MKSAP6 Flashcards
In comparison to a ipratropium what has been found to be the case with using tiotropium instead?
Improved lung function, decreased hospitalizations and exacerbations of COPD and improved quality of life
How long after administration of aminoglycosides does AKI classically occur? What other abnormalities are associated with aminoglycoside induced AKI?
5-10 days later; associated with hypokalemia and hypomagnesemia due to renal wasting of these
What is the definition of Resistant HTN (or “Difficult to control HTN)?
Must still be hypertensive on more than 3 drugs, one of which is a diuretic; chlorthalidone preferred
What is HTN in office but not at home? What about at home but not in office? How can you Dx?
White coat HTN; Masked HTN; ambulatory BP monitoring
What should make you be concerned that someone may have a late complement deficiency?
C5-C9 (MAC) complex; recurrent N. meningitidis infxns
Treatment of chronic idiopathic urticaria is best achieved with what meds?
Long acting antihistamines
As a general rule of thumb, how many platelets are seen on a bloodsmear per HPF?
about 7, if you see more than that suspect thrombocytosis
What did the PROUD study evaluate?
PrEP (Pre Exposure ppx) for AIDS. Prevents infxn. Does NOT promote resistance or higher rates of infxn with other STIs; Tenofovir-Emtracitabine
Spelling world backwards helps to evaluate what condition?
Delirium (problem of focus, inattention)
T/F: KRAS mutations are associated with poor response to EGFR inhibitors in lung cancer
False this is only true in colorectal cancer; all NSCLC patients with metastatic dz should be screened for EGFR, ROS1, and PD1 and can get afatinib, gefitinib, or erlotinib regardless of ras status
What should you do for a patient with polymyalgia rheumatica with osteoporosis and DM?
This would be considered high risk PMR; while low dose (15 mg) prednisone can help should consider adding methotrexate to spare steroids
What is a medically professional way to describe an interview with a patient who isnt making sense?
Call it inappropriate or tangential; “requiring frequent redirecting”
What is the adjunctive tx of GBM s/p surgery for all patients?
Temozolomide + RT
Difference in dosing of prednisone for PMR and Giant Cell Arteritis
PMR 15 mg daily; GCA 60 mg daily
What is the most important aspect of ARDS mgmt?
Low tidal volume ventilation (6 ml/kg IBW) EVEN IF it results in hypercapnia = permissive hypercapnia. Also keep plateau pressure <30 mmHg
What is the drug to treat dabigatran overdose? Factor Xa inhibitors?
Idaracizumab (praxbind); Adanexet alfa
A 2016 study of chronic HBV patients undergoing chemotherapy for solid organ cancers found what?
That they should be treated with HBV reactivation ppx (tenofovir/lamivudine) as they are high risk for HBV reactivation (recall HBV integrates into host genome); also need to screen for anti-CD20 drugs i.e. rituximab as well as for Allo-HSCT
What is a characteristic finding on micro of aspergillus fumigatus vs. mucor (zygomycetes)?
45 degree angle branch vs. 90
What treatment would improve symptoms of an eosinophilic pneumonia? Presentation?
Steroids; photographic negative of pulmonary edema with most occuring at periphery
T/F: a radioactive iodine uptake study can be useful when trying to diagnose etiology of hypothyroidism?
False: ONLY useful if used to Dx hyperthyroidism
Assuming that you are not giving TPA, what is the threshold to Tx BP in an acute ischemic stroke?
BP >220/120 but if giving TPA then 180/105
What sorts of motion make patellofemoral pain syndrome worse?
anterior knee pain made worse by running, climbing stairs, or prolonged sitting
What is the CRB-65 score?
Old CURB-65 omitting BUN; confusion, RR >30, BP <90 and age over 65
When working someone up for DI i.e. with lithium use; what is a normal urine osmolality response to fluid restriction?
With fluid restriction, should have Uosm increase to >600; If it fails to concentrate you administer DDAVP; if it increases then it is central DI and if not then it is nephrogenic
What is the issue with diuretics in HOCM? What is the optimal mgmt of HOCM? What if drug-refractory?
Diuretics can increase propensity for dynamic LVOT obstruction; negative chronotropes are cornerstone; if need be then surgical myectomy or alcohol septal ablation can be done
What two antihypertensive agents are uricosuric and can lower the serum uric acid?
Losartan and CCBx
How often should patients with FAP receive an EGD and why?
Every 5 years to rule out duodenal cancer and periampullary cancers
What disorder should you think about in a patient with recurrent, severe asthma with peripheral eosinophilia and elevated IgE levels? Dx?
ABPA, skin testing for aspergillus
What is the difference in upfront tx of rheumatoid arthritis compared to ankylosing spondylitis?
RA should be tx upfront with a DMARD (preferred initial drug = MTX) whereas tx of ankylosing spondylitis upfront is NSAID with TNF-alpha added if it doesnt work
What should be done first genetic counseling or genetic testing?
Genetic counseling because need to address risk vs. benefit of testing first
Pain located on the superior and lateral aspect of the shoulder with tenderness to palpation is likely due to what?
AC joint degeneration (note that adhesive capsulitis would have decreased ROM and pain with movement)
What other test should be performed in patients with pulmonary cryptococcosis whether immunocompromised or not? Tx?
LP to rule out CNS involvement; Tx is liposomal AmB and Flucytosine; Echinocandins have NO ACTIVITY against crypto
What DM classes of medications are “incretin-based drugs”? AE?
GLP-1 agonists and DPP4 inhibitors (sitagliptin); they activate the GLP-1 receptor and stimulate insulin secretion and inhibit glucagon secretion; GLP1 analogues can cause pancreatitis and cholelithiasis
What does CH50 assess; AH50?
CH50 assesses classical complement; AH50 assesses alternative complement
What is the best Tx of severe bleeding in vitamin K antagonist associated major bleeding? What is cryoprecipitate used for?
4 factor PCC with II, VII, IX, and X; Cryo is for DIC and dys/hypofibrinogenemia
Where do most bronchial carcinoids occur and why?
Most occur in the proximal upper airways and can present as post-obstructive PNA or unilateral wheeze; this is bc neuroendocrine tumors are often from gut and bronchopulmonary tree comes from foregut in development
If a patient has both HBV and HIV what is a good backbone to therapy?
Tenofovir or emtracitabine as they have activity against both
What FEV1:FVC ratio is consistent with airway obstruction?
<70%
What effect should increased serum osmolality have on ADH?
Should signal hypothalamus to increase secretion of ADH
Per the PARADIGM-HF trial, how long should one wait after discontinuing an ACE inhibitor to start an ARNI
36 hours to prevent angioedema
Explain what osmotic nephrosis is and what sorts of things cause it? What is seen on histology?
Renal damage due to hyperosmolar substances such as IVIG/Mannitol/Hydroxyethyl Start; form of ATN assoc with vacuolization and swelling of proximal tubular cells
What drug, aside from acetaminophen and NSAIDs is a nonopiate shown to have benefit in knee osteoarthritis?
Duloxetine
Excess deposition of _________ in the retrorbital area causes Graves ophthalmopathy. Initial Tx of Graves ophthlamopathy is what
Glycosaminoglycans; normalize the thyroid fxn with methimazole (PTU more highly assoc with liver failure and necrosis)
What 3 activating mutations are looked for in metastatic lung adenocarcinoma
EFGR (afatinib, gefitinib, erlotinib), EML4/ALK (certinib) and ROS (crizotinib); also if > 50% PD1 expressivity can do pembrolizumab (but they do it anyway)
What is the MOA of AKI due to contrast and calcineurin inhibitors? What about aminoglycosides and platinum analogues?
Renal vasoconstriction; directly toxic to tubular cells
Name 5 TNF-alpha inhibitors
Adalimumab, Golimumab, Etanercept, Infliximab, and Certolizumab
What is a Biosimilar product?
A cheaper version of a TNF-alpha i.e. Adilimumab-atto
What are the first line agents for RLS? What needs to be ruled out?
Dopamine agonists (ropinirole, pramipexole); check a ferritin
What is the appropriate mgmt of a patient with an incidentally noted metastatic low grade carcinoid tumor (NET) that is hormonally nonfunctional?
Can observe; for low grade that needs Tx then octreotide/everolimus or sunitinib; if high grade tx as SCLC with Cisplatin and Etoposide
What is the definition of erythroderma and what are 2 conditions in which it can be seen?
Redness and scaling of >90% of the body and can be seen in psoriasis (Tx is systemic steroids) or in Sezary syndrome
A phase III study comparing nivolumab (PD-1 inhibitor) to docetaxel (taxane) what was found in both SCC and non-SCC nonsmall cell lung cancers?
Nivolumab resulted in increased OS in both squamous and nonsquamous (adenocarcinoma)
What steps would you take to diagnose central DI?
Always start with a fluid restriction; if Uosm do not increase to >600 osm then need to administer DDAVP; if Uosm increase that is suggestive of central DI. If they do not that is nephrogenic
A recent phase III RCT showed that patients receiving anti-thymocyte globulin had a significantly lower risk of what after Allo-HSCT?
Chronic GVHD
