MKSAP Monday: High yield facts

Our HEROES team came together and shared some good learning points from their MSKAP studying session! Here is a sample of them:

DERM:

Topical steroid facts:
In general, twice-daily dosing of steroids is the most common dosing schedule, and the medication should be applied in a thin film. A rule of thumb is that 30 grams of a topical glucocorticoid will be enough to cover the entire surface of a 70 kg adult, once. Proportionately less is needed for smaller areas.
Topical glucocorticoids are frequently commercially combined with topical
antifungal agents (clotrimazole-betamethasone). These combinations should be avoided. The use of a combination drug can worsen some tinea infections and when used in the groin area has a high risk of causing striae.

Contact dermatitis facts:
Urushiol, the allergen that is a common cause of allergic contact dermatitis, is found in plants such as poison ivy, oak, and sumac—> presents with intensely pruritic, often linear, vesicular papules, plaques, and vesicles

Lesions can present at different locations at different times up to 14 days after exposure in sensitized patients. Fluid from vesicles and blisters is not antigenic.

Fragrances are also common allergens found in many cosmetic products,
moisturizers, and detergents. They may also be present as flavoring agents of toothpastes, mouthwashes, and food beverages.


Neomycin and bacitracin are commonly used for wound care. They can cause an allergic contact dermatitis that mimics a wound infection. Given the prevalence of sensitivity to these products, patients should use plain petrolatum in place of topical antibiotics to aid healing of clean wounds.


Almost all household cleansers and personal hygiene products contain
preservatives that can produce allergic contact dermatitis. Certain occupations also are at increased risk of allergic contact dermatitis.

GI:

1)Hep B phases: a.Immune tolerant: HBsAg positive, HBeAg positive, normal ALT/AST b.Immune active: HBsAg positive, HBeAg positive, high ALT (TREAT)c.Immune control/inactive: HBsAg positive, HBeAg negative, normal ALT/ASTd.Reactivation: HBsAg positive, HBeAg negative, high ALT (TREAT)
2) Colon cancer screening: a. 1 year: 10 or more adenomas (sessile serrated polyps), Lynch/hereditary polyposis syndromes b. 3 years: 3-9 sessile serrated polyps, 1 sessile serrated polyp > 1 cm, any villous or high grade dysplasia c. 5 years: 1-2 sessile serrated polyps, 1st degree family member w/colon cancer diagnosed before age 60
3) NSAIDs and PPIs increase risk of microscopic colitis (think older adult with chronic nonbloody watery diarrhea).

Pulm:

Solitary pulmonary nodule:– if imaging demonstrates stability of a SPN without suspicious features (and no other new findings) for 24 months, no further imaging is required (nice rule of thumb), requires at least 2 scans unless called hamartoma or granuloma outright

Stable COPD management:– Roflumilast (PDE-4-I) may have a ?modest benefit for severe COPD with ongoing exacerbations after bronchoD regimen is optimized (can be helpful for severe COPD with otherwise optimized regimen)
— review of 34 RCTs of roflumilast or cilomilast vs placebo found modest FEV1 improvement (51mL, CI 43-59) and reduced likelihood of exacberation (OR 0.78, 0.73-0.83)
Bronchiectasis:– treatment of flares with abx is tailored to prior sputum cultures and sensitivities (rather than empiric as you would for PNA) since the cough is characteristically productive- in the absence of sputum culture data, a respiratory FQ is suggested- tx is longer (10-14 days)