ABIM1 Flashcards
Which nerve: leg flexion at the hip & extension at the knee?
Femoral nerve (gives off saphenous nerve at medial calf)
Foot drop & sensory loss of dorsal foot and lateral shin- Which nerve is injured?
Common peroneal nerve (often at fibular head region)
RF Common Peroneal N Injury
Prolonged immobilization, leg crossing, squatting, leg casting (esp when combined w/ significant weight loss)
Weakness of dorsiflexion and eversion. Dx?
Common peroneal nerve injury(often at fibular head region)
Tx Common peroneal nerve injury?
Removing pressure on nerve, ankle-foot orthosis splint to keep the foot dorsiflexed & PT
***Variable Tx results with little recovery in most cases
Burning pain of the foot and heel, paresthesias/sensory loss in the sole. Which nerve is affected?
Posterior tibial n (Via Tarsal Tunnel Injury)
Plantar flexion, toe flexion and foot inversion. Which nerve?
Tibial N
Radiculopathy at 1) Knee, 2) Dorsal foot 3) heel/lateral calf. Which nerve distribution?
1) L4, 2) L5 3) S1
Etiologies central hypothyroidism.
Mass lesions.
Infiltration (sarcoidosis, hemochromatosis),
Radiation, trauma, pituitary surgery.
Pituitary infarct (sheehan Sx).
Empty Sella Syndrome.
Low free T4, Low TSH. NSIM?
ACTH test to r/o central (secondary) hypothyroidism
Tx Central Hypothyroidism?
Levothyroxine (goal free T4 high normal range)
*First line Tx Fibromyalgia?
TCA (ie amitrypyline)….2nd line: pregabalin, duloxetine, milnacipran.
Tx Fibromyalgia (4)
- TCA (amitryptaline)
- Pregabalin, duloxetine, milnacipran
- combo drug therapy, supervised rehab, pain management, CBT
Milnacipran use?
SNRI for fibromyalgia (2nd line to TCA)
MOA hyperCa in sarcoidosis?
Extrarenal production of 1-hydroxylase leading to excessive conversion of 25-OH vitD to 1,25 DiH vit D (calcitriol). Calcitriol then increases Ca GI absorption as well as bone resorption. (**PTH independent, note: PTH is often low)
PTH level in sarcoidosis?
LOW hyperCa is PTH independent (Extrarenal production of 1-hydroxylase leading to excessive conversion of 25-OH vitD to 1,25 DiH vit D (calcitriol). Calcitriol then increases Ca GI absorption as well as bone resorption.
Tx hyperCa in sarcoidosis?
IVF & low dose GCS. Also decrease sun exposure and dietary Ca. MOA: In sarcoid, Extrarenal production of 1-hydroxylase leads to excessive conversion of 25-OH vitD to 1,25 DiH vit D (calcitriol). Calcitriol then increases Ca GI absorption as well as bone resorption. **GCS decreases calcitriol production
Zolendronate is contraindicated in patients w/ ____
renal failure
Dermatomyositis Tx?
High dose GCS 1mg/kg/day. (**age-appropriate cancer screening). +/- CT chest/abd/pelvis, UA (hematuria), CA125, CA19-9, PSA, EGD
Tx: Polymyalgia rheumatica
low dose GCS
Heliotrope rash, transaminitis, high CK & ESR. NSIM?
high dose GCS & age-appropriate cancer screening). +/- CT chest/abd/pelvis, UA (hematuria), CA125, CA19-9, PSA, EGD
Medication w/ rapid & short term Ca reduction (w/in 4-6h) used with bisphosphonates in severe hyperCa (most commonly assd w/ malig).
Calcitonin
Calcium mimetic drug acts on Ca receptors on parathyroid cells to decrease PTH secretion (ie in hyperCa primary or tertiary hyper parathyroidism)
Cinacalcet (Sensipar)
Medication which decreases Ca d/t excessive bone resorption.
Zolendronate