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More Questions Flashcards

1
Q

Management of ER +, PR +, HER-2 negative breast cancer w/ low risk of recurrence

A

Radiation + Tamoxifen

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2
Q

Tx for patients w/ advanced ovarian cancer after optimal treatment and surgical resection

A

IV and Intraperitoneal cisplatin and paclitaxel

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3
Q

Patients w/ increased breast density

A

At increased risk for breast cancer (20-25%), HOWEVER, normal cancer monitoring is recommended

If other coexisting risk factors are present, then patients need breast MRI

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4
Q

Diffuse idiopathic skeletal hyperostosis

A

Flowing, linear calcifications and ossifications on the anterolateral aspects of the vertebral bodies

Typically see upward pointing spurs in the lumbar spine; downward in cervical

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5
Q

Relapsing, remitting HAV

A

Pt who develops HAV symptoms again 3 months after infection resolved

Typically milder, but can be assoc. w/ nephritis, arthralgia, vasculitis, and cryoglobulinemia

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6
Q

Consideration prior to starting allopurinol

A

HLA-B 5801 allele which can cause DRESS

Pts to screen include Thai, Chinese, Korean, and CKD pts

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7
Q

Test for Alzheimer’s in pts w/ MCI

A

LP; shows decreased AB42 peptide and increased tau protein

> 80% sensitivity and specificity

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8
Q

Other EKG findings of hypercalcemia

A

PR prolongation
Increased QRS amplitude
T wave upslope

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9
Q

Skin changes of amyloidosis

A

Pinch purpura (bruising w/ slight pressure). ecchymoses around eyes (raccoon eyes), yellow, waxy pearls in periorbital area

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10
Q

Indications for AV replacement w/ SEVERE regurgitation

A

Symptomatic
LVEF <50%
LV dilation

If absent, then just repeat echo q6-12months

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11
Q

Tx of MSSA osteomyelitis w/ infected hardward

A

Penicillin + Rifampin

-Helps to eradicate potential biofilms formed on the hardware

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12
Q

Amyopathci dermatomyositis

A

Experience heliotrope rash, Gottron papules, shawl sign, but w/o clinical or lab evidence of muscle disease

-Pts still at increased risk of malignancy and pulmonary fibrosis

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13
Q

Shawl sign

A

Widespread, flat, and red area on the upper back and shoulders associated w/ dermatomyositis

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14
Q

Respiratory-bronchiolitis associated ILD

A

Imaging in smokers reveal centrilobular micronodules w/ tan-pigmented macrophages on biopsy

-Pts often asymptomatic and in 4-5th decade of smoking

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15
Q

Pts w/ afib and HOCM

A

Needs anticoagulation

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16
Q

Microscopic colitis

A

Typically presents in the setting of months of chronic, watery diarrhea unresponsive to medical therapy

Tx: Stop offending meds, loperamide, budesonide last line but very effective

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17
Q

Primary angiitis of the CNS

A

Presents w/ gradual, progressive neurologic sx like HA, cognitive deficits, and other unusual focal findings

Labs: Unremarkable but LP shows lympocytic pleocytosis and increased protein

Cerebral angiogram CAN MAYBE show beading

Brain bx shows granulomatous vasculitis but only has 50% sensitivity

Tx: High dose glucocorticoids + cyclophosphamide for 3-6months followed by azathioprine maintenance therapy

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18
Q

Indications for kidney biopsy

A

Glomerular hematuria
Severely increased albuminuria
Acute or Chronic Kidney Disease of unclear cause
Kidney transplant dysfnxn or monitoring

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19
Q

Myoclonic seizure

A

Consists of one, single jerk of the entire body lasting approx 1 sec; pts retain awareness and have no post-ictal confusions

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20
Q

Tx of hypertensive emergency

A

Lower BP by no more than 25% in first hour; lower SBP to 160 within 6 hrs

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21
Q

Tx for gouty cellulitis

A

Prednisone

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22
Q

Adrenal mass indicators of malignancy

A

> 4cm
Density >10 Houndsfield units
Absolute contrast washout <50% after 10 mins

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23
Q

Labs to monitor in hypoparathyroidism

A

Calcium

Mg

Cr

Urine calcium-many patients will have low levels

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24
Q

First step in management of prepatellar bursitis

A

ASPIRATE

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25
Q

Management of tricuspid regurgitation

A

TTE first

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26
Q

STD screening in homosexuals

A

Require annual HIV, syphilis, gonorrhea, and chlamydia screening

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27
Q

Osborn wave

A

EKG finding in hypothermia; looks like a second QRS immediately after the first one

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28
Q

Medication to start within 24 hours of an MI-related case of acute CHF

A

ACEI or ARB

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29
Q

Cyclic mastalgia

A

Bilateral, diffuse breast pain that worsens during menses then abates

First line tx= Well fitting bra

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30
Q

Treatment of post-MI Mobitz Type II HB

A

Temporary pacing

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31
Q

Stage I Pulmonary Sarcoidosis

A

Bilateral hilar lymphadenopathy with no other symptoms or disruption of pulmonary architecture

Management = Observation

May need to check Ca, EKG, and eye exam

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32
Q

Red Flags for Secondary Headache

A 
Age > 50 
Use of anticoagulant 
Progressive pattern
Abrupt onset/thunderclap
Association w/ neurologic symptoms lasting >1hr 
Alterations in consciousness 
Abnormal physical exam
Onset after exertion or sex

=>Presence of these factors warrants Brain MRI

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33
Q

1st Line Prevention therapy for Tension-Type Headache

A

Amitriptyline

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34
Q

Nutritional management of acute necrotic pancreatitis

A

Initiate enteral tube feeding ASAP; helps to maintain healthy mucosal GI barrier

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35
Q

“Mechanic’s Hands”

A

Hyperkeratotic and fissured skin on the lateral sides and tips of the fingers (extra dry skin); associated w/ dermatomyositis, polymyositis…particularly associated w/ antisynthetase syndrome

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36
Q

Patient’s at higher risk of developing hypocalcemia and symptoms on bisphosphonate therapy

A

Vitamin D deficient patients

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37
Q

Hungry Bone Syndrome

A

Occurs following parathyroidectomy; following loss of PTH, rapid influx of Ca into bone from the bloodstream

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38
Q

Morphea

A

Localized form of scleroderma limited to one or two indurated, thickened plaques on the extremities or around the waistline

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39
Q

Screening for HCV patients w/ evidence of cirrhosis

A

RUQ US q6months; evaluate for development of hepatocellular carcinoma

*This is done REGARDLESS of their response to HCV treatment

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40
Q

Defining MS

A

Clinical relapses or MRI changes = Activity

Gradual accumulation of deficits = Progression

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41
Q

First line tx for Ankylosing Spondylitis

A

DAILY NSAIDs

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42
Q

Goal UOP w/ hypercalciuria to prevent stones

A

2.5-3L/day

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43
Q

Indications for surgery w/ SEVERE aortic regurg

A

Symptoms attributable to this or EF < 50%

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44
Q

Treatment of HBV in pregnancy to prevent vertical transmission

A

Tenofovir

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45
Q

Treatment for adrenal insufficiency

A

Hydrocortisone twice daily + fludrocortisone once daily

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46
Q

Antiplatelet therapy for patient’s treated w/ conservative management after MI

A

ASA + Ticagrelor for one year

-Shown to be superior to Plavix in prevent CV death, MI, and CVA

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47
Q

Most likely culprit of Infection Related Glomerulonephritis in first world countries

A

Staph aureus

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48
Q

Treatment for impaired mobility w/ MS

A

Dalfampridine; voltage gated K+ channel antagonist

Theoretically promotes conductance along the axons of long motor neurons

Studies have showed significant improvements in timed walking tests

ADR: Increases seizure potential; do not use w/ renal dysfnxn

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49
Q

Management of pressure ulcers

A

Hydrocolloid or foam dressings
Protein supplementation
Electrical stimulation

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50
Q

Screening study for cirrhotic patients

A

DEXA scan

Patient’s are known to be at higher risk for developing osteoporosis; all patient’s should be evaluated w/ baseline scan

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51
Q

First step in management of CNS lymphoma

A

Intravitreous sampling

HOLD GLUCOCORTICOIDS; they are lymphotoxic and will lead to false negative serology

ONLY GIVE W/ SIGNS of BRAINSTEM COMPRESSION

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52
Q

Treatment for persistent Crohn’s Disease

A

Anti-TNF agents

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53
Q

Evaluation for recurrent epistaxis

A

Nasal endoscopy

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54
Q

Medication to add w/ CHF patients w/ EF <40% and history of STEMI

A

Aldosterone antagonist

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55
Q

Treatment of behavioral variant FTD

A

SSRIs; TCAs

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56
Q

Pseudostenosis

A

Patient w/ EF <35% who appears to have severe aortic stenosis; appears the valve doesn’t open due to decreased cardiac contractility and SV

Differentiate b/w true aortic stenosis w/ dobutamine echocardiography

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57
Q

Chest CT in rheumatoid patient

A

May have subpleural or intraseptal nodules

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58
Q

AI Pancreatitis lab

A

IgG4

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59
Q

When to initiate dialysis

A

Either when GFR <7 or when uremic symptoms appear

This data is based off the IDEAL study in 2010

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60
Q

Treating a relapse of polymyaglia rheumatica

A

Increase prednisone to the lowest effective dose previously then taper by 1mg every 4 weeks

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61
Q

First line agents for MS treatment

A

IFN-B or Glatiramir acetate

***Give glatiramir w/ any compromise in hepatic function

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62
Q

Therapy for MS when 1st line therapy has failed

A

Natilizumab

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63
Q

Iron levels to maintain as suggested by KDIGO in CKD

A

Transferrin saturation > 30%
Ferritin >500

If Stage 5 CKD, likely needs IV iron

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64
Q

Milan Criteria

A

Criteria for liver transplant w/ hepatocellular carcinoma

3 tumors <3cm or one tumor <5cm; excellent fiver year survival rate if treated w/ transplant

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65
Q

First medication to give with myxedema coma

A

Hydrocortisone

If you give thyroid hormone first, you could precipitate an adrenal crisis; make sure to check cortisol on EVERY PATIENT WITH MYXEDEMA COMA

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66
Q

Most common form of syncope in young people

A

Neurocardiogenic syncope; typically occurs after stimulus of fear, noxious stimuli, stress, heat exposure, situational w/ coughing, micturition

Can also occur w/ carotid sinus hypersensitivity in people wearing tight collars

Prodromal symptoms are usually absent

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67
Q

Sudden sensorineural hearing loss

A

Associated w/ fullness, tinnitus, and a Weber’s test that lateralizes to the opposite ear

Requires urgent otolaryngologist work up

Treat w/ high dose steroids although the effectiveness of this is questionable

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68
Q

Treatment for ESRD lupus nephritis

A

Mycophenolate mofetil

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69
Q

Treatment of kidney stone w/ hypercalciuria

A

Thiazides

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70
Q

MS patient on maximum therapy who is still developing new lesions

A

Measure Vitamin D level; deficiencies associated w/ disease progression

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71
Q

Bone infarct

A

Osteonecrosis of the metaphysis/diaphysis of a bone; appears to show patchy lucencies and necrosis w/ occasional collapse of the bone

If occurring at the epiphysis, you call it avascular necrosis

72
Q

Morphea

A

Limited scleroderma to one of two patches to the torso or proximal extremities

Lacks the visual manifestations and Raynaud’s of systemic sclerosis

73
Q

Patient w/ peripheral neuropathy on therapy who begins developing peripheral edema

A

Likely due to pregabalin; is a CCB, therefore, produces edema via that mechanism

74
Q

Chronic Lead Nephropathy

A

Occurs in pts w/ occupational exposure, lead in water, soil, plant, or food or distilled alcohol
-Lead-containing car radiators condense the alcohol

Associated w/ HTN, hyperuricemia, and gout attacks

75
Q

Pt w/ abdominal fullness and neurologic signs like choreoathetosis, pysch stuff, seizures

A

NMDA encephalitis 2/2 ovarian teratoma

50% of pts w/ ovarian teratoma will have positive antibodies

76
Q

What to do when echo findings of are in-congruent w/ physical exam findings?

A

Cardiac catheterization; needs evaluation prior to consideration for TAVR

77
Q

Sudden rise in Cr after initiating ACEI in a young hypertensive pt

A

Consider RAS

78
Q

Tx for HBV in pregnant patient

A

Tenofovir; could also use lamivudine, however, it is a category C medication in pregnant patients

Use if HBV level >200,000 IU/mL at 24-28weeks

79
Q

Monitoring for patient’s w/ secondary hypothyroidism

A

Must monitor free T4; want to keep in the upper halfo of the normal range

Take Levothyroxine on an empty stomach, 1-3 hours before ingestion of food

Calcium and iron supplements will interfere w/ absorption; avoid taking 3 hours prior to taking levothyroxine

80
Q

HCV testing to obtain prior to discharging patient’s in order for them to get f/up w/ Carr

A

Viral load
Antibody testing
UDS
Fibrometer testing

81
Q

Medication to start on patient w/ maximum dosing of COPD meds and still having recurrent exacerbations

A

Roflumilast; CI’d w/ liver disease; may cause insomnia, depression

82
Q

Management of BP in long term after hemorrhagic CVA

A

<130/<80; best data surrounds starting an ACEI

83
Q

Treatment of dermatitis herpetiformis

A

Dapsone

Remember, still need gluten free diet as well as pt likely has celiac disease

84
Q

Causes of NONANION gap metabolic acidosis

A 
Carbonic anhydrase 
RTA
Urostomy
Diarrhea
Expansion w/ NS
85
Q

Patient w/ minimal protein on dipstick but greatly elevated Urine Protein-Cr ratio

A

Have to consider MM as cause of renal dysfnxn

86
Q

Pyroglutamic acidosis

A

Patients w/ anion gap metabolic acidosis and AMS who take acetaminophen on a chronic basis.

Pts w/ decreased nutrition, CKD, liver disease, vegetarian diet

87
Q

Ranexa benefits

A

Decreases chest pain and decreases risk for afib

88
Q

Drug cause of reversible hearing loss

A

Zithromax

89
Q

Treatment of cryoglobulinemia

A

Just treat the hep c

90
Q

Meltzer triad

A

Combination of asthenia, arthralgia, and palpable purpura in a patient with Hep C compatible with cryoglobulinemia

91
Q

Management of ER + ductal carcinoma in situ

A

Anastrazole

92
Q

Treatment of dermatitis herpetiformis

A

Gluten free diet + DAPSONE

93
Q

Treatment of behavioral manifestations of FTD

A

Citalopram

94
Q

Test to order to evaluate for cardiac ischemia w/ baseline LVH and repolarization abnormalities

A

Coronary CTA

PROMISE TRIAL: Compared coronary CTA with exercise angiography and had no differences in 2 year outcomes that included death, MI, hospitalizations for unstable angina)

95
Q

Reversible cerebral vasoconstriction syndrome

A

“Thunderclap” headache that reaches its worst within 5 mins; typically occurs multiple times

Normal head imaging distinguishes from SAH

Dx: MRA/Head CTA

Triggers: SSRIs, sympathomimetic agents, exertion, shower, valsava, emotion

Tx: CCBs

96
Q

How often to screen older patients for glaucoma

A

Every 1-2 years

97
Q

FRAIL Score

A

Fatigue: Feeling this way most of the time for 4 weeks
Resistance: Difficulty walking up 10 steps
Ambulation: Can’t walk 100 yards without difficulty
Illness: 5 or more medical comorbidities
Loss of weight: >5% weight loss in one year

98
Q

Service that covers ADLs for at frail at home patients if needed

A

Medicaid

Medicare DOES NOT

99
Q

Rehab facility requirement

A

Must be able to participate in 3 hours of physical therapy 5 days/week

Medicare/Medicaid will pay for up to 100 days of this just like with nursing home

100
Q

Surgery to perform in myxomatous mitral valve degeneration

A

Mitral valve repair; associated w/ better overall mortality outcomes

Indications:

  1. Symptomatic patient w/ EF > 30%
  2. Asymptomatic patient w/ EF 30-60% and/or LV end systolic diameter > 40mm
  3. Patients undergoing another cardiac procedure
  4. PAH (PA pressure >50)
  5. New onset afib
101
Q

Winter’s Formula

A

1.5 x [HCO3] + 8 +/- 2

Checks for appropriate response to metabolic acidosis

102
Q

Medication for patient w/ newly discovered, symptomatic brain metastasis

A

Glucocorticoids

Should be tapered to lowest tolerated dose following radiosurgery

103
Q

Atopic dermatitis classic areas of involvement

A

Antecubital and popliteal fossae and flexural wrists

104
Q

Ranolazine and diltiazem

A

Must decrease ranolazine by 50% if starting nondihydropyridine CCB due to CYP inhibition; additionally, ranolazine will affect the Na-dependent Ca2+ channels in the myocardium

105
Q

Patient with leukemia and a high potassium

A

Pseudohyperkalemia; due to elevated WBC

Check plasma potassium

106
Q

Substitute for cisplatin in patients w/ poorly differentiated SCC and have CKD

A

Cetuximab

107
Q

Contraindication for adenosine in patient’s with COPD who need cardiac eval

A

Adenosine causes bronchospasm

108
Q

Pruritic urticarial papules and plaques of pregnancy

A

Self limiting condition that arises in the third trimester; can be treated w/ topical glucocorticoids

109
Q

Pseudobulbar affect

A

Neurologic disorder characterized by involuntary outbursts of laughing/crying out of proportion to event

Sometimes associated w/ vascular cognitive dementia; may get improvement w/ donepezil

110
Q

Outpatient management of PE

A

NOAC therapy is equivalent to LMWH

111
Q

Labs for COVID-19

A

CBC, BMP, Mg, LFT, CRP, procal, CPK, trop, d dimer, PTT, INR, proBNP

Repeat w/ clinical worsening

112
Q

Considerations for worsening pulm status w/ COVID

A

Proning

Inhaled epoprostenol, NO

113
Q

Lab markers of worse disease w/ COVID-19

A 
Lymphopenia
Elevated troponin 
LDH 
D-dimer
CRP
114
Q

Figure 3 sign

A

Sign of aortic correction where the aorta dilates and then narrows on CXR giving the aorta and mediastinal area an appearance of a “3”

115
Q

Anticoagulation w/ mechanical aortic valve

A

Warfarin AND ASA

116
Q

Cardiac syndrome

A

Young woman who presents w/ symptoms of classic angina but normal workup

Kinda like fibromyalgia but cardiac version

117
Q

Infection related glomerulonephritis

A

Mostly caused by S. aureus in America

Associated w/ low complement and IgA, elevated urine protein-creatinine ratio, and proliferative glomerulonephritis on biopsy w/ subepithelial hump deposits

118
Q

Treatment for microscopic colitis

A

Budesonide

119
Q

Lab to order if you want to r/out Strep infection

A

ASO

120
Q

Meds you can order for hiccup

A

Gabapentin
Thorazine
Baclofen

121
Q

Intracranial Hypotension

A

Noted by orthostatic headache that improves after laying down; may have falsely localizing exam w/ CN VI palsy

Tx: Epidural blood patch; examine for CSF loss

122
Q

Maintenance chemo for patients who have received 6 cycles of cisplatin + pemetrexed therapy for non small cell pulmonary adenocarcinoma

A

Pemetrexed maintenance chemotherapy

123
Q

Way to check if hypokalemia is due to renal losses

A

Spot Urine K+ : Cr ratio

> 13 indicates renal losses

Consider Falconi syndrome, Vitamin D deficiency in these cases

124
Q

21-Gene recurrence score for breast cancer

A

If <10%, patient’s w/ ER +, Progesterone + cancer just need tamoxifen

If > 10, also need adjuvant chemo

125
Q

AMPLE quick assessment

A 
Allergies
Medications 
Past Medical History
Last meal 
Recent events
126
Q

Treatment of carabapenemase producing Klebsiella

A

Colistin, tigecycline, ceftazidime-avibactam

127
Q

Electrolyte abnormality associated w/ high respiratory failure mortality

A

Hypophosphatemia; repletion associated w/ better outcomes

128
Q

Living will

A

ONLY GOES INTO EFFECT AFTER PATIENT IS IN A VEGETATIVE STATE

THEY CAN BE FULL CODE PRIOR TO THIS

129
Q

When to start chemical thromboprophylaxis in hemorrhagic CVA patient

A

With 48 hours of no continued bleeding evidence on MRI

130
Q

Lab to measure in management of hypoparathyroidism

A

Urine calcium; want to limit long term hypercalciuria

131
Q

Calcineurin-inhibitor induced HTN

A

Caused by upregulation of the NaCl channels in the DCT

Treat w/ thiazides

132
Q

Papillary fibroelastoma

A

Small lesion on a myocardial valve usually associated w/ a stalk

Tx: Surgery if symptomatic; controversial if asymptomatic

133
Q

Treatment for cryptococcal meningitis

A

Liposomal amphotericin B + Flucytosine

134
Q

Medication to add for diuresis when loop diuretics fail in nephrotic syndrome

A

Thiazide diuretics

135
Q

Preferred treatment for methemeglobinemia

A

Methylene blue; indicated for methemeglobin levels >20% and works by causing NAD+ to convert Fe3+ (shifts Hgb-dissoctaion curve to left) to Fe2+, the natural state of Hgb within the RBC

136
Q

Causes of methemeglobinemia

A

Dapsone, Reglan, antimalarials, and topical anesthetics

  • Risk is intensified in patients w/ G6PD deficiency
  • Check w/ Masmo oximeter
137
Q

Erythromelalgia

A

Pain, numbness, and burning in the feet/hands associated w/ erthrocytosis

138
Q

Indications for parathyroidectomy in hyperparathyroidism

A
  • Calcium level >1 above normal
  • CrCl <60
  • 24hr urine calcium >400mg/day
  • Presence of nephrolithiasis on imaging
  • T score < -2.5
  • Age <50

Otherwise, just SERIALLY MONITOR serum calcium, creatinine, and BMD q6months

139
Q

2nd most common cause of thunderclap headache

A

Reversible Cerebral Vasoconstriction Syndome

Presents w/ multiple thunderclap headaches over a short period of time; can be brought on by vasoactive substances and SSRIs

Dx/Tx: CTA/MRA; CCBs

140
Q

Patients who need abx prophylaxis for SBP

A

Ascitic fluid protein level <1.5 AND (one of these):

  • Serum Na <130
  • Serum Cr >1.2
  • Serum BUN >25
  • Serum bilirubin >3
  • Child-Turcotte-Pugh Class B or C cirrhosis
  • Any previous episode of SBP

Tx; Lifelong Ciprofloxacin

141
Q

Microvascular angina

A

Patients w/ typical angina and found to have elevated cardiac biomarkers HOWEVER have normal coronary angiography; patients are typically female and in their 50s

Typically, cardiac MRI will reveal perfusion defects though

Tx: CCBs

142
Q

When to stop denosumab therapy

A

Never; it only works as long as it is being administered; DEXA isn’t even recommended while on therapy

143
Q

Standard therapy for castrate-positve prostate cancer

A

GnRH agonist + docetaxel

144
Q

Meds patients who have had bariatric surgery cannot take

A

NSAIDs

145
Q

Therapy for most athersclerotic renal disease

A

ACEI; only in severe cases is there an intervention performed

146
Q

Periop management of SCD patients

A

Transfuse to Hgb 10

Ensure Incentive spirometry post op

147
Q

Hallmark of therapy for IgA nephropathy

A

ACEI/ARB

Obviously, with more progressive disease, will need more severe interventions but these meds are proven to slow progression

148
Q

Treatment of chronic HBV that is in the immune reactive phase

A

Tenofovir

149
Q

Required overlap for warfarin bridging

A

5 days with at least two documented therapeutic INRs

150
Q

Telogen effluvium

A

Most common cause of diffuse alopecia in women that occurs commonly after pregnancy (can occur after any physiologically stressing event as well)

Generalized, nonscarring alopecia that presents as excessive shedding

Typically resolves spontaneously in 6-12 months

151
Q

a-blocking agent to start before removal of pheochromocytoma

A

Phenoxybenzaprine

152
Q

What to do with heparin after cardiac cath

A

STOP IT UNLESS OTHERWISE INSTRUCTED

153
Q

Complication when you anticoagulate someone after cardiac cath or fail to compress the radial artery

A

Pseudoanyeursm

Can threaten the function of the hand as a whole; if > 2 cm or expands rapidly, may need surgical intervention

154
Q

Level at which a 1mg dexamethasone suppression test is positive

A

> 5

155
Q

Hepatosplenic candidiasis

A

Presents in patients w/ acute leukemia, prolonged neutropenia, and/or long term vascular access; often times septic w/ RUQ pain

Labs/Imaging: Elevated AP, hypodensities in the spleen, liver, and sometimes kidneys

Patients should remain on antifungal therapy as long as they are expected to be neutropenic

156
Q

Treatment of Barrett’s with associated dysplasia

A

Endoscopic ablation

157
Q

Tool to use to grade whether someone should undergo urgent angiography

A

TIMI score

158
Q

Elevated opening pressure on LP

A

> 20mmHg

159
Q

Secondary focal segmental glomerulosclerosis

A

Most common form of FSGC in black persons and accounts for 40% of idiopathy nephrotic syndromes

Patients typically have subnephrotic range proteinurea due to effacement of the podocytes due to hyperfiltration reactive changes

Found in black persons, obese persons, and premature born people

160
Q

Lipoprotein glomerulopathy

A

Characterized by mod-severe proteinurea, progressive renal failure, and biopsy revealing glomerulocapillary dilation due to lipid thrombi

<100 cases ever reported so this is not a great card lol

161
Q

Treatment for chronic cervical stenosis

A

Physical therapy + pain control

162
Q

Eval of hypercortisolism

A

Initial testing (should include 2):

  1. Low dose dexamethasone suppression
  2. 24hr urinary cortisol
  3. Late-night salivary cortisol

If positive =» ACTH level

If high =» Pituitary MRI

163
Q

In what situation does Hungry Bone Syndrome occur?

A

Occurs post-parathyroidectomy when calcium suddenly enters the bone matrix from the serum due to sudden loss of PTH

164
Q

What medications are NOT helpful in treating SLE?

A

TNF-a inhibitors. In fact, may make disease worse

165
Q

What medication can be used to treat refractory SLE on multiple immunomodulating therapies?

A

Belimumab, a B-lymphocyte stimulator inhibito (BLyS). This marker plays a substantial role in the development of SLE and is indicator for mild-moderately active lupus in addition to standard therapies

166
Q

Testing following treatment for H. pylori

A

At 4 weeks, you can confirm eradication via:

  1. Urea breath test OR
  2. Monoclonal stool antigen testing
167
Q

Work up for single, isolated inguinal lymph node

A

Perianal inspection (and genital) and anoscopy

168
Q

Treatment of ulcers in Behcet’s Syndrome

A

Topical Glucocorticoids

169
Q

Tumoral Calcinosis

A

AR disorder affecting FGF-23, the major phosphaturic hormone

=» Increased phosphorus reabsoprtion in the PCT

-Patients may have tumor-like calcifications

Tx: Low phosphorus diet

170
Q

Low FEV1, normal FEV1/FVC ratio, normal DLcO

A

Obesity Hypoventilation Syndrome

171
Q

Patient with systemic sclerosis who now has diarrhea with most meals

A

SIBO

40-70% of patients with DSSc have decreased small bowel motility that leads to SIBO

Dx: Glycogen breath test or jejunal aspirate culture

Tx: Screen for deficiencies, rotate abx, try probtioics (nothing perfect to do)

172
Q

Scoring system to evaluate a TIA patient’s risk for stroke in the next 48 hours

A 
Age - 60 or older
B- >140/>90
C- clinical features (+2 if unilateral weakness; +1 for speech only)
D- duration of symptoms 
D- diabetes
173
Q

When to treat prostate cancer bone mets with zoledronic acid

A

If they are castrate resistant

IF they are susceptible to ADT, only need to treat with this HOWEVER these patients to need DEXA prior to therapy to screen for underlying osteoporosis so they may need it anyways

174
Q

Superficial venous thrombosis management

A

ASH: Anticoagulation for 6 weeks if ≥5 cm in length, close to the deep venous system, or other thrombophilic risk factors exist

CHEST: Fondaparinux for 45 days if increased risk for clot progression (extensive SVT; involvement above the knee; severe symptoms; involvement of the greater saphenous vein; history of DVT, PE, or SVT; active cancer; recent surgery)

If not anticoagulated, follow up in 1 week and image if symptoms are persistent or worsening

175
Q

Protamine adverse effects

A

Protamine adverse effects include allergic reactions, hypotension, bradycardia, and respiratory toxicity.

176
Q

Side effect of PPIs

A

Hypomagnesemia has become increasingly recognized in patients taking proton pump inhibitors (PPIs) and is listed as a potential adverse effect in package inserts. The longer duration a person has been taking PPIs, the greater the likelihood of developing hypomagnesemia.

Because urine magnesium levels are low in patients with hypomagnesemia, the presumed mechanism is believed to be inhibition of the magnesium transporters in the gastrointestinal tract. Recent genomic analysis has identified a genetic polymorphism in the TRMP 6 magnesium transporter in patients with PPI-induced hypomagnesemia. Until the hypomagnesemia is corrected, the kidney will continue to waste potassium, making correction of hypokalemia difficult.

177
Q
A

MKSAP (15 decks)

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