mksap 3 Flashcards
(188 cards)
1
Q
timing ccy
A
prior to d/c
2
Q
Na levels in pregnancy
A
mild hyponatremia
3
Q
crest is
A
calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia
4
Q
expiratory plateau on flow/volume loop
A
variable intrathoracic upper airway obstruction
5
Q
rx neuroendocrine tumor
A
even if metastatic, can often monitor with imaging q3-6 months. if symptomatic, somatostatin anologue
6
Q
SDH indications for drainage
A
thickness of 10 mm+, midline shift 5 mm+, sig Neuro compromise
7
Q
exanthemous drug eruption
A
means widespread
8
Q
DRESS new dame
A
DIHS
9
Q
1 and #2 for FSGS rx
A
prednisone, then cyclophosphamide
10
Q
how often Pap smears in IBD
A
annually
11
Q
rx anthrax
A
doxy or fluoroquinolone, + 2nd agent (e.g., penicillin, meropenem, vancomycin), and a protein synthesis inhibitor (e.g., linezolid, clindamycin if active
12
Q
dermatitis herpetiformis
A
grouped, pruritic, erythematous papulovesicles and erosions, associated w/ celiac disease
13
Q
when to start 2 agents for HTN?
A
If above goal by 20/10
14
Q
uric acid stone
A
rhomboid, needle, hexagon
15
Q
when stopping denosumab do what?
A
start alendronate
16
Q
PPI dose after ulcer
A
high dose x 2 weeks
17
Q
smallpox
A
high fever, malaise, vomiting, headache, backache, and severe abdominal pain several days before the onset of the skin eruption
18
Q
initial eval of bronchiectasis
A
immunoglobulin measurement and assessment for connective tissue disease
19
Q
checkpoint inhibitor diarrhea rx?
A
Methylpred + withdrawal
20
Q
cluster headaches rx
A
oxygen and SC sumatriptan
21
Q
vaginal lichen sclerosis
A
atrophic white plaques or papules
22
Q
colchicine in gout
A
if severe refractory to steroids
23
Q
rx idiopathic cough
A
pseudoephedrine and benadryl
24
Q
rx UC that is not responding well to steroid taper
A
azathioprine and infliximab
25
claudication and PAD first line
"supervised exercise training"
26
reversal agent for dabigatran
idarucizumab
27
reversal for apixaban
4 factor prothrombin complex concentrate or andexanet
28
high intensity statin
atorvastatin or rosuvastatin
29
surgical decompression in spinal mets
<65, single area of compression, paraplegia <48 h, predicted survival>6mo
30
diagnoses CLL
flow cytometry, do not need BMBx
31
urine osms in DI
low! vs. high in solute diuresis such as urea diuresis
32
MALT rx
RTX, if gastric can start with PPI+H pylori rx first; if localized are sensitive to radiatio
33
rx IPF
pirfenidone or nintedanib; pred/azathrioprine worsens outcomes
34
which agent to drop in triple therapy after MI
aspirin
35
FDA approved meds for fibromyalgia
Pregabalin, duloxetine, milnacipran
36
causes of hyperprolactinemia
overt hypothyroidism
37
central vs OSA
in central, would not see rib cage trying to work
38
finerenone
used to decrease proteinuria after max ace/arb in diabetes, non steroid mineralocorticoid antagonist
39
age PSA
55-69
40
aspergillus angle
45 degrees
41
VZV vaccine?
50+, even if patients have received the active vaccine previously
42
when to start sumatriptan?
after 3x NSAIDs not working
43
insulinoma cancer syndrome?
MEN1 PTH glands, anterior pituitary, pancreatic islet cells. MEN2 does not have hereditary cancer syndrome
44
Crohn's management
1) immunomodulator (azathioprine+6MP), if this fails, add 2) TNF alpha inhibitor: infliximab, adalimumab, certolizumab
45
Post-transplant lymphoproliferative disorder
PTLD; EBV
46
SJS vs TEN
SJS <10%, TEN >30%
47
if can't tolerate alendronate
try zolendronic acid, can cause 3 days of systemic symptoms+HA, if all fails then denosumab
48
what asx INR to reverse
>10; if also life threatening bleeding, add prothrombin complex concentrate
49
***ESBL infections for test purpuses
not cefepime, use carbapenems
50
AML treatment after induction
if high risk (secondary AML from prior chemo or high risk mutations), stem cell transplant, if low risk, consolidative
51
hydroxyurea side effect
macryocytic anemia, no hemolysis vs B12 deficiency has hemolysis
52
acyclovir and the kidneys
needle deposition!
53
AVNRT P waves
Hidden. In A tach can see them
54
opioids and hormones
can cause low T
55
how long to withhold aspirin in hemorrhagic conversino
2-7days
56
DAPT and surgery
required for 1 mo bare metal, 3-6 DES, can drop plavix PRN for surgery 5d prior
57
rx transfusion dependent MDS
Lenalidomide - decreases transfusion need - if 5q− mutation present
58
Peutz-Jeghers
2/3 criteria: 2+ PJS-type hamartomatous polyps in GI tract; melanotic macules in the mouth, buccal mucosa, nose, eyes, genitalia, or fingers; family history of PJS
59
thalassemia smear findings
target cells
60
cancer of unknown primary
just treat
61
rx epididymitis if RF for STI
ceftriaxone+levofloxacin; doxy would be ok in a young man or a man that does not have insertive anal intercourse
62
unique thrombosis to PV
splenic
63
when to exchange emergently placed catheters?
<48h in new site
64
SJS/TEN treatment
supportive care
65
Center criteria
fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough: 2 or fewer do not need testing
66
BP before TPA
<185/110 , use labetalol or nicardapine to get there
67
rx membranous nephropathy:
conservative x 3-6 months, see if it self-resolves
68
rx gout CKD or intolerant of allo
febuxostat
69
idioventricular rhythm
post MI complication, beats come from the ventricles, so like a wide but slow VT. Junctional come from AV area so QRS narrow
70
PPI's after EGD
can do once daily if low risk lesion. for high risk lesions, 80 IV x 72 h then for 2 weeks after
71
hemochromatosis
HFE gene, DM, hook shaped osteophytes
72
Antisynthetase syndrome
Mechanic's hands, Gottron papules, arthritis, Raynaud, ILD are more common in patients with antisynthetase syndrome than in other forms of dermatomyositis.
Ab to aminoacyl-transfer RNA synthetases, most commonly anti–Jo-1
73
Anticentromere
CREST
74
cervical cancer treatment
stage I+II hysterectomy, stage III cisplatin +radiation
75
papillary thyroid cancer and thyroid supplementation
TSH stims the tumor, so give a high dose of levothyroxine to suppress the TSH
76
irregular bleeding
start with endometrial bx
77
DISH
Diffuse idiopathic skeletal hyperostosis - noninflammatory, causes back pain and stiffness W/OUT SI pain, 45+
flowing linear calcification and ossification along the anterolateral aspects of the vertebral bodies.
78
aspirin for primary prevention
in favor: 40 to 59 years who are at high risk for ASCVD and do not have an increased bleeding risk; against: over 60 or on a/c
79
does MKSAP believe in changing diuretics ie lasix to bumex?
no
80
labyrinthitis
postviral inflammation of the vestibulocochlear nerve (cranial nerve VIII)->sudden-onset, severe, persistent vertigo and hearing loss. Rx with pred
81
rheumatoid nodules
sublpelural nodules can be solid or cavitary, can cause fistula
82
salvage h pylori
Bismuth, tetracycline, metronidazole, and omeprazole x 14 d
83
stage II HTN
>140 start therapy don't just try lifestyle
84
when to refer for liver transplant
MELD >15 or signs of decompensation; treating HCV in decompensated patients is not good
85
threshold for bisphosphonates
≥3% at the hip or ≥20% for major osteoporosis-related fracture)
86
Bactrim and the kidney
decreases secretion of creatinine without changing the GFR, so creat goes up
87
Vaccines for the asplenic
Hemophylis influenza and MenB
88
seizure med with mood issues
keppra
89
what's the treatment for campylobacter
azithromycin
90
treatment of IgA nephropathy
ACE/ARB: lowers intraglomerular pressure resulting in decreased excretion of proteins; steroids would be after failure of this
91
first line for etoh use disorder
naltrexone and acamprosate
92
how do diagnoses diabetes
2 abnormal tests: A1C>6.5+, fasting glucose 126+, 2h plasma glucose test 200+
93
test for hyper secretion in pituitary mass
prolactin and ILGF1
94
lichen Planus association and appearance
looks like a purple polygonal papule, associated with liver disease
95
ibrutininib side effect
a fib
96
UC biliary association
PSC
97
keratocanthoma
SCC variant, looks like a volcano
98
med for quitting smoking
varenicline
99
ivabradine
a fib, HFREF<35, HR>70 despite max tolerated BP meds
100
sideroblastic anemia
blue dots in ring around erythrocyte precursors, MDS, EtOH, Cu, Pb, linezolid, isoniazid
101
unexplained cough rx
gabapentin??
102
Ankylosing spondylitis bowel disease?
IBS
103
systemic sclerosis GI manifestation
SIBO
104
aspirin after GIB
stop if primary prevention, resume after hemostasis if secondary prevention
105
subsolid nodule monitoring 6-10mm
1 year, then q2 for 5
106
ILD in systemic sclerosis rx
MMF
107
MGUS
M protein< 3 g/dL (or less than 500 mg/24 h of urinary monoclonal free light chains), clonal plasma cells<10% of the bone marrow cellularity, absence of related signs and symptoms of end-organ damage
108
flexural surfaces rash
atopic dermatitis
109
ICD indications in HOCM
prior arrest, prior VT
110
septal reduction indications
receiving GDMT but still sx, and LVOT gradient 50 or great
111
SJS/TEN mucosal involvement #
2+surfaces
112
bp in first 48h after syroke
let it autoreg for 220/120
113
ddx benefit in mening which organism
s pneump
114
best influenza test
NAAT not antigen
115
test for WNV?
IgM, because virus has cleared by the time you have symptoms; impacts the basal ganglia and can cause rash
116
EF cutoff for preserved
50%
117
rx aspirin OD
respiratory alkalosis, AGMA, metabolic alk. Rx with bicarb, increases urine pH goal >7.5 to keep salicylic acid from the CNS. serum pH at 7.50 to 7.55 avoids CNS accumulation
118
staining on kidney biopsy ANCA vs GBM
ANCA: crescents, GBm: linear
119
goal INR mechanical mitral
3
120
rx levodopa induced dyskinesia
amantadine
121
new bcl next test?
LDH - helps decide how aggressive to be with rx - don't need MRI or BMBx
122
rapid onset chorea
pregnancy
123
treat extensive AK's?
5FU
124
androgen deprivation therapy screening?
DEXA
125
travellers diarrhea
self limited 5-7 days, just support. for moderate/severe sx, give azithro
126
RAA on EKG
peaked P waves in II, III, aVF
127
eval diabetic foot ulcer with probe to bone+
plain film->MRI->bx
128
teardrop erythrocytes
myelofibrosis
129
age lung cancer screening!!!
50-80, 20-pyhx, currently smoke or have quit within the past 15 years. d/c screening once a person has not smoked x 15y
130
LV wall thickness athlete heart vs HOCM
<13 mm athlete heart
131
seoncdary memranous glomerulonephritis causeses
infections like hep C
132
Type A dissection mgmt?
Open repair
133
SIADH paraneoplastic?
SCLC
134
Serotonin syndrom vs NMS
1) serotonin syndrome has hyperreflexia and myoclonus, rx with benzos vs. NMS d/c the agent, cool
135
acute bronchitis (9 days sx)
no imaging! supportive care
136
rx back prostatic not sexually active
bactrim
137
cutoff for aortic repair in bicuspid AV
4.5 if severe AS/AR, 5.5 if no other issues, or >5 with additional RF for dissection
138
colon cancer PET?
no
139
rx urge incontience
timed voiding, then oxybutynin/mirabegron
140
oseltamivir
give even after 48 h!!
141
rx hyperprolactinemia from antipsychotics?
estrogen/progesteron. cabergoline can induce psychosis so not that
142
eosinophilic granulomatosis with polyangiitis
asthma, mononeuritis multiplex, cutaneous deposits
143
graves in pregnancy
PTU, especially in the first trimiester
144
fractional exhaled nitric oxide (FeNO)
eosinophilic airway inflammation
145
acute cutaneous lupus
butterfly rash, arhtraglia vs. subacute cutaneous lupus: often patients do not have true SLE - annular and polycyclic photosensitive plaques on the back, chest, and extremities, or psoriasiform scaly plaques in a similar distribution
146
rx nausea chemo
serotonin antagonists, neurokinin-1 receptor antagonists, glucocorticoids, and olanzapine
147
brucellosis
more insidious than tularemia
148
rx gout
colchicine, NSAIDs, steroids
149
scabies dx
mineral oil, vs KOH for tinea
150
RIPE therapy CNS dx adjuvant?
steroids
151
symptomatic hyponatremia
desmopressin+3%
152
anti seizure meds in pregnancy
lamotrigine and keppra
153
positive FABER
SI joint
154
PPI risk kidney disease
can hasten progression of CKD
155
oral abx for pyelo?
fluoroquinolones
156
suspected scaphoid fxr normal xr
splint+repeat in 2 weeks or MRI now
157
scleroderma renal crisis
hemolytic anemia, thrombocytopenia, seizure, HTN - rx captopril
158
lumbar plexopathy association?
diabetes
159
eval fasting hypoglycemia?
72h fast, vs mixed meal test for postprandial hypoglycemia
160
G6PD
BITE CELLS
161
OSTIUM SECONDUM ASD
Clinical findings in patients with an ASD include a parasternal impulse, fixed splitting of the S2, and a pulmonary outflow murmur. ON EKG right axis deviation (negative QRS in lead I with positive QRS in leads II, III, and aVF) and incomplete right bundle branch block (QRS duration <120 ms, prominent S wave in lateral leads, and prominent qR in V1
162
early salicylate toxicity
resp alk/AGMA
163
fundic gland polyp f/u
no
164
light's
>.5 pleural/serum ptn, LDH ratio >.6, LDH>2/3 ULN serum
165
rx salmonella gastroenteritis?
only if typhoid, otherwise leads to prolonged shedding
166
rx metastatic melanoma
anti–CTLA-4 antibody plus an anti-programmed death antibody; use BRAF therapy if they have a BRAF mutation
167
timed up and go test
>12 should prompt intervention for fall risk
168
essential tremor improves with?
EtOH, propranolol, primidone
169
elevated urine ptn
upep
170
PEP
hep a vaccine, +igg if>40
171
subacute pji
staph epi, cutibact
172
UTI rx
3 days Bactrim, 5 days nitro, 1 day fosfo
173
rx AI hep
azathioprine, prednisone x 3 years, then bx, think about stopping if history quiet
174
Static mattress overlay
prevents pressure wounds the best
175
ulnar neuropathy also
makes it hard to pinch btw thumb and index
176
cutaneous anthrax
painless, from animal hide
177
social isolation/CAD
risk factor!
178
crypto meningitis management
ambisome, flucytosine, LP to decrease pressure
179
immune checkpoint inhibitors intracranial issue
hypophysitis
180
levothyroxine in pregnancy
increase by 30-50% in the first trimester. TSH should be maintanied at <2.5 or in the lower half of the trimester specific range
181
cilostozol c/i
HFrEF<40%
182
primary adrenal insufficiency
hyperpigmentation
183
hi calcium low urine calcium
familial hypocaclin*. if Vit D toxicity would see low PTH and hi urine calc
184
IgA nephropathy
hematuria after races or when ill, monitor
185
postural hypotension in Parkinson's
increase the carbidoba part of things, can be a levodopa side effect
186
Dengue
petechial rash after BP cuff deflation, LFT's aches, HA's - similar to Chikungunya but no peticheia in that
187
CT colonography frequency
5 years
188
