Questions Flashcards
1
Q
Pt with episode of chronic, inflamed knee joint and crystals
What is seen on xray?
A
Acute calcium pyrophosphate crystal arthritis
Radiopaque lines on chondral surfaces of long bones called “chondrocalcinosis”
2
Q
Ranolazine
A
Inhibits the Na+ current leading to decrease myocardial wall tension, O2 consumption
=>Decreased angina and increased exercise tolerance
3
Q
What medications cannot be used w/ ranolazine?
A
Ketoconazole, azithromycin, ritonavir (strong CYP inhibitors)
4
Q
Initial studies for FUO
A
CMP, CBC, Blood cx, UA, ESR, PPD, CXR, CT Abd
5
Q
Orthopnea corresponds to what CWP
A
20mmHg
6
Q
Patient w/ urticarial wheals that are lasting for >24hrs, are painful, and leave bruises
A
Urticarial vasulitis
-Is associated w/ other AI disease
Dx: Skin biopsy
7
Q
Pt w/ stroke of undetermined origin and inpatient workup is all negative
A
Will require 30 days of cardiac rhythm monitoring
8
Q
Post-Lyme Disease Syndrome
A
Disordered immunologic response to Lyme characterized by myalgia, arthralgia, fever,and fatigue up to 6 months after acute disease and may wax/wane
9
Q
Difference b/w scleritis and episcleritis
A
Scleritis has PAIN
10
Q
Causes of tricuspid regurgitation
A
Rheumatic disease Radiation Endocarditis Myxomatous degeneration Ebstein anomaly Carcinoid syndrome Trauma PACEMAKER/ICD PLACEMENT
11
Q
ASD that is associated w/ mitral regurgitation
A
Ostium primum defect
12
Q
Uncommon side effect of heparin
A
Hypoaldosteronism =» Hyperkalemia
-Especially common w/ CKD or DM
13
Q
MCCo primary adrenal insufficiency
A
AI adrenalitis
- Test=21-hydroxylase antibodies
- Glands will appear atrophic on CT
14
Q
Increase RF for having sclerodermic crisis
A
Presence of anti-RNA Polymerase III abs
15
Q
Paroxysmal Nocturnal Hemoglobinurea
A
Intravascular hemolysis, pancytopenia, fatigue, abd pain
-Increased risk of malignancy, clots in unusual locations
*Test=Flow cytometry (lack of CD 55 and 59)
16
Q
Lab to check prior to statin initiation
A
Hepatic profile
17
Q
Hemoglobin BS
A
Pts have lifelong mild hemolytic anemia and microcytosis and detectable HgbA
-Amount of HgbA is inversely proportional to symptom severity
18
Q
Amount of HgbS in Sickle Cell Disease
A
90% approx
19
Q
First step to take in Parkinson’s patient w/ hallucinations
A
D/c any dopamine agonisist BUT don’t stop L-dopa
20
Q
Pimavanserin
A
Non-dopaminergic atypical antipsychotic that is the ONLY FDA approved medicine for Parkinson’s psychosis
21
Q
Alport syndrome diagnosis
A
Genetic analysis
22
Q
Patient who has persistent supraclavicular lymphadenopathy
A
Excisional biopsy required
R-side=Thoracic malginancy; L side=abdominal malignancy or lymphoma
23
Q
Tumor marker for gastroesophageal adenocarcinoma
A
HER-2
-Can treat w/ Herceptin if positive
24
Q
Cabergoline monitoring for hyperprolactinemia tx
A
1 month; then 3-4; then maybe stop at 6
25
1st line tx of comedonal acne
Topical retinoid
26
3 drugs approved for fibromyalgia
1. Duloxetine
2. Pregabalin
3. Milnacipran
27
Pregabalin MoA
Inhibits glutamate release in the DRG =>> decreased perception of pain
28
Recovery from Guillan-Barre
Typically, the disease reaches a peak in <4 weeks and then will slowly improve w/ most pts becoming ambulatory within 6 months
-Therefore, once a pt starts to improve, they no longer need inpatient monitoring
29
Management of acute hemolytic crisis splenomegaly
Observation; only perform splenectomy if CHRONIC
30
Tx of severe allergic contact dermatitis
2-3 weeks of systemic glucocorticoids
31
D-lactic acidosis
Form of LA presenting in patients specifically w/ short-bowel syndrome
- Think of this w/ history of small bowel resection or jejunal bypass
- Typically occurs after pt consumes large carbohydrate load
32
Acute management of severe head injury
```
Maintain pO2 > 60mmHg
SBP >90mmHg
Treat fever (common complication)
```
33
Follow up after acute diverticulitis
Colonoscopy within 4-8 weeks
34
Young women needing chemo needs what before starting treatment
Fertility doctor consult
35
Pts who receive radiation therapy during childhood have an increased risk of developing what type of cancer
Papillary Thyroid Cancer
36
Fingolimod
Sequesters lymphs in LNs =>> decreased MS relapse rate by 50% over 2 yrs and also decreases disease progression
*0.5% risk/year of macular edema =>> Needs annual ophthalmology f/up
37
Drug that reactivates JC virus
Natilizumab (Tysabri)
38
First test to look at with metabolic alkalosis
Urine Cl
If <15 =>> Saline RESPONSIVE
If >15 =>> Suspect mineralcorticoid excess
39
Subacute cutaneous lupus erythematosis
Photodistributed, burning rash w/ light pink tone
40
Causes of subacute cutaneous lupus erythematosis
TNF-a inhibitors (adalimumab), HCTZ, ACEIs, NSAIDs, PPIs, Terbinafine
41
Treatment of refractory MS-fatigue after trying lifestyle management
Modafanil, amantadine, methylphenidate
42
Screening needed 2 weeks prior to cardiothoracic or orthopedic surgery
MRSA surveillance
43
3-2-1-1-0 Rule
3 family members affected
2 successive generations affected
1 family member is a first-degree relative of the other 2
1 cancer diagnosed at age <50
O chance of FAP; tumor histological diagnosis
44
Gene deletions associated w/ Lynch Syndrome
MLH1, MSH2, MSH6, PMS2
45
Screening for Lynch Syndrome
Age 20 or 2 years prior to earliest affected family member
46
Tx of Lynch Syndrome if cancer found
Colectomy + annual surveillance of remaining rectum
47
MCCo muscle disease in elderly
Inclusion Body Myositis
48
Infertility eval in 35 year old
Starts at 6 months of no conception
49
Initial eval for ICU-acquired weakness
Medical Research Council (MRC) muscle scale
50
Lupus pernio
Variant of sarcoidosis involving non-caseating, granulomatous inflammation of the skin around the nares producing plaques and nodules on the central face and nose
Has chronic, refractory course
51
Tx of alcoholic ketoacidosis
D5W + NS'
| -Need D5W to induce insulin secretion
52
Restrictive Lung Disease findings
Decreased TLC (should be normal in obstructive)
If RV and FRC are preserved, suspect neuromuscular weakness
53
Test to perform prior to aortic valve replacement
Cardiac catheterization
| -Must make sure symptoms aren't due to CAD
54
Pts w/ Inflammatory Bowel Disease have an increased risk of what while hospitalized?
DVT; Only avoid anticoagulation w/ hemodynamic instability
55
Olaparib
Oral poly-adenosine diphosphate-ribose polymerase inhibitor (PARP)
FDA approved as monotherapy for pts w/ germline BRCA (+) advanced ovarian cancer after 3 or more lines of chemotherapy have failed
PARP inhibition =>> double-stranded DNA breaks in BRCA tumors that they are unable to repair
One study showed response rate of 31% in ovarian, prostate, breast, and pancreatic cancers
ADR: N/V, anemia
56
PMNs in Folate Deficiency
Also hypersegmented
57
Victoza (and questions to ask before starting it)
Liraglutide (GLP-1 agonist): patients must be asked about history of pancreatitis and FH of medullary thyroid cancer
58
Recommended length of VTE therapy for prophylaxis following major orthopedic surgery
35 days of LMWH
59
Emergently placed central lines pose a risk for what
Sepsis
60
Tx for small cell carcinoma
Chemo + Rads
61
Tx for EHEC
Supportive
62
Tx for UC
Mesalamine; preferable oral AND enema
63
Palpable purpura + Abd pain + Arthralgia =?
IgA vasculitis (Henoch-Schonlein)
64
Diabetic mononeuropathy
Acute or subacute pain and paresthesia in a dermatomal distribution pattern in the thoracic or abdominal region in pts w/ poorly controlled DM and no evidence of active Zoster infxn
Can be unilateral or cross the midline
Can be associated w/ superficial abdominal swelling in the affected area
65
Abs in primary membranous glomerulopathy
Anti-phospholipase A2 receptor (PLA2R)
66
Primary Restrictive Cardiomyopathy
A lot of the same findings as constrictive pericarditis BUT has...
1. Elevated BNP
2. Concordant rise and fall of L/R systolic pressures w/ respiration (should be vice versa in constrictive pericarditis)
67
When to stop NOACs prior to surgery
2-3 days
If renal fnxn exists, check anti-Xa level 72 hours before surgery
68
Myelodysplastic syndrome findings on peripheral smear
Dysplastic PMNs w/ hypogranulation, hypersegmentation and NRBCs
69
Tx of necrotizing fascitis 2/2 Aeromonas Hydrophilia infxn
Doxy + Rocephin/Cipro
70
Patient who presents w/ viral meningitis in the winter time
More likely to be HSV-2; enteroviruses are May-November
71
Focal Segmental Glomerulosclerosis
Seen in African Americans, people who were preemies, obese pts, or people w/ only one kidney
Path: Hyperfiltration injury in setting of relative reduction of renal mass =>> adaptive podocyte injury and segmental sclerosis
72
Gastral antral vascular ectasia (GAVE)
Pts w/ AI disease or cirrhosis who have "watermelon stripes" on upper endoscopy; tx is argon plasma or laser photocoagulation
73
Cameron Lesions
Erosions of the crest of the gastric folds within a large hiatal hernia thought to be caused by mechanical trauma of the esophagus sliding up and down
74
Dieulafoy lesions
Submucosal gastric vessels that occasionally protrude through the gastric mucosa and can cause hemorrhage
75
Tx for acute Bell's Palsy
Prednisone w/in 72hrs
76
Meds to give prior to intubation
Midzolam 1-2mg IV q 5mins
Fentanyl 20-50mg IV
Etomidate .3mg/kg
77
Patient w/ SEVERE leukocytosis and elevated K+
Recheck Plasma K+
78
RAVE Trial (Rituximab vs Cyclophosphamide for ANCA-assoc. vasculitis)
Rituximab > Cyclophosphomide for tx of RELAPSE at 6 months pts had 67% improvement vs 42%
79
Rapid improvement in blood glucose in DM should concern you for what
Increased risk of development of diabetic retinopathy
80
DM patient who is pregnant
NEEDS EYE EXAM
81
Preferred tx of cancer related pain w/ CKD
Dilaudid
Can also consider fentanyl patch in non-opioid naive pts
82
Recommended duration of therapy for VAP
7 days
83
Cisplatin-Induced AKI
Characterized by polyuria, tubular injury (due to oxidative stress, mitochondrial injury, and activation of apoptosis pathways), proximal RTA, hypomagnesemia
Occurs 7-10 days after initiation of therapy
84
Neoadjuvant chemotherapy
Given prior to planned curative-intent surgery to patients with fully resectable disease
*Goal is to eradicate micrometastatic disease
85
Subsolid nodules on CT Chest and monitoring
"Ground glass" = No solid component
6-8mm = @6-12 months; then q2yrs for 5yrs
-Average doubling time for these nodules = 3-5yrs
86
Rhythmic life threatening complication of MI
Mobitz Type II
87
Pts to treat prophylactically for traveler's diarrhea
IBD and IC pts
Tx w/ Cipro for 2-3 weeks max
88
Common ADR of ticagrelor
Dyspnea; occurs in 15-20% of pts; is self-limiting
89
Methylnaltrexone
Peripherally acting opioid antagonist given for tx of opioid induced constipation
90
Primary Progressive Aphasia
"Language variant FTD"
- Prominent early changes in language
- Typically, see asymptomatic degeneration of the LEFT frontotemporal regions
91
Relapsing Polychondritis
AI condition characterized by inflammation and damage of cartilaginous tissues
MC=External/Middle ear, nose, tracheobronchial tree, joints
* Pts need CT chest to address for airway damage
* Labwork is nonspecific; clinical diagnosis
92
Cogan Syndrome
Interstitial keratitis + cochlear/vestibular dysfunction
93
Pt w/ stable CAD and new onset of afib; CHADS-VASC >2
Tx ONLY W AC
- Adding antiplatelet therapy only increases bleeding risk w/ no improvement in mortality
- Only DAPT if w/ MI or stent in last 12 months
94
Work up for myeloproliferative neoplasm
JAK2 V617F testing
Performed in setting of abnormal thromboses, splenomegaly, and portal HTN
DONE EVEN W/O ERYTHROCYTOSIS
95
Tx of carbapenem-resistant infection
Ceftolozane-Tazobactam
| -New, antipseudomonal B-lactam and B lactamase inhibitor
96
Tx of cyclospora diarrhea
Dbl-strength bactrim for 7-10 days
97
Tx for PAH w/ response to NO
CCB
98
Treatment of actinic keratosis
1. Cryotherapy
2. 5-FU, imiquimod
3. Biopsy to r/out cancer (NOT AN EXCISIONAL BIOPSY)
99
Caprini Score
A score used to assess pts risk for development of pos-surgical thrombosis
>5 = HIGH RISK; requires BOTH ICD and medicinal prophylaxis
100
Pt w/ history of gout who has cellulitis that has not responded to antibiotics
This is gouty cellulitis; just treat it like gout
101
Mycobacterium fortuitum
Chronic, rapidly growing mycobacterium that grows in small breaks in the skin (or ulcers) and do not respond to antibiotic therapy
-May have history of hot tub exposure
102
Pt w/ chronic silicosis and develops red-flag symptoms w/ increasing pulmonary illness
May need to consider TB
-Pts w/ silicosis already have DECREASED macrophage function increasing their risk for mycobacterium infxn
103
Diagnosis of hepatopulmonary syndrome
Diagnose O2 tension of <80mmHg or an A-a gradient of >15 along w/ evidence of intrapulmonary shunting on echocardiography w/ agitated saline or macroaggregated albumin study
Symptoms include platypnea and orthodoexia
104
Tx of bladder cancer that has not invaded muscular wall
Intravesicular bacillus-CG injection and cystoscopy at 3 and 6 months
105
POEMS syndrome
```
Peripheral neuropathy, Papilledema
Organomegaly
Edema
Monoclonal plasma cell dyscrasia
Skin changes
```
Also has Castleman disease (angiofollicular lymph node hyperplasia)
106
Colon cancer screening that does not require bowel prep or dietary changes
FIT testing
107
Sumatriptan in migraine
Targets trigeminovascular activation assoc. w/ migraine headache by activating 5-HT1B and reversing vasodilation
**Pts must use this at first sign of headache
108
Tx of refractory ACUTE gout
Anakinra: IL-1 inhibitor; it is expensive tho
109
Meds to d/c prior to screening for pheochromocytoma
```
SNRIs
TCAs
OTC decongestants
L-dopa
Buspirone
Prochlorperazine
Amphetamines
```
110
Prochlorperazine
Antipsychotic that blocks D1 and D2 receptors in mesolimbic system =>anti-a1, anti-a2, and anticholinergic effects => decreased RAS stimulation
Uses: N/V
ADRs: Anticholinergic, CNS depression, aspiration, EPS, hyperprolactinemia, hypothyroidism
111
New pt w/ onset of dyspepsia and is <60 yrs old
Stool H Pylori testing needed
112
Pt w/ brisk bleed and hypotension that briefly stops but then has a repeat GI Bleed
HERALD BLEED
***Worrisome for AORTOENTERIC FISTULA
***Consider in ANY pt w/ history of aortic graft and GI bleed
-Possibly assoc. w/ an inciting infxn; needs CT w/ CONTRAST
113
Metabolic surgery in diabetic consideration
W/ BMI >35 and if they are unable to meet their A1c goals
*Assoc. w/ decreased CV events and deaths
114
IgG4-disease
Characterized by IgG4-producing plasma cell infiltration and tumefication of affected tissues => painless organ enlargement, fibrosis, and dysfnxn
***Commonly see retroperitoneal fibrosis + inflammatory aortitis
115
Management of acute hemodynamic compromise in HOCM
Theory: Increase pt volume status and decreased LVOT obstruction
1. Elevate legs and give IVF (increase preload)
a. Also correct anemia
2. IV BB
3. Phenylephrine (has NO B-adrenergic activity)
4. Consult cards for possible myomectomy
***Avoid inotropes
116
Stone w/ increased urine pH
Calcium phosphate
*Common w/ distal RTA, hyperparathyroidism, CA inhibitors (increase proximal tube reabsoprtion of Na, HCO3, and Cl)
117
Main difference b/w labyrinthitis and vestibular neuritis
Auditory symptoms present in labyrinthitis
Otherwise, similar disease processes
118
Antiepileptic drugs which do NOT cause bone loss
Lamotrigine, Levitracetem
119
Pt w/ chronic joint pain presenting w/ pulm effusion but find SEVERELY LOW GLUCOSE <10 in exudate
Likely rheumatoid pleuritis; MC pulmonary manifestation of RA
120
Unique finding in TB pulm effusion
Elevated adenosine deaminase
-Normal level essentially excludes TB
121
ICD placement in HOCM indications
1. Massive myocardial hypertrophy (wall thickness >30mm)
2. Previous cardiac arrest due to ventricular arrythmia
3. Blunted BP response or hypotension during exercise
4. Unexplained syncope
5. Non-sustained V-tach on ambulatory EKG
6. FH of sudden cardiac death 2/2 HOCM
122
Pts on prolonged abx therapy and suddenly develop bleed
Suspect Vitamin K deficiency; check INR
*Most vitamin K is derived from saprophytic bacteria of the gut
123
EKG findings consistent w/ PE
S1Q3T3
Inverted T-waves
RBBB
RAD
124
Goal of urate lowering therapy for tophaceous gout
<5.0
125
Med to worry about when using allopurinol
Diuretics
Otherwise, max dose = 800mg/day
126
Main therapy for HFpEF
DIURETICS (including lasix)
BBs, ACEIs, ARBs not giving mortality benefit; some question w/ aldosterone tho
127
Red Flags of new headache
```
Age >50
Use of anticoagulant
Progression
Abnormal physical exam
"Thunderclap"
Episode of neurologic sx lasting >1hr w/ headache
AMS
Onset after exertion/sex/valsalva
```
128
1st line treatment for tics
Clonidine
129
Tx of iron overload in pts w/ ongoing anemia requiring chronic transfusions
Deferoxamine or Deferasirox (oral version)
-Require close monitoring due to kidney/eye/brain toxicity
130
Indications for cardiac transplantation in CHF
Age <65
No end organ complications from disease
Good social support
Good adherence to therapy previously
131
Pt w/ MGUS and develops renal failure
GET BIOPSY
-Diagnose Monoclonal gammopathy or renal significance
132
Tx of acute epididymitis in pts >65 who do insertive anal intercourse
Rocephin + FQN
*Needs pseudomonas coverage
133
Amyopathic dermatomyositis
Characteristic features of dermatomyositis w/ muscular manifestations
*Still at increased risk for malignancies and pulmonary fibrosis
134
Tx of hepatorenal syndrome
Octreotide + milrinone
135
Management of HTN w/ CKD
Needs diuretic; w/ low GFR, thiazides will be ineffective tho
136
Tx of early-stage laryngeal cancer
Radiation ALONE
137
Pts w/ genetically confirmed HOCM need what offered?
Genetic counseling to offspring
138
Polymorphous light eruption
Light-induced, pruritic eruption of pink/red papules or vesicles
Appear within hrs of exposure and persist for weaks
Dx of exclusion
139
Tx of Q Fever
Doxy
140
Linaclotide
Peripherally acting guanylate-cyclase C receptor antagonist used for tx of chronic idiopathic constipation that has NOT responded to 1st line therapy
MoA: Increased c-GMP => Increased Cl and HCO3 secretion into the intestinal lumen => increased intestinal fluid content
*Take on an empty stomach 30mins before meals to avoid diarrhea
141
Managment for well-differentiated, low-grade metastatic GI neuroendocrine tumors
JUST MONITORING; usually indolent
142
Populations at increased risk of Giardia
Campers
Child-care workers
Fucking kids
143
Flow-volume loop of variable intrathoracic upper airway obstruction
Plateau during expiration due to increase in pleural pressure; this pressure during inspiration relieves the obstruction
144
Tool to use for STEMIs
TIMI calculator
145
Prevention of repeat secondary spontaneous pneuomothorax or 2nd occurrence of primary pneumonthorax
Pleurodesis
Performed w/ blood patch, tetracycline, or talc powder thru thoracostomy tube OR VATS
146
Prevention of breast cancer recurrence w/ high risk, early stage tumors
Leuprolide
147
Tx of epidermal inclusion cyst
Excision
148
Management of non-small cell lung cancer for maintenance chemo following adequate response
Pemetrexed
or
Erlotonib (if EGFR positive)
149
Unexplained chronic cough management
Multimodality speech pathology therapy; can also try gabapentin to decrease neurologic sensation
150
MVR murmur
ALWAYS NEEDS A TTE at least
151
Pt w/ asthma-COPD overlap and eosinophilia need what
LABA AND GLUCOCORTICOID
152
Left posterior fascicular block on EKG
Small QRS in I, aVL, tall positive R wave in II, aVF
*Also needs positive QRS in I and negative in aVF
153
Fracture Intervention Trial in Long-Term Extension (FLEX)
Continuing alendronate for 10yrs vs stopping after 5yrs was associated w/ more vertebral fractures
*Predictive factors for repeat fracture: Age >76, Femoral neck T-score
154
Pitted Keratolysis
Waxy, scaly plaques of the plantar skin w/ small punctate erosions; also very smelly
RFs; Hyperhidrosis
Tx: Topical abx; antiperspirant
155
Pseudoachalasia
Caused by tumor at GEJ infiltrating the myenteric plexus and causing esophageal motor dysfunction
-Similar signs/symptoms and studies as achalasia
Management: Upper EGD
156
Sweet Syndrome
Acute Febrile Neutrophilic Dermatosis
Causes: Idiopathic, post-infectious, medications, hematologic malignancy (MC AML)
Sx: Abrupt onset of fever, arthalgia, myalgia, cutaneous tender and bright-pink papules/plaques
157
Diagnosing overflow incontinence
Check Urinary Bladder scan
158
Mirabegron
B-agonist medication by enhancing the inhibitory signals to the detrusor muscle
Good medication for BPH induced incontinence
159
Pt with a massive increase in DLCO in PFTs likely has what?
Pulmonary hemorrhage
160
Patients w/ Parkinson’s who need their sinemet but experience dyskinesia and hypotension
May be candidates for DBS
161
Dyshydriotic eczema
Characterised by multiple small vesicles on the palmar or plantar skin, especially along the lateral aspects of fingers/toes
Pts have history of recurrent episodes of intense pruritis with the lesions
Vesicles desquamate leaving erosions and fissures
162
Goal calcium in hypoparathyroid patients
Low-normal WO EVIDENCE OF CALCIURIA
-Especially important w/ history of thyroidectomy or parathyroidectomy
If urine Ca is greater than 300, calcium and vit d should be decreased
Consider thiazides for patients w hypercalciuria
163
Management of Acidosis in CKD
Initiating daily bicarbonate therapy once the serum bicarbonate is chronically less than 22
164
Textbook answer for treatment of gallstone pancreatitis
Same-admission cholecystectomy following stabilisation
165
Additional therapy for MM patients who receive chemo
IV bisphosphonates
IV zoledronic acid has been shown to improve survival and prevent skeletal-related events
166
Management of hypertensive emergency
Lower SBP by 25% in first hour followed by lowering to <160 within the next 2-6 if stable
Then return to normal over 48hrs
167
Helpful DM med for weight loss
Liraglutide
Increases satiety and helps weight loss over one year
168
Code check list
1 Summary
-What’s been given, how long, what’s on the monitor, what they’re here for, prior events, PMH, meds
2 Use your cards, it’s ok
3 Contact ICU
4 Intubate
-3 Mac for regular/4mac if obese
-Neck towels and move quickly; don’t rush
-Check cuff, lubricate tube, check blade
-21cm F/ 23 Cm M
-Check tub, listen to epigastrium and chest
5 contact primary attending and specialist if indicated
6 Get sheet; write note
169
Induction agents for intubating
Midazolam 1-2mg q5mins
Fentanyl 25-50mcg
Propofol 40mg to start
Etomidate .3mg/kg
170
Hs and Ts
```
Hypovolemja
Hypoxia
Hydrogen
Hypo/hyperkalemia
Hypothermia
```
```
Tension pneumo
Tamponade
Toxins
Thrombosis, Pulm
Thrombosis, cars
```
171
Patient with diffuse dilation of the main pancreatic duct without evidence of obstruction and mucin exuding from ampulla on endoscopy
Main duct intraductal papillary mucinous neoplasms
172
Pt who has scabies and was treated with topical permethrin, however, still has itching but no new lesions
Post scabetic pruritis
| Tx with antihistamine; maybe glucocorticoid
173
Pts getting parathyroidectomy need what checked prior to surgery?
Vitamin D level
Need to avoid postoperative hypocalcemia
174
Transient acantholytic dermatosis
Benign eruption in elderly men with scaly, papules on the trunk that are itchy
Triggered by excessive sweating
Treat with cortisone ya dingus
175
Treatment of acute mountain sickness
High dose dexamethasone + supplemental O2
176
Which women with epithelial ovarian cancer should get BRCA testing?
ALL WOMEN
177
Treatment for BRCA-mutated ovarian cancer treated w/ 3+ lines of chemo
Olaparib
Oral PARP-inhibitor that induces breaks in dsDNA that BRCA cells cannot repair; response rate of 31% for 7 months
Also approved for maintenance therapy in patient's who have successfully completed 1st line platinum based therapy
178
Sickle Cell Management in pregnant ladies
Monitor; exchange transfusion not prophylactically helpful and hydrea is teratogenic
179
Evaluation of smoldering MM
Needs whole body MRI
180
Chemo drug you can't use w/ renal dysfunction
Cisplatin
181
Tx of chronic noncancer pain after exhausting typical modalities
Reefer
182
Indication for thoracic artery aneurysm repair
>4.5cm or concurrent CAD w/ CABG
183
Definitive diagnosis of late, disseminated Lyme
B. Burgdorferi enzyme immunoassay
If positive => IgG Western Blot
184
Iron goals for CKD patients
Transferrin saturation >30%
| Ferritin >500
185
Mepolizumab
Antibody to IL-5, pro-eosinophilic cytokine
***Used in patients w/ mod-severe uncontrolled asthma w/ concurrent eosinophilia
186
Erythrasma
Scaly, reddish-brown rash w/ thin-wrinkled appearance that occurs in inguinal or axillary areas and is caused by Corynebacterium minutissimum
*Will fluoresce coral red under UV light from Wood's lamp
187
W/up or erythema nodosum
NEEDS CXR; Also ANA, med review, possibly IBD w/up if clinically indicated
188
Type I Amiodarone Thyrotoxicosis
Occurs in pts w/ underlying multinodular goiter or latent Grave's; assoc. w/ increased vascularity of thyroid on Dopper
Tx: Methimazole
189
Type II Amiodarone Thyrotoxicosis
Affects pts w/o preexisting thyroid disease; pts DO NOT have anti-thyroid abs and no structural disease on doppler
Tx: High-dose prednisone
190
MS medication to avoid w/ hepatic dysfunction
Fingolimad
Natalizumab
191
Gallbladder polp management
Cholecystectomy
192
Moh's Surgery indications
Tumors w/ aggressive subtypes
High cosmetic risk w/ surgery
*Otherwise, can do electrocurettage D&C
193
Test to check for Cushing's patient w/ estrogen use OR abnormal sleep patterns
24 hour urine cortisol test
194
Generalized pustular psoriasis
Occurs following withdrawal of steroids in psoriasis patients
195
Ivabradine indications for CHF
1. LVEF <35%
2. NYHA II-IV
3. HR >70
4. BB at max dose
If all present, start med
196
Eval for unexplained erythrocytosis and increased EPO
CT abdomen; needs RCC eval
197
"Sausage-shaped" pancreas
AUTOIMMUNE PANCREATITIS
-CHECK IG-G4 antibodies
198
DAPT duration for stent placement in STABLE ANGINA
6 months
199
Pts who have increased risk of neutropenia following chemo
Give G-CSF on Day 2 of cycle
200
Tx of glucocorticoid refractory transverse myelitis
Plasma-exchange therapy
201
Outpatient monitoring for pt w/ SYMPTOMATIC palpitations
External event recorder
*Only need the 24 hour holter if ASYMPTOMATIC
202
Contraindication to IO line
Osteoporosis
203
Pt who is muscular and you want to check kidney fnxn
Check Cystatin C
204
When is a patient in ACCELERATED idioventricular rhythm
HR 50-120
>120=V tach
205
When to use hyperbaric O2 in CO poisoning
Carboxyhemoglobin level >25%
206
Cyanide poisoning in fire
Path: Disruptive oxidative phosphorylation => anaerobic metabolism => MODS
Dx: Lactic acidosis + Increased venous O2 sat
207
Do I have to give steroids for a brain tumor if there is no vasogenic edema?
No
208
Finerenone
Finerenone is recommended for patients with type 2 diabetes mellitus and chronic kidney disease (CKD) who have persistent albuminuria despite maximal renin-angiotensin system (RAS) inhibition, normal serum potassium levels (<4.8 mEq/L [4.8 mmol/L]), and an estimated glomerular filtration rate ≥25 mL/min/1.73 m2 to slow the progression of kidney disease.
In the pooled analysis of the FIGARO and FIDELIO-CKD trials, finerenone showed significant cardiorenal benefits in more than 13,000 individuals with diabetic kidney disease (DKD). Although robust data are lacking for the combined effects of a non-steroidal MRA with sodium-glucose cotransporter 2 (SGLT2) inhibitors, the American Diabetes Association and Kidney Disease: Improving Global Outcomes recommend the addition of finerenone for high-risk patients with DKD (i.e., those with persistent albuminuria) in combination with a maximal renin-angiotensin-aldosterone system inhibitor and SGLT2 inhibitor treatment.
209
Screening interval for esophageal varices in patients with compensated cirrhosis
3 years
210
