MKSAP Flashcards
(43 cards)
type 1 and 2 amiodarone induced hyperthyroidism
hyrotoxicosis occurs in patients with underlying multinodular goiter or latent Graves disease and is associated with increased vascularity on color flow Doppler ultrasonography. Type 2 (destructive thyroiditis) usually affects those without thyroid disease and is not associated with increased vascularity on color flow Doppler. Mixed forms can also be seen and making the correct diagnosis can be difficult. The patient’s clinical presentation is most consistent with type 2 amiodarone-induced thyrotoxicosis given the absence of structural thyroid disease (no nodules or goiter), absent thyroid-stimulating hormone (TSH) receptor antibody, and absent parenchymal flow seen on Doppler ultrasound. Moderate- to high-dose prednisone is an effective treatment that can be gradually tapered over 1 to 3 months.
Treatment of PAN
Prednisone and cyclophosphamide are agents typically used to treat mild and severe manifestations of idiopathic
Sofosbuvir and ledipasvir are direct-acting antiviral agents used to treat hepatitis C virus (HCV) infection and would be an appropriate choice for mild HCV-related PAN.
Tenofovir, emtricitabine, and raltegravir are used to treat HIV infection. This drug combination would be an appropriate choice for HIV-related PAN,
The most appropriate treatment is entecavir. Hepatitis B virus (HBV)–related polyarteritis nodosa (PAN) is the most likely diagnosis in this patient.
prolactinoma treatment
Prolactinomas are treated with dopamine agonists. The two FDA-approved dopamine agonists are bromocriptine and cabergoline.
Hep B treatment in pregnancy
Guidelines recommend treatment with lamivudine, telbivudine, or tenofovir for the prevention of vertical transmission in pregnant women who have HBV DNA levels greater than 200,000 IU/mL at 24 to 28 weeks’ gestation.
pulmonary stenosis treatment
Balloon valvuloplasty is recommended for symptomatic patients with appropriate valve morphology who have a peak Doppler gradient of greater than 50 mm Hg or a mean gradient greater than 30 mm Hg and favorable valve characteristics for percutaneous intervention.
Aortic Regurg surgical criteria
For patients with severe aortic regurgitation, surgical aortic valve replacement is recommended in the presence of symptoms attributable to regurgitation, left ventricular ejection fraction less than 50%, or another indication for cardiac surgery. In addition, surgical aortic valve replacement can be beneficial in asymptomatic patients with significant left ventricular dilatation (end-systolic dimension >50 mm or indexed end-systolic dimension >25 mm/m2). In the absence of these findings, clinical evaluation and surveillance echocardiography every 6 to 12 months is recommended.
Side Effects of pantoprazole
Osteoporosis.Other possible PPI-related adverse reactions include vitamin B12 and mineral (calcium and magnesium) malabsorption, as well as increased risk for community-acquired pneumonia, Clostridium difficile infection, and cardiovascular events.
role of rifaximin
Lactulose is first-line treatment and should be titrated to produce three stools per day. Rifaximin is added to lactulose for prevention of recurrent episodes after a second episode of hepatic encephalopathy. Due to its expense, it is not a first-line therapy for hepatic encephalopathy.
Infliximab in Chron’s
prine. Infliximab is an anti–tumor necrosis factor (TNF)-α antagonist effective in inducing and maintaining remission in moderate to severe Crohn disease. O
Colon Cancer guidelines
ccording the American Cancer Society’s Colorectal Cancer Survivorship Care Guidelines published in 2015, a history and physical examination should be performed every 3 to 6 months for the first 2 years, then every 6 months for 5 years. After treatment for stages 1, 2, or 3 colorectal cancer, patients at high risk for recurrence (for example, with poorly differentiated histology, lymphatic or vascular invasions, or positive resection margins) should receive annual abdominal-pelvic and chest CT scans for 5 years after resection. A history and physical examination should also be performed every 3 to 6 months for 5 years. Carcinoembryonic antigen measurement is recommended every 3 to 6 months for the first 2 years, then every 6 months to 5 years if the patient is a potential candidate for further intervention. Follow-up evaluation recommendations from other expert organizations vary.
Ranolazine interactions
Ranolazine is primarily metabolized by cytochrome P450 3A4 (CYP3A4); therefore, caution should be exercised when prescribing ranolazine with CYP3A4 inhibitors, which will result in significantly increased plasma levels of ranolazine. Ranolazine should not be used with strong CYP3A4 inhibitors, such as ketoconazole, clarithromycin, and ritonavir. With moderate CYP3A4 inhibitors, including verapamil and diltiazem, the dosage should be decreased by 50% and should not exceed 500 mg twice daily
IBS C treatment
Linaclotide,Plecanatide , and . Lubiprostone
Adenomas managemnt
Adenomas larger than 5 cm in size have an increased risk for bleeding that can occasionally cause hemodynamic compromise.
GLP-1 receptor agonists.(liraglutide and exenatide) side effects
GLP-1 receptor agonists.
. Tenofovir or entecavir is first-line treatment for immune-active HBV infection because of low rates of resistance. T
n. Tenofovir or entecavir is first-line treatment for immune-active HBV infection because of low rates of resistance. T
hepatorenal syndrome
Two types of hepatorenal syndrome have been recognized. Type 1 is characterized by acute kidney dysfunction and is usually triggered by a precipitating event such as spontaneous bacterial peritonitis, other infections, gastrointestinal hemorrhage, or a major surgical procedure. Type 2 is more common and is characterized by more slowly progressive kidney failure in patients with refractory ascites.
Type 1 hepatorenal syndrome is characterized by a rise in serum creatinine of at least 0.3 mg/dL (26 μmol/L) and/or ≥50% from baseline within 48 hours with a bland urinalysis and normal findings on renal ultrasonography. It is also supported by a lack of improvement in kidney function after withdrawal of diuretics and two days of volume expansion with intravenous albumin. Often patients with hepatorenal syndrome also have low urine sodium, low fractional excretion of sodium, and oliguria. In addition, patients should have no evidence of shock, no current or recent use of nephrotoxic drugs, and no evidence of renal parenchymal disease (proteinuria less than 0.5 g/day, no microhematuria, and normal renal ultrasound). The main treatment of hepatorenal syndrome is the removal of drugs that may reduce kidney perfusion and volume expansion. Ultimately, hepatorenal syndrome is a condition for which the only cure is liver transplantation.
Criteria for Parathyroidectomy
alcium level ≥1 mg/dL (0.25 mmol/L) above upper limit of normal; creatinine clearance <60 mL/min, 24-hour urine calcium >400 mg/day (>10 mmol/day), or increased stone risk by biochemical stone risk analysis; presence of nephrolithiasis or nephrocalcinosis by radiograph, ultrasound, or CT; T-score (on DEXA scan) of less than or equal to −2.5 at any site or evidence of vertebral fracture; and age younger than 50 years.
Cardiac transplantion criteria
ardiac transplantation remains the gold standard therapy for patients with end-stage heart failure. Indications for cardiac transplantation in these patients include age younger than 65 to 70 years, no medical contraindications (diabetes with end-organ complications, malignancies within 5 years, kidney dysfunction, other chronic illnesses that will decrease survival), and good social support and adherence. Heart transplant is contraindicated in this patient.
mitral valve surgerical indications
. Surgical treatment with repair of the mitral valve is indicated for chronic severe primary mitral regurgitation in (1) symptomatic patients with left ventricular ejection fraction greater than 30%, (2) asymptomatic patients with left ventricular dysfunction (left ventricular ejection fraction of 30%-60% and/or left ventricular end-systolic diameter ≥40 mm), and (3) patients undergoing another cardiac surgical procedure. Mitral valve repair should also be considered in asymptomatic patients with chronic severe primary mitral regurgitation who have new-onset atrial fibrillation or pulmonary hypertension (pulmonary artery systolic pressure >50 mm Hg).
Metabolic Alkalosis
For those who have a high urine chloride (>15 mEq/L [15 mmol/L]) with elevated blood pressure and hypokalemia and do not appear to be overtly volume overloaded, a mineralocorticoid excess disorder must be considered (saline-resistant metabolic alkalosis). Examples include Cushing syndrome and primary aldosteronism. N
Saline-responsive metabolic alkalosis typically presents with hypovolemia and a low urine chloride of <15 mEq/L (15 mmol/L); the most common causes are vomiting, nasogastric suction, and diuretic use.
CKD anemia
Improving Global Outcomes (KDIGO) recommendations suggest maintaining transferrin saturation levels of >30% and serum ferritin levels of >500 ng/mL (500 µg/L).
HTN guidelines
, the American College of Physicians and American Academy of Family Physicians recommend that antihypertensive drugs be initiated in patients ≥60 years old if blood pressure is >150/90 mm Hg, with a goal of reducing systolic blood pressure to <150 mm Hg; the American College of Cardiology/American Heart Association recommends a systolic blood pressure target of <130 mm Hg in patients ≥65 years old.
White coat HTN guidelines
According to the American College of Cardiology/American Heart Association blood pressure guideline, in adults with untreated systolic blood pressure >130 mm Hg but <160 mm Hg or diastolic blood pressure >80 mm Hg but <100 mm Hg, it is reasonable to screen for white coat hypertension using either ABPM (the gold standard) or home blood pressure monitoring.
Kidney Failure prediction
The kidney failure risk equation uses four variables (age, sex, estimated glomerular filtration rate, and albuminuria) to predict 2-year and 5-year risk of end-stage kidney disease in patients with stages G3 to G5 chronic kidney disease.
