hematology, onc, endocrin, renal Flashcards
drugs that impair vit D metabolites
phenytoin, carbamazepine, rifamin –> Vit D def by inducing P450 in the liver, which degrades vit D to inactivate metablites
DVT in patient with renal disease
warfarin with unfractionated heparin
LMWH and rivaroxaban are contraindicated in renal failure
how to prevent DVT after surgery
warfarin for 3 months
Acute adrenal insufficiency (adrenal crisis) - etiology
- adrenal hemorrhage or infraction
2. acute illness/injury/surgery in patiens with chronic adranl insuf or long term glucocorticoid use
Acute adrenal insufficiency (adrenal crisis) - clinical features
- hypotension/shock
- nausea, vomiting, abd pain
- fever
- weakness
Acute adrenal insufficiency (adrenal crisis) - treatment
- hydrocortisone or dexamethasone
- high flow IV fluids
Acute adrenal insufficiency (adrenal crisis) after surgery - doses of cortisone
- as little as 3 wks in patietns taking prednisone 20 or more mg/day
- low dose glucocorticoids (5 or less) have minimal risk and usually do not require stress doing
intermediated doses (5-20) can cause suppression and require preopoerative evaluation (with early morning corsitol)
Embryonal carcinoma - markers
if pure (rare) --> high hCG, normal AFP if mixed with other tumors --> high hCG, increased AFP
- Leyding tumor produces
- Yolk sac produces
- choriocarcinoma produces
- seminoma
- estrogens, testosterone
- AFP
- HCG
- placental ALP, mildly HCG
DDX of ANTERIOR mediastinal mass
4Ts 1 Thymoma 2. Teratoma (and other germ cell tumors) 3. Thyroid neoplasm 4. Terible lymphoma
seminimas vs non seminomas regarding markers
seminomas –> elevated β-HCG (mildly) but normal AFP
nonseminomas –> elevated AFP, with considerable number also having elevated βHCG
how can bladder injury causes peritonitis
rupture of the dome (upper, in contact with peritoneum) –> urine leaking into the peritoneal cavity –. chemical peritonitis
extreaperitoneal bladder injury
contusion or rupture of the neck, anterior wall or anterolateral wall of the bladder –> extravasation of urine into adjacent tissues causes localised pain in the lower abd and pelvic)
pelvis fracture is almost always present with, and sometimes a bony fragment can directly puncture and rupture the bladder
gross hematuria is also usually present, urinary retention may occur (esp if in the neck)
ureteral injury
The mcc is iatrogenic
- rare from trauma
MC site: uteropelvic junctio
- hematuria, fever, flank pain, renla mass (hydronephrosis)
IV cefazolin in trauma
used for antimicrobial prophylaxis before surgery to prevent wound infections (60 mins before the procedure
prerenal acute kidney injury - treatment
fluids
initial hematuria - DDX
(URETHRA)
- urethritis
- trauma (eg. catheterization)
hematuria throughout urinary stream - ddx
(RENAS + URETERS)
- renal mass
- glumerulonephritis
- urolithiasias
- Polycystic kidney disease
- pyelonephrittis
- trauma
- urothelial ca
terminal hematuria - ddx
(bladder or prostate or ureters)
- urothelial cancer
- cystitis
- Urolithiasias
- BPH
- Prostate cancer
urethral injury - characteristics
- almost exclusively in men
- suspect if blood seen at urethral meatus/ motile prostate
- urethral catheterization is relatively contraindicated
- perform retrograde urethrogram (x-ray during injection) –> extravasasion of inability to reach bladder confirm it
parts of male urethra (and direction)
(AFTER bladder and bladder neck) preprostatic urethra –> prostatic –> membranous urethra (through pelvic floor) –> spongy (penile) within the bulb and corpus sponsgiosum
spongy (penile urethra) is sometimes further divided to
bulbar and penile urethra
male urethral injury - division according to location
posterior urethra - membranous
anterior urethra - bulbar and penile urethra
posterior urethra (membranous) trauma
prone to injury from pelvic fracture –> injury can cause urine to leak into retropubic space
anterior urethra bulbar and penile trauma
at risk of damage due to perineal straddle injury –> urine leak beneath deep fascia of Buck –> if fascia is torn, urine escapes into superficial perineal space
an important step in the management of traumatic spinal cord injuries
urinary catheter placement to assess urinary retention + prevent acute bladder distention + damage
indications for cystoscopy
- gross hematuria with no evidence of glomerular or infection
- microscopic hematuria with no evidence og glomerular disease or infection but increaed risk for malignancy
- recurrent UTI
- Obstructive symtpoms with suscpicion for stricture, stone
- irritative symptoms without UTI
- abnormal bladder imaging or urine cytology
how many months anticoagulation for provoked DVT
at least 3
DVT after surgery - when to start anticoagulation
in stable –> as early as 48-72 hours after surgery
when to give atropine in trauma
if SYMPTOMATIC bradycardia
