Podcast
Questions and Answers
What is the primary cause of bleeding associated with Meckel’s diverticulum?
What is the primary cause of bleeding associated with Meckel’s diverticulum?
What condition is indicated by severe abdominal pain and distension in a patient with a history of Ulcerative Colitis?
What condition is indicated by severe abdominal pain and distension in a patient with a history of Ulcerative Colitis?
Which thyroid condition is most commonly associated with antibodies against thyroid peroxidase (TPO)?
Which thyroid condition is most commonly associated with antibodies against thyroid peroxidase (TPO)?
In which thyroid cancer might a patient present with profound weight loss and an enlarging thyroid gland?
In which thyroid cancer might a patient present with profound weight loss and an enlarging thyroid gland?
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What is the main complication associated with lung cancer that can cause a neurological syndrome?
What is the main complication associated with lung cancer that can cause a neurological syndrome?
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Which imaging technique is the best initial step for a patient with suspected subarachnoid hemorrhage?
Which imaging technique is the best initial step for a patient with suspected subarachnoid hemorrhage?
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What is the next best step for a patient with a pleural effusion and possibility of malignancy based on imaging findings?
What is the next best step for a patient with a pleural effusion and possibility of malignancy based on imaging findings?
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What is the classic imaging sign of sigmoid volvulus?
What is the classic imaging sign of sigmoid volvulus?
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What is a key feature of small cell lung cancer related to its endocrinological effects?
What is a key feature of small cell lung cancer related to its endocrinological effects?
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In patients with narcolepsy, which neurotransmitter shows low levels in CSF?
In patients with narcolepsy, which neurotransmitter shows low levels in CSF?
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Study Notes
Gastrointestinal Issues
- Meckel's Diverticulum: Characterized by failure of the vitelline duct obliteration. Diagnosis often involves tech-99/pertechnetate scan. Resection is the treatment.
- Small Bowel Obstruction (SBO): A patient with a history of Crohn's disease with nausea/vomiting and no bowel movements may have this. Strictures in the small intestine contribute to SBO. Gastroesophageal reflux disease (GERD) can also cause strictures.
- Toxic Megacolon: Patients with ulcerative colitis (UC) can present with severe abdominal pain, distended transverse colon, and toxic megacolon. Confirmation may require exploratory laparotomy. Conditions like C. diff and Chagas disease can also cause it.
Thyroid Disorders
- Hypothyroidism: Hashimoto's thyroiditis is the most frequent cause in the US, characterized by anti-TPO antibodies. Thyroid dysgenesis is the most common cause in newborns.
- Hashimoto's Thyroiditis: Fatigue, low mood, bradycardia, and carpal tunnel syndrome can occur. Radioactive iodine uptake is typically minimal to none in Hashimoto's.
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Other Hypothyroidism Causes:
- De Quervain's thyroiditis (painful thyroid, history of recent viral URI, decreased radioactive uptake; can also be hyperthyroid initially).
- Factitious hyperthyroidism (low TSH and radioactive uptake, low thyroglobulin).
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Hyperthyroidism Causes:
- Graves' disease (autoantibodies against TSH receptor, widespread increased radioactive uptake).
- Struma ovarii (elevated T3/T4, low TSH, decreased radioactive uptake).
- Toxic adenoma (single hotspot on radioactive scan).
- Multinodular goiter (multiple, interspersed hot and cold spots on the radioactive scan).
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Thyroid Cancer:
- Papillary thyroid cancer (most common): notable for psammoma bodies and orphan Annie eye nuclei.
- Follicular thyroid cancer: spreads hematogenously.
- Anaplastic thyroid cancer: manifested by profound weight loss and enlarging thyroid in elderly patients.
- Medullary thyroid cancer: linked to multiple kidney stones, recurrent abdominal pain, and enlarged thyroid. MEN2A is a related condition frequently associated with hypercalcemia. Elevated calcitonin levels are a tumor marker, possibly causing prolonged QT intervals. Amyloid develops, producing apple-green birefringence on Congo red.
- Reidel's Thyroiditis: Characterized by a rock-hard thyroid gland directly associated with IgG4 related disease. Other symptoms include autoimmune pancreatitis, retroperitoneal fibrosis (causing BL hydronephrosis), and autoimmune gallbladder disease.
Other Cancers
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Lung Cancer: Adenocarcinoma is the leading cause.
- Squamous cell carcinoma: Recognized by keratin pearls; can cause hypercalcemia (due to PTHrP).
- Small cell lung cancer: Usually metastatic at diagnosis; associated with syndrome of inappropriate antidiuretic hormone (SIADH), Lambert-Eaton myasthenic syndrome (weakness improving with use), and Cushing's syndrome (ACTH does not suppress with dexamethasone).
- Lung Cancer Complications: Can cause SVC syndrome (radiation therapy could be a next step). Pancoast tumors result in Horner's syndrome. Hypertrophic pulmonary osteopathy necessitates imaging studies.
Neurological Conditions
- Volvulus: Sigmoid volvulus (head toward RUQ) presents with nausea/vomiting. Cecal volvulus (head toward LUQ) is another possible issue.
- Subarachnoid Hemorrhage (SAH): Characterized by xanthochromia. A critical diagnosis; mimics meningitis but has a sudden onset. Diagnostic test – non-contrast head CT. Prevention of superimposed ischemic stroke via nimodipine may be necessary.
- Herpes Encephalitis/Meningitis: MRI shows hyperintense signaling in temporal regions. CSF with red blood cells warrants IV acyclovir if inpatient.
- Creutzfeldt-Jakob Disease (CJD): Marked by memory loss, myoclonus, and proprioception loss over a six-week period. Elevated protein 14-3-3 is a possible factor.
- Narcolepsy: A sleep disorders characterized by low orexin/hypocretin levels in CSF. Diagnosis with sleep study; treatment using scheduled naps, and stimulants like modafinil, or sodium oxybate (for cataplexy).
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Description
Test your knowledge on gastrointestinal issues like Meckel's diverticulum and small bowel obstruction, as well as common thyroid disorders such as hypothyroidism and Hashimoto's thyroiditis. This quiz covers definitions, symptoms, diagnosis, and treatment options for these conditions.
