ismailalmokyad's version from 2018-01-17 01:00


Question Answer
1-wt r the nerve injuries can occur during carotid endarterectomy1-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 hypothyroidismLithium 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 level1-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 worseningA 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 featuresschizoaffective 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 meningoencephalitistreat 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 meningitispapular 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 meningitisserial 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 untreatedIf untreated, brain herniation and death may occur.
19-what is the phases of pertussis infection1-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 pertussismacrolides 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 stroke1-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
24-what is the most frequent cause of early death in acute stroke patientPE, keep in mind DVT risk is also high in the first 7 days after stoke and can go up to 10% of patient without ppx
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 drugBoth hypothyroidism(more common) and hyperthyroidism can occur, although
29-how does amiodrone cause hypothyroidismThe 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 amiodaroneperiodic monitoring of TSH (every 3-4 months).

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