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Section
Question | Answer |
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1-wt r the nerve injuries can occur during carotid endarterectomy | 1-hypoglossal nerve causes tongue deviation to the site of injury 2-Recurrent laryngeal nerve injury leads to unilateral vocal cord paralysis, with a resultant change in voice quality. 3-facial nerver can result in asymmetric smile 4-vagus nerve |
2-how does lithium cause hypothyroidism | Lithium interferes with the synthesis and release of thyroid hormone, mainly during first 2 years. |
3-what is the prevalence of hypothyroidism while treated with lithium for bipolar? | Goiter(hyper) occurs in 40%-50% and hypothyroidism in 20%-30% of lithium-treated patients. |
4-how often to follow thyroid function while on lithium treatment | -prior to initiating lithium and every 6-12 months thereafter. |
5-how to manage hypothyroidism while taking lithium ? | not an indication to stop lithium. Patients may continue lithium if necessary and receive treatment with levothyroxine. |
6-what medication can increase lithium level | 1-thiazide diuretics 2-NSAID (not ASA) 3-ACE inhibitors. |
7-what is the disease associated with anti-tissue transglutaminase ? | celiac disease |
8-how long celiac disease patient need to avoid gluten before symptoms start to improve ? | 2 weeks |
9-what is the first step in managing celiac disease symptoms worsening | A detailed dietary review, |
10-how to know if celiac diseased patient is not complainet | -Serologic studies (eg, anti-tissue transglutaminase, anti-gliadin antibodies) correlate with disease activity and can be helpful in assessing compliance. -antibodies should decline 50% in 8 weeks and normalize within 12 months on a gluten-free diet |
11-what is the deference between schizoaffective disorder (with depression on bipolar type) and major depression or bipolar with psychotic features | schizoaffective disorder has psychosis even without depression or mania but major depression with psychotic features has psychosis only during depression. |
12-when does cryptococcal meningoencephalitis affect HIV pt (wt cd count )? | <100 |
13-what is the csf study finding in cryptocoaal meningoencephalitis ? | 1-Markedly elevated opening pressure, often >250-300 mm H2O 2-Low leukocyte count (<50/mm3) (compared to other meningitides) with a lymphocytic predominance 3-Elevated protein 4-Low glucose 5-Positive India ink preparation or cryptococcal antigen test |
14-how to treat cryptococcal meningoencephalitis | treat in 3 stages. 1-induction amphotericin B and flucytosine for >2 weeks (until symptoms abate and CSF is sterilized). 2-Consolidation - high-dose oral fluconazole for 8 weeks. 3-Maintenance - lower-dose oral fluconazole for >1 year to prevent recurrence |
15-what is skin finding in cryptococcal meningitis | papular lesions with central umbilication that resemble molluscum contagiosum |
16-how does cryptococcal meningitis lead to increase CSF pressure ? | fungal capsular polysaccharides can clog the arachnoid villi, which prevents cerebrospinal fluid outflow and increases intracranial pressure (ICP). |
17-how to manage increase ICP assocaited with cryptococcal meningitis | serial lumbar punctures until symptoms abate. no role for mannitol or steroid |
18-what is the complication of increase ICP assocaited with cryptococcal meningitis if left untreated | If untreated, brain herniation and death may occur. |
19-what is the phases of pertussis infection | 1-catarrhal 1-2 weeks of mild cough and rhinitis 2-paroxysmal(2-6 weeks) of cough with inspiratory whoop and emesis 3-convalescent (week -months ) symptoms resolve gradually. |
20-how to treat pertussis | macrolides will work if given during catarrhal phase only, however it will be given at any phase because it decrease risk of transmission |
21-what is the inclusion criteria for TPA use in stroke | -Schemic stroke with neurodeficits -Symptom onset <3-4.5 hours before treatment initiation |
22-what is the Strict exclusion criteria for the use of TPA during stroke? | 1-Hemorrhage or multilobar infarct involving >33% of cerebral hemisphere on CT scan 2-Stroke/head trauma in past 3 months 3- History of intracranial hemorrhage, neoplasm, or vascular malformation 4-Recent intracranial/spinal surgery 5-Active bleeding or arterial puncture in past 7 days at noncompressible site 6-BP >185/110 mm Hg Platelets <100,000/mm3 or glucose <50 mg/dL 7-Anticoagulant use with INR >1.7, PT >15 sec, or ↑ aPTT |
23-what is Relative exclusion criteria for TPA use during stroke | 1-Minor or rapidly improving neurodeficits 2-Major surgery/trauma in the past 14 days 3-MI in the past 3 months 4-GU or GI bleeding in the past 21 days 5-Seizure at stroke onset 6-Pregnancy |
24- | |
25-what is the target BP during treating acute stoke patient? | 1-220/120 if no TPA 2-<185/105 for at least 24 hours if TPA |
26-how to manage renal stone | -if Stones >10 mm, uncontrolled pain, presence of acute renal failure, and urosepsis are indications for urgent urologic referral for stone removal. -if <10 hydration, pain control, alphablockers, strain urine but still if not stone passage in 4-6 weeks or uncontolled pain ask for urology consult. |
27-what is most common thyroid dysfunction associated with amiodarone drug | Both hypothyroidism(more common) and hyperthyroidism can occur, although |
29-how does amiodrone cause hypothyroidism | The large iodine load suppresses synthesis of thyroid hormone (Wolff-Chaikoff effect), and amiodarone itself directly inhibits the conversion of T4 to T3. |
30-how often should check TSH in patient being treated with amiodarone | periodic monitoring of TSH (every 3-4 months). |
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