hematology, onc, endocrin, renal

Question 1

drugs that impair vit D metabolites

Answer 1

phenytoin, carbamazepine, rifamin –> Vit D def by inducing P450 in the liver, which degrades vit D to inactivate metablites

Question 2

DVT in patient with renal disease

Answer 2

warfarin with unfractionated heparin

LMWH and rivaroxaban are contraindicated in renal failure

Question 3

how to prevent DVT after surgery

Answer 3

warfarin for 3 months

Question 4

Acute adrenal insufficiency (adrenal crisis) - etiology

Answer 4

1. adrenal hemorrhage or infraction

2. acute illness/injury/surgery in patiens with chronic adranl insuf or long term glucocorticoid use

Question 5

Acute adrenal insufficiency (adrenal crisis) - clinical features

Answer 5

• hypotension/shock
• nausea, vomiting, abd pain
• fever
• weakness

Question 6

Acute adrenal insufficiency (adrenal crisis) - treatment

Answer 6

• hydrocortisone or dexamethasone

- high flow IV fluids

Question 7

Acute adrenal insufficiency (adrenal crisis) after surgery - doses of cortisone

Answer 7

1. as little as 3 wks in patietns taking prednisone 20 or more mg/day
2. 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)

Question 8

Embryonal carcinoma - markers

Answer 8

if pure (rare) --> high hCG, normal AFP
if mixed with other tumors --> high hCG, increased AFP

Question 9

1. Leyding tumor produces
2. Yolk sac produces
3. choriocarcinoma produces
4. seminoma

Answer 9

1. estrogens, testosterone
2. AFP
3. HCG
4. placental ALP, mildly HCG

Question 10

DDX of ANTERIOR mediastinal mass

Answer 10

4Ts
1 Thymoma
2. Teratoma (and other germ cell tumors)
3. Thyroid neoplasm
4. Terible lymphoma

Question 11

seminimas vs non seminomas regarding markers

Answer 11

seminomas –> elevated β-HCG (mildly) but normal AFP

nonseminomas –> elevated AFP, with considerable number also having elevated βHCG

Question 12

how can bladder injury causes peritonitis

Answer 12

rupture of the dome (upper, in contact with peritoneum) –> urine leaking into the peritoneal cavity –. chemical peritonitis

Question 13

extreaperitoneal bladder injury

Answer 13

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)

Question 14

ureteral injury

Answer 14

The mcc is iatrogenic
- rare from trauma
MC site: uteropelvic junctio
- hematuria, fever, flank pain, renla mass (hydronephrosis)

Question 15

IV cefazolin in trauma

Answer 15

used for antimicrobial prophylaxis before surgery to prevent wound infections (60 mins before the procedure

Question 16

prerenal acute kidney injury - treatment

Answer 16

fluids

Question 17

initial hematuria - DDX

Answer 17

(URETHRA)

• urethritis
• trauma (eg. catheterization)

Question 18

hematuria throughout urinary stream - ddx

Answer 18

(RENAS + URETERS)

1. renal mass
2. glumerulonephritis
3. urolithiasias
4. Polycystic kidney disease
5. pyelonephrittis
6. trauma
7. urothelial ca

Question 19

terminal hematuria - ddx

Answer 19

(bladder or prostate or ureters)

1. urothelial cancer
2. cystitis
3. Urolithiasias
4. BPH
5. Prostate cancer

Question 20

urethral injury - characteristics

Answer 20

1. almost exclusively in men
2. suspect if blood seen at urethral meatus/ motile prostate
3. urethral catheterization is relatively contraindicated
4. perform retrograde urethrogram (x-ray during injection) –> extravasasion of inability to reach bladder confirm it

Question 21

parts of male urethra (and direction)

Answer 21

(AFTER bladder and bladder neck) preprostatic urethra –> prostatic –> membranous urethra (through pelvic floor) –> spongy (penile) within the bulb and corpus sponsgiosum

Question 22

spongy (penile urethra) is sometimes further divided to

Answer 22

bulbar and penile urethra

Question 23

male urethral injury - division according to location

Answer 23

posterior urethra - membranous

anterior urethra - bulbar and penile urethra

Question 24

posterior urethra (membranous) trauma

Answer 24

prone to injury from pelvic fracture –> injury can cause urine to leak into retropubic space

Question 25

anterior urethra bulbar and penile trauma

Answer 25

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

Question 26

an important step in the management of traumatic spinal cord injuries

Answer 26

urinary catheter placement to assess urinary retention + prevent acute bladder distention + damage

Question 27

indications for cystoscopy

Answer 27

1. gross hematuria with no evidence of glomerular or infection
2. microscopic hematuria with no evidence og glomerular disease or infection but increaed risk for malignancy
3. recurrent UTI
4. Obstructive symtpoms with suscpicion for stricture, stone
5. irritative symptoms without UTI
6. abnormal bladder imaging or urine cytology

Question 28

how many months anticoagulation for provoked DVT

Answer 28

at least 3

Question 29

DVT after surgery - when to start anticoagulation

Answer 29

in stable –> as early as 48-72 hours after surgery

Question 30

when to give atropine in trauma

Answer 30

if SYMPTOMATIC bradycardia