myeloma?
Pamidronate and Zoledronic acid; studies show that the risk of skeletal events is decreased by the use of these agents
What is the “prognostic utility” of MRI in evaluating osteonecrosis?
If greater than 20% of the bone is lost then progressive disease is expected; smaller infarcts, however, rarely progress
How is cyclic mastalgia treated? What drug has FDA-approval for it?
Conservatively with appropriate fitting bra; Danazol but this is limited by AE
What is “Conversion Chemotherapy”?
Chemo that is given to patients with unresectable tumors in an attempt to shrink the tumor to a resectable size (not technically the same as neoadjuvant; whereas the primary goal of neoadjuvant chemo is to knock out micrometastases in an already resectable tumor)
What are the hallmark adverse effects of Natalizumab? Interferon B? Teriflunomide?
Natalizumab- JC virus reactivation; IFN B- autoimmune hepatitis; and Teriflunomide- pancreatitis
What did the recent trial comparing ibrutinib to chlorambucil show?
Ibrutinib was superior to chlorambucil in most every parameter and is now considered a first line for CLL that requires tx (recall Ibrutinib can lead to an initial lymphocytosis as it messes w/ signalling to BM stroma)
How can you effectively exclude Lyme Arthritis?
If the symptoms have started at least one month after the exposure and the Western Blot IgG is NEGATIVE; this is bc it is a late manifestation of Lyme and so the WB should be positive
Deficiency of what enzyme can lead to toxicity with 5-FU? What mutation can lead to irinotecan toxicity?
Dihydropyridine dehydrogenase; UGT1A1
What is the follow up for colorectal CA survivors?
CT yearly for 5 years; CEA trended after resection and post-op colonoscopy 12 months after
In whom is Acral Lentiginous melanoma the MC?
Asians and Dark-skinned people
What is a complication of witholding anti-Parkinsonian meds in a hospitalized PD patient?
Parkinsonian-Hyperpyrexia syndrome–an acute syndrome resembling NMS; Tx is to restart the meds
What are the symptoms of Parkinsonian-Hyperpyrexia syndrome?
AMS, hyperthermia, rhabdomyolysis and EPS often associated with dystonia and rigidity
Regarding pulmonary neuroendocrine neoplasms- which is often a bulky hilar mass with mediastinal LAD and which is often an endobronchial lesion?
Small Cell Lung CA is usually large hilar mass; Endobronchial is usual bronchial carcinoid
If a patient has Budd-Chiari, even w/ normal CBC and hct you should check for what?
Check for JAK2 V617F and also consider PNH workup; should check even in the absence of overt evidence of MPN on CBC
What sorts of cardiac rest are attendant with polymyositis and dermatomyositis?
Both are associated with 4x increase risk of MI; also cause patchy myocardial fibrosis which can increase risk of CHF; used to think just SLE assoc. w/ MI but not true; dermato also assoc w/ ovarian CA
Why does stasis dermatitis lead to increased propensity for skin breakdown? What is the best mgmt?
Fluid extravasation leads to stretches the skin leading to increased propensity for breakdown; Tx should always include compression stockings which decreases stretching of skin
What is the best test for pregnant women with suspected nephrolithiasis?
US to avoid radiation, looking for hydro
What is the most appropriate next step for a patient with suspected DAH?
Bronchoscopy w/ BAL and possible biopsy; Bx will show capillaritis with immune deposits
What is MEN2A?
Medullary Thryoid CA, pheochromocytoma, and primary hyperparathyroidism (assoc. w/ RET proto-oncogene)
What are two situations in which one can expect palmar erythema?
Cirrhosis and normal pregnancy
What is present in 50% of patients with “idiopathic” Budd Chiari syndrome?
JAK2 activating mutation (V617F or Exon 12)
How should you approach anticoagulation in a patient with atrial fibrillation who has recently had a stent placed for MI and is on DAPT?
Do the CHADSVASC and HAS-BLED just like anyone else and decide from there
