MKSAP Question Review

Question 1

Orthostatic Proteinuria

Answer 1

Common in kids and teens. Increase in proteinuria when standing. Asymptomatic.

Question 2

Most common cause of acute interstitial nephritis?

Answer 2

Beta lactam antibiotics.

Question 3

Presenting triad of acute interstitial nephritis?

Answer 3

AKI, sterile pyuria, wbc casts.
May also have
Fever, rash, eosinophilia.

Question 4

How to evaluate a patient with persistent hematuria?

Answer 4

Cytoscopy

Question 5

Rhabdomyolysis symptoms and sign on urine.

Answer 5

Pain, dark urine, weakness. Blood on urine dipstick but no erythrocytes.

Question 6

What drugs cause acute tubular necrosis?

Answer 6

Aminoglycosides and cisplatin.

Question 7

How much of a bump in creatinine is tolerated when placing a person on ARB/ACEi?

Answer 7

30%. Better to manage htn than worry about small bump in cr.

Question 8

When to start dialysis?

Answer 8

If increase in K, increase in volume, ams, uremia+platelet issue.

Don’t do it if asymptomatic.

Question 9

Which diuretic can cause severe hyponatremia?

Answer 9

Hydrochlorothiazide

Question 10

How do NSAIDs affect kidney?

Answer 10

Reduce GFR, can increase K

Question 11

How to treat hypercalcemia of sarcoid?

Answer 11

With steroids?

Question 12

Major electolyte derangement in alcoholics?

Answer 12

Decrease in phosphate due to severe malnutrition.

Question 13

Drug fever

Answer 13

Persistent fever while using an antibiotic even though initial infection has resolved. Tx: stop drug and reevaluate need based on sxs.

Question 14

How to manage levothyroxine for hypothyroidism in pregnancy?

Answer 14

Need to increase dose by 30% due to increased demand.

Question 15

How to manage subacute hypothyroidism?

Answer 15

Repeat tests in 6 months, don’t treat until TSH>10.

Question 16

How to f/u adrenal incidentaloma?

Answer 16

Investigate with dex suppression, 24 hour metanephrines, etc, even if asx.

Question 17

Management of a patient with adrenal insufficiency and upper respiratory infection

Answer 17

Increase dose of glucocorticoids at least 3x.

Question 18

Alendronate vs Zoledronic Acid

Answer 18

Zoledronic acid is IV, decreases the risk for esophagitis. Prescribe IV bisphosphonates in patients with esophageal pathology (like gerd).

Question 19

How to diagnose nephrolithiasis?

Answer 19

Helical CT scan

Question 20

How to work up acute abdominal pain?

Answer 20

Supine and upright XR to assess for perf or obstruction.

Question 21

How to confirm chronic pancreatitis?

Answer 21

Calcification on xray

Question 22

How to diagnose HUS?

Answer 22

Do a peripheral smear which should show schistocytes

Question 23

How to screen for HCC in Hep B

Answer 23

Liver US.

Question 24

Common complication of hit?

Answer 24

Venous thrombosis due to increased mediators from platelet consumption.

Question 25

Asymptomatic patient with low platelet count but above 40,000?

Answer 25

Check labs again in a week

Question 26

Initial tx for PV?

Answer 26

Phlebotomy and aspirin

Question 27

How to screen for bleeding disorders in a patient with no family history of bleeding?

Answer 27

Clinical history alone is sufficient.

Question 28

How to transfuse a patient with transfusion associated anaphylaxis?

Answer 28

Washed erythrocytes and platelets

Question 29

What to suspect in an older patient with thrombosis?

Answer 29

Cancer.

Question 30

How to treat pyelonephritis?

Answer 30

Ceftriaxone or fluoroquinolone

Question 31

When to give prophylactic antibiotics to a woman for UTI?

Answer 31

When UTIs after sex

Question 32

How to treat severe cap?

Answer 32

Cefotaxime, vancomycin, levofloxacin

Question 33

How to treat lung abscess after aspiration?

Answer 33

Ampicillin-Sulbactam

Question 34

How to treat grave's disease?

Answer 34

Atenolol and methimazole

Question 35

What is post partum thyroditis

Answer 35

5% women become thyrotoxic after birth, followed by hypothyroid

Question 36

Euthyroid sick syndrome

Answer 36

When very stressed, patient can be hypothyroid without symptoms. Don't treat, just monitor.

Question 37

How to treat chronic gout?

Answer 37

Allopurinol, but make sure to start low dose colchicine at the same time to prevent any exacerbations while uric acid levels adjust.

Question 38

How to treat RA in alcoholic?

Answer 38

Can't use methotrexate because of hepatic clearance, so use hydroxychloroquine

Question 39

Can HIV cause psoriatic arthritis?

Answer 39

Yeah, at CD4 counts

Question 40

How to treat lupus nephritis?

Answer 40

High dose steroids.

Question 41

How to manage symptomatic PVCs?

Answer 41

Metoprolol

Question 42

In which patients are BNP levels falsely elevated?

Answer 42

Obese patients