MKSAP7 Flashcards
How frequently should pt with Severe AS have TTE performed?
Every 6-12 months; SAVR if symptomatic or asymptomatic but with LV dysfunction
What is used to estimate GH levels? What is the primary therapy for Acromegaly? Possible complications?
IGF-1; Transsphenoidal resection which can cause pituitary damage leading to transient DI followed by SIADH after stored ADH released from damaged neurons, then possibly permanent DI from damage to HP axis
Explain why you use aspirin in a patient with a carotid artery dissection?
Because in situ thrombosis often leads to a subsequent stroke
A patient with MEN2A about to undergo thyroid surgery for medullary thyroid CA should have what done first?
Screen for pheochromocytoma first as the stress of surgery could lead to a massive catecholamine release (RET mutation is in MEN2A and B; MEN gene for the Menin protein is for MEN1- Wermer syndrome)
What is the big side effect assoc with SGLT-2 inhibitors?
Aside from UTIs and candidal infxn; they can cause a Euglycemic DKA and this occurs particularly in insulin deficient pts (so if Sx suggestive then check ABG and B-hydroxybutyrate, UA for ketones)
What values on PFTs can make you consider a Dx of pulmonary HTN?
An isolated DLCO w/o other findings
What are the two important parts of therapy for SBP?
Dx if PMN count in fluid is >250; Tx with cephalosporin and albumin can do 1.5 g/kg on Day 1 and 3 OR just do 100 g q8h for 3 days (what most ppl do)
What is the next best step in an adult patient with the worst headache of their life and negative CT of the head?
LP to evaluate for xanthochromia to rule out SAH
What is the typical presentation of chronic mesenteric ischemia? Best test?
Abdominal pain within hours of a meal, fear of food ingestion, and weight loss; CT angiography (i.e. it is basically mesenteric atherosclerosis)
What is the name of the condition when 80-90% of skin is erythematous and is considered a dermatologic emergency?
Erythroderma; often due to an uncontrolled dermatosis like cutaneous T cell lymphoma, GVHD, or Pityriasis rubra pilaris
How is chronic kidney dz of a tubulointerstitial process often manifested?
Slowly progressive course wihtout a clear inciting event that often has subnephrotic range proteinuria and bland urine sediment; can have Fanconi syndrome which is a PCT dysfunction
What renal abnormalities can occur in pt on TMP-SMX? Why?
Increase in sCr as TMP inhibits SECRETION of it (worse CKD bc they are already secreting more); HyperK bc inhibits Enac so basically works as a K-sparing diuretic
What is the best initial therapy for patients with organ or life-threatening ANCA vasulitis?
Glucocorticoids (1 g methylprednisolone) and EITHER Cyclophosphamide OR Rituximab (trials show noninferiority w/ Ritux)
What is the classic trigger for Anti-NMDA-R encephalitis?
Ovarian teratoma; think about in patients with psychiatric sx, choreoathetoid movements, etc.
What is the best initial mgmt of a patient with high pretest probability of HIT?
DC heparin and start on direct thrombin inhibitor (argatroban, danaparoid, bivalrudin, lepirudin); Can check PF4 ab and serotonin release assay as confirmatory tests
What is often the initial drug of choice for Waldenstroms macroglobulinemia?
Rituximab monotherapy or sometimes as combination; often initiated (i.e. over observation) in patients symptoms i.e. B symptoms or marrow suppression etc; cold agglutinin AIHA etc
What physical exam finding can be effectively monitored in Ankylosing Spondylitis? Tx?
Schober Test (>5cm excursion is normal); NSAIDs = primary tx; If Schober INCREASES, that is a good thing bc spine more mobile; imaging to be done q2 years unless issue
What is the tx of refractory temporal lobe epilepsty (i.e. mesial temporal sclerosis)
Can consider temporal lobectomy; refractory epilepsy is persistence of disabling seizures for longer than 1 year despite tx with adequate doses of 2 or more AEDs
What should you consider if a person has glucosuria and a normal serum glucose?
Fanconi syndrome (PCT dysfxn w/ RTA and poor handling of Aas, bicarb, urate, phos)
What should be added to patients with ineffectively controlled RA who are on MTX?
Add a TNF-alpha inhibitor
What is important in patients with cancer who develop sx of possible spinal cord compression?
No matter what they need steroids; RT alone may not prevent the swelling that can lead to permanent neurologic deficit
Aside from hepatic encephalopathy, what else is rifaximin used for?
550 bid can actually be used for IBS-D (also use the FODMAP diet) was FDA approved in 2015, use for 14 days at a time
What is the most common structural disorder that occurs following Tetralogy of Fallot repair?
Pulmonary Regurgitation
What would be the best option for a patient with pulmonary arterial HTN (WHO I) with a negative vasoreactivity test?
A negative test is less than 10 mmHg change. PDE-5 inhibitors (sildenafil/tadalafil) and endothelin receptor agonists (bosentan and ambrisentan) are preferred; if negative vasoreactivity test, CCBs do not work (nifedipine)
PBC is assoc with what Ab and Tx with _____ increases transplant free survival?
Anti-AMA; ursodiol
What is the MOA of pramlintide? Along with what other class of DM meds does this help lose weight?
Amylin analogue and slows gastric emptying; GLP-1 Agonists can help lose weight
What is the drug of choice to treat Stenotrophomonas?
TMP-SMX
What may be performed in some patients with recurrent pleural effusions?
Pleurodesis; or Pleurex catheter if for palliation
What is the definition of massive hemoptyisis?
100 mL (one half cup is about 120 mL)
What is a Cameron Ulcer?
One that is present in a hiatal hernia
With the exception of ________ microbes from the surface of wounds or draining sinus tracts rarely correlate with cultures from bone and so should not be acted upon
S. aureus
What is the most important component of FOLFOX? Explain the history
5-FU; in the 1990s it was just 5-FU and leucovorin for stage 3 and greater colon CA; in 2004 oxaliplatin was added
What is the treatment of locally advanced cervical cancer (i.e. Stage III)
Cisplatin based concurrent chemoradiation; these are the ones that extend to the pelvic side wall; Stage I can get a cone excision or hyster
What should you do for someone traveling very soon to an area w/ endemic HAV?
Give HAV vaccine and IM immunoglobulin NOW
What is the appropriate screening of patients with BRCA1/2 mutations or other familial breast CA syndromes?
annual DIAGNOSTIC mammography and annual breast MRI
What are sequestra and involucrum?
Seen in chronic osteo; Sequestra is dead bone; Involucrum is newly forming bone
In addition to vasodilating agents (CCBs if + vasoreactivity test) or PDE-5 inhibitors/Endothelin receptor agonists, what is the additional therapy needed for PAH?
Supplemental O2 if needed and warfarin; also, if needed prostanoids such as epoprostenol (IV) and iloprost (inhaled) can be given in hospital
The Surviving Sepsis Campaign recommends what pressor to be given first?
Norepinephrine and titrate to MAP > 65; this is also true of cardiogenic shock per the AHA guidelines and then they recommend adding an inotrope if needed
What is the drug class of choice for PO abx in moderate-severe inflammatory acne? AE?
Tetracyclines (Doxy or Minocycline); Mino in particular can cause drug induced SLE
What is the tx of post-inflammatory hyperpigmentation seen after having acne?
Tx w/ topical retinoids
What is the recommended frequency EUS of Barrett Esophagus without dysplasia
every 3-5 years
What test will differentiate primary hyperparathyroidism from familial hypocalciuric hypocalcemia (defect in CASR gene)?
24 hour urine calcium and creatine levels; Total urine calcium <200 and Calcium-Creatinine ratio <0.01 are highly suggestive of it being FHH
What are some contraindications to NPPV?
Encephalopathy, bulbar dysfxn, medical instability such as severe acidosis, arrhythmias or active UGIB
In general what sorts of tests are done to test for Endocrine excess vs. Endocrine insufficiency?
Endocrine excess = suppression tests (i.e. Dex suppression test); Endocrine insufficiency give a stimulation test (i.e. cosyntropin stim)
Presence of what antibody places a patient with polymyositis, amyopathic dermatomyositis (Rash only no muscle), and dermatomyositis at increased risk of ILD?
Presence of Anti-Jo-1 ab which means they likely have an antisynthetase syndrome
What should be given within 8 hours of a traumatic spinal cord injury?
High dose (30 ml/kg) methylprednisolone it is assoc with improved motor function ; can even do before MRI as that takes time
What does FOD MAP stand for and what is it used for?
Fermented Oligosaccharides, Disaccharides, Monosaccharides, and Polyols; used for IBS-D
What is Jaccoud Arthropathy?
A nonerosive arthropathy seen in SLE that predominately affects the periarticular structures leading to REVERSIBLE deformities (i.e. Swann Neck etc.). Will see REDUCIBLE subluxation of digits and no erosion on XR
What is urticarial vasculitis?
Like chronic idiopathic urticaria but instead the urticaria will be painful and last >24 hours and leave behind bruises
2016 Gyn Onc and ASCO guidelines say what about neoadjuvant chemo for ovarian CA?
If high preoperative risk or low likelihood of optimal tumor debulking, give neoadjuvant followed by cytoreductive surgery then probs more chemo
What disease is characterized by painful wheals that last >24 hours and leave bruise-like changes behind?
Urticarial ; may also have low grade fevers and systemic inflammation
What agents could be used for acromegaly in pt w/ unresectable pituitary adenomas?
Octreotide or Lanreotide will decrease GH secretion by the tumor; Pegvisomant can block GH receptors; but transsphenoidal surgery is primary therapy
What labs will be abnormal in patients with OA secondary to hemochromatosis?
Ferritin and transferrin levels
What can you say about conservative fluid strategies in ARDS?
Conservative fluid strategy (i.e. CVP <4; as opposed to <12 which is a liberal fluid strategy) can improve lung fxn, shorter duration of mechanical ventilation (but I don?t think improved OS); remember the important thing for OS is protective lung ventilation (low tidal volume)
What is the best second generation antipsychotic from the standpoint of not causing EPS?
Clozapine; good to give if pt is having EPS AND it is just a very effective drug but otherwise causes issues with agranulocytosis
What are the biochemical tests to check in a patient with an incidenal adrenal nodule?
Low dose Dex suppression test or 24 Hr urinary cortisol; Plasma metanephrines, and IF HTN then Aldo:Renin level
What are the rules for screening colonoscopies in IBD?
8 years after Dx (or based on age and FMH of colon CA) and then every 1-2 years after that
What infectious disease drug causes retrobulbar neuritis?
Ethambutol (need to check color discrimination prior to starting)
What statin dose should be decreased in patients on amiodarone?
Simvastatin should be no more than 20 mg per day and should consider switching to a different statin
What is Dalfambridine used for?
Voltage-gated potassium channel antogonists that can potentiate action potentials along demyelinated axons for MS and can improve lower extremity fxn
What is Pegvisomant?
A GH receptor antagonist that could theoretically be used in unresectable GH-secreting pituitary adenomas but has no effect on the primary tumor; A somatostatin analog such as octreotide or lanreotide is used but only if unresectable
What can be stated about the use of Perfenidone in Tx of idiopathic pulmonary fibrosis?
Associated with a decreased rate in the reduction of FVC (PO antifibrotic agent that inhibitis TGF-B); don?t think it improves OS
What can you see on a CBC in a patient with cyanotic heart dz?
Compensatory erythrocytosis which is important to consider given that these patients may become symptomatic much quicker and at a “normal” hgb
What is the first line Tx for Discoid Lupus (Chronic Cutaneous Lupus Erythematosus)? Second line?
Hydroxychloroquine, Dapsone
What should be suspected in a patient with an acute HA and neck pain who has a Horner Syndrome?
Carotid Artery Dissection (Aspirin is DOC to prevent the in situ thrombosis and subsequent stroke)
What is a potential treatment to be used in patients with fluctuating INRs while taking warfarin?
Consideration of daily low-dose vitamin K (100-150 ug)
HTN prior to the 20th week of pregnancy is referred to as ________
Chronic HTN (in general, labetolol is the preferred drug in pregnancy)
