Lectures

Question 1

Thyroiditis

Answer 1

Destruction of thyroid gland

Painless - autoimmune or post viral
Postpartum - autoimmune
Subacute - painful, post viral
Suppurative 
Radiation

Question 2

Medication induced thyrotoxicosis

Answer 2

Amiodarone - has iodine in it (increased production) also is directly toxic
Lithium - hypothyroidism is more common
Contrast - has iodine in it (increased production)
Exogenous thyroid hormone - psychiatrists do this

Question 3

Atrial tachycardia treatment

Answer 3

Ablation

Metoprolol or flecainide second choice

Question 4

Ventricular tachycardia etiology

Answer 4

Reentry

Question 5

ARVC

Answer 5

Epsilon waves
Inherited myocardial disease
Fibrofatty replacement of the RV
Autosomal dominant, more common in men, Mediterranean 
No sports - accelerates progression
First degree relative screening

Question 6

Giant cell myocarditis

Answer 6

Eosinophils
T cell dysregulation
Diagnose with biopsy
Immunosuppression, transplant

Question 7

Ornithine transcarbamylase deficiency

Answer 7

Isolated hyperammonemia
Dialysis or ammonul
Arginine and citrulline supplementation - urea cycle intermediates
Diagnosis with urine orotic acid, genetics

Question 8

Mitral stenosis severity

Answer 8

Rate matters

Gradient >10 is severe

Question 9

HIT

Answer 9

Platelet factor 4
~10 days after heparin
Warfarin
Argatroban
Bivalrudin

Question 10

Rheumatic afib

Answer 10

Very high thrombotic risk

Warfarin w INR goal 2.5-3.5

Question 11

Gitelman syndrome

Answer 11

Urine high k high na high cl high mag low calcium

Question 12

Scleroderma renal crisis

Answer 12

Htn, maha, nephritis

Ace inhibitor

Question 13

LMN weakness differential

Answer 13

Anterior horn:
WNV
ALS
Lead
Polio

Spinal nerve

Peripheral neuropathy - GBS, amyloid, DM

Question 14

Muscle weakness ddx

Answer 14

Electrolyte - Mg Phos K Ca
Medications - statins, steroids, linezolid, colchicine, hydroxychloroquine
Inflammatory - dermatomyositis, polymyositis, inclusion body
Endocrine - hypothyroid, Cushing
Toxins - alcohol

Question 15

Dermatomyositis and polymyositis

Answer 15

Proximal weakness
Ck
Ana
Jo-1
Mi-2 (dermatomyositis)
Assoc with malignancy, scleroderma, mctd (dermatomyositis)

Steroids, azathioprine, mtx

Question 16

Inclusion body myositis

Answer 16

Insidious onset
Prox and distal weakness
Asymmetric
Dysphagia - cricopharyngeal muscle

cN1A antibody
Mild CK elevation

Question 17

Necrotizing myositis

Answer 17

Anti-SRP
Anti-hmgcr (statins)
Negative

Risk: statins, paraneoplastic, rheum

No infiltrate on biopsy

Question 18

Spirometer study quality

Answer 18

6 seconds or plateau of exhalation

Question 19

Spirometry obstruction

Answer 19

FEV1/FVC < 0.70
FVC > lln
Bronchodilator response increase by 12% and 200 cc

Question 20

Spirometry restriction

Answer 20

Can’t diagnose by itself
FVC < LLN
Confirm with lung volumes

Question 21

Obstructive Lung disease severity

Answer 21

%FEV
Mild >80
Mod 50
Severe 30

Question 22

Intrathoracic vs extrathoracic central airway obstruction

Answer 22

Intrathoracic - flattening expiration

Extrathoracic - flattening inspiration

Question 23

Lung volumes

Answer 23

Up obstruction

Down restriction

Question 24

DLCO

Answer 24

Area available for gas exchange
Low - emphysema, ild, lobectomy, anemia, pulmonary hypertension, vasculitis

High - L-R shunt, high CO, polycythemia, DAH

Question 25

Neurocystercercosis treatment

Answer 25

Albendazole

Question 26

Anti phospholipid clues

Answer 26

Mild thrombocytopenia Prolonged PTT Livedo reticularis

Question 27

Antiphospholipid antibody testing

Answer 27

Lupus anticoagulant (Russel viper venom) test falsely positive if anticoagulated Other tests are beta 2 glycoprotein and cardiolipin To diagnose you need antibodies and thrombosis or pregnancy event

Question 28

Hypertensive emergency treatment options

Answer 28

Aortic dissection - esmolol Pulmonary edema - nipride NSTEMI - nitroglycerin

Question 29

Sjogren’s patient with new parotid swelling

Answer 29

Lymphoma

Question 30

Igg4

Answer 30

``` Fibroinflammatory All organs involved Lymph nodes, parotid Retroperitoneal fibrosis, aortitis Sausage pancreas Plasmocytic infiltration B cells, cd4 T cells, eos ``` Treat with steroids

Question 31

Hypermagnesemia

Answer 31

Distributive shock | Don’t give mag citrate to old people or esrd

Question 32

Ecthyma gangrenosum

Answer 32

Pseudomonas bacteremia Rapidly progressive Fever Bullae

Question 33

Hook osteophytes

Answer 33

Hemochromatosis

Question 34

Primary spontaneous pneumothorax treatment

Answer 34

Observe if less than 2 cm Needle if more than 2 cm

Question 35

Diet for calcium oxalate stones

Answer 35

Increase dietary calcium Low protein Low sodium High citrate

Question 36

Lupus nephritis classifications

Answer 36

``` I - normal II - mesangiocapillary III - focal sclerosis IV - diffuse sclerosis V - membranous VI - burnt out ``` Immunosuppression for 3 and 4

Question 37

Sodium and skin

Answer 37

Glycosaminoglycans buffer sodium 7 day circadian rhythm Extensive burns end up with aldosterone mechanism alone - salt sensitive labile blood pressure

Question 38

Methanol vs ethylene glycol

Answer 38

Methanol causes vision changes

Question 39

Aspergillus in lung

Answer 39

Fungal ball w halo sign Galactomannan and beta d glucan, not sensitive

Question 40

Rheumatoid ILD

Answer 40

Men more likely Smoking more likely Monitor if asymptomatic Steroids MMF cytoxan if symptomatic

Question 41

RA vasculitis

Answer 41

25-30% of patients Medium vessels Cutaneous (scleritis, aortitis, GN) Rituxan or cytoxan

Question 42

RA lymphoma

Answer 42

DLBCL

Question 43

Felty syndrome

Answer 43

``` NHL risk up RA plus neutropenia plus splenomegaly Low complements High immunoglobulins Methotrexate, rituximab If ANC <1000 can give GSF stimulation ``` Atabacept for inadequate response Splenectomy if medical management fails