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ABIM > MKSAP8 > Flashcards

MKSAP8 Flashcards

1
Q

What are the two goals of medical therapy in an aortic dissection?

A

Lower BOTH the HR and the BP to reduce shear stress on aortic wall; esmolol and labetalol are good options (BP <120; HR <65)

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2
Q

What are some drugs that can cause thrombotic microangiopathies (5)?

A

MOA = endothelial damage; Sunitinib, Bevacizumab (both inhibit VEGF; also cause HTN), mitomycin C, Gemcitabine, mTOR inhibitors (cyclosporine, tacrolimus, etc)

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3
Q

When can you stop cervical cancer screening?

A

In women >65 with 3 consecutive negative pap smears or 2 consecutive negative smears and a negative HPV

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4
Q

What is the first line tx for claudication due to PAD? First line medical? Contraindication?

A

Supervised exercise program; Cilostazol (PDE-3 inhib) contraindicated in heart failure

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5
Q

What is the difference in tx for OSA vs. CSA?

A

OSA = CPAP or BiPAP; CSA = Adaptive servoventilation; risk factors for CSA = afib or CHF

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6
Q

How is abdominal compartment syndrome usually defined?

A

New organ dysfunction in a patient with abdominal pressure > 20 mmHg (measured by bladder pressure); can have worsening respirations or increased peak pressures if on ventilator

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7
Q

What are the CD4:CD8 ratios in hypersensitivity pneumonitis vs. sarcoidosis?

A

Low in HP because there are more CD8 cells; High in sarcoid bc it is granulomatous inflammation; though there are recent challenges; The IMPORTANT thing is that the BAL is lymphocytic

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8
Q

What might a CT scan look like in a patient with Acute Hypersensitivity pneumonitis? The BAL?

A

Ground glass opacities with centrilobular nodules in the upper and middle lobes; Lymphocytic infiltrate on BAL often with low CD4:CD8 whereas sarcoid thought to be more CD4 bc granulomatous

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9
Q

Explain the issues of the A1C in ESRD?

A

Can be falsely elevated due to carbamylated hgb due to uremia, falsely low due to anemia of CKD; need to really look at fasting sugars and post prandial

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10
Q

The labs in Euthyroid Sick Syndrome look most similar to what?

A

Central hypothyroidism; there is often low TSH and low T4/T3; so if someone has a high TSH it prob is actually hypothyroidism and NOT euthyroid sick syndrome

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11
Q

What can you say about nonbiologic DMARDs (i.e. MTX and sulfasalazine and NOT TNF-alpha) in the mgmt of Ankylosing Spondylitis?

A

Not useful for axial dz but can be ok for peripheral arthritis; No matter what though NSAIDs first line then biologic DMARD = TNF-alpha

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12
Q

When can rituximab be used in RA? What labs do you need to check first?

A

Can be used if no response to MTX or TNF-alpha; check HBV serologies first as can reactivate; if + then entacavir or tenofovir

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13
Q

What is March Hemoglobinuria?

A

i.e. Runners Hemoglobinuria; a hemolytic anemia due to running can get secondary Fe def due to this

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14
Q

If you think someone has an HSV type infxn why should you still consider DFA or PCR of vesicle?

A

Can differentiate HSV1, HSV2, and VZV which may be important for IC patients

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15
Q

What are Sjogrens pt at increased risk of? What other condition can cause a keratoconjunctivitis sicca type presentation?

A

DLBCL and MALT (Marginal zone) lymphomas of glands; GVHD can often present this way

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16
Q

How should a patient with myasthenic crisis be treated?

A

Emergently in an ICU w/ IVIG or PLEX (most often IVIG, no benefit one way or another); avoid quinolones

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17
Q

How can you diagnose infertility related to pelvic inflammatory disease?

A

Hysterosalpingogram

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18
Q

How do you Tx MAC in a patient with HIV/AIDS

A

Clarithromycin + Ethambutol and continuation of HARRT

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19
Q

What should you consider doing in a patient diagnosed with Atypical Ductal Hyperplasia (ADH)?

A

Consider chemoprophylaxis as often can cause CA; tamoxifen if premenopausal or exemestane (or other AI; letrozole) if post

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20
Q

What are the imaging findings for adrenocortical carcinoma?

A

Large mass with irregular borders and calcification often with high attenuation (increased Hounsfield units) and a DELAY IN CONTRAST WASHOUT

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21
Q

What is the Tx of adrenocortical carcinoma

A

Surgical excision if possible and then mitotane

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22
Q

What should be tested for in all patients with metastatic melanoma?

A

BRAF V600E mutation and then give vemurafenib or dabrafenib if + (both BRAF inhibitors); recall BRAF part of MAPK pathway

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23
Q

Tx of multinodular goiter with compressive sx

A

Total thyroidectomy

24
Q

Which HLA markers are associated with Celiac dz?

A

HLA-DQ2 and HLA-DQ8

25
Q

What are the effective treatments for idiopathic intracranial HTN?

A

The only really good medical tx are carbonic anhydrase inhibitors i.e. acetazolamide; Optic nerve fenestration is an operation to relieve intracranial HTN

26
Q

What FEV1 cutoff is pulmonary rehab indicated for all patients w/ COPD?

A

Less than 50% and can be considered for some symptomatic or exercise limited patients >50%

27
Q

What kind of kidney injury do PPIs cause (if you believe it)?

A

Tubulointerstitial; Chronic tubulointerstitial dz often arises from an acute tublointerstitial insult but can occur subacutely as well

28
Q

What test would you need in order to diagnose acute HIV?

A

Nucleic acid amplification test as the antibody may be negative (window period); So a positive antigen/antibody test tells you pt EITHER has p24 antigen or antibody

29
Q

What is the next best test to order if a patient has a positive HIV test?

A

T cell subsets as they may have full on AIDS (i.e. CD4 <200)

30
Q

What is the best tx for bone-only breast CA metastases?

A

Aromatase inhibitors i.e. if patient has been free of dz for a while and gets bone mets start an AI (exemestane) and if they are resistant to that add everolimus (mTOR inhib); chemo with paclitaxel may be used instead if pt is hormone neg or has impending visceral crisis

31
Q

Name a non-SLE vasculitis that often causes fevers, abdominal pain, and peripheral mononeuropathies (mononeuritis multiplex)

A

Polyarteritis Nodosa (assoc with HBV)

32
Q

What are the steps if a patient has low ACTH but high cortisol? High ACTH and high cortisol?

A

This is ACTH independent so scan adrenals; if ACTH high then MRI pituitary or petrosal venous sampling OR consider ectopic ACTH production

33
Q

A diagnosis of cushing requires how many screening tests?

A
  1. These include 24 hour urinary free cortisol, low dose dexamethasone suppression test, and midnight salivary cortisol
34
Q

What is the first line tx for sympathomimetic overdose syndromes (i.e. cocaine, meth, bath salts)

A

Benzos are first line drugs; other supportive care includes intubation, evaporative cooling/cooling blankets, and consideration that they may develop rhabdo

35
Q

Drug of choice in anticholinergic toxicity and “nerve agent” bioterrorism

A

Physostigmine

36
Q

What disease should be on the DDx for patients with weird sensory sx and weakness that extends beyond 8 weeks of the onset?

A

CIDP - Chronic Inflammatory Demyelinating Polyneuropathy; diff from Guillian Barre or AIDP in the length of sx whereas AIDP hits its nadir within 4 weeks

37
Q

What is the major difference between AIDP and CIDP?

A

Length of sx. AIDP will max out by 4 weeks; CIDP takes up to 8 weeks

38
Q

What test can suggest presence of tuberculous effusion? Confirmatory?

A

ADA level (less than 40 rules it out; high NPV) and a pleural biopsy is required to confirm; suspect in pt w/ lymphocytic predominant pleural effusion

39
Q

T/F a positive sputum culture will show Mycobacteria in patients with suspected tuberculous effusions

A

False (kind of); it will only show it if there is also pulmonary parenchymal disease; a patient with a possible tuberculous effusion should have ADA level checked and pleural bx and should not be considered ruled out only on the basis of negative sputum Cx

40
Q

What disorder will have differential cyanosis on physical exam i.e. cyanosis and clubbing in lower body but not upper

A

Patent Ductus Arteriosus (PDA) with Eisenmenger physiology

41
Q

What is the difference between D-lactic acidosis and Type B lactic acidosis?

A

D-lactic acidosis occurs in patients w/ SIBO etc. as the bacteria produce the D enantiomer of lactate; Type B lactic acidosis is still the regular L-Lactate picked up on lab tests but occurs due to inability to clear lactate as opposed to excess production

42
Q

What should you do in a patient with hyperalbuminemia or MM with HYPOcalcemia?

A

Order ionized calcium as these situations may have more protein binding to albumin

43
Q

How do you treat a sickle cell pain crisis in pregnant patients?

A

Same as for a normal pt i.e. fluids, narcotics, etc; if worsening or signs of fetal distress then would transfuse

44
Q

Why should you perform a radical inguinal orchiectomy in patients with metastatic testicular cancers?

A

Because there is a blood-gonadal barrier that can prevent chemo from getting into the testis

45
Q

What renal issue is HIV assoc with?

A

Collapsing Variant of FSGS

46
Q

How should you manage a pt who undergoes a RUQ US and findings of a 2 cm polyp are found?

A

Cholecystectomy even if asymptomatic; any polyp >1 cm needs to come out bc can be cholangio; otherwise can be followed unless pt has PSC

47
Q

What is the purpose of ambulatory pH testing in pt w/ GERD?

A

Can be done if atypical sx of GERD to see if that is the cause or if ongoing sx while on PPI to see if there is adequate acid suppression; if not can do Nissen

48
Q

What is the concern for a patient with prolactinoma who gets pregnant?

A

They can grow in response to estrogen and so need to carefully monitor for changes in vision; additionally can get Sheehan syndrome after delivery

49
Q

Vesicles on tip of nose suggestive of VZV is known as __________. Who to call?

A

Hutchinson Sign; Ophtho

50
Q

In whom are air filters in IV lines important?

A

Patients with Eisenmengers or any R->L shunt because they can get a paradoxical air embolism to the brain

51
Q

What two populations are the most likely to get ABPA?

A

Asthma and Cystic Fibrosis

52
Q

What should be tested for in patients with FIXED Livedo reticularis (i.e. that remains despite changes in position or temp changes)

A

Antiphospholipid antibodies esp. if sx of thrombosis or multiple pregnancy loss

53
Q

What is the best mgmt for an advanced Parkinson pt who benefits from anti-parkinsonian meds but has bad side effects?

A

Deep Brain stimulator to subthalamic nucleus; most approp first steps when DA agents work but wear off are to increase dose of carbidopa/levodopa and then to ADD entacapone

54
Q

What are sporadic fundic gland polyps assoc with?

A

Usually with PPI and require no tx; if FAP then assoc with APC gene mutation and can harbor dysplasia

55
Q

What should you do if you suspect hypothyroidism but pt has low or normal TSH?

A

Check T4 because it may be central hypothyroidism and not primary

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