IM 3

Question 1

Definition and Clinical Presentation of Retinal Detachment

Answer 1

Separations of the layers of the retina, in patients 40-70s, caused by myopia or trauma, through which fluid seeps in and separates the retinal layers.

Photopsia (flashes of light), floaters (spots in the visual field), and curtain coming over the eyes

Tx: laser therapy and cryotherapy are done to create permanent adhesions between the neurosensory retina and the retinal pigment epithelium and choroid

Question 2

Choroidal rupture

Answer 2

Blunt ocular trauma resulting in central scotoma, retinal edema, hemorrhagic detachment of the macula sub retinal hemorrhage, crescent shaped streak concentric to the optic nerve.

Question 3

Central retinal artery occlusion (CRAO)

Answer 3

Sudden painless loss of vision in one eye, pallor of the optic disc, cherry red fovea, and boxcar segmentation of blood in the retinal veins.

Question 4

Proliferative diabetic retinopathy

Answer 4

Initial stages is asymptomatic but later with decrease visual acuity. Neovascularization is the hallmark of proliferative diabetes retinopathy

Question 5

Exudative macular degeneration

Answer 5

Acute or insidious progressive blurring of central vision bilaterally. Abnormal vessels in the retinal space.

Question 6

Porphyria Cutanea Tarda

Answer 6

Deficiency of Uroporhyrinogen decarboxylase, part of the Heme synthesis pathway. Results in painless blisters and fragility on the dorsal surface of the hand, facial hypertrichosis, and hyperpigmentation. Can be triggered by ingestion of certain substances (estrogen, ethanol). Elevated urinary prophyrin levels confirms the diagnosis. Phlebotomy and hydroxychloroquine and alpha interferon may provide some relief.

Question 7

Dermatitis Herpetiform

Answer 7

Pruritic papules and vesicles that are mainly on the elbows and knees, buttocks, posterior neck, and scalp. The condition arises in the context of gluten-sensitive enteropathy, which may be subclinical

Question 8

Crigler’s Najjar syndrome Type 1

Answer 8

Autosomal recessive disorder of bilirubin metabolism characterized by severe jaundice, and neurological impairment from kernicterus. In infants, indirect bilirubin + 20-25, but can go to 50. If intravenous phenobarbital is administered, the serum bilirubin remains unchanged. Phototherapy and plasmapheresis typically helpful for short term, but liver transplant is the only cure.

Question 9

Crigler’s Najjar syndrome type 2

Answer 9

Milder autosomal recessive disorder of bilirubin metabolism characterized by lower serum bilirubin levels (<20) and survival into adulthood with no neurological impairment from kernicterus. Liver enzymes and histology are normal. Intravenous phenobarbital can reduce the serum bilirubin levels. Treatment is often unnecessary though periodic administration of phenobarbital or clofibrate can reduce serum bilirubin levels.

Question 10

Gilbert’s Syndrome

Answer 10

Familial syndrome of bilirubin glucuronidation, where the levels of UDP glucuronyl transferase is reduced. Approximately 9% are homozygous, while another 30% are heterozygous and asymptomatic. Manifestations include icterus 2/2 mild predominately unconjugated hyperbilirubinemia - normal levels are <3. Those who are symptomatic have nonspecific complaints such as abdominal pain, increasing fatigue or malaise. Certain events such as hemolysis, fasting, or costuming a fat free diet, physical exertion, stress, fatigue can trigger for hyperbilirubinemia in these patients.

Question 11

Dx for Man with syncope when micturating or coughing?

Answer 11

Situational syncope 2/2 autonomic dysregulation by straining and rapid bladder emptying.

Question 12

How does weight loss affect the systolic blood pressure?

Answer 12

5-20 per 10kg weight loss

Question 13

How does the dash diet affect systolic blood pressure?

Answer 13

Reduction in 8-14 lbs

Question 14

In atrial fibrillation with Rapid Ventricular response, how do you manage?

Answer 14

In atrial fibrillation with Rapid Ventricular response, rate control should be attempted initially with a beta blocker or calcium blocker (diltiazem). Immediate synchronized is indicated in hemodynamically unstable patients with rapid atrial fibrillation.

Question 15

What is Beck’s Triad?

Answer 15

Hypotension, muffled heart sounds, and Jugular venous distention (and pulses paradoxus) –> Tamponade. It can be a complication of aortac dissection

Question 16

HACEK organisms

Answer 16

Haemophilus aphrophilus, Aggregatibacter actinomycetemcomitans, Carciobacterium hominis, Eikenella Carrodens, Kingella kingae

Question 17

Risk factors for OSA?

Answer 17

Obesity, Hypothyroidism, tonsillar hypertrophy.

Typical symptoms: daytime sleepiness, headache in the morning, snoring, poor judgement, impotence

Question 18

Narcolepsy

Answer 18

Poorly regulated rapid eye movement, patients may also suffer from hypnagogic and hypnopompic hallucinations

Question 19

Pickwickian Syndrome

Answer 19

Obesity hypoventilation syndrome impeding the expansion of the chest and abdomen during breathing causing under ventilation of lungs at all hours.

Question 20

Murphy’s sign

Answer 20

Worsening of RUQ pain with inspiration, indication of cholecystitis

Question 21

When does cholecystitis normally arise

Answer 21

It is secondary to stone formation and most commonly arises when gallstone impacts the cystic duct

Question 22

Cluster headache

Answer 22

recurrent episodes of unilateral, periorbital headache accompanied by ipsilateral rhinorrhea, lacrimation, red eye, and Horner syndrome. Episodes typically affect men between 20-50, occur at night and less than 2 hours.

Question 23

Enthesitis

Answer 23

When the site where the ligaments/tendon attach to bone becomes inflamed. Typical site include the heel, tibial tuberosity, and iliac crest. Common finding in Ankylosing Spondylitis and other HLA-B27 associated

Question 24

What drugs/supplement increases the effect of warfarin?

Answer 24

Acetominophen, NSAIDs, antibiotic/antifungal, amiodarone, cranberry juice, ginkgo, vitamin E, omeprazole, thyroid hormone SSRI

Question 25

What drugs/supplement decrease the effect of warfarin?

Answer 25

Leafy green, Rifampin, Carbamazepine, Oral contraception, Ginseng, St. John's wort, Green vegetables

Question 26

What is the pH of empyema?

Answer 26

<7.2. This indicates the need to remove by thoracostomy

Question 27

Metoclopramide

Answer 27

Dopamine receptor antagonist used to treat nausea, gastroparesis, vomitting. Should be monitored for drug induced extrapyramidal signs (tar dive dyskinesia, dystonic reaction, parkinsonism)

Question 28

What is mixed cryoglobulinemia?

Answer 28

Palpable purpura, proteinuria, hematuria. Other suggestive clinical manifestations include non-specific symptoms, arthralgias, hepatosplenomegaly, hypocomplementemia, majority of patients have an underlying HCV

Question 29

Henoch Scholein Purpura

Answer 29

Presents in childhood with palpable purpura on the buttocks, arthralgias, proteinuria, and hematuria with RBC casts on urinalysis. Serum complement levels are normal.

Question 30

Tumor lysis Syndrome

Answer 30

Tumors with high cell turnover which are commonly poorly differentiated lymphomas (i.e. Burkitt's lymphoma) and leukemias. Results in hyperphosphotemia, hypocalcemia, hyperkalemia, and hyperuricemia. Allopurinol has greatly reduced the rate of acute urate nephropathy.

Question 31

Most common type of blood transfusion reaction

Answer 31

Febrile Non-hemolytic: fevers, chills, within 1-6 hours of transfusion, caused by cytokine accumulation during blood storage.

Question 32

Other types of blood transfusion reactions: Acute hemolytic

Answer 32

Acute hemolytic: flank pain, hemoglobinuria, renal failure & DIC, within one hour of transfusion, positive direct Coomb's test, pink plasma, Caused by ABO incompatibility

Question 33

Blood transfusion reaction: Delay Hypersensitivity

Answer 33

2-10 days after, mild fever, hemolytic anemia, positive direct Coomb's test, positive new antibody screen, caused by anamnestic antibody response Anaphylactic: Rapid onset of shock; angioedema/urticaria & respiratory distress, within seconds to minutes of transfusion, caused by recipients anti-IgA antibodies Urticaria/allergic: urticaria, flushing, angioedema, & pruritis, , within 2-3 hours of transfusion; caused by recipient IgE antibodies and mast-cell activation

Question 34

Primary Raynaud' Phenomenon

Answer 34

No underlying cause Usually woman < 30 Possible prevalence in multiple family members Symmetric attacks, no tissue injury, digital pitting, negative nailfold capillary examination, negative antinuclear antibodies, erythrocyte sedimentation rate Tx: no further evaluation, avoidance of aggravating factors Avoidance of aggravating factors Calcium channel blockers for persistent symptoms

Question 35

Secondary Raynaud's Phenomenon

Answer 35

Connective Tissue Diseases, Occlusive vascular conditions (i.e. Buerger's disease), sympathomimetic drugs (i.e. ephedrine, epinephrine), vibrating tools, hyper viscosity syndromes (cryoglobinemia) Usually men>40, asymmetric attacks, presence of another attack, painful episodes of tissue injury, abnormal nailfold capillary examination. Abnormal studies for vascular or autoimmune disorder Tx: eval/tx underlying etiology, Ca blocker for symptoms, aspirin if at risk for digital ulceration, chemical/surgical sympathectomy for severe ischemia

Question 36

Those with suspected secondary Raynaud's Phenomenon should have which tests?

Answer 36

Urinalysis ANA and RF Complete Blood count/metabolic panel Erythrocyte sedimentation and complement levels

Question 37

Guillain-Barre Syndrome

Answer 37

Ascending polyradiculoneuropathy that often preceded by an upper respiratory tract infection or diarrhea (i.e. Campylobacter Jejeuni). Presents as bilateral leg weakness that ascends to the arms, respiratory muscles, and face to generalized flaccid paralysis. Distal parasthesia is common. Reflexes are diminished or absent. Reflexes are diminished/absent. Autonomic disturbances are common and include tachycardia, bradycardia, hypertension, orthostatic hypotension, and urinary retention. Tx: IVIG, plasmapheresis

Question 38

CSF composition of Guillain Barre

Answer 38

Protein - increased (due to increase permeability of BBB) (normal is <40) WBC - normal (0-5) RBC - normal Glucose - normal (40-70) Albuminocytologic dissociation

Question 39

CSF composition of Bacterial, fungal, tubercular meningitis

Answer 39

Protein - increased WBC - increased RBC - normal Glucose - decreased

Question 40

CSF composition of viral meningitis

Answer 40

Protein - normal to slightly elevated WBC - increased RBC -normal glucose - normal

Question 41

What type of toxicity is seen in smoke inhalation

Answer 41

CO poisoning, CO binds to hemoglobin with an affinity of 260x O2, it will displace the O2 and decrease the Hg binding sites available for O2. CO will cause a LEFT shift to the oxyhemoglobin curve. This disallow unloading of the oxygen to the tissues. This results in an increased anaerobic metabolism by the tissue leading to increase lactic acid production and development of an anion gap metabolic acidosis

Question 42

What induces a seizure?

Answer 42

Emotions, sleep loss, alcohol withdrawal, flashing lights Clinical clues: auras (olfactory, hallucinations), can occur with sleeping or sitting position, head movements, tongue bitting, rapid, strong movements

Question 43

What induces a syncope?

Answer 43

Upright position, emotion, heat, crowded places Clinical clues: signs of pre syncope (i.e. lightheadedness), unlikely to occur with sleeping, or sitting, rarely several clonic jerks can occur with prolonged cerebral hypo perfusion, pallor and diaphoresis, weak slow pulses

Question 44

Pseudotumor cerebri

Answer 44

young obese female with headaches that suggest brain tumor but has normal neuroimaging and normal CSF pressures. tx: weight reduction and acetozolamide if weight loss fails. Shunting or optic nerve sheath fenestration can prevent blindness

Question 45

What is pronator drift indicative of?

Answer 45

Upper motor neuron disease

Question 46

How to test for proprioception?

Answer 46

Patient closes eyes, and you move patients fingers. Romberg's test (patient closes eyes, and see if he falls over)

Question 47

What does the parietal control

Answer 47

sensation, perception, and the integration of sensory input

Question 48

How to test the cerebellum

Answer 48

Dysmetria, and rapidly alternating movements. Lesion can also produce upward drift

Question 49

When is infliximab used?

Answer 49

TNF-alpha blocker - Inflammatory bowel disease, ankylosing spondylitis, rheumatoid arthritis

Question 50

When is cyclophosphamide used?

Answer 50

SLE with renal involvement, chemotherapeutic agent

Question 51

When is hydroxychloroquine used?

Answer 51

Prophylaxis for malaria, treatment for acute malaria, SLE, and rheumatoid arthritis

Question 52

Sarcoidosis presentation and treatment

Answer 52

X-ray with hilar adenopathy with or without reticulonodular infiltrates, and biopsies showing noncaseating granulomas. Others: erythema nodosum, anterior uveitis, acute polyarthritis. ACE may be elevated. If symptomatic, treat with glucocorticoids

Question 53

What are some etiology of left axis deviation

Answer 53

LVH, LBBB, inferior MI, WPW

Question 54

What are some etiologies of right axis deviation

Answer 54

RVH, PE, COPD, septal defects, lateral MI, WPW

Question 55

What does DVT management entail?

Answer 55

Acute anti-coagulation and stabilization of the clot, chronic anticoagulation, and treatment of DVT complications. Heparin retards further thrombus formation, and stabilizes it, however, does not lyse existing clot. It normally takes 4-5 days before warfarin comes into effect, hence bridging with Heparin is needed. New DVTs should wear compression stockings to decrease the risk of developing post-phlebitic syndrome, a devastating complications. First time DVT are treated with anticoagulants for 6 months.

Question 56

Are thrombolytics indicated for DVT?

Answer 56

NO. They are indicated for hemodynamically significant pulmonary emboli.

Question 57

What is delayed sleep phase syndrome?

Answer 57

A circadian sleep wake disorder characterized by sleep onset insomnia and excessive morning sleepiness. Advanced sleep phase syndrome is the opposite problem

Question 58

What is pseudo gout?

Answer 58

Caused by calcium pyrophosphate dehydrate (CPPD) deposition. Synovial fluid reveals rhomboid shaped, positive bifirengent crystals.

Question 59

Heart murmur at the left sternal border that decreases with increase preload is classic for what?

Answer 59

Hypertrophic cardiomyopathy

Question 60

What drugs induce drug-induced lupus?

Answer 60

hydralazine, procainamide, isoniazid

Question 61

What are signs of Cushing syndrome?

Answer 61

Fatigue, weight gain, easy bruising, central adiposity, proximal muscle weakness, hyperglycemia, osteopenia, and osteoporosis, hypertension, acne, susceptibility to infections. Excess corticosteroids can act like mineral corticoids like aldosterone and induce potassium wasting.

Question 62

What is the significance of leukocyte esterase and nitrites?

Answer 62

Leukocyte esterase indicates the prescence of significant pyuria. While nitrites indicates the presence of Enterobacteriacaece which turns the urinary nitrate to nitrite

Question 63

What is the most common cause of secondary hypertension?

Answer 63

``` Renovascular disease (renal artery stenosis) Severe hypertension (>180 mmHg systolic and/or 120 mmHg diastolic) after age 55. Possible recurrent pulmonary edema or resistant heart failure. Unexplained rise in serum creatinine, abdominal bruit ``` Should be suspected in asymmetric kidneys, diffuse atherosclerosis, recurrent pulmonary edema, elevated serum creatinine >30% after starting a ACE inhibitor or ARB.

Question 64

Other causes of secondary hypertension?

Answer 64

Renal parenchymal disease - elevated serum creatinine, abnormal urinalysis (proteinuria, RBC casts) Primary aldosteronism - easily provoked hypokalemia, slight hypernatremia, hypertension with adrenal incidentaloma Pheochromocytoma - paroxysmal elevated blood pressures with tachycardia, pounding headaches, palpitations, diaphoresis, vanillylmandelic acid Cushing Syndrome, Hypothyroidism, Primary hyperparathyroidism, Coarctation of the aorta

Question 65

What is mupirocin used for?

Answer 65

Topical antibiotic used to treat superficial skin infections like impetigo and to eradicate MRSA colonization from the nares

Question 66

Uses for topical 5-fluorouracil?

Answer 66

Skin conditions that rapidly divide like actinic keratosis and basal cell carcinoma

Question 67

How does cauda equine syndrome present?

Answer 67

Severe lower back pain with unilateral radiculopathy, saddle anesthesia, hyporeflexia, profound asymmetric motor weakness, and late-onset bowel and bladder dysfunction

Question 68

How does conus medullaris syndrome present?

Answer 68

severe back pain with less degree of radiculopathy, perianal anesthesia, hyperreflexia, mild bilateral motor weakness, and early-onset bowel and bladder disturbances.

Question 69

Lumbar spinal stenosis

Answer 69

Degenerative condition where the spinal canal is narrowed resulting in compression of 1+ spinal roots. Most commonly due to enlarging osteophytes at the facet joints and hypertrophy of the ligamentum flavum. Most affected patients are over 60. Patients experience pain that radiates to the buttocks and thighs. Numbness and paresthesias may occur. Typically worse on extension, and better on flexion. Diagnosis confirmed with MRI.

Question 70

Lumbar disc herniation

Answer 70

Present with acute onset of back pain with or without radiation down one leg. Patient can recall the inciting event. Flexion and sitting will make it worse.

Question 71

How does metastatic disease of the back present?

Answer 71

Pain that is chronic, dull, worse at night, and change little with activity. Usually non-radiating.

Question 72

Serum Osmolarity and Osmolar gap

Answer 72

Serum Osmolarity = 2Na + Glu/18 + BUN/2.8 Osmol gap = Observed osmolarity - calculated osmolarity Normal = <10

Question 73

Normal Anion gap

Answer 73

6-12

Question 74

Interstitial lung disease findings

Answer 74

Decreased lung volumes ( low residual volume) with preserved or increased FEV1/FVC ratios, reduced DLCO, and increase A-a gradients.

Question 75

What are clinical associations with minimal change disease?

Answer 75

NSAIDs, lymphoma

Question 76

What are clinical associations with focal segmental glomerulonephritis

Answer 76

African American, Hispanic, HIV and Heroine use

Question 77

Clinical associations with membranous nephropathy

Answer 77

Adenocarcinoma(breast lung), NSAID, Hep B, SLE

Question 78

Clinical associations with membranoproliferative glomerulonephritis

Answer 78

Hep B, C, lipodystrophy, chronic bacterial infection (i.e. endocarditis)

Question 79

Clinical associations with IgA nephropathy

Answer 79

Upper respiratory tract infections

Question 80

How does total parenteral nutrition increase risk for gallstones?

Answer 80

The normal stimulation of CCK and gallbladder contraction (protein and fat in duodenum) is absent --> biliary stasis -- >stones.

Question 81

Lead time bias?

Answer 81

Prolongation of apparent survival in patients to whom a test (screening) is applied without changing the prognosis of the disease

Question 82

EKG of atrial fibrillation

Answer 82

Absent p waves which are replaced with tiny chaotic fibrillatory waves, irregularly irregular R-R intervals and narrow QRS complexes. Pulmonary veins are the most common origin for ectopic foci that cause atrial fibrillation.

Question 83

Where does Paroxysmal supra ventricular tachycardia form re-entry circuits

Answer 83

Most commonly within the AV node or via accessory bypass tracts

Question 84

What does whole blood contain that chelates calcium

Answer 84

Citrate anticoagulant chelates the calcium and magnesium and can cause hypocalcemia

Question 85

Gold standard for diagnosis of Obstructive Sleep Apnea

Answer 85

Nocturnal polysomnography

Question 86

What are smudge cells pathognomonic for?

Answer 86

CLL. Disease of older individuals (median age = 70). Flow cytometry can prove clonality of the abnormal lymphocyte and is generally used to confirm the diagnosis.

Question 87

What is JAK2 mutations used to diagnose?

Answer 87

Myeloproliferative disease particularly polycythemia vera

Question 88

When is serum protein electrophoresis used?

Answer 88

Detect elevated levels of a monoclonal protein as seen in multiple myeloma

Question 89

When is Epstein Barr virus serology used?

Answer 89

Confirm a diagnosis of mononucleosis which typically targets a younger population

Question 90

What is the most common cause of ductopenia (vanishing bile duct syndrome)?

Answer 90

Primary Biliary cirrhosis.

Question 91

Hyperestrogenemia from cirrhosis of the liver can lead to what findings?

Answer 91

Gynecomastia, palmar erythema, spider angioma, testicular atrophy, decrease body hair

Question 92

What is the murmur heard for infective endocarditis?

Answer 92

Tricuspid valve. | Holosystolic murmur that gets louder upon inspiration.

Question 93

What is the function of the liver?

Answer 93

Synthetic (synthesizes coagulation factors, cholesterol, proteins) Metabolism (metabolism of estrogen, drugs, steroids) Excretion (bile excretion)

Question 94

What is the treatment for hyperkalemia if you want to remove from the body?

Answer 94

K+ can be removed from the body via diuretics, cation-exchange resin (kayexalate), or dialysis!

Question 95

Treatment for hyperkalemia which shifts the potassium into the cells

Answer 95

Sodium bicarbonate, insulin plus dextrose drip, and beta agonist will drive the potassium into the cells.

Question 96

What are the vascular phenomenons of infective endocarditis? (makes up minor criteria in Duke's Criterias)

Answer 96

Systemic arterial emboli (focal neurological deficits, renal or splenic infarcts) Septic pulmonary infarcts Janeway lesion - macular, erythematous lesions on the palms and soles Conjunctival hemorrhages mycotic aneurysms

Question 97

What are the immunological phenomenons of infective endocarditis? (makes up a minor criteria in Duke's Criteria)

Answer 97

Osler's Node - painful, violaceous nodules seen on the fingertips and toes Roth spots - edematous and hemorrhagic lesions on the retina Glomerulonephritis Arthritis or positive RF

Question 98

Classic triad for normal pressure hydrocephalus?

Answer 98

Cognitive dysfunction, gait difficulty, and urinary incontinence

Question 99

Presentation of spinal cord compression

Answer 99

Worsening focal back pain, bilateral lower-extremity weakness, sensory loss, and gait ataxia. Bowel/bladder disturbances are late findings. In the acute phase of the spinal injury, there can be flaccid paralysis and absence of reflexes

Question 100

What are the three categories of diabetic retinopathy? Tx?

Answer 100

(1) Background, simple retinopathy - microaneurysms, hemorrhages, exudates, and non-insulin dependent diabetes mellitus (2) Pre-proliferative retinopathy - cotton wool spots (3) Proliferative/malignant retinopathy - neovascularization Visual impairment occur with macular edema Tx: Argon photolaser coagulation for prevention of complications

Question 101

Central retinal vein occlusion

Answer 101

Sudden, unilateral visual impairment that normally happens in the mornings. Ophthalmoscopy reveals disc swelling, venous dilation, and tortuosity, retinal hemorrhage, and cotton wool spots

Question 102

Macular degeneration

Answer 102

Affects central vision - distorted vision and central scotoma. Macular degeneration affects central vision. Ophthalmoscopy findings are: Atrophic - multiple sores in the macular region Exudative form - new blood vessels that may leak, bleed and scar the retina

Question 103

Open angle glaucoma

Answer 103

Gradual loss of peripheral vision, resulting in tunnel vision. Ophthalmoscopy shows pathologic cupping of the optic disc.

Question 104

What are normal changes to the aging heart?

Answer 104

Decrease in resting and maximal cardiac output, decreased maximum heart rate, increase contraction, and relaxation time of the heart, increased myocardial stiffness, during diastole, decreased myocyte number and pigment accumulation in myocardial cells

Question 105

What are the causes of hypovolemic hyponatremia?

Answer 105

Renal loses (diuretic) Acute blood loss Primary adrenal insufficiency GI loss - Diarrhea and vomiting

Question 106

What are the causes of euvolemic hyponatremia?

Answer 106

SIADH (i.e. due to drugs and malignancy) Primary (psychogenic polydipsia) Secondary adrenal insufficiency Hypothyroidism

Question 107

What are the causes of hypervolemic hyponatremia?

Answer 107

CHF Cirrhosis Chronic kidney disease or nephrotic disease

Question 108

Cause of hyponatremia

Answer 108

Excess water intake that is greater than the kidney's ability to remove the free water. Thus hyponatremia is due to increase water intake, inability to suppress ADH release or impaired renal ability to excrete free water. Hypovolemic hyponatremia has appropriately increased ADH levels. Euvolemic and hypervolemic usually have inappropriately elevated ADH.

Question 109

How is ADH secretion regulated?

Answer 109

Primarily by plasma osmolarity. However, significant hypovolemia is also a potent stimulator of ADH release.

Question 110

Rotator cuff tears causes, dx, and tx.

Answer 110

Result from chronic rotator cuff tendonitis and shoulder trauma. Shoulder pain and weakness when lifting the arms, above the head is suggestive of rotator cuff pathology. Lidocaine injections ameliorate the pain of rotator cuff tendonitis, but does not improve symptoms of rotator cuff tear. MRI is a great way to look at soft tissue structures and the study of choice for rotator cuff tears.

Question 111

What do patients with atrial fibrillation need to be screened for?

Answer 111

Occult hyperthyroidism