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hammer10 Flashcards

1
Q

What are the features of papillary thyroid cancer vs follicular cancer?

A

Papillary is unencapsulated, psa momma bodies, large cells with ground glass cytoplasm, pale nuclei and inclusion bodies with central grooving.
Follicular is encapsulated, hematogenous spreads with normal appearing cells

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2
Q

What is the presentation of hypercalcemia?

A

Confusion, stupor, lethargy and constipation. Short QT and hypertension. Nephrolithiasis, Diabetes insipidus, renal insufficiency.

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3
Q

What is a major etiology of hyperparathyroidism? Which ion is elevated besides calcium and what GI disorder is seen? What is the treatment when surgery doesn’t work?

A

Solitary adenoma in 80-85% of cases. Hyperplasia of all 4 glands in 15-20 percent of all cases. Chloride is elevated and peptic ulcer disease.cinacalcet to inhibit PTH.

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4
Q

Whatever are signs of neural hyperexcitability in Hypocalcemia? EKG and slit lamp findings?

A

Chvostek sign, carpopedal spasms, peri oral numbness, tetany. Prolonged QT and cataracts.

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5
Q

What is the next step if ACTH level is elevated and does not suppress with high dose dexamethasone ? What must you always do prior to imaging tests?

A

Do an MRI to see if there is a pituitary lesion, or sample the inferior petrosal sinus for ACTH after stimulating patient with CRH to see if pituitary is still the source. Confirm the source of hypercortisolism with biochemical tests.

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6
Q

What are lab findings in hypercortisolism? Hypocortisolism and treatment? In acute adrenal insufficiency what is the first step before diagnosis?

A

Hyperglycemia, hyperlipidemia, hypokalemia, metabolic alkalosis, leukocytosis 2/2 demargination of WBC. Opposite in hypoadrenalism plus eosinophilia. Replace steroid with hydrocortisone or fludrocortisone. Draw cortisol level and administer hydrocortisone.

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7
Q

What is the sideeffects of spirnolactone?

A

Gynecomastia and decreased libido

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8
Q

What are the symptoms of pheochromocytoma and what is the treatment?

A

Episodic HTN, headache, sweating, palpitations and tremor. Phenoxybenzine is an alpha blockers best initial therapy. CCB and bb are used next. Surgical excision.

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9
Q

What is the mechanism of sulfonylureas in diabetes and what are they not firstline?

A

Increase insulin release from pancreas, dive glucos intracellularly and increase obesity.

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10
Q

What is the mechanism of DPP-IV inhibitors (sitagliptin etc)?

A

They block the metabolism of incretins (GIP and GLP) which help release insulin.

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11
Q

What is the mechanism a fun side effects of alpha gluocosidase inhibitors? Mechanism of pramin tide?

A

Block glucose absorption in the bowel and cause flatus, diarrhea and abdominal pain. Pramlintide is an amylin analog that decreases gastric emptying, decreases glucagon levels reassess appetite.

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12
Q

Which is the most accurate measure of the severity of DKA?

A

Serum bicarbonate because it is a measure of anion gap

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13
Q

What vaccine should diabetics get? What is the BP, LDL levels wanted, what is the best way to treat diabetic nephropathy? What is the treatment for diabetic neuropathy?

A

Below 140/90, less than 100, ACEi or ARBs. Pregabalin, gabapentin, TCAs.

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14
Q

What is the best initial treatment for nonhemorrhagic stroke? What meds should you start stroke patients on? What type of surgery?

A

Less than 3 hours, thrombolytics. More than3 hours aspirin, plus dipyridamole if already on it or discontinue aspirin and switch to clopidogrel. Statins. Carotid endartectomy for more than 70 percent stenosis. No carotid angioplasty.

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15
Q

Which headache type can cause ipsilateral horners? Why is there diplopia in pseduotumor cerebri?

A

Cluster. Six cranial nerve abducens palsy

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16
Q

What is the treatment for migraines and what is prophylaxis?

A

Treatment is NSAIDS and triptans. Prophylaxis is propranolol which is the best one and sodium valproate,ccbs, SSRI, topiramate.

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17
Q

What is the treatment for cluster headaches and what is prophylaxis?

A

Treatment is sumitriptan, octreotide, oxygen. Ppx is Verapamil, prednisone, sodium valproate.

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18
Q

What is the treatment for trigeminal neuralgia if medications don’t work?

A

Gamma. Knife surgery

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19
Q

What is the treatment of status epilepticus?

A
  1. Benzodiazepine 2. Fosphenytoin (or phenytoin but it is associated with hypotension and AV block) 3. Phenobarbital 4. General anesthesia
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20
Q

When can you discontinue seizure meds?

A

Symptom free for 2 years

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21
Q

What is the usual cause of a subarachnoid hemorrhage? Symptoms?

A

Rupture on anterior portion of circle of Willis. Severe headache, stiff neck, photophobia and fever. Loss of consciousness in 50% of cases.

22
Q

What is xanthochromia and what is the ratio of zeBC to zrBc in normal csf? What should you suspect if it exceeds this ratio ?

A

Yellow csf discoloration from RBC breakdown. 1 WBC to 500-1000 rbc. Suspect meningitis.

23
Q

What is the treatment options for subarachnoid hemorrhage?

A

Nimodipine to prevent subsequent stroke, embolization over surgical clipping, vp shunt, seizure Ppx with phenytoin.

24
Q

What are symptoms of anterior spinal artery infarction?

A

Loss of all function except posterior column, flaccid paralysis, loss of DTRs, loss of pain and temperature

25
Q

How does a brain abscess look like on CT or MRI? What is empiric treatment while waiting on results?

A

Ring or contrast enhancing lesion that will likely have surrounding edema and mass effect. Empiric treatment with penicillin plus metronidazole plus ceftriaxone.

26
Q

What are the findings in tuberous sclerosis?

A

Neurological abnormalities like seizures, adenoma sebaceum (red facial nodules), shagreen patches (leathery plaques on trunk), ash leaf spots (hypo pigmentation), retinal lesions, cardiac rhabdomyomas.

27
Q

What are the findings in neurofibromatosis ?

A

Soft, flesh colored lesions attached to peripheral nerves, cn 8 lesions, meningiomas and gliomas and cafe at lait spots. Nf1 is neurofibromin chromosome 17 while nf2 is Merlin.

28
Q

What is the presentation of sturgeon weber syndrome?

A

Port wine stain, seizures, homonymous hemianopsia, hemiparesis, mental sub normality. X-ray showing calcifications of angiomas.

29
Q

Which parkinson meds relieve tremor and rigidity? Which one increases release of dopamine from substantial nigra? What is best initial treatment in severe Parkinsonism? Which meds slow down disease progression? What kind of crisis happens with MAOI and Tyramine containing foods?

A

Anticholinergics such as benztropine and trihexyphenidyl. Amantadine, also good for those who can’t tolerate anticholinergics. Dopamine agonists pramiprexole and ropinirole. Mao inhibitors like rasagiline and selegiline. Htn.

30
Q

What is the treatment for parkinson patients treated with meds presenting with psychosis and confusion?

A

Start clozapine as these are well known side effects.

31
Q

How is Huntington disease diagnosed and treatment? What is Tourette treatment?

A

Specific gene test for CAG trinucleotide repeats. Dyskinesia is treated with tetrabenzine, psychosis is treated with haldol, quetiapine. Risperidone, fluphenazine, clonazepam.

32
Q

What is the most common presentation in multiple sclerosis? Which drugs apse and progression? Which medication causs progressive multifocal leukoencephalopathy?

A

Gait and balance problems, optic neuritis, bilateral trigeminal neuralgia. Inter nuclear opthalmoplegia. Glatiramer (copolymer) and beta interferon. Natalizumab which inhibits alpha4 integrin.

33
Q

What is the presentation, diagnosis and treatment of ALS?

A

Weakness of unclear etiology, difficulty in chewing and swallowing, decreased gag reflex. EMG shows loss of neural innervation in multiple muscle groups. Riluzole decreases glutamate buildup, baclofen treats spasticity ,cpap and bipap to deal with respiratory issues.

34
Q

What nerve is damaged when trauma to medial side of elbow? Falling asleep over arm chair? Pain or numbness on outer aspect of thigh?

A

Ulnar, radial, lateral cutaneous nerve of thigh

35
Q

What should you worry about in facial nerve palsy if patient can wrinkle their forehead? What are the two other features of Bell’s palsy? How is it tested?

A

Stroke. Hyperacusis 2/2 stapedius muscle dysfunction and tast disturbances to anterior 2/3 of tongue. EMG and nerve conduction studies.

36
Q

What is the pathophysiology behind GBS? What is the most specific diagnostic test? Treatment?

A

Autoimmune damage of peripheral nerves by antibody that attacks myelin sheaths. Nerve conduction studies or electromyography. IVIG or plasmapheresis not both.

37
Q

What are the diagnostic tests for myasthenia gravis? What imaging test should be done? Treatment?

A

Acetylcholine receptor antibodies, ediohonium which is an acetylcholinesterase inhibitor, EMG shows decreased strength with repetitive stimulation. Neostigmine or pyridostigmine. Chest imaging to look for thymoma and thymomectomy if patient is under 60.

38
Q

What is the management of acute myasthenic crisis?

A

IVIG or plasmapheresis.

39
Q

What kind of gait is seen in frontal lobe degeneration?

A

Magnetic freezing gait, start adn turn, hesitation.

40
Q

What is the symptoms of Creutzfeldt Jakob disease? What is the most accurate diagnostic tool?

A

Rapidly progressing dementia, myoclonic jerks, csf with 14-3-3 protein. Biopsy is most accurate.

41
Q

What is the presentation of non allergic rhinitis and what is the treatment?

A

Nasal congestion, rhinorrhea, sneezing and post nasal drainage. Intranasal antihistamine, intranasal glucocoritcoids

42
Q

What is the relationship between oral estrogen intake and TBG levels? What happens to the requirement for patients who are hypothyroid?

A

Oral estrogen leads to elevated TBG levels2/2 decreased clearance of TBG. They need additional supplementation of L-thyroxine, same like pregnant patients.

43
Q

What is the clinical presentation of granulomatosis with polyangitis? Treatment?

A

Sinusitis/otitis, saddle nose deformity, lung nodules, rapidly progressing GN, livedo reticularis, non healing ulcers. ANCA (PR3), MPO (20%). Tx - Corticosteroids and immunomodulators

44
Q

How is Wegner’s diagnosed?

A

Biopsy shows leukocytoclastic vasculitits, pauce immune GN and granulmoatous vasculitis.

45
Q

What property does a confounder have to have?

A

It should have properties linking it with exposure and outcome of interest.

46
Q

Which antiseizure medsa dna antibiotics cause pancreatitis?

A

Valproic acid and metronidazole

47
Q

What is the workup of hyperemesis gravidarum?

A

Ultrasound with severe vomiting and weight loss

48
Q

What causes a complete mole? a partial mole?

A

Abnormal fertilization of trophoblastic tissue. 2 sperm fertilize an ovum lacking genetic material and no fetal tissue. 2 sperm fertilize a haploid ovum, resulting in abnormal placenta and fetal tissue with a triploid karyotype.

49
Q

What are the values of FSH and LH in primary ovarian failure?

A

Both are elevated and FSH/LH ratio is greater than 1

50
Q

What is the first step in evaluating an NF patient with neurologic symptoms?

A

MRI of brain and orbits.

51
Q

What medication should you add to GERD patients who have worsening asthma?

A

PPI

52
Q

What is the treatment for myasthenic crisis after intubation for respiratory failure?

A

Plasmapheresis or IVIG, and corticosteroids

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