Rheumatology
Duloxetine, Pregabalin, milnacipran (???)
Patient has diabetic nephropathy with significant proteinuria. He is on max dose Losartan and Empagliflozin, what additional medication should be added?
Finerenone
What type of medication should you avoid in cocaine induced chest pain?
Beta blockers (even selective beta blockers)
Before initiating treatment for central hypothyroidism what additional testing should be ordered?
Must rule out adrenal insufficiency with morning cortisol +/- cosyntropin test. Initiating treatment for hypothyroidism can precipitate an adrenal crisis.
What is the name of the longest river in the world?
The Nile
Patient with tophaceous gout who is allergic to allopurinol. Name alternate options (at least 2)
Probenecid, Febuxostat, Pegloticase
Pegloticase is a q2weeks infusion, brings uric acid levels to 0 within hours. Requires discontinuation of other prophylactic medications and initiation of indomethacin/colchicine/glucocorticoids to prevent flare
Probenecid is contraindicated in GFR <60
Febuxostat kills you (associated w/ increased cardiovascular and all cause mortality)
What would urine studies show in someone with SIADH?
Name 2 side effects of PPIs
Increased risk of C. dif, progression of CKD, fractures (conflicting data but will accept as answer), hypomagnesemia -> hypokalemia
IV fluids
Acyclovir is insoluable in urine and can lead to urinary obstruction and AKI. Goal of about 2L per day 75ml/hr urine output. Can consider loop diuretics and in severe cases warrants HD
What is the largest planet in our solar system?
Jupiter
Which types of Lupus nephritis require immunosuppressive therapy?
Type 3 focal lupus nephritis: fewer than 50% of glomeruli involve
Type 4 diffuse lupus nephritis: greater than 50%
Types 1, 2 and 5 may require treatment if proteinuria is significant ( <500 mg/d can be typically monitored, >1g/d should typically be treated)
Type 6 might require HD because glomeruli are completely sclerotic
Name at least 3 causes of AKI with low complement levels
The Champs
Thrombotic microangiopathy
Hemolytic US
Cryoglobulinemia
Heavy chain deposition (multiple myeloma)
Atheroembolism
MPGN
PSGN
SLE
Name 2 conditions that predispose someone to clinically significant AVMs
ESRD, Aortic stenosis, congenital disease (hereditary hemorrhagic telangiectasia, Sturge Weber)
30 year old is admitted to the hospital for bloody diarrhea. Lab workup shows elevated PT/aPTT. You see the patient in the clinic and repeat bloodwork is similar. Next step in management/what additional test should be now ordered?
Plasma mixing studies
What is the name of the smallest country in the world?
What auto-antibody can be ordered to help confirm the diagnosis of Polymyositis
Anti-Jo1 is most common although only found in 20-30% of cases. More common in Polymyositis but can be seen in Dermatomyositis. Anti Mi-2 is more common in Dermatomyositis
20 year old with fatigue and weakness. Labs show normal creatinine
Sodium 136
Potassium 2.7
Chloride 98
Bicarb 29
Urine potassium 45
Urine chloride <10
Urine pH 7
Vomiting
Hyperchloremic hypokalemic metabolic alkalosis
Patient is found to have elevated liver enzymes on routine labs, he is asymptomatic. BMI is 32 and he is a non-drinker. What additional testing is required to establish the diagnosis? (Excluding hepatitis panel, RUQ US or biopsy). Name 3 tests/diagnosis
NAFLD is a diagnosis of exclusion. Must exclude hepatitis C/B, alcohol, hemochromatosis, drug induced hepatitis. If is unrevealing should expand investigation to include autoimmune hepatitis, Wilson disease, Alpha-1 antitrypsin deficiency
Patient returns from visiting family in the northeast then develops fever, malaise, headache, myalgia. Physical exam shows a erythematous skin rash with central clearing. Labs shows severe thrombocytopenia, leukopenia and elevated liver enzymes. Diagnosis?
Anaplasmosis (coinfection with lyme)
Transmitted by Ixodes
Bonus: Name another infection that can be transmitted by Ixodes tick?
In which year did the moon landing take place?
1969
24 year old man with 6 weeks of fever that starts in the early evening and resolves by next morning. He also has joint pain, myalgia, and occasional sore throat. He has a salmon-pink macular rash on the trunk and arms, which resolves with the fever
On physical examination, temperature is 37.5 °C (99.6°F). There is bilateral cervical lymphadenopathy. A friction rub is heard bilaterally at the lung bases. Abdomen is tender without guarding. The knees have effusions. Cardiac examination is normal.
Labs show elevated inflammatory markers, elevated ferritin, leukocytosis and mild anemia.
Chest CT shows small bilateral pleural effusions
Diagnosis?
Adult onset stills disease
Diagnosis of exclusion
Treatment with interleukin-β–directed biologic therapies, including anakinra and canakinumab. Anti–interleukin-6 therapies have shown promise.
Name 1 condition associated with a distal RTA and 1 condition associated with a proximal RTA
Type 1: Sjogrens syndrome, SLE, nephrolithiasis
Type 2: multiple myeloma, fanconi syndrome, acetazolamide
IV penicillin G every 4 weeks. With valvular disease present needs IV penicillin injection every 4 weeks for 10 year or until age 40.
Name at least 3 indications for parathyroidectomy in primary hyperparathyroidism
Age <50, Symptomatic hypercalcemia, >1 mg/dl over normal, osteoporosis, nephrolithiasis, CKD (GFR <60), Urinary 24 hour calcium excretion >400, Vertebral fractures
Board question might give you older patient w/o symptoms and mildly elevated calcium. Will need to order either urinary calcium, DEXA scan, or X-ray of vertebral spine
Which ancient civilization is credited with the first written language?
The Sumerian civilization