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ABIM > MKSAP6 > Flashcards

MKSAP6 Flashcards

1
Q

In comparison to a ipratropium what has been found to be the case with using tiotropium instead?

A

Improved lung function, decreased hospitalizations and exacerbations of COPD and improved quality of life

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2
Q

How long after administration of aminoglycosides does AKI classically occur? What other abnormalities are associated with aminoglycoside induced AKI?

A

5-10 days later; associated with hypokalemia and hypomagnesemia due to renal wasting of these

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3
Q

What is the definition of Resistant HTN (or “Difficult to control HTN)?

A

Must still be hypertensive on more than 3 drugs, one of which is a diuretic; chlorthalidone preferred

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4
Q

What is HTN in office but not at home? What about at home but not in office? How can you Dx?

A

White coat HTN; Masked HTN; ambulatory BP monitoring

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5
Q

What should make you be concerned that someone may have a late complement deficiency?

A

C5-C9 (MAC) complex; recurrent N. meningitidis infxns

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6
Q

Treatment of chronic idiopathic urticaria is best achieved with what meds?

A

Long acting antihistamines

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7
Q

As a general rule of thumb, how many platelets are seen on a bloodsmear per HPF?

A

about 7, if you see more than that suspect thrombocytosis

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8
Q

What did the PROUD study evaluate?

A

PrEP (Pre Exposure ppx) for AIDS. Prevents infxn. Does NOT promote resistance or higher rates of infxn with other STIs; Tenofovir-Emtracitabine

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9
Q

Spelling world backwards helps to evaluate what condition?

A

Delirium (problem of focus, inattention)

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10
Q

T/F: KRAS mutations are associated with poor response to EGFR inhibitors in lung cancer

A

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

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11
Q

What should you do for a patient with polymyalgia rheumatica with osteoporosis and DM?

A

This would be considered high risk PMR; while low dose (15 mg) prednisone can help should consider adding methotrexate to spare steroids

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12
Q

What is a medically professional way to describe an interview with a patient who isnt making sense?

A

Call it inappropriate or tangential; “requiring frequent redirecting”

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13
Q

What is the adjunctive tx of GBM s/p surgery for all patients?

A

Temozolomide + RT

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14
Q

Difference in dosing of prednisone for PMR and Giant Cell Arteritis

A

PMR 15 mg daily; GCA 60 mg daily

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15
Q

What is the most important aspect of ARDS mgmt?

A

Low tidal volume ventilation (6 ml/kg IBW) EVEN IF it results in hypercapnia = permissive hypercapnia. Also keep plateau pressure <30 mmHg

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16
Q

What is the drug to treat dabigatran overdose? Factor Xa inhibitors?

A

Idaracizumab (praxbind); Adanexet alfa

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17
Q

A 2016 study of chronic HBV patients undergoing chemotherapy for solid organ cancers found what?

A

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

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18
Q

What is a characteristic finding on micro of aspergillus fumigatus vs. mucor (zygomycetes)?

A

45 degree angle branch vs. 90

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19
Q

What treatment would improve symptoms of an eosinophilic pneumonia? Presentation?

A

Steroids; photographic negative of pulmonary edema with most occuring at periphery

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20
Q

T/F: a radioactive iodine uptake study can be useful when trying to diagnose etiology of hypothyroidism?

A

False: ONLY useful if used to Dx hyperthyroidism

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21
Q

Assuming that you are not giving TPA, what is the threshold to Tx BP in an acute ischemic stroke?

A

BP >220/120 but if giving TPA then 180/105

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22
Q

What sorts of motion make patellofemoral pain syndrome worse?

A

anterior knee pain made worse by running, climbing stairs, or prolonged sitting

23
Q

What is the CRB-65 score?

A

Old CURB-65 omitting BUN; confusion, RR >30, BP <90 and age over 65

24
Q

When working someone up for DI i.e. with lithium use; what is a normal urine osmolality response to fluid restriction?

A

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

25
Q

What is the issue with diuretics in HOCM? What is the optimal mgmt of HOCM? What if drug-refractory?

A

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

26
Q

What two antihypertensive agents are uricosuric and can lower the serum uric acid?

A

Losartan and CCBx

27
Q

How often should patients with FAP receive an EGD and why?

A

Every 5 years to rule out duodenal cancer and periampullary cancers

28
Q

What disorder should you think about in a patient with recurrent, severe asthma with peripheral eosinophilia and elevated IgE levels? Dx?

A

ABPA, skin testing for aspergillus

29
Q

What is the difference in upfront tx of rheumatoid arthritis compared to ankylosing spondylitis?

A

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

30
Q

What should be done first genetic counseling or genetic testing?

A

Genetic counseling because need to address risk vs. benefit of testing first

31
Q

Pain located on the superior and lateral aspect of the shoulder with tenderness to palpation is likely due to what?

A

AC joint degeneration (note that adhesive capsulitis would have decreased ROM and pain with movement)

32
Q

What other test should be performed in patients with pulmonary cryptococcosis whether immunocompromised or not? Tx?

A

LP to rule out CNS involvement; Tx is liposomal AmB and Flucytosine; Echinocandins have NO ACTIVITY against crypto

33
Q

What DM classes of medications are “incretin-based drugs”? AE?

A

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

34
Q

What does CH50 assess; AH50?

A

CH50 assesses classical complement; AH50 assesses alternative complement

35
Q

What is the best Tx of severe bleeding in vitamin K antagonist associated major bleeding? What is cryoprecipitate used for?

A

4 factor PCC with II, VII, IX, and X; Cryo is for DIC and dys/hypofibrinogenemia

36
Q

Where do most bronchial carcinoids occur and why?

A

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

37
Q

If a patient has both HBV and HIV what is a good backbone to therapy?

A

Tenofovir or emtracitabine as they have activity against both

38
Q

What FEV1:FVC ratio is consistent with airway obstruction?

A

<70%

39
Q

What effect should increased serum osmolality have on ADH?

A

Should signal hypothalamus to increase secretion of ADH

40
Q

Per the PARADIGM-HF trial, how long should one wait after discontinuing an ACE inhibitor to start an ARNI

A

36 hours to prevent angioedema

41
Q

Explain what osmotic nephrosis is and what sorts of things cause it? What is seen on histology?

A

Renal damage due to hyperosmolar substances such as IVIG/Mannitol/Hydroxyethyl Start; form of ATN assoc with vacuolization and swelling of proximal tubular cells

42
Q

What drug, aside from acetaminophen and NSAIDs is a nonopiate shown to have benefit in knee osteoarthritis?

A

Duloxetine

43
Q

Excess deposition of _________ in the retrorbital area causes Graves ophthalmopathy. Initial Tx of Graves ophthlamopathy is what

A

Glycosaminoglycans; normalize the thyroid fxn with methimazole (PTU more highly assoc with liver failure and necrosis)

44
Q

What 3 activating mutations are looked for in metastatic lung adenocarcinoma

A

EFGR (afatinib, gefitinib, erlotinib), EML4/ALK (certinib) and ROS (crizotinib); also if > 50% PD1 expressivity can do pembrolizumab (but they do it anyway)

45
Q

What is the MOA of AKI due to contrast and calcineurin inhibitors? What about aminoglycosides and platinum analogues?

A

Renal vasoconstriction; directly toxic to tubular cells

46
Q

Name 5 TNF-alpha inhibitors

A

Adalimumab, Golimumab, Etanercept, Infliximab, and Certolizumab

47
Q

What is a Biosimilar product?

A

A cheaper version of a TNF-alpha i.e. Adilimumab-atto

48
Q

What are the first line agents for RLS? What needs to be ruled out?

A

Dopamine agonists (ropinirole, pramipexole); check a ferritin

49
Q

What is the appropriate mgmt of a patient with an incidentally noted metastatic low grade carcinoid tumor (NET) that is hormonally nonfunctional?

A

Can observe; for low grade that needs Tx then octreotide/everolimus or sunitinib; if high grade tx as SCLC with Cisplatin and Etoposide

50
Q

What is the definition of erythroderma and what are 2 conditions in which it can be seen?

A

Redness and scaling of >90% of the body and can be seen in psoriasis (Tx is systemic steroids) or in Sezary syndrome

51
Q

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?

A

Nivolumab resulted in increased OS in both squamous and nonsquamous (adenocarcinoma)

52
Q

What steps would you take to diagnose central DI?

A

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

53
Q

A recent phase III RCT showed that patients receiving anti-thymocyte globulin had a significantly lower risk of what after Allo-HSCT?

A

Chronic GVHD

ABIM (18 decks)

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