GU/ nephrology Flashcards
DDx acute scrotal pain
- testicular torsion
- torsion of appendage
- epididymitis
- strangulated inguinal hernia
- trauma
- orchitis (very rare)
- Henoch-Schonlein purpura
Henoch-Schönlein purpura triad
- palpable purpura (without thrombocytopenia
- abdominal pain
- arthritis
often after episode of upper respiratory tract infection
precipitating factors of testicular torsion
- trauma
- cryptorchidism
- congenital deformity
management of testicular torsion
urgently surgical referral
attempt manual detorsion
features of acute epiglottitis
∙ Toxic appearance ∙ High fever ∙ Sudden onset and Rapid Progression ∙ Tripod position ∙ Drooling, dysphagia
∙ Respiratory distress signs (sterna recession/ in-drawing suprasternal or intercostal muscles – use of accessary muscles)
∙ NO barking cough
symptoms of croup
- Acute/rapid onset
- Barking cough
- Inspiratory stridor
- Hoarseness
- Usually at night
- Respiratory distress
- Fever
organisms causes croup
∙ Parainfluenza virus
∙ Respiratory syncytial virus, adenovirus
Management of croup
∙ Dexamethasone 0.6 mg/kg single dose PO
∙ Humidified air or oxygen – blow-by O2, nebulized epinephrine
Neonate (0-1mo) with meningitis
Organisms (LEG)
∙ Group B streptococcus
∙ E coli
∙ Lysteria monocytogenes
Initial antibiotics
∙ Ceftriaxone 200 mg/kg/day divided q6hrs + ampicillin 200 mg/kg/day divided q6hrs - ampicillin + cefotaxime (3rd generation)
Newborn (1-23mo) meningitis pathogens
SHN
- S. pneumonia
- H. influenza
- N. meningitidis
Empiric Antibiotics: vancomycin + 3rd cephalosporin (cefotaxime, ceftriaxone)
> 50 y/o meningitis organism
- S. pneumonia
- N. meningitidis
- Aerobic gram-negative bacilli
Initial antibiotics: vancomycin + ampicillin + 3rd cephalosporin
Diagnostic tests for H. Pylori
∙ H. pyrlori serology – check antibody
∙ Urea breath test
∙ Gastroscopy with biopsy and culture
Treatment regime of H. Pylori
[CLAMET] for 14 days ∙ Clarithromycin500mg BID PO ∙ Amoxicillin 1000mg BID PO ∙ Metronidazole 500mg BID PO ∙ Pantoprazole 40mg (or other PPI) BID PO
Conditions associated with temporal arteritis
Polymyalgia rheumatica
Risk factors of testicular cancer
- cryptorchidism (undescended testis)
- family history of testicular ca
- personal history of testicular ca
- age
- ethnicity (white)
- infertility
Screening and Investigation for testicular ca
NO routine screening for asymptomatic
Ix:
Initial imaging: scrotal ultrasound –> orchiectomy for diagnosis and treatment
lab:
- beta human chorionic gonadotropin (hCG) -seminoma
- lactate dehydrogenase (LDH) - seminoma
- alpha fetoprotein (non-seminoma)
Physical exam:
- testicular exam, both side: mass, firm, tender, swollen, fixed/non-movable areas, not detached from the epididymis)
- inguinal and supra-clavicular LNs
- abdomen (intra-abdominal mets)
- gynecomastia (++ beta hCG tumor)
Who should be tested for CKD (asymptomatic)?
- Hypertension
- DM
- Cardiovascular disease (CVD)
- First degree relative with CKD
- First nation, Inuit, Metis, or urban indigenous peoples
What should be ordered to screen for CKD?
eGFR and urine ACR
criteria of obesity for Bariatric Surgery
1) BMI ≥40 kg/m² OR
2) BMI ≥35 - 40 kg/m² with an obesity (adiposity) related complication OR
3) BMI ≥30 kg/m² with poorly controlled type 2 diabetes
criteria of Pharmacological Therapy for obesity
1) BMI ≥30kg/m2 OR
2) BMI ≥27 kg/m2 with obesity (adiposity) related complications
Pharmacological management for obesity
a) . liraglutide (GLP-1 receptor agonist)
b) . naltrexone/bupropion (Opioid antagonist/ Dopamine/norepinephrine-reuptake inhibitor)
c) . orlistat (lipase inhibitor)
Non-pharmacological management for obesity
1) medical nutrition therapy
2) physical activity recommendations
pharmacological management for smoking cessation
1) Varenicline (Champix)
1) Nicontine replacement therapy
2) Bupropion SR
3) Clonidine
3) Nortriptyline
contraindication of Bupropion for smoking cessation
- Seizure disorder
- Eating disorder
- MOI inhibitor use
- Alcohol withdrawal
- Allergy
- CYP 2D6 inhibitor use (Fluoxetine, paroxetine)
common s/e of bupropion
- elevated BP
- insomnia
- dry mouth
Cautions of using varenicline for smoking cessation
- renal failure (CrCl <30)
- depression
- suicide
(can still be used for pt with MH)
