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ABIM > MKSAP5 > Flashcards

MKSAP5 Flashcards

1
Q

What drug can be used in patients with inappropriate sinus tachycardia assuming all else has been excluded? What other reason can it be used?

A

Ivabradine; can also be used in patients w/ CHF who are intolerant to or maximally dosed on BB w/o having achieved goal HR

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2
Q

What should you be concerned about in patients with SLE who have pain or limitation of a large joint (i.e. hip or knee)?

A

Be concerned for osteonecrosis of the joint; check XR first then MRI

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3
Q

What is the most common complication of E. coli 0157:H7 dysentery?

A

HUS; can be made worse if abx or antimotility agents used

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4
Q

What may be a reasonable option for a person with pyoderma gangrenosum who has severe DM and osteoporosis?

A

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

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5
Q

What is the general tx of superficial bladder CA?

A

TURBT followed by intravesical BCG or by mitomycin then follow w/ serial cystoscopy

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6
Q

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?

A

Scleritis; Autoimmune conditions like rheumatoid arthritis, relapsing polychondritis, IBD, and vasculitis; should always consider ANCA vasculitis

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7
Q

A 2016 study suggests adding radiotherapy to the prostate even in metastatic prostate CA, why is this?

A

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

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8
Q

What are the two types of microscopic colitis?

A

Collagenous colitis and Lymphocytic colitis

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9
Q

What should you do with statins, ACE/ARBs in pregnant patients?

A

discontinue both as they are teratogenic; dyslipidemia can best be managed by lifestyle modification and diet

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10
Q

When is cystectomy indicated for recurrent superficial bladder CA?

A

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

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11
Q

How long after radiation does radiation pneumonitis typically take to take effect?

A

6-12 weeks

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12
Q

What is the most common pulmonary neuroendocrine tumor? How does it present radiographically?

A

Small Cell Lung Cancer; often with large hilar mass and bulky mediastinal LAD; can be associated with LEMS

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13
Q

How can you discern radiation pneumonitis on CT imaging?

A

The presence of a nonanatomic straight line on imaging demarcating involved vs. uninvolved lung is pathognomonic

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14
Q

What is the only FDA approved drug for gastroparesis?

A

Metoclopromide; but is acquired with hyperprolactinemia and galactorrhea as well as tardive dyskinesia

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15
Q

What is the best way to diagnose Occupational Asthma?

A

spirometry before and after workplace exposures

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16
Q

What should you think in a patient with fever, petechial rash, and meningitis with possible tick exposure?

A

RMSF and should tx with doxycycline (100 bid)– SEROLOGIC TESTING may NEGATIVE in the acute setting.

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17
Q

What is the best dopamine agonist is the best for RLS? What is the “risk of augmentation”?

A

Ropinirole; Augmentation is the worsening of symptoms over time with dopamine supplementation

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18
Q

When should you suspect occupational asthma?

A

Suspect in patients with asthma-like symptoms that vary with exposure to the workplace

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19
Q

What multiple sclerosis drug can lead to autoimmune hepatitis? What is the recommended screening?

A

Interferon B; should monitor serum aminotransferases

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20
Q

What is the most common presenting symptom for esophageal cancer?

A

Progressive solid food dysphagia

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21
Q

What should you do in a patient with CAP who is not responding within 2-3 days of standard abx?

A

Order a chest CT; this is the best to evaluate a nonresponsive pneumonia for things like parapneumonic effusion, lung abscess, cavitary lesion

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22
Q

What are oval fat bodies on a UA? What appearance do they usually have?

A

They are seen in nephrotic syndrome; they look like maltese crosses under plane polarized light

23
Q

What does the finding of “maltese crosses” on UA suggest?

A

Oval fat bodies seen on UA (have “maltese cross” under plane-polarized light) is assoc with nephrotic syndrome

24
Q

If a person with gastroparesis on metoclopromide starts to get tardive dyskinesia what would be the next step aside from stopping the med

A

Metoclopromide is the only FDA approved drug but in this case would have to stop and start scheduled promethazine and small scheduled meals

25
Q

What kind of imaging should be done for patients slated to undergo thyroid surgery with suspected or confirmed thyroid CA?

A

Cervical US to evaluate lymph nodes and biopsy any that appear abnormal (>8-10 mm in short axis)

26
Q

What chemotherapy drug is associated with pneumonitis as well as increased risk of radiation pneumonitis?

A

Gemcitabine

27
Q

What (occasionally wide complex) tachycardia can occur within 24 hours after reperfusion from an MI?

A

Accelerated Idioventricular Rhythm (AIVR); postulated to result from abnormal automaticity in the subendothelial Purkinje fibers

28
Q

Why does ascending aortic dilation occur in patients with bicuspid AoV? How should you follow them?

A

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

29
Q

Why does hypomagnesemia cause hypocalcemia?

A

Low serum magnesium levels impair PTH secretion which can lead to low Ca

30
Q

Why should you check K-RAS and N-RAS mutations in patients with metastatic colorectal cancer?

A

Because their presence predicts for resistance to EGFR inhibitors

31
Q

According to a recent RCT taking HTN meds at what time may help prevent new-onset DMII

A

Taking them at night time

32
Q

What can you say about the relationship of S. aureus nasal colonization and risk of surgical site infection?

A

Increases the risk of surgical site infection; can tx w/ 5 day course intranasal mupirocin apparently found to decrease the risk

33
Q

What bisphosphonates are good for newly diagnosed multiple myeloma?

A

Pamidronate and Zoledronic acid; studies show that the risk of skeletal events is decreased by the use of these agents

34
Q

What is the “prognostic utility” of MRI in evaluating osteonecrosis?

A

If greater than 20% of the bone is lost then progressive disease is expected; smaller infarcts, however, rarely progress

35
Q

How is cyclic mastalgia treated? What drug has FDA-approval for it?

A

Conservatively with appropriate fitting bra; Danazol but this is limited by AE

36
Q

What is “Conversion Chemotherapy”?

A

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)

37
Q

What are the hallmark adverse effects of Natalizumab? Interferon B? Teriflunomide?

A

Natalizumab- JC virus reactivation; IFN B- autoimmune hepatitis; and Teriflunomide- pancreatitis

38
Q

What did the recent trial comparing ibrutinib to chlorambucil show?

A

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)

39
Q

How can you effectively exclude Lyme Arthritis?

A

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

40
Q

Deficiency of what enzyme can lead to toxicity with 5-FU? What mutation can lead to irinotecan toxicity?

A

Dihydropyridine dehydrogenase; UGT1A1

41
Q

What is the follow up for colorectal CA survivors?

A

CT yearly for 5 years; CEA trended after resection and post-op colonoscopy 12 months after

42
Q

In whom is Acral Lentiginous melanoma the MC?

A

Asians and Dark-skinned people

43
Q

What is a complication of witholding anti-Parkinsonian meds in a hospitalized PD patient?

A

Parkinsonian-Hyperpyrexia syndrome–an acute syndrome resembling NMS; Tx is to restart the meds

44
Q

What are the symptoms of Parkinsonian-Hyperpyrexia syndrome?

A

AMS, hyperthermia, rhabdomyolysis and EPS often associated with dystonia and rigidity

45
Q

Regarding pulmonary neuroendocrine neoplasms- which is often a bulky hilar mass with mediastinal LAD and which is often an endobronchial lesion?

A

Small Cell Lung CA is usually large hilar mass; Endobronchial is usual bronchial carcinoid

46
Q

If a patient has Budd-Chiari, even w/ normal CBC and hct you should check for what?

A

Check for JAK2 V617F and also consider PNH workup; should check even in the absence of overt evidence of MPN on CBC

47
Q

What sorts of cardiac rest are attendant with polymyositis and dermatomyositis?

A

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

48
Q

Why does stasis dermatitis lead to increased propensity for skin breakdown? What is the best mgmt?

A

Fluid extravasation leads to stretches the skin leading to increased propensity for breakdown; Tx should always include compression stockings which decreases stretching of skin

49
Q

What is the best test for pregnant women with suspected nephrolithiasis?

A

US to avoid radiation, looking for hydro

50
Q

What is the most appropriate next step for a patient with suspected DAH?

A

Bronchoscopy w/ BAL and possible biopsy; Bx will show capillaritis with immune deposits

51
Q

What is MEN2A?

A

Medullary Thryoid CA, pheochromocytoma, and primary hyperparathyroidism (assoc. w/ RET proto-oncogene)

52
Q

What are two situations in which one can expect palmar erythema?

A

Cirrhosis and normal pregnancy

53
Q

What is present in 50% of patients with “idiopathic” Budd Chiari syndrome?

A

JAK2 activating mutation (V617F or Exon 12)

54
Q

How should you approach anticoagulation in a patient with atrial fibrillation who has recently had a stent placed for MI and is on DAPT?

A

Do the CHADSVASC and HAS-BLED just like anyone else and decide from there

ABIM (18 decks)

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