High Yield Test Hints

Question 1

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

Answer 1

-

Question 2

Present with green-yellow frothy discharge, pruritis & increased pH. Treatment?

[On Test]

Answer 2

Trich –> single dose (4 pills) of metronidazole

Question 3

What tests are generally done for trich in a primary care setting?

[On test]

Answer 3

Saline & PAP

NOT culture

Question 4

Thin gray discharge, fishy odor & no inflammation/pruritis. Diagnosis?

[On test]

Answer 4

BV

Question 5

Diagnostic test for appendicitis?

[On test]

Answer 5

CT

WBC can also be helpful as is elevated & has left shift

Question 6

Diagnostic test for stones?

[On test]

Answer 6

Best is Ultrasound (for calcified)
CT if ultrasound is not diagnostic
Will also have gross or microscopic blood in urine

Question 7

Diagnostic test for ectopic preg?

[On test]

Answer 7

Urine hcg
Ultrasound
CBC/Hematocrit (blod loss)

Question 8

Diagnostic test for PID?

[On test]

Answer 8

PCR/Nucleic Acid Amplification Test (NAAT) for gonorrhea & chlamydia
WBC
Ultrasound for cysts

Question 9

What are the different imaging studies & when are they used?

[On test]

Answer 9

Ultrasound for younder patients (does better with denser breasts & patients are low risk)

Mammogram screening test of choice

MRI = only for high risk patients

Question 10

What makes a definitive diagnosis in breast cancer?

[On test]

Answer 10

Stereotactic or excisional biopsy

Question 11

What should be at the top of the diff diagnosis if find purulent/yellow disharge from the nipple?

[On test]

Answer 11

Mastitis

Question 12

What are risk factors for mastitis?

[On test]

Answer 12

Breast feeding (Puerperal)
Trauma (Non-Puerperal)
Piercings (Non-Puerperal) even in men

Question 13

What organisms cause mastitis?

[On test]

Answer 13

Staph Aureus (70%)
Strep Viridans (30%)

Question 14

Treatment of Mastitis?

[On test]

Answer 14

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)

Question 15

What is suspected when there is a bloody nipple discharge?

[On test]

Answer 15

Intraductal papilloma

Malignancy

Question 16

Causes of Galactorrhea?

[On test]

Answer 16

Idiopathic
Drugs (anti-psychotic)
Hypothyroidsim (TRH can increase prolactin)
Pituitary mass --> increase in prolactin
Chest wall irritation

Question 17

What things do you need to look for in a breast mass?

[On test]

Answer 17

discharge
firm/cystic
skin changes
overlying skin changes
tenderness

Question 18

Tests for Galactorrhea?

[On test]

Answer 18

Serum prolactin & TRH

Question 19

Diagnostic test for Candida?

[On test]

Answer 19

KOH prep looking for hyphae & budding yeast

Question 20

Candida Treatment?

[On Test]

Answer 20

Topical Miconazole (monostat) or Clotrimazole 
Single dose oral Fluconazole (Diflucan)

Question 21

How does Cushing effect growth?

[On test]

Answer 21

Growth failure

Question 22

What is the number 1 cause of Secondary Adrenal Insufficiency?

[On test]

Answer 22

Exogenous steroids = cortisone & prednisone

Question 23

What other diseases do people with Addisons usually get?

[On test]

Answer 23

50% get other autoimmune endocrinopathies , most often thyroid (25%)

Question 24

How do cortisol levels change during the day?

[On test]

Answer 24

Very high at about 7am & very low at about 11pm

Measure at morning peak for def
Measure at low point to measure excess

Question 25

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]

Answer 25

``` In head (not ectopic) In pituitary more so on the right side than the left ``` Ectopic

Question 26

What is the acute managment of hypercalcemia? [On test]

Answer 26

Hydrate (to make pee out) Give Lasik (induces calciuria) Treat underlying cause

Question 27

What are the indications for surgery in hyperparathyroidism? [On test]

Answer 27

``` 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 ```

Question 28

What is the management of hypocalcemia? [On test]

Answer 28

Continuous infusion of Ca (instead of bolus) | IV Mg

Question 29

If see hypothyroidism, what else should you test for? [On test]

Answer 29

``` DM Vitiligo Alopecia Celiac Inflam bowel disease ```

Question 30

What do you do if a child has anti-thyroid antibodies but no symptoms? [On test]

Answer 30

Probably wont become hypothyroid Monitor with TSH every 6-12 months If ever have high TSH, begin treatment

Question 31

Anti-thyroid antibodies can be a sign of what? How liekly is it? [on test]

Answer 31

thyroid cancer (but rare so dont automatically test everyone) 1 in 1000 hashimotos to cancer ratio 60-80% of thyroid cancers have Ab

Question 32

When do you do an ultrasound for suspected thyroid cancer (anti-thyroid Ab +)? [On test]

Answer 32

Only if gland is asymmetrical or look bizarre/concerning cuz rare

Question 33

How do new borns with congenital hypothyroidism present? [On test]

Answer 33

Mainly normal, cuz getting hormone from mom 60% jaundice 40% enlarged fontanels

Question 34

What is the goal with Levothyroxine therapy? [On test]

Answer 34

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

Question 35

What test(s) should be order for suspected hyporthyroidism? [On test]

Answer 35

Only TSH, as T3 has little value with normal TSH

Question 36

Why do we get T3 when testing for hyperthyroidism? [On test]

Answer 36

Can get low TSH, normal T4 & isolated elevated T3 toxicosis (graves disease)

Question 37

How do you treat Thyroid Binding Globulin Deficiency? [On test]

Answer 37

Low binding protein but free T4 is fine --> no treatment

Question 38

If a thyroid Ultrasound is suggestive of cancer, how do you proceed? [On test]

Answer 38

NOT definitive, only do ultrasound to find additional nodules & to figure out where need to biopsy Do a FINE NEEDLE BIOPSY