MKSAP 1

Question 1

Rx crypto meningitis

Answer 1

Ampho B+flucytosine, consolidate to fluc

Question 2

Ppx travelers diarrhea in high risk (IBD, CKD, IC)

Answer 2

rifaximin

Question 3

urgent test after TIA

Answer 3

carotid US

Question 4

ferric carboxy side effect

Answer 4

hypophos

Question 5

Radiographic findings of osteonecrosis

Answer 5

Increased density of the femoral head (white) and then cysts (black) - associated with SLE

Question 6

acute rehab how active

Answer 6

3 hrs therapy 5 days/week

Question 7

Membranous nephropathy: typical antibody + next steps if negative

Answer 7

PLA2R (phospholipase A2 receptor) - if negative, look for malignancy

Question 8

best discharge med for etoh cessation?

Answer 8

injectable naltrexone

Question 9

workup for suspected BPH

Answer 9

UA: infectious or hematuria (s/o malignancy)

Question 10

SBP rx in addition to abs?

Answer 10

Albumin if bili>4

Question 11

Buerger test for PAD

Answer 11

pallor with foot elevation, rubor when dependent

Question 12

Inclusion body vs polymyositis vs statin induced

Answer 12

Inclusion body: slow, also involves distal areas, usually symmetric. Poly: weeks to months, only proximal muscles.

Question 13

Immune tolerant Hep B

Answer 13

HBeAG positive, antibody negative, DNA elevated, treatment not recommended

Question 14

Transfusion associated GVHD

Answer 14

In immunocompromised patients after transfusion -exanthem that can progress to bullous, can be fatal - blood should be irradiated to prevent

Question 15

CRT for what QRS

Answer 15

> 150

Question 16

Meds after SAH

Answer 16

PO nimodipine

Question 17

Positive PPD size

Answer 17

> 5 mm high risk, >10 possible exposure, >15 no risks

Question 18

Graves vs. destructive thyroiditis how to rx

Answer 18

Grave’s: methimazole/PTU, >30% uptake. Destructive: atenolol

Question 19

Still’s disease - sx and how to rx?

Answer 19

Salmon rash, joint effusion, pericardial rub - rx with anakinra (IL6 therapies)

Question 20

Long PTT that doesn’t correct with mixing

Answer 20

Acquire hemophilia A (factor VIII deficiency) - rx with factor VII

Question 21

AAA screening?

Answer 21

65-75 men who have smoked 5 packs of cigarettes in their lifetime!

Question 22

chancroid organism, and distinction from syphilis

Answer 22

Hemophylis ducreyi, and painful, multiple, tender LAD

Question 23

VWF vs. Factor VIII deficiency

Answer 23

VWF with abnormal platelet fxn testing, also Hemophilia A is x linked recessive

Question 24

Heterozygous HFE mutation

Answer 24

No need for monitoring,

Question 25

Screening with testosterone for gender transition?

Answer 25

Hct

Question 26

ACROMEGALY DX?

Answer 26

Insulin-like GF 1 measurement

Question 27

Reduce CV death, MI, stroke in PAD?

Answer 27

Low dose rivaroxaban+aspirin

Question 28

Familial Mediterranean fever - features and rx?

Answer 28

fever, and pain, rash, arthritis x several days - lifeline daily colchicine - prevents attacks and renal amyloidosis

Question 29

Imaging if dementia suspected?

Answer 29

<3 years of sx - MRI or CT without contrast

Question 30

Refractory essential tremor

Answer 30

First line: propranolol, primidone, topiramate (c/I in kidney stones), after that DBS and US thalamotomy

Question 30

Refractory essential tremor

Answer 30

First line: propranolol, primidone, topiramate (c/I in kidney stones), after that DBS and US thalamotomy

Question 31

BPPV duration of symptoms

Answer 31

latency of 2-20 seconds, last <1 min, fatiguable with multiple maneuvers

Question 32

PE in pregnancy rx?

Answer 32

lovenox

Question 33

Treatment refractory RA

Answer 33

Triple therapy (MTX, hydroxychloroquine, sulfasalazine) or a biologic (s/a adalimumab)

Question 34

Cryoglubulinemia

Answer 34

Low C4, high RF, palp purpura, digital ischemia, neuropathy, arthralgia, glomerulonephritis (usually membranoproliferazive)

Question 35

first line for allergic rhinitis?

Answer 35

intranasal steroids

Question 36

Khorana score

Answer 36

Calculates risk of VTE in patients priort to starting chemo

Question 37

Clinical manifestations of cardiac sarcoid

Answer 37

new conduction disease and arrhythmia

Question 38

Nec fasc rx?

Answer 38

Clinda+penicillin (some Clostridium is resistant to clinda)

Question 39

Rx symptomatic PVCs

Answer 39

Beta blocker or non-dihydro calcium channel blocker (verapamil), beta blockers preferred if ventricular dysfxn. If >10% burden, can cause CM

Question 40

Migraine prevention

Answer 40

5+ days/month. SNRI, propranolol, timolol, venlafaxine, amitrip, topiramate, valproate, eptinezumab

Question 41

multiple myeloma on smear

Answer 41

roleaux

Question 42

Echinocytosis

Answer 42

RBC with small spurs around it - is from liver disease OR uremia

Question 43

Treatment low risk low back pain?

Answer 43

Non-pharm (heat, massage, etc) before NSAIDs

Question 44

CD4 counts for MAC vs. TB

Answer 44

MAC rarely if CD4>50

Question 45

Rx pseudo gout

Answer 45

intra-articular steroids

Question 46

DVT ppx in surgery for malignancy duration?

Answer 46

One month if abdominal or pelvic surgery and additional RF

Question 47

Rx CLL?

Answer 47

ibrutinib, IVIG to reduce risk of infection

Question 48

Anal cancer treatment?

Answer 48

Chemo and radiation, not surgery

Question 49

contraindications to anti-arrhythmic?

Answer 49

ischemic heart disease

Question 50

kidney stones after gastric bypass?

Answer 50

calcium oxalate (because fat malabsorption)=calcium also not excreted

Question 51

NMS drugs?

Answer 51

Antipsychotics OR withdrawal of sinemet

Question 52

TII RTA (=proximal)

Answer 52

NAGMA, low K, glycosuria, phos wasting - vs. TI: hypokalemic distal: low K, NAGMA, urine pH>6, stones, T IV=hyperk, Liddle=HTN, metabolic alkalosis, low k

Question 53

TPA window?

Answer 53

3 hrs