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MKSAP > mksap 3 > Flashcards

mksap 3 Flashcards

1
Q

timing ccy

A

prior to d/c

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2
Q

Na levels in pregnancy

A

mild hyponatremia

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3
Q

crest is

A

calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia

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4
Q

expiratory plateau on flow/volume loop

A

variable intrathoracic upper airway obstruction

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5
Q

rx neuroendocrine tumor

A

even if metastatic, can often monitor with imaging q3-6 months. if symptomatic, somatostatin anologue

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6
Q

SDH indications for drainage

A

thickness of 10 mm+, midline shift 5 mm+, sig Neuro compromise

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7
Q

exanthemous drug eruption

A

means widespread

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8
Q

DRESS new dame

A

DIHS

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9
Q

1 and #2 for FSGS rx

A

prednisone, then cyclophosphamide

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10
Q

how often Pap smears in IBD

A

annually

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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

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12
Q

dermatitis herpetiformis

A

grouped, pruritic, erythematous papulovesicles and erosions, associated w/ celiac disease

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13
Q

when to start 2 agents for HTN?

A

If above goal by 20/10

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14
Q

uric acid stone

A

rhomboid, needle, hexagon

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15
Q

when stopping denosumab do what?

A

start alendronate

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16
Q

PPI dose after ulcer

A

high dose x 2 weeks

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17
Q

smallpox

A

high fever, malaise, vomiting, headache, backache, and severe abdominal pain several days before the onset of the skin eruption

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18
Q

initial eval of bronchiectasis

A

immunoglobulin measurement and assessment for connective tissue disease

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19
Q

checkpoint inhibitor diarrhea rx?

A

Methylpred + withdrawal

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20
Q

cluster headaches rx

A

oxygen and SC sumatriptan

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21
Q

vaginal lichen sclerosis

A

atrophic white plaques or papules

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22
Q

colchicine in gout

A

if severe refractory to steroids

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23
Q

rx idiopathic cough

A

pseudoephedrine and benadryl

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24
Q

rx UC that is not responding well to steroid taper

A

azathioprine and infliximab

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25
Q

claudication and PAD first line

A

“supervised exercise training”

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26
Q

reversal agent for dabigatran

A

idarucizumab

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27
Q

reversal for apixaban

A

4 factor prothrombin complex concentrate or andexanet

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28
Q

high intensity statin

A

atorvastatin or rosuvastatin

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29
Q

surgical decompression in spinal mets

A

<65, single area of compression, paraplegia <48 h, predicted survival>6mo

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30
Q

diagnoses CLL

A

flow cytometry, do not need BMBx

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31
Q

urine osms in DI

A

low! vs. high in solute diuresis such as urea diuresis

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32
Q

MALT rx

A

RTX, if gastric can start with PPI+H pylori rx first; if localized are sensitive to radiatio

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33
Q

rx IPF

A

pirfenidone or nintedanib; pred/azathrioprine worsens outcomes

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34
Q

which agent to drop in triple therapy after MI

A

aspirin

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35
Q

FDA approved meds for fibromyalgia

A

Pregabalin, duloxetine, milnacipran

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36
Q

causes of hyperprolactinemia

A

overt hypothyroidism

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37
Q

central vs OSA

A

in central, would not see rib cage trying to work

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38
Q

finerenone

A

used to decrease proteinuria after max ace/arb in diabetes, non steroid mineralocorticoid antagonist

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39
Q

age PSA

A

55-69

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40
Q

aspergillus angle

A

45 degrees

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41
Q

VZV vaccine?

A

50+, even if patients have received the active vaccine previously

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42
Q

when to start sumatriptan?

A

after 3x NSAIDs not working

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43
Q

insulinoma cancer syndrome?

A

MEN1 PTH glands, anterior pituitary, pancreatic islet cells. MEN2 does not have hereditary cancer syndrome

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44
Q

Crohn’s management

A

1) immunomodulator (azathioprine+6MP), if this fails, add 2) TNF alpha inhibitor: infliximab, adalimumab, certolizumab

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45
Q

Post-transplant lymphoproliferative disorder

A

PTLD; EBV

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46
Q

SJS vs TEN

A

SJS <10%, TEN >30%

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47
Q

if can’t tolerate alendronate

A

try zolendronic acid, can cause 3 days of systemic symptoms+HA, if all fails then denosumab

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48
Q

what asx INR to reverse

A

> 10; if also life threatening bleeding, add prothrombin complex concentrate

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49
Q

***ESBL infections for test purpuses

A

not cefepime, use carbapenems

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50
Q

AML treatment after induction

A

if high risk (secondary AML from prior chemo or high risk mutations), stem cell transplant, if low risk, consolidative

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51
Q

hydroxyurea side effect

A

macryocytic anemia, no hemolysis vs B12 deficiency has hemolysis

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52
Q

acyclovir and the kidneys

A

needle deposition!

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53
Q

AVNRT P waves

A

Hidden. In A tach can see them

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54
Q

opioids and hormones

A

can cause low T

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55
Q

how long to withhold aspirin in hemorrhagic conversino

A

2-7days

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56
Q

DAPT and surgery

A

required for 1 mo bare metal, 3-6 DES, can drop plavix PRN for surgery 5d prior

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57
Q

rx transfusion dependent MDS

A

Lenalidomide - decreases transfusion need - if 5q− mutation present

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58
Q

Peutz-Jeghers

A

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

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59
Q

thalassemia smear findings

A

target cells

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60
Q

cancer of unknown primary

A

just treat

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61
Q

rx epididymitis if RF for STI

A

ceftriaxone+levofloxacin; doxy would be ok in a young man or a man that does not have insertive anal intercourse

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62
Q

unique thrombosis to PV

A

splenic

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63
Q

when to exchange emergently placed catheters?

A

<48h in new site

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64
Q

SJS/TEN treatment

A

supportive care

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65
Q

Center criteria

A

fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough: 2 or fewer do not need testing

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66
Q

BP before TPA

A

<185/110 , use labetalol or nicardapine to get there

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67
Q

rx membranous nephropathy:

A

conservative x 3-6 months, see if it self-resolves

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68
Q

rx gout CKD or intolerant of allo

A

febuxostat

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69
Q

idioventricular rhythm

A

post MI complication, beats come from the ventricles, so like a wide but slow VT. Junctional come from AV area so QRS narrow

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70
Q

PPI’s after EGD

A

can do once daily if low risk lesion. for high risk lesions, 80 IV x 72 h then for 2 weeks after

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71
Q

hemochromatosis

A

HFE gene, DM, hook shaped osteophytes

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72
Q

Antisynthetase syndrome

A

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

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73
Q

Anticentromere

A

CREST

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74
Q

cervical cancer treatment

A

stage I+II hysterectomy, stage III cisplatin +radiation

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75
Q

papillary thyroid cancer and thyroid supplementation

A

TSH stims the tumor, so give a high dose of levothyroxine to suppress the TSH

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76
Q

irregular bleeding

A

start with endometrial bx

77
Q

DISH

A

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
Q

aspirin for primary prevention

A

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
Q

does MKSAP believe in changing diuretics ie lasix to bumex?

A

no

80
Q

labyrinthitis

A

postviral inflammation of the vestibulocochlear nerve (cranial nerve VIII)->sudden-onset, severe, persistent vertigo and hearing loss. Rx with pred

81
Q

rheumatoid nodules

A

sublpelural nodules can be solid or cavitary, can cause fistula

82
Q

salvage h pylori

A

Bismuth, tetracycline, metronidazole, and omeprazole x 14 d

83
Q

stage II HTN

A

> 140 start therapy don’t just try lifestyle

84
Q

when to refer for liver transplant

A

MELD >15 or signs of decompensation; treating HCV in decompensated patients is not good

85
Q

threshold for bisphosphonates

A

≥3% at the hip or ≥20% for major osteoporosis-related fracture)

86
Q

Bactrim and the kidney

A

decreases secretion of creatinine without changing the GFR, so creat goes up

87
Q

Vaccines for the asplenic

A

Hemophylis influenza and MenB

88
Q

seizure med with mood issues

A

keppra

89
Q

what’s the treatment for campylobacter

A

azithromycin

90
Q

treatment of IgA nephropathy

A

ACE/ARB: lowers intraglomerular pressure resulting in decreased excretion of proteins; steroids would be after failure of this

91
Q

first line for etoh use disorder

A

naltrexone and acamprosate

92
Q

how do diagnoses diabetes

A

2 abnormal tests: A1C>6.5+, fasting glucose 126+, 2h plasma glucose test 200+

93
Q

test for hyper secretion in pituitary mass

A

prolactin and ILGF1

94
Q

lichen Planus association and appearance

A

looks like a purple polygonal papule, associated with liver disease

95
Q

ibrutininib side effect

A

a fib

96
Q

UC biliary association

A

PSC

97
Q

keratocanthoma

A

SCC variant, looks like a volcano

98
Q

med for quitting smoking

A

varenicline

99
Q

ivabradine

A

a fib, HFREF<35, HR>70 despite max tolerated BP meds

100
Q

sideroblastic anemia

A

blue dots in ring around erythrocyte precursors, MDS, EtOH, Cu, Pb, linezolid, isoniazid

101
Q

unexplained cough rx

A

gabapentin??

102
Q

Ankylosing spondylitis bowel disease?

A

IBS

103
Q

systemic sclerosis GI manifestation

A

SIBO

104
Q

aspirin after GIB

A

stop if primary prevention, resume after hemostasis if secondary prevention

105
Q

subsolid nodule monitoring 6-10mm

A

1 year, then q2 for 5

106
Q

ILD in systemic sclerosis rx

A

MMF

107
Q

MGUS

A

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
Q

flexural surfaces rash

A

atopic dermatitis

109
Q

ICD indications in HOCM

A

prior arrest, prior VT

110
Q

septal reduction indications

A

receiving GDMT but still sx, and LVOT gradient 50 or great

111
Q

SJS/TEN mucosal involvement #

A

2+surfaces

112
Q

bp in first 48h after syroke

A

let it autoreg for 220/120

113
Q

ddx benefit in mening which organism

A

s pneump

114
Q

best influenza test

A

NAAT not antigen

115
Q

test for WNV?

A

IgM, because virus has cleared by the time you have symptoms; impacts the basal ganglia and can cause rash

116
Q

EF cutoff for preserved

A

50%

117
Q

rx aspirin OD

A

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
Q

staining on kidney biopsy ANCA vs GBM

A

ANCA: crescents, GBm: linear

119
Q

goal INR mechanical mitral

A

3

120
Q

rx levodopa induced dyskinesia

A

amantadine

121
Q

new bcl next test?

A

LDH - helps decide how aggressive to be with rx - don’t need MRI or BMBx

122
Q

rapid onset chorea

A

pregnancy

123
Q

treat extensive AK’s?

A

5FU

124
Q

androgen deprivation therapy screening?

A

DEXA

125
Q

travellers diarrhea

A

self limited 5-7 days, just support. for moderate/severe sx, give azithro

126
Q

RAA on EKG

A

peaked P waves in II, III, aVF

127
Q

eval diabetic foot ulcer with probe to bone+

A

plain film->MRI->bx

128
Q

teardrop erythrocytes

A

myelofibrosis

129
Q

age lung cancer screening!!!

A

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
Q

LV wall thickness athlete heart vs HOCM

A

<13 mm athlete heart

131
Q

seoncdary memranous glomerulonephritis causeses

A

infections like hep C

132
Q

Type A dissection mgmt?

A

Open repair

133
Q

SIADH paraneoplastic?

A

SCLC

134
Q

Serotonin syndrom vs NMS

A

1) serotonin syndrome has hyperreflexia and myoclonus, rx with benzos vs. NMS d/c the agent, cool

135
Q

acute bronchitis (9 days sx)

A

no imaging! supportive care

136
Q

rx back prostatic not sexually active

A

bactrim

137
Q

cutoff for aortic repair in bicuspid AV

A

4.5 if severe AS/AR, 5.5 if no other issues, or >5 with additional RF for dissection

138
Q

colon cancer PET?

A

no

139
Q

rx urge incontience

A

timed voiding, then oxybutynin/mirabegron

140
Q

oseltamivir

A

give even after 48 h!!

141
Q

rx hyperprolactinemia from antipsychotics?

A

estrogen/progesteron. cabergoline can induce psychosis so not that

142
Q

eosinophilic granulomatosis with polyangiitis

A

asthma, mononeuritis multiplex, cutaneous deposits

143
Q

graves in pregnancy

A

PTU, especially in the first trimiester

144
Q

fractional exhaled nitric oxide (FeNO)

A

eosinophilic airway inflammation

145
Q

acute cutaneous lupus

A

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
Q

rx nausea chemo

A

serotonin antagonists, neurokinin-1 receptor antagonists, glucocorticoids, and olanzapine

147
Q

brucellosis

A

more insidious than tularemia

148
Q

rx gout

A

colchicine, NSAIDs, steroids

149
Q

scabies dx

A

mineral oil, vs KOH for tinea

150
Q

RIPE therapy CNS dx adjuvant?

A

steroids

151
Q

symptomatic hyponatremia

A

desmopressin+3%

152
Q

anti seizure meds in pregnancy

A

lamotrigine and keppra

153
Q

positive FABER

A

SI joint

154
Q

PPI risk kidney disease

A

can hasten progression of CKD

155
Q

oral abx for pyelo?

A

fluoroquinolones

156
Q

suspected scaphoid fxr normal xr

A

splint+repeat in 2 weeks or MRI now

157
Q

scleroderma renal crisis

A

hemolytic anemia, thrombocytopenia, seizure, HTN - rx captopril

158
Q

lumbar plexopathy association?

A

diabetes

159
Q

eval fasting hypoglycemia?

A

72h fast, vs mixed meal test for postprandial hypoglycemia

160
Q

G6PD

A

BITE CELLS

161
Q

OSTIUM SECONDUM ASD

A

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
Q

early salicylate toxicity

A

resp alk/AGMA

163
Q

fundic gland polyp f/u

A

no

164
Q

light’s

A

> .5 pleural/serum ptn, LDH ratio >.6, LDH>2/3 ULN serum

165
Q

rx salmonella gastroenteritis?

A

only if typhoid, otherwise leads to prolonged shedding

166
Q

rx metastatic melanoma

A

anti–CTLA-4 antibody plus an anti-programmed death antibody; use BRAF therapy if they have a BRAF mutation

167
Q

timed up and go test

A

> 12 should prompt intervention for fall risk

168
Q

essential tremor improves with?

A

EtOH, propranolol, primidone

169
Q

elevated urine ptn

A

upep

170
Q

PEP

A

hep a vaccine, +igg if>40

171
Q

subacute pji

A

staph epi, cutibact

172
Q

UTI rx

A

3 days Bactrim, 5 days nitro, 1 day fosfo

173
Q

rx AI hep

A

azathioprine, prednisone x 3 years, then bx, think about stopping if history quiet

174
Q

Static mattress overlay

A

prevents pressure wounds the best

175
Q

ulnar neuropathy also

A

makes it hard to pinch btw thumb and index

176
Q

cutaneous anthrax

A

painless, from animal hide

177
Q

social isolation/CAD

A

risk factor!

178
Q

crypto meningitis management

A

ambisome, flucytosine, LP to decrease pressure

179
Q

immune checkpoint inhibitors intracranial issue

A

hypophysitis

180
Q

levothyroxine in pregnancy

A

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
Q

cilostozol c/i

A

HFrEF<40%

182
Q

primary adrenal insufficiency

A

hyperpigmentation

183
Q

hi calcium low urine calcium

A

familial hypocaclin*. if Vit D toxicity would see low PTH and hi urine calc

184
Q

IgA nephropathy

A

hematuria after races or when ill, monitor

185
Q

postural hypotension in Parkinson’s

A

increase the carbidoba part of things, can be a levodopa side effect

186
Q

Dengue

A

petechial rash after BP cuff deflation, LFT’s aches, HA’s - similar to Chikungunya but no peticheia in that

187
Q

CT colonography frequency

A

5 years

188
Q
A

MKSAP (5 decks)

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