11 JAN 2017 0659 IM

Question 1

What is the best therapeutic option for a single brain metastasis in a surgically accessible location (ie gray white matter junction)?

Answer 1

Resection (followed by stereotactic radiosurgery or whole brain radiation)

Question 2

What is brachytherapy? Why is it effective?

Answer 2

• Implantation of a radioactive source directly into an intracerebral mass or surgical cavity
• It allows higher radiation doses to be delivered directly to the brain without affecting other organs

Question 3

What condition leads to fibrous tissue replacement of smooth muscle in the esophagus? What diagnostic modality is used for diagnosis?

Answer 3

• Systemic sclerosis

- Manometry shows LOW LES pressure

Question 4

What is the drug of choice for cyclosporine-induced HTN?

Answer 4

CCBs

Question 5

Major toxicities of cyclosporine?

Answer 5

• Nephrotoxicity (reversible acute azotemia, irreversible progressive renal dz)
• HTN (treat with CCBs)
• Neurotoxicity
• Glucose intolerance
• Infection
• Malignancy (SCC, lymphoproliferative)
• GINGIVAL HYPERTROPHY*
• HIRSUTISM*
• GI (N, V, anorexia)

Question 6

Major toxicities of azathioprine?

Answer 6

• Dose related diarrhea
• Dose related leukopenia
• Dose related hepatotoxicity

Question 7

Major toxicities of mycophenolate?

Answer 7

• Marrow suppression

- Mycophenolate = Marrow suppression

Question 8

What is the “rare disease assumption?”

Answer 8

In a case control study, if the disease is rare, disease incidence is typically low, and the OR generally approximates the RR

Question 9

What is the best imaging modality for acoustic neuromas seen in neurofibromatosis type II?

Answer 9

MRI with gadolinium

Question 10

What are the classic autoantibodies associated with dermatomyositis?

Answer 10

Anti-Jo-1 and anti-Mi-2

Question 11

What is the main complication associated with dermatomyositis?

Answer 11

Malignancy (ovarian, lung, pancreatic, stomach, colorectal, non-Hodgkin lymphoma)

Question 12

What will raising the cut off point of a screening test do to sensitivity and specificity?

Answer 12

• DECREASE sensitivity

- INCREASE specificity

Question 13

What is a morton neuroma?

Answer 13

Mechanically induced neuropathic degeneration of the interdigital nerves that cause numbness, aching, and burning in the distal forefoot from the metatarsal heads to the third and fourth toes

Question 14

What is the female athlete triad?

Answer 14

• Oligomenorrhea
• Decreased caloric intake
• Osteopenia / osteoporosis

Question 15

Why does pyridoxine deficiency lead to peripheral neuropathy?

Answer 15

Pyridoxine is a cofactor for neurotransmitters

Question 16

What is the MOA of niacin-induced pruritis? How can it be treated?

Answer 16

• Increased prostaglandins – vasodilation

- Low dose aspirin

Question 17

What drugs are used for restless leg syndrome?

Answer 17

• Dopamine agonists (pramipexole, ropinirole)

- a2-delta calcium channel ligands (gabapentin)

Question 18

What is the initial screening test for primary hyperaldosteronism? What test confirms it?

Answer 18

• Ratio of plasma aldosterone concentration to plasma renin activity
• Adrenal suppression test

Question 19

What test differentiates adrenal adenoma and bilateral adrenal hyperplasia?

Answer 19

Adrenal venous sampling