High Yield Test Hints Flashcards
Last unit each lecture got 5 questions. For lec 1 duff gave 5 hints, Lec 2 he gave 5, lec 3 he gave a bunch of hints & none for lec 4
-
Present with green-yellow frothy discharge, pruritis & increased pH. Treatment?
[On Test]
Trich –> single dose (4 pills) of metronidazole
What tests are generally done for trich in a primary care setting?
[On test]
Saline & PAP
NOT culture
Thin gray discharge, fishy odor & no inflammation/pruritis. Diagnosis?
[On test]
BV
Diagnostic test for appendicitis?
[On test]
CT
WBC can also be helpful as is elevated & has left shift
Diagnostic test for stones?
[On test]
Best is Ultrasound (for calcified)
CT if ultrasound is not diagnostic
Will also have gross or microscopic blood in urine
Diagnostic test for ectopic preg?
[On test]
Urine hcg
Ultrasound
CBC/Hematocrit (blod loss)
Diagnostic test for PID?
[On test]
PCR/Nucleic Acid Amplification Test (NAAT) for gonorrhea & chlamydia
WBC
Ultrasound for cysts
What are the different imaging studies & when are they used?
[On test]
Ultrasound for younder patients (does better with denser breasts & patients are low risk)
Mammogram screening test of choice
MRI = only for high risk patients
What makes a definitive diagnosis in breast cancer?
[On test]
Stereotactic or excisional biopsy
What should be at the top of the diff diagnosis if find purulent/yellow disharge from the nipple?
[On test]
Mastitis
What are risk factors for mastitis?
[On test]
Breast feeding (Puerperal)
Trauma (Non-Puerperal)
Piercings (Non-Puerperal) even in men
What organisms cause mastitis?
[On test]
Staph Aureus (70%) Strep Viridans (30%)
Treatment of Mastitis?
[On test]
Sodium Dicloxacillin (cousin of pen)
Cephalexin (Cephalosporin, give if have mild pen allergy)
Trimethoprim-sulfamethaxole (If severe allergy)
Clindamycin (If allergic to sulfa drugs & pen)
What is suspected when there is a bloody nipple discharge?
[On test]
Intraductal papilloma
Malignancy
Causes of Galactorrhea?
[On test]
Idiopathic Drugs (anti-psychotic) Hypothyroidsim (TRH can increase prolactin) Pituitary mass --> increase in prolactin Chest wall irritation
What things do you need to look for in a breast mass?
[On test]
discharge firm/cystic skin changes overlying skin changes tenderness
Tests for Galactorrhea?
[On test]
Serum prolactin & TRH
Diagnostic test for Candida?
[On test]
KOH prep looking for hyphae & budding yeast
Candida Treatment?
[On Test]
Topical Miconazole (monostat) or Clotrimazole Single dose oral Fluconazole (Diflucan)
How does Cushing effect growth?
[On test]
Growth failure
What is the number 1 cause of Secondary Adrenal Insufficiency?
[On test]
Exogenous steroids = cortisone & prednisone
What other diseases do people with Addisons usually get?
[On test]
50% get other autoimmune endocrinopathies , most often thyroid (25%)
How do cortisol levels change during the day?
[On test]
Very high at about 7am & very low at about 11pm
Measure at morning peak for def
Measure at low point to measure excess
Do Inferior Petrosal Sinus Sampling, then give hCRH. Plasma ACTH raise on both sides but a ton on the right side. Where is tumor?
What if ACTH level do not rise much?
[On test]
In head (not ectopic) In pituitary more so on the right side than the left
Ectopic
What is the acute managment of hypercalcemia?
[On test]
Hydrate (to make pee out)
Give Lasik (induces calciuria)
Treat underlying cause
What are the indications for surgery in hyperparathyroidism?
[On test]
Symptomatic Younger than 50 High serum Ca High urinary Ca excretion Low bone density Medical monitoring may not work Uncertain follow up Reduce creatine clearance Coexistent confounding disease
What is the management of hypocalcemia?
[On test]
Continuous infusion of Ca (instead of bolus)
IV Mg
If see hypothyroidism, what else should you test for?
[On test]
DM Vitiligo Alopecia Celiac Inflam bowel disease
What do you do if a child has anti-thyroid antibodies but no symptoms?
[On test]
Probably wont become hypothyroid
Monitor with TSH every 6-12 months
If ever have high TSH, begin treatment
Anti-thyroid antibodies can be a sign of what? How liekly is it?
[on test]
thyroid cancer (but rare so dont automatically test everyone)
1 in 1000 hashimotos to cancer ratio
60-80% of thyroid cancers have Ab
When do you do an ultrasound for suspected thyroid cancer (anti-thyroid Ab +)?
[On test]
Only if gland is asymmetrical or look bizarre/concerning cuz rare
How do new borns with congenital hypothyroidism present?
[On test]
Mainly normal, cuz getting hormone from mom
60% jaundice
40% enlarged fontanels
What is the goal with Levothyroxine therapy?
[On test]
To get in the upper half of normal range (12-20) so that when they outgrow their dose they are still in normal range
Also want greater than 50% free T4
What test(s) should be order for suspected hyporthyroidism?
[On test]
Only TSH, as T3 has little value with normal TSH
Why do we get T3 when testing for hyperthyroidism?
[On test]
Can get low TSH, normal T4 & isolated elevated T3 toxicosis (graves disease)
How do you treat Thyroid Binding Globulin Deficiency?
[On test]
Low binding protein but free T4 is fine –> no treatment
If a thyroid Ultrasound is suggestive of cancer, how do you proceed?
[On test]
NOT definitive, only do ultrasound to find additional nodules & to figure out where need to biopsy
Do a FINE NEEDLE BIOPSY
