Internal Medicine 01

Front 1

What kind of thyroid cancer has psammoma bodies on FNA Bx?

Back 1

Papillary cancer.

- large cells with ground glass cytoplasm

- pale nuclei with inclusion bodies and central grooving ("pupil" nuclei / "Orphan Annie" nuclei)

- unencapsulated

- excellent prognosis (even with mets)

- 90% pts survive > 10 yrs after Dx
- females > males (3:1)

Front 2

What kind of thyroid cancer has Hurthle cells?

Back 2

Papillary

and

Follicular

Front 3

Hurthle cell carcinoma is a variant of...

Back 3

Follicular cell carcinoma

Front 4

To Dx Follicular thyroid cancer, what must be demonstrated?

Back 4

- invasion of the tumor capsule
- blood vessels

Follicular cancers are usually:
- encapsulated
- rarely have local lymph node involvement
- usually have early hematogenous spread to the lung, brain, and bone
- good prognosis

Front 5

What is the prognosis of the different thyroid cancers from best to worst?

Back 5

1. Papillary (best)

2. Follicular

3. Medullary

4. Anaplastic (10% pts survive > 3 yrs after Dx)

Front 6

What type of thyroid cancer secretes calcitonin?

Back 6

Medullary thyroid cancer.
- from C cells
- prognosis is related to degree of vascular invasion

Front 7

What is Medullary thyroid cancer associated with?

Back 7

MEN Type 2A: Sipple's syndrome

and

MEN Type 2B

Front 8

Wermer's Syndrome is:

Back 8

MEN TYpe 1:

- pancreatic islet cell tumors (eg. Zollinger-Ellison syndrome, insulinomas)

- parathyroid hyperplasia

- pituitary adenomas

Front 9

Sipple's Syndrome is:

Back 9

MEN Type 2A:

- medullary carcinoma of the thyroid

- pheochromocytoma or adrenal hyperplasia

- parathyroid gland hyperplasia

Front 10

MEN Type 2B is:

Back 10

Characterized by:

- medullary carcinoma of the thyroid

- pheochromocytoma

- oral/intestinal ganglioneuromatosis (mucosal neuromas)

- marfanoid habitus

Front 11

MEN stands for?

Back 11

Multiple Endocrine Neoplasia

- autosomal dominant inheritance

Front 12

Tx't for malignant thyroid FNA?

Back 12

- surgical resection (first-line)

- adjunctive radioiodine ablation following excision is appropriate for follicular lesions

Front 13

Tx't for benign thyroid FNA?

Back 13

- f/u with PE or U/S

or

- trial of levothyroxine suppression Tx't

Front 14

Tx't for indeterminate FNA?

Back 14

- remove nodule by surgical excision

- send to pathology for report

Front 15

Thyroid neoplasms are usually:

Back 15

- solid and cold

Front 16

What are Dx-tic tests for thyroid nodules?

Back 16

- FNA

- TFTs

- U/S (= solid vs cystic)

- radioactive scan (cold vs hot)

Front 17

Which thyroid cancer increases in risk with irradiation?

Back 17

Papillary carcinoma of the thyroid.

Front 18

Activating RET proto-oncogenes are associated with what type fo thyroid cancer?

Back 18

Medullary thyroid cancer.

- parafollicular C cells produce calcitonin

- sheets of cells in amyloid stroma

Front 19

What should you suspect in a young patient with:

- chronic diarrhea

- abdominal pain

- weight loss

Back 19

Crohn's disease

Front 20

What are features of Crohn's disease?

Back 20

- chronic inflammatory disease

- can involve GI tract anywhere from esophagus to anus (eg. shallow ulcers in mouth)

- freq. associated with intestinal fistula, strictures, anal disease

Front 21

What are some lab findings of EVERY chronic inflammatory disease?

Back 21

- anemia

- reactive thrombocytosis

Front 22

What are the types of inflammatory bowel disease?

Back 22

Crohn's disease

and

Ulcerative colitis

Front 23

IBD is MC in what population?

Back 23

- whites

- Ashkenazi Jews

Front 24

1 unit of pRBCs increases:

- Hg by ___ units?

- Hct by ___ units?

Back 24

Hg = increases by 1 unit

Hct = increases by 3-4 units

...for every 1 unit of pRBCs

Front 25

Other Crohn's dz Sxs:

Back 25

- skip lesions along GI tract

- transmural inflammation

- perianal fissures / fistulas

- gallstones
- nephrolithiasis
- fistulas to skin or bladder (btwn loops)

- string sign lesions on barium swallow x-ray

Front 26

How do you Tx't IBD?

Back 26

5-ASA agents:
- sulfasalazine
- mesalamine

Corticosteroids and immunomodulating agents (= azathiorpine) for refractory disease.

Front 27

What are surgical options for UC vs. Crohn's?

Back 27

UC:
- total proctocolectomy is curative for long-standing or fulminant colitis or toxic megacolon
- also decreases colorectal cancer risk

Crohn's disease:
- surgical resection

Front 28

Extra-intestinal manifestations of Crohn's disease?

Back 28

- erythema nodosum

- migratory polyarthritis

- ankylosing spondylitis

- uveitis

- immunologic disorders

Front 29

Extra-intestinal manifestations of UC?

Back 29

- pyoderma gangrenosum

- PSC

Front 30

For Crohn's...think of:

Back 30

A fat granny and an old Crohn skipping down a coblestone road away from the wreck (rectal sparing).

Front 31

50% of patients with temporal arteritis also have:

Back 31

Polymyalgia rheumatica:

- pain is a prominent finding
- elevated ESR
- Sxs will remit with steroids

Front 32

What is a MSK side-effect from corticosteroid use?

Back 32

Drug-induced myopathy:

- painless proximal muscle weakness

- pts have a difficult time rising from a chair or brushing their hair

- muscle strength improves after d/c of steroids, but may take weeks to months to see improvement

Front 33

What are the guidelines for the Dx of diabetes mellitus?

Back 33

2 readings of:

- HbA1C > 6.5%
or
- fasting plasma glucose > 125
or
- plasma glucose of > 200 mg/dl 2 hours into a 75-g GTT
or
- plasma glucose > 200 and hyperglycemic Sxs