December MKSAP Flashcards
Which features on colonoscopy warrant close surveillance intervals (3-6 months)?
Large adenomas, > 2 cm
Adenomas w/ invasive carcinoma and favorable prognostic features
What are the indications for parathyroidectomy in PHT?
- GFR<60
- 24h Urine calcium > 400 mg
- Nephrolithiasis or calcinosis on CT, U/S, or KUB
- Age < 50
- Serum Ca > 1 above ULN
- T-score < -2.5
How do you treat major bleeding in a patient with supratherapeutic INR on warfarin?
IVF, vitK, and 4-factor prothrombin complex (4f-PCC or K-centra). 4f-PCC is more advantageous to FFP because it can be stored at room temp, smaller volume and faster admin, and does not require ABO typing. Also shown in RCT to achieve faster hemostasis with lower risk of volume overload.
What is Parkinsonian-hyperpyrexia syndrome?
Withdrawal from dopaminergic meds in Parkisonian patients that presents with rigidity, hyperthermia, rhabdo, AMS and often similar to NMS or malignant hyperthermia. Tx by restarting home meds.
What are the indications for 3 year colonoscopy?
Large (>10 mm), sessile serrated, or traditional serrated adenomatous polyps
What are the features and epidemiology of small cell lung carcinoma (SCLC)?
15% of lung cancers are SCLC. 85% are NSCLC with the top two causes being adenocarcinoma (38% of lung cancers) and squamous cell carcinoma (20%). SCLC tend to be more aggressive and present dramatically with dyspnea, hoarseness, dysphagia with large hilar mass, bulky LAD, and disseminated disease; however, much more responsive to initial chemo and XRT. The key association is Lambert Eaton syndrome.
How do you treat essential thrombocytosis and what are the indications?
Hydroxyurea + ASA. Age > 60, plt > 1 million, and history of thrombosis.
How do you establish and work up Cushing’s syndrome?
There are 3 ways to screen: Low Dose dexamethasone Suppression Test (LDST), late night salivary cortisol (physiologically is the lowest level during the day), and 24-hour urinary free cortisol.
Once you meet 2 out of 3, you’ve secured the diagnosis. The next step is to measure ACTH.
How is refractory epilepsy defined and what do you do next?
Persistence of disabling seizures for at least 1 year despite being on adequate doses of 2 anti-epileptics. Get an MRI and if any structural defects refer to nsgy.
What is the approach to superficial transitional cell carcinoma?
Use transurethral resection of the bladder tumor (TURBT) and instilled BCG or mitomycin. If recurs within 6-12 months of initial TURBT or recurrence after 1-2 times of TURBT+BCG, then do cystectomy.
How do you manage pulmonary cryptococcus and what is the treatment/prognosis?
Check the CNS with LP. Requires fluconazole for 6-12 months, but many immunocompetent patients will self resolve.
