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ABIM > MSKAP3 > Flashcards

MSKAP3 Flashcards

1
Q

What should you think if a patient with SLE has a new foot drop? Best test? Tx?

A

Mononeuritis multiplex (vasculitis of vasa nervorum); EMG/NCS; more aggressive immunosuppression

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2
Q

If doing a R heart cath for suspected pulmonary HTN shows a mean PAP of 30 mmHg and an elevated PCWP what is the probable Dx? Tx?

A

WHO II Pulmonary HTN i.e. secondary to left heart failure and tx guided towards heart failure

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3
Q

What are D-Dimer levels in liver failure?

A

Often elevated (FDPs - fibrin degradation products) as they are cleared by the liver so not overly helpful in differentiating DIC from liver dz

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4
Q

What class of drugs are the first line for Type B aortic dissections?

A

Beta-Blockers i.e. esmolol gtt or labetolol

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5
Q

Patients with Lewy Body dementia have increased sensitivity to which meds?

A

Neuroleptic meds (already lacking some dopamine)

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6
Q

Small bowel bleeding is best treated with _______

A

Push enteroscopy; do after negative EGD and Colo or after + pill study

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7
Q

Cortisol replacement therapy should be initiated immediately in persons with confirmed adrenal insufficiency with a serum cortisol level < ____

A

3

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8
Q

What are some causes of malignant SVC syndrome? (5)

A

SCLC, NSCLC, Lymphoma, Thymoma, and Germ Cell Tumors

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9
Q

How should a patient with atrial fibrillation with a recent stent placement be treated?

A

Dual Antiplatelet Therapy (DAPT) and appropriate anticoagulation based on CHADSVASC so warfarin or DOAC + DAPT = triple therapy

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10
Q

Aside from RA what other condition is often RF+ and is often a vasculitic type of event?

A

Cryoglobulinemia (often w/ low C4, relatively normal C3); here there is a monoclonal protein and +RF w/ low C4 and nl C3

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11
Q

In whom can you see acute progressive disseminated histoplasmosis? Dx? Tx?

A

AIDS w/ CD4 <200, Heme malignancies who have new fever, weight loss and HSM; Dx w/ histo antigen in urine/blood or bone marrow Bx; Ampho B and long term suppressive Tx

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12
Q

Relative risk is often calculated from what kind of study?

A

Cohort studies; investigate the outcomes of similar patients w/ different exposures; the standard outcome measurement is relative risk

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13
Q

What is an obstructive pattern on PFT?

A

FEV1:FVC ration <0.7 and if there is a >12% response to bronchodilator test probably asthma

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14
Q

What progressive neurodegenerative disorder is triggered by repetitive mild head injuries and occurs in military combat victims and athletes in contact sports?

A

CTE- Chronic Traumatic Encephalopathy

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15
Q

What is the safest option for birth control in women with a history of migraine with aura?

A

IUD or condoms

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16
Q

Determination of ______ receptor status is indicated in all patients with metastatic gastric and GE junction cancer?

A

HER2; addition of trastuzumab to cisplatin + 5-FU or to capecitabine (prodrug of 5-FU); good to check if metastatic at Dx or if new metastatic lesions are found after remission

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17
Q

What is the appropriate first step in managing a probable malignant SVC syndrome?

A

Obtaining a histologic diagnosis

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18
Q

T/F: BOTH antipsychotics and SSRIs cause hyperprolactinemia

A

False; only antipsychotics have the dopamine blocking activity (DA= PIF; prolactin-inhibing factor)

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19
Q

Why might a patient with staphylococcal impetigo develop a blister at the site?

A

Exfoliative toxin (same toxin as staphylococcal scalded skin syndrome)

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20
Q

What is Type I Autoimmune Pancreatitis associated with?

A

IgG4

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21
Q

What are two conditions associated with Roth spots in the eyes?

A

Endocarditis and Leukemic retinopathy (i.e. CML)

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22
Q

Do you need to have proteinuria to have pre-ecclampsia?

A

No; If you have new HTN after 20 weeks of pregnancy w/ END-ORGAN damage; that counts too; this includes thrombocytopenia w/ the end organ being BM; concern is for HELLP

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23
Q

What is ambulatory blood pressure monitoring the most useful for?

A

Detecting Masked Hypertension- especially in patients with evidence of end-organ dysfunction i.e. LVH on EKG or AKI

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24
Q

Why is a right heart catheterization required in patients with probable WHO 1 (pulmonary arterial; primary) pulmonary HTN?

A

To confirm the hemodynamics and to determine if there is a response to vasodilator infusion because it guides further tx; in confirming the hemodynamic expect to see mean PAP of >25 mmHg and normal PCWP

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25
Q

What is the cornerstone of tx for Autoimmune pancreatitis?

A

Glucocorticoids

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26
Q

Prior use of what type of chemo predisposes to an increased risk for developing arthralgias on aromatase inhibitors?

A

Taxanes (Paclitaxel/Docetaxel)

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27
Q

How may the presentation of autoimmune pancreatitis differ from that of regular ethanol/GB pancreatitis?

A

It often has extrapancreatic organ involvement such as sclerosing cholangitis; need glucocorticoids; assoc w/ IgG4

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28
Q

What is the DLCO in asthma?

A

Normal as the alveolar-capillary surface area is preserved and so diffusing capacity is normal

29
Q

How do isopropyl, ethanol, and ethylene glycol differ in terms of lab values?

A

All 3 can cause encephalopathy; methanol and ethylene glycol will cause an anion gap metabolic acidosis and isopropyl will not, ALL increase the osmolar gap

30
Q

What is Perioral Dermatitis? In whom do you see it?

A

discrete papules and pustules w/o comedones on an erythematous base around the mouth; often seen as eruptions after the initiation of topical or inhaled corticosteroids

31
Q

A QTc greater than > _____ increases the risk for Torsades de Pointes

A

500 ms

32
Q

When is an ACTH stimulation test useful?

A

For borderline cases of adrenal insufficiency; suspect if pt is hyponatremic and hyperkalemic

33
Q

What is the difference between a “Bone Infarct” and “Avascular Necrosis”?

A

Bone Infarct: lesions occuring at the metaphysis and diaphysis; AVN occurs at epiphysis

34
Q

If you check for cryoglobulins and they are present you should then screen for what dz?

A

Hepatitis C infection; probably already ordered this when thinking of cryoglobulins though

35
Q

What is the treatment of a boil (simple furuncle) in an immunocompetent patient?

A

Incision and Drainage without antibiotics; if IC, systemic sx, or nonresponsive then: linezolid, TMP-SMX, Clindamycin, or Doxycycline

36
Q

What are some non-malignant causes of SVC syndrome? (2)

A

Thrombosis i.e. from CVC or fibrosing mediastinitis

37
Q

What is the best test for diagnosing HSV lesion?

A

DFA or PCR

38
Q

What is the next step in any patient with a possible implanted cardiac device infection with or without fever?

A

Two sets of blood cultures; most commonly S. aureus or coagulase negative staph

39
Q

A patient with a vasculitic picture who has ear infarctions probably has what?

A

Mixed cryoglobulinemia; This is often associated with LOW C4 but relatively preserved C3; you should check serum cryoglobulin levels; often RF+

40
Q

Patients with enteric hyperoxaluria may benefit from what drugs?

A

Bile salts i.e. cholestyramine to decrease absorption in the intestines; i.e. Crohns pt w/ calcium oxalate stone should get

41
Q

What is the most appropriate VTE ppx for patients undergoing cancer surgery especially if abdominal?

A

Enoxaparin (LMWH) for up to 28 days s/p surgery (cancer is prothrombotic and the prolonged immobility of surgery increases risk)

42
Q

How do you calculate the plasma osmolality?

A

(2 x Sodium) + (glucose/18) + (BUN/2.8)

43
Q

What kind of fluid is known to exacerbate hypophosphatemia and why?

A

Dextrose containing fluids as they stimulate insulin release which then lowers the phosphate; hypophosphatemia can lead to respiratory failure (poor diaphragmatic fxn) and rhabdomyolysis

44
Q

What is the preferred initial diagnostic test for a pregnant patient with probable PE?

A

LE US; if + then no need for CT-PE

45
Q

Explain difference in utilization of metal biliary stents and plastic stents?

A

Metal Biliary stents often used for palliation in malignant strictures; Plastic stents more useful if temporary in setting of a “dominant stricture” as they can be removed at a later date

46
Q

Why might looking at factor V, VII, and VIII be useful in patients with suspected coagulopathy of liver disease?

A

Patients with coagulopathy of liver disease have elevated PT (extrinsic pathway) and elevated PTT (intrinsic pathway); factor VII is low (extrinsic, elevated PT), factor V is low (common; elevated PT and PTT); and factor VIII is often normal as it is produced in the vascular endothelium AND you need a functioning liver to adequately clear factor VIII

47
Q

Mononeuritis multiplex is highly specific for what type of condition? Most common nerve affected?

A

Vasculitis; it is due to inflammation of the vasa nervorum which is a small vessel; Peroneal nerve - new foot drop in pt w/ SLE

48
Q

When is it safe to add a beta blocker to new HFrEF?

A

After the patient is euvolemic

49
Q

What is the most common immunodeficiency and what is the treatment?

A

Selective IgA deficiency; clinical observation w/ prn antibiotics for the recurrent sinopulmonary infections

50
Q

T/F: cholestasis in primary sclerosing cholangitis (i.e. conjugated/direct hyperbilirubinemia) is always assoicated with a dominant stricture

A

False- that may be the answer but there isn’t always one to stent and there is some evidence that cholestasis may be independent of a dominant stricture though that is certainly a possibility

51
Q

What is the first step in evaluating hyperprolactinemia?

A

Check a TSH

52
Q

In whom are pharmacologic vasodilators such as dypyridamole, adenosine, and regadenoson contraindicated in for cardiac stress testing?

A

Patients with any active wheezing; caution in patients with COPD (w/o wheezing)

53
Q

What do you do first in suspected Giant Cell Arteritis- steroids or biopsy?

A

Prednisone 60 mg daily; histopathology is still readable 1-2 weeks after starting steroids

54
Q

If both TSH and prolactin are high what should you do?

A

Treat the hypothyroidism first and the prolactin may normalize

55
Q

How can you treat arthralgias associated with aromatase inhibitor therapy aside from stopping the drug?

A

NSAIDs and Duloxetine can help

56
Q

What kinds of behavioral symptoms are seen in CTE (Chronic Traumatic Encephalopathy)?

A

Depression and disinhibition in a patient w/ hx of multiple concussions and subconcussions

57
Q

Why is IVIG not useful in selective IgA deficiency?

A

Because IgA is produced and secreted locally at the GI mucosa so IV formulation not useful; only useful in CVID, X-linked hypogammaglobulinemia, and CLL-associated hypogamma

58
Q

What is the approach to a patient with history of breast CA who develops arthralgias from aromatase inhibitor therapy?

A

Can switch to another AI but if the arthralgias continue then can try tamoxifen (Raloxifene also an option but not as effective as tamoxifen but w/ least side effects)

59
Q

What are two serious clinical outcomes associated with hypophosphatemia?

A

Respiratory failure secondary to impaired diaphragmatic function and rhabdomyolysis

60
Q

What is mononeuritis multiplex? What types of conditions is it associated with?

A

Abnormal findings in the territory of two or more nerves in separate parts of the body; highly specific for vasculitic conditions due to inflammation of vasa nervorum

61
Q

What do you do if a pregnant patient has acute cholecystitis?

A

Can safely perform a laparoscopic cholecystectomy esp. if in 2nd trimester

62
Q

What are the two main types of IUDs?

A

Levonorgestrel containing (hormone containing) or hormone free (copper); Levonorgestrel containing ones lead to significant diminution of menstrual bleeding

63
Q

What is Inverse Psoriasis?

A

Psoriasis that forms predominately at the skin folds

64
Q

What is oncogenic osteomalacia?

A

Bone pain w/ hypophosphatemia and low 1,25 hydroxy vitamin D with a normal 25-hydroxyvitamin D; often due to benign mesenchymal tumors from overexpression of FGF-23 which causes decreased phosphate resorption @the tubules and impairs calcitriol synthesis.

65
Q

How can you differentiate coagulopathy of liver dz from vitamin K deficiency?

A

Coagulopathy of liver disease will have low factor V (common pathway); Vitamin K def. will have a normal factor V level as it is not a vitamin K dependent factor

66
Q

What is Acne Keloidalis Nuchae?

A

Firm, skin colored lesions centered on hair follicles on the back of the neck in black ppl

67
Q

Where do adrenal insufficient patients typically have discoloration? Why?

A

Extensor surfaces and buccal mucosa due to increase production of MSH which is made from POMC

68
Q

What is a cohort study? What is the standard outcome measurement?

A

Study that investigates the outcomes of similar patients with different exposures; relative risk

69
Q

What transporter is responsible for refractory hypokalemia due to hypomagnesemia?

A

ROMK; Mg inhibits K secretion through ROMK; low Mg levels disinhibit this and lead to more K secretion

ABIM (18 decks)

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