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1
Q

Abortion due to APLS

A

before week 10

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2
Q

Normal post-void urine volume

A

Less than 12 ml

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3
Q

BPH versus prostate cancer location

A

BPH involves the Center that is transitional zone

Prostate cancer more often involves the periphery of the gland and presents with firm asymmetric or nodular enlargement

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4
Q

The preferred initial treatment for uncomplicated benign prosthetic hyperplasia

A

Alpha-1 blockers

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5
Q

5-alpha-reductase inhibitors initiation of effect For treatment of BPH

A

6-12 mo

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6
Q

Pathology associate with analgesic nephropathy

A

Papillary necrosis
Chronic tubulointerstitial nephritis
Polyuria/strile pyuria with WBC cast are early findings
Microscopic hematuria and renal colic may occur following sloughing of renal papilla
Proteinuria/impaired urinary concentration

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7
Q

Consequences of chronic analgesic abuse

A

Premature aging
atherosclerotic vascular disease
urinary tract cancer

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8
Q

Muddy brown granular cast seen in

A

Acute tubular necrosis

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9
Q

When to report to the coroner or medical examiner?

A

Patients in the hospital who died due to an unknown cause, a medical complications, suspected illegal activities, or within 24 hours of presentation

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10
Q

Pick’s disease symptoms

A 
Fronto-temporal dementia:
Personality changes (euphoria, disinhibition, apathy ) compulsive behaviors (peculiar eating habits), hyperorality, impaired memory. visual and spatial functions are usually intact
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11
Q

General paresis type of neurosyphilis

A

Decreased concentration and memory loss, dysarthria, tremor of fingers and lips, irritability and mild headache

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12
Q

PPSV23 vs PCV13

A

PPSV23: Contains 23 polysaccharides. Induces a relatively T-cell-independent B-cell-response that is less affective in young children and the elderly.

PCV13: contains 13 polysaccharides that have been covalently attached to inactivated diphtheria toxin protein. Induces a T-cell-dependent B-cell response resulting in improved immunogenicity due to the formation of higher affinity antibodies and memory cells

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13
Q

Pneumococcal vaccine recommendations

A

PCV 13 for all infants and young children.
PPSV 23 administered to adults less than 65 years old with predisposing conditions for example chronic heart/lung disease, diabetes mellitus, cirrhosis.
Both vaccines for immunocompromised patients and all individuals above 65

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14
Q

Vaccines producing a predominantly CD8+ T cell response

A

MMR

Intranasal influenza

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15
Q

Duchenne inheritance pattern

A

X-linked recessive

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16
Q

Duchenne screening test

A

CPK, aldolase

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17
Q

8 AM cortisol level/ ACTH levels in adrenal insufficiency

A

Cortisol <5 + high ACTH, confirms adrenal insufficiency

Both low, suggests central AI

Cortisol >15 rules out AI

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18
Q

Initial evaluation of pts with suspected adrenal insufficiency

A

8AM Cortisol
Plasma ACTH
ACTH stimulation test

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19
Q

Normal chloride levels

A

96 to 106

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20
Q

Aspirin exacerbated respiratory disease

A

Asthma
Chronic rhinosinositis
Nasal polyposis
Nasal congestion/bronchospasm following NSAIDs

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21
Q

Adrenal destruction to produce insufficiency

A

90%

e.g. metastasis from SCLC

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22
Q

Infectious agents causing adrenal destruction

A

TB
Fungal
CMV

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23
Q

The most common cause of vitreous hemorrhage

A

Diabetic retinopathy

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24
Q

Difficulty to visualize eye fundus or its details

A

Vitreous hemorrhage

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25
Treatment of choice for malignant otitis externa
IV cipro Others: Piperacillin, ceftazidime
26
Medications causing priapism
``` Trazodone Prazocin (the most common) ```
27
Treatment of premature ejaculation
SSRIs (delay orgasm)
28
Intussusception in HSP versus other cases
More likely to be small-bowel or ileo-ileal in HSP. If do not reduce spontaneously often require surgical management. Not evident contrast enema. Diagnosis with target sign on ultrasound
29
Acyclovir nephrotoxicity
When the acyclovir concentration in the collecting duct exceeds its solubility crystallization crystalluria and renal tubular damage may result. Usually transient Can be prevented and treated with adequate hydration and dosage adjustment and slowing the rate of intravenous infusion.
30
Treatment of acute prostatitis
``` TMP-SMX or Fluoroquinolone 4-6 wk Urethral catheterization should be avoided ```
31
Salicylate intoxication
Tinnitus, fever, tachypnea, nausea, GI irritation Causing respiratory alkalosis+ anion gap metabolic acidosis pH usually around normal Rx: alkalanization and dialysis
32
Prevention of bladder complications of cyclophosphamide
Drinking plenty of fluids Voiding frequently Taking MESNA
33
Cochlear dysfunction is as side effect of
Cisplatin Carboplatin Aminoglycosides
34
Optic neuritis is a side effect of
Ethambutol | HCQ
35
Peripheral neuropathy is adverse effect of
``` Phenytoin Isoniazid Vincristine Heavy metals Chronic alcohol ```
36
Raynaud is side effect of
Beta blockers | Ergotamines
37
Gout is side effect of
Cyclosporin
38
Brain abscess etiology in non-HIV patients
Viridans streptococci (the most common) Staph aureus Gram negatives
39
Brain abscess on CT scan
Typically reveals cerebritis initially, but within 1 to 2 weeks the infection consolidates to ring- enhancing and Central necrosis
40
Brain abscess treatment
Prolonged antibiotic therapy (metro, ceftriaxone, vancomycin) and aspiration
41
The most common source of a single brain abscess
Direct extension from adjacent infection for example otitis media, sinusitis, dental infection
42
Penile fracture management
A urological emergency and urgent surgical management is necessary Retrograde urethrogram if: blood at the meatus, hematuria, dysuria, urinary retrntion
43
Adversely effects of Tamoxifen
``` Hot flashes(most common) VTE Endometrial hyperplasia/carcinoma ```
44
The most common adverse effect of inhaled corticosteroid
Oropharyngeal candidiasis
45
Trichotillomania subtype in DSM5
Obsessive compulsive related disorder
46
Treatment for trichotillomania
Habit reversal training which is a form of cognitive behavioral therapy
47
Eye complication of neurofibromatosis
``` Optic gliom Causing: Slowly progressive unilateral visual loss Dyschromatopsia Exophthalmus ```
48
Whistling noise during respiration following rhinoplasty
Septal perforation | Usually due to septal hematoma but also septal abscess
49
Mild proteinuria(microalbuminuria)
30-300 mg/d
50
Clues for reasons other than DM accountable for proteinuria in DM pts
Onset of proteinuria <5y after disease onset Active urine sediment >30% reduction in GFR within 2-3 mo of ACEI/ARB initiation
51
Respecters for developing diabetic microangiopathy
``` DM>10y Poor glycemic control Elevated blood pressure Smoking Increasing age Ethnicity (African-American, Mexican-American) ```
52
Gall stone formation in pts on TPN is due to:
No protein/fat in duodenum, no secretion of CCK, gall bladder stasis. In case of resection of distal ileum, no resorption of conjugated bile acids And Ca, increased concentration of cholesterol in hepatic bile.
53
Gallbladder stone formation in pregnancy is due to
Estrogen, increased cholesterol secretion Progesterone, decreases reduces bile acid secretion and gallbladder motility
54
Lambert-Eaton involved receptor
Autoantibodies against Presynaptic membrane voltage-gated Ca channels in motor nerves
55
Lambert-Eaton features
``` Proximal muscle weakness Autonomic dysfunction Cranial nerve involvement Diminished or absent DTR Vigorous muscle activity can improve reflexes and muscle strength temporarily ```
56
Lambert-Eaton Rx
Guanidine 3,4-diaminopyridine IVIg Immunosuppressants
57
Mixed upper and lower motor neuron symptoms
ALS
58
Adenomatous polyps with higher chance of malignancy
Sessile Villous Increased size (esp >2.5cm)
59
The mist common type of polyp found in colon
Adenomatous
60
Prevalence of adenomatous polyps
30-50%
61
Risk of malignancy in adenomatous polyps
<1%
62
People with colon polyps having positive FOB
5%
63
The null value of RR
1
64
Hyperkalemia definition
>5
65
K sparing diuretics
Triamterene Amiloride Spironolactone Eplerenone
66
K decreasing diuretics
Hydrochlorithiazide | Furosemide
67
K increasing drugs
``` Non selective BB ACEI ARB NSAIDs Cardiac glycosides K sparing diuretics ```
68
Gender dysphoria duration for diagnosis
At least six months
69
Vaginismus duration for diagnosis
At least six months
70
Normal calcium range
8.5 to 10.3 | Ionized calcium 4.4 to 5.4
71
Hypercalcemia features
Stones, bones, abdominal moans, psychic groans
72
Deficiencies in chronic alcoholism
``` Hypomagnesemia Hypokalemia Hypophosphatemia Hypoalbuminemia Vit B1 ```
73
Reason for refractive hypokalemia in people with chronic alcohol consumption disorder
Hypomagnesemia
74
IgA nephropathy (vs PSGN)
Within 5 days after infection (vs 10-21d in PSGN) Young male adults, 20-30y (vs children 6-10y) Normal complement (vs low C3)
75
The most common cause of GN in adults
IgA nephropathy
76
GNs with low complement level
PSGN (C3) | Lupus (C3, C4)
77
Hemorrhagic transformation definition
Deterioration of neurological status in less than 48 hours after the initial ischemic stroke,
78
Patients more susceptible to hemorrhagic transformation
If stroke affects a large area If stroke is due to an embolic cause If a stroke has been treated with thrombolytics
79
Management of hemorrhagic transformation
Emergent noncontrast CT scan of the head | Urgent surgical decompression
80
Saline responsive metabolic alkalosis (volume loss)
Vomiting (low urine chloride) NGT (low urine chloride) Prior diuretic use (low urine chloride) Current diuretic (urine chloride high)
81
Saline unresponsive metabolic alkalosis
``` Bartter Gitelman Primary hyperaldostronism Cushing Ectopic ACTH ``` All with high urine chloride
82
The difference between previous and current diuretic consumption
Low urine chloride level in prior diuretic use
83
Extrathyroidal manifestations of secondary hyperthyroidism
None
84
Normal TSH range
0.45 to 4.12
85
Normal T4 level
4.6 to 12
86
Normal T3 levels
80 to 180
87
MPGN Pathology/pathogenesis
Dense intramembranous deposits that stain for C3. (Type2, dense deposit disease) Due to IgG Ab against C3 convertase of the alternative complement pathway (C3 nephritic factor). These Abs lead to persistent complement activation and kidney damage
88
Nephrotic syndrome complications
``` Increased TG, Cholesterol Hypercoagulability state Increased risk of atherosclerosis, stroke, MI Decreased Vit D, increased PTH Decreased iron, alb, protein Loss of transferrin, microcytoc anemia Loss of TBG, decreased T4 levels Decreased immunity ```
89
The most common manifestation of coagulopathy in nephrotic syndrome
Renal vein thrombosis | Usually due to membranous glomerulopathy
90
Associations of ADPKD
``` Hepatic cysts Berry aneurisms Mitral valve prolapse Aortic regurgitation Colonic diverticuli Abdominal wall/ inguinal hernia ```
91
Oligohydramnios in late-term with normal fetal screening tests
Delivery
92
Mg excretion
Solely by kidneys, therefore needs dose adjustment based on kidney function
93
Mg toxicity management
Stop Mg therapy | Give IV Ca Gluconate
94
Flushing Headache Nausea Hyporeflexia
mild Mg toxicity
95
Hypocalcemia Areflexia Somnolence
Moderate Mg toxicity
96
Anosognosia
Lack of insight
97
Brain lobe damage resulting receptive aphasia
Left temporal lobe
98
Brain lobe damage responsible for motor aphasia
A frontal cortex lesion if the dominant lobe is involved
99
Urine osmolality in primary polydipsia
<100 mOsm/kg
100
Nephrolithiasis <5mm Rx
NSAIDs | Fluid intake> 2 litter/d
101
Indication of complete and detailed metabolic evaluation and patients with urinary stones
Recurrent stone
102
A complete urinary evaluation for recurrent stone includes
Calcium, citrate, creatinine, uric acid, oxalate, pH, sodium levels
103
MgSO4 for PTL up to
To all < 32 wk
104
Tocolytic+betamethasone for PTL
To all <34 wk
105
For 35th, 36th, 37th wk PTL
+/- Betamethasone
106
GBS prophylaxis in cesarian versus vagina delivery
Not needed for cesarian unless indications present AND PROM
107
Body habitus in MEN2B
Marphanoid Kyphosvoliosis Lordosis
108
Test necessary for pts with MTC
RET mutation (to look for pheo before operation of MTC)
109
Cystinuria
``` Hexagonal crystals in urine Defective transport of dibasic aa Radio-opac, hard Recurrent stones since childhood Positive family history Positive urinary cyanide nitroprusside test (screening, comfirmation) ```
110
The greatest risk factor for variant angina
Smoking
111
Associations of variant angina
Raynaud | Migraine
112
Factors worsening variant angina
``` Exercise Hyperventilation Emotional stress Cold wxposure Cocaine use ```
113
Prinzmetal ECG
ST elevation during attack (during the night)
114
Rx of variant angina
CCB Nitrate +smoking cessation
115
Drugs that should be avoided in prinzmetal
BB | ASA
116
Migraine preventative Rx
``` BB Topiramate Valproate TCA (amitriptyline) Venlafaxine ```
117
Migraine abortive Rx
``` NSAIDs Acetaminophen Antiemetics Ergots Triptans ```
118
Anti epileptic drugs causing low folate levels
Phenytoin Primidone Phenobarbital (Inhibit intestinal absorption)
119
Drugs antagonizing dihydrofolate reductase
Trimethoprim | MTX
120
At which GFR will there be metabolic acidosis due to renal failure?
<20
121
Normal AG metabolic acidosis with hyperkalemia (+ mild/moderate RF)
``` Hyperkalemic RTA (type4) Aldosterone deficiency/resistance ```
122
RTA in DM pts
``` RTA 4 (damage to juxtaglomerular apparatus) They have: K: 5.2-6 HCO3: 15-20 GFR: 20-50 ```
123
How to discontinue lithium
Slow tapering
124
Neurocysticercosis Rx
Albendazole | CS seizure/ICH Rx
125
Tinea solium infection route
Fecal-oral, ingested eggs
126
Myasthenia crisis onset symptoms
Generalized and bulbar muscle weakness
127
Factors precipitating myasthenic crisis
Infection Surgery Drugs (azithromycin, aminoglycosides, BB)
128
Myasthenic crisis Rx
If deteriorating respiratory status, intubate Pyridostigmine temporarily held (to reduce secretions) CS IVIG or plasmaphresis (preferred) once stabilized +/- MFM, AZA
129
Chlorthalidone drug category
Thiazide diuretic
130
Thiazides metabolic effect
Increased insulin resistance, increased BS | Increased TG, Cholesterol
131
The thiazide diuretic with most hyperglycemic effect and most cardiovascular beneficial effect
Chlorthalidone
132
Late-onset CAH symptoms
``` Premature adrenarche/pubarche Severe cystic acne (resistant to Rx) Accelerated linear growth Advanced bone age Normal electrolytes ```
133
Idiopathic precocious puberty
Almost exclusively in girls | Accounts for 80% of gonadotropin-related puberty
134
Center (gonadotropin-dependent) vs peripheral (gonadotropin-independent) puberty
Baseline level of LH is increased or will Increased with GnRH stimulation
135
Neurological symptoms in Plagra
Affective symptoms, memory loss, psychosis
136
niacin deficiency observed in:
``` Corn products as main food (deficient in B3) Alcoholism Chronic illness Carcinoid syndrome Hartnup disease Prolonged INH ```
137
Post void residual volume diagnostic of retention
>50 ml
138
Uncomplicated cystitis w/u
Just urinalysis | Culture not needed unless failure of initial treatment
139
Complicated cystitis
Associated DM, pregnancy, RF, obstruction, catheter, procedure, ImSupp, hospital acquired
140
Rx for uncomplicated cystitis
Nitrofurantoin 5 d TMP/SMX 3 d Fosfomycin single dose Q if above not possible
141
Rx of complicated cystitis
Urine culture Q (cipro, levo) 5-14 d Ampi/genta , ceftriaxone if severe
142
Pyelonephritis Rx
U/C Outpatient: Q (cipro, levo) Inpatient: Q, AG +/- ampi
143
If symptoms of UTI with negative U/A (dipstick)
U/C
144
Positive nitrite in U/A indicates
Enterobacteriaceae
145
Tx of a single bone eosinophilic granuloma (LCH)
Conservative | Spontaneously resolves
146
Most common etiology of nephrotic syndrome associated with renal vein thrombosis
Membranous glomerulopathy
147
Asymptomatic bacteriuria in pregnancy
Culture > 100,000 colonies/ml
148
Rx of UTI/ asymptomatic bacteriuria in pregnancy
``` Nitrofurantoin 5-7 d Amoxi, amoxi-clav 3-7 d Fosfomycin single dose Cephalexin Avoid: Q Avoid: TMP-SMX in 1st and 3rd T Test of cure ```
149
Pyelonephritis treatment during pregnancy
Hospitalization Intravenous antibiotics (b-lactams, meropenem) Avoid aminoglycosides unless other agents cannot be used Change to 10 to 14 day course of oral antibiotics after afebrile for 24 hours
150
Other name for osgood-schlatter
Traction apophysitis of tibial tubercle
151
PAS-positive material in intestinal lamina propria
Whipple
152
Whipple symptoms
``` White men 4th-6th decades of life Wt loss Abd pain, diarrhea, malabsorption,distention, flatulence, steatorrhea Migratory polyarthropathy Chronic cough Myocardial, valvular involvement Dementia, Supranuclear ophthalmoplegia, myoclonus Intermittent low grade fever Skin pigmentation LAP ```
153
Indication of renal Bx in children with nephrotic syndrome
>10 y/o Unresponsive to Tx Progressive
154
Intervention based on APGAR
< 7, further evaluation and resuscitations, If apnea/gasping, HR< 100, positive pressure ventilation, +/- ETT HR< 60, intubate, chest compression, 100% O2
155
Children stroke etiologies
SCD (Hx of pain crisis, dactylitis, ethnicity) congenital diseases Infections Systemic illness
156
Diagnosis of fat emboli
Presence of fat droplets in urine | Intra-arterial Fat globules on fundoscopy
157
CXR in fat emboli
Diffuse bilateral pulmonary infiltrates
158
Time of fat emboli
12-72 hr after injury
159
Rx of fat emboli
Respiratory support
160
Mediastinal germinal cell tumor markers
Seminoma (beta in 1/3) | Non- seminomatous (AFP, beta
161
Esophageal coin Rx
If asymptomatic: observe for 24 hours | If symptomatic, time unknown: flexible endoscopy
162
Batteries, sharp objects, multiple magnets in esophagus Rx
Immediate endoscopy
163
Dx of wilson
Low serum ceruloplasmin (<20) Increased urinary copper excretion Kayser-Fleischer
164
PAS positive, diastase resistant granules on hepatic Bx
Alpha1 antitrypsin deficiency
165
Mallory bodies on liver biopsy
Wilson
166
Dx of Ogilvie syndrome
Abdominal CT
167
Spinal cord complication years following a cord injury
Syringomyelia (whiplash injury)
168
Post operative mediastinotis presentation
Within 14 days
169
Acute mediastinitis Rx
drainage debridement Immediate closure Antibiotics, prolonged
170
Anabolic steroid abuse signs
``` Infertility Acne Gynecomastia Hepatic failure Cholestasis dyslipidemia Elevated Hb Elevated Crdecreased testicular size Aggressiveness Psychosis Decreased FSH, LH, GnRH ```
171
Pts with CAD who should refrain from sex
``` Ongoing stable/unstable angina Incomplete revascularization LV dysfunction Symptomatic heart failure High risk arrhythmia Within 2 wk of MI ``` Until appropriately evaluated and stabilized
172
1st line Tx for erectile dysfunction in CAD
Sildenafil Contraindicated with nitrates and a-blockers
173
Blue discoloration of vision
Sildenafil
174
First line treatment for erectile dysfunction in diabetic patients
Sildenafil
175
Chronic prostatitis or chronic pelvic pain syndrome symptoms
``` Pelvic pain for more than three months without an identifiable cause Irritative voiding symptoms Pain with ejaculation Blood in the semen Afebrile Little or no prostate tenderness Normal urinalysis and urine culture Treatment includes:alpha blockers, 5alpha reductase inhibitors, antibiotics (Q) ```
176
Testicular tumor with increased testosterone and estrogen
Leydig
177
Isolated Diminished or lost Achilles reflexes in old ages
Normal finding
178
Cryptochidism Tx
Surgery before one year of age
179
Neonatal hydrocele management
Both communicating and non-communicating hydroceles will resolve spontaneously by the age of 12 months and can be safely observed during that period.
180
Varicocele treatment
If fertility desired: ligation of gonadal vein | If fertility not desired: Scrotal support and NSAIDs.
181
The most common form of shoulder dislocation
Anterior
182
Anterior versus posterior shoulder dislocation
Anterior: arm slightly abducted externally rotated Posterior: arm adducted and internally rotate had
183
Duchenne vs Becker muscular dystrophy
Absent vs reduced Dystrophin | Under 5 vs older than 5 y/o
184
Friedriech ataxia
``` The most common type of spinocerebellar ataxia AR Presentsbefore 22 y Gait ataxia Dysarthria Concentric hypertrophic cardiomyopathy DM Hammer toe Scoliosis Dysmetria Nystagmus Ansent DTR ```
185
Bacterias causing HUS
EHEC Shigella Pneumococ
186
Iridodonesis
A rapid contraction and dilation of the iris in Marfan
187
Marfan mutation
Fibrillin-1 | AD
188
Homocystinuria
``` AR Deficiency of cystathion synthase (Metabolism of methionine) Fair complexion Thromboembolic events Intellectual disability Downward lens dislocation ```
189
EDS
Collagen disorder
190
Fibrillin2 mutation
Congenital contractional arachnodactyly No ocular/ cardiovascular disorder Joint contractures
191
Narrow forehead Almond-shaped eyes Downturned mouth compulsive binge eating
Prader-Willi syndrome | Maternal uniparental disomy
192
Prominent forehead | Macrorchidism
Fragile X
193
``` Hyperuricemia Self mutilation Mental retardation Dystonia Choreoathetosis ```
Lesch-Nyhan
194
Precocious puberty Cafe-au-lait Polyostotic fibrous dysplasia +/- (hyperthyroidism, prolactin- , GH-secreting pituitary adenoma, adrenal hypercortisolism)
McCune-Albright | Sporadic
195
Chlamydia/gonorrhea screening
NAAT method (on urine, endocervical, urethral, vaginal specimens) Target: High risks Sexually active <25
196
If positive NAAT
AB Abstinence from sex Testing of partner within past 2 mo
197
ECG, Echo, exercise test in athletes indicated when:
``` Marfan Chest pain DOE FHx of CMP, long QT Syndrome Premature cardiac death/disability in close relative <50 ```
198
``` Clenched hands with overlapping fingers Micrognathia Low set ears Heart defect Renal defect Limited hip abduction Rocker-bottom feet ```
Trisomy 18
199
``` Aplasia cutis Microphthalmia Microcephaly Holoprosencephaly Polydactyly Cleft palate Cardiac defect Umbilical hernia/omphalocele Renal defect Rocker-bottom feet ```
Trisomy 13
200
Lymphedema Cystic hygrome Fetal hydrops Horse-shoe kidney
Turner
201
C1q and C4 levels in angioedema
C1 q normal in hereditary angioedema, depressed in acquired form. C4 levels depressed in all forms of angioedema.
202
Angioedema due to ACEI occurs at:
Anytime | Tx: epinephrin if life threatening
203
Drug causing HUS
Cyclosporine
204
Cyclosporine neurotoxicity
``` Often reversible Headache Visual disturbance Seizure Mild tremor Akinetic mutism ```
205
Tx Of hypertension due to cyclosporine
Calcium channel blocker
206
The most common side effect of cyclosporine
Nephrotoxicity | Reversible or irreversible
207
Drug with gout as side effect
Cyclosporine
208
Cyclosporine side effects
Nephrotoxicity, hypertension, neurotoxicity, glucose intolerance, infection, malignancy, gingival hypertrophy, gout, hirsutism, GI manifestations, hyperkalemia, hypophosphatemia, hypomagnesemia
209
Tacrolimus versus cyclosporine regarding side effects
Tacrolimus does not cause hirsutism or gum hypertrophy | And has a higher incidence of neurotoxicity diarrhea and glucose intolerance
210
Chronic granulomatous disease
XLR Inability to produce hydrogen peroxide, impaired intracellular killing in phagosomes. Recurrent pulmonary and cutaneous infections, suppurative adenitis, osteomyelitis. Catalase positive organisms (staph A, serratia, Burkholderia, aspergillus, nokardia) Test: Neutrophil function testing: Dihydrorhodamine 123 test Nitroblue tetrazolium test Normal CBC Tx: prophylaxis with: TMP-SMX, itra. IFN gamma injection if severe
211
Chediak-Higashi
Staph A, strep pyogenes
212
Leukocyte adhesion efficiency
``` Impaired neutrophil migration Delayed umbilical cord separation (>21d) Recurrent nonpurulent skin infection Severe Periodontitis, omphalitis Marked neutrophilia Poor wound healing Staph A, G negative bacilli ```
213
CVID
``` Recurrent respiratory and G.I. infections: Pneumonia, sinusitis, otitis Salmonella, campylobacter, giardia AI disease: RA, thyroid Chronic lung disease: Bronchiectasis G.I. disorders: Chronic diarrhea(spru-like) , chronic giardiasis IBD-like conditions Granuloma development Increased risk for NHL ```
214
CVID diagnosis
Low IgG, IgA/IgM No response to vaccination Tx: Ig Replacement therapy
215
The most common primary immunodeficiency in adults
CVID
216
Hyper IgM shndrome
Absence of CD40 ligand on T-cells Increased IgM Decreased other classes of Ig Nl B-cell count Recurrent sinopulmonary infections with encapsulated bacteria Increased risk of opportunistic infections (PCP) FTT Tx: prophylactic ABs, interval IVIg admenistration
217
Bruton
``` X-linked Agammaglobulinemia Low Igs Absent/low B-cells Absence of lymphoid tissue ```
218
The most common primary immunodeficiency
Selective IgA deficiency
219
Selective IgA def
Usually asymptomatic Recurrent Sinopulmonary and gastrointestinal infections Associated with Autoimmune diseases and atopy Anaphylaxis during transfusion Low or absent IgA
220
Traveling to north Africa
``` Vaccins: Hepatitis A (the most common vaccine preventable disease) Hepatitis B Typhoid Polio booster ```
221
Yellow fever vaccine
For those traveling to sub-Saharan Africa and equatorial South American countries
222
Meningococcal vaccination
Hajj
223
Contraindication to pertussis vaccine
Progressive neurologic disorder (until treatment is established and condition stabilized) Encephalopathy within a year of previous vaccine dose
224
Precautions for dT vaccine:
Moderate-severe acute illness Guillain Barré within 6 wk of vaccine Arthus type hypersensitivity following dT containing vaccine
225
Precautions for pertussis vaccine
Moderate or severe acute illness Reaction to previous doses Seizure within three days Temperature 40.5 or higher within two days Hypotonic hyporesponsive episode within two days Inconsolable persistent crying within two days
226
Vaccinations in stable preterm infants
According to chronological age
227
The exception to hepatitis B vaccine at birth in a premature infant
Weight under 2 kg
228
Rota vaccine contraindication
Anaphylaxis Hx of intussusception History of uncorrected congenital malformation of the gastrointestinal tract for example Meckel’s diverticulum SCID
229
SCID
Failure of T cell development X linked recessive Autosomal recessive Recurrent severe viral fungal or opportunistic infections FTT Chronic diarrhea Low Ig levels Low T cell count (viral, fungal, opportunistic) B cell dysfunction (sinopulmonary, GI infections) Chronic diarrhea Absence of lymphoid tissue on examination Treatment: stem cell transplant
230
Vaccines contraindicated in CLA (Bruton)
Live vaccines
231
Randomization is a method to control
Confounding | Selection bias
232
Statistical modeling for example multi variant analysis is to control
Confounding
233
The null value for correlation coefficient
0
234
Confounding versus effect modification
Can be elucidated via stratification: If stratification leads to no significant difference in the stratified groups then it is confounding. Conversely if there is a significant difference between the two groups then the variable is an effect modifier.
235
When is the odd ratio a good approximation of relative risk in a study
When the disease is rare
236
The medication reconciliation intervention most likely to result in a decrease in adverse drug events and healthcare utilization
Pharmacist directed interventions | High-risk patients targeted interventions
237
Respondent bias
Is present when the outcome is obtained by the patient’s response and not by objective diagnostic methods For example migraine headache
238
The effect of sample size on confidence interval
Smaller sample size=increased CI=decreased power | Larger sample size=decreased CI=increased power
239
Hazard ratio
The ratio of an event rate occurring in the treatment group compared to an event rate occurring in the non-treatment group. A ratio less than 1 indicates that the treatment group had a significantly lower events rate while values greater than 1 indicate that the treatment group had a much higher event rate.
240
Factorial design
Involves two or more experimental interventions, each with two or more variables that are studied independently
241
Susceptibility bias
When is the treatment regimen selected for a patient depends on the severity of the patient’s condition, a form of selection bias known as susceptibility bias can result (confounding by indication)
242
Intention to treat analysis
To avoid selection bias in studies patients are randomly assigned to treatments to minimize potential confounding variables. many studies also perform any intention to treat analysis to deal with the selection bias. An I TT analysis compares 2 initial randomized treatment groups (the original intention) regardless of the eventual treatment, to avoid counting crossover patients.
243
As-treated analysis
Conversely to ITT, as-treated analysis compares the groups based on the actual treatment received. An as-treated analysis is performed to gauge the effectiveness of the treatment itself, with less regard for potential confounders.
244
Drugs associated with photosensitivity reaction
``` Tetracyclines Chlorpromazine Prochlorperazine Furosemide Hydrochlorothiazide Amiodarone Promethazine Piroxicam ```
245
Infection organisms in burn patients
Staphylococcus aureus and other gram-positive organisms immediately after a severe burn After more than 5 days most infections are due to gram-negative organisms (for example pseudomonas aeruginosa) or fungi (for example Candida)
246
Burn patients more susceptible to infection
If more than 20% surface area is involved
247
The earliest signs of infection in a burn patient
A change in appearance ( partial thickness injury turns into a full thickness injury) of the wound or the loss of a viable skin graft
248
Burn wound sepsis findings
T<36.5 or >39 Progressive tachycardia>90 Progressive tachypnea>30 Refractory hypotension (systolic blood pressure <90)
249
Diagnosis of burn wound infection:
Quantitative wound culture (>100,000/g) | Biopsy to determine tissue invasion depth
250
Treatment of burn wound infection
Piperacillin/tazobactam Carbapenem +/- vancomycin (MRSA) +/- AG (MDR pseudomonas)
251
Burn wound infection symptoms
``` A change in appearance of the wound Reduce or increase temperature Tachycardia Tachypnea Hypotension Oliguria Unexplained hyperglycemia Thrombocytopenia Mental status changes ```
252
Erysipelas vs cellulitis
Raised edges vs flat edges Rapid spread vs indolent spread Early fever vs later fever
253
Self resolution of molluscum
Within 6 to 12 months
254
Molluscum virus
Pox
255
Treatment of low risk BCC on trunk and extremities
Electrodesiccation and Curettage
256
Treatment of high-risk BCC on trunk and extremities
Total excision with 3 to 5 mm margins
257
Treatment of BCC on face
Mohs
258
Conditions associated with PTC
``` Hepatitis C HIV Excessive alcohol consumption Estrogen use Smoking ```
259
Treatment of PCT
Hydroxychloroquine Phlebotomy Treatment of the underlying condition
260
Treatment of seborrheic dermatitis
First line: emollience and non-medicated shampoos | Second line: topical antifungals or low potency glucocorticoids
261
medications causing drug-induced acne
``` Steroids Androgens Azathioprine EGFR inhibitors Phenytoin Antipsychotics Isoniazide Cyclosporine ```
262
Chloracne locations
Head, neck, axilla Exposure to pollutant dioxin
263
The most common reason for black dot Tinea capitalist
T. Tonsurans
264
Pityriasis versicolor micro-organism
M. Gobosa
265
The infection causing TEN
Mycoplasma pneumoniae
266
Potassium levels in primary adrenal insufficiency versus Central adrenal insufficiency
Those with PAI usually have hyponatremia and hyperkalemia due to concurrent mineralocorticoid insufficiency. by contrast potassium is normal in patience with Central adrenal insufficiency, although hyponatremia can be present due to increased release of antidiuretic hormone
267
Treatment for adrenal crisis
Should be started empirically with intravenous hydrocortisone or Dexamethasone and with aggressive fluid support
268
Doses of corticosteroid Needing stress does during acute illness
``` Three weeks in patients taking prednisones 20 mg/day or higher. Patients taking less than 5 mg have minimal risk and usually do not require a stress dosing. Intermediate does (5 to 20) can cause HPA suppression and require pre-operative evaluation with an early morning cortisol levels to determine risk. ```
269
Primary vs secondary adrenal insufficiency
Primary: hyponatremia, hyperkalemia, hyperchloremic metabolic acidosis, hypotension, hyperpigmentation. Other AI disorders. Secondary: normal K, normal acid-base, normal/low Na.
270
Acute adrenal crisis symptoms
Abdominal pain shock fever Altered mental status
271
Adrenal insufficiency due to HIV
can be due to opportunistic infections | Or due to treatment with Azoles
272
Initial evaluation of adrenal insufficiency
8 AM cortisol Baseline ACTH Cosyntropin stimulation
273
The most common electrolyte abnormality in PAI
Hyponatremia
274
Ovary dysfunction syndrome’s discovered by karyotyping
Turner | Fragile x
275
Diagnosis of carcinoid syndrome
24 hour urinary excretion of 5-HIAA CT/MRI of abd, pelvis OctreoScan to detect metastases Echo if symptoms of carcinoid heart disease
276
Carcinoid syndrome treatment
Octreotide ( if symptomatic/prior to surgery or anesthesia) | Surgery for liver metastasis
277
Heart problem with carcinoid syndrome
Tricuspid regurgitation
278
Effect of hypomagnesemia on Ca, P, PTH
PTH level is variable (decreased mg induces PTH resistance, decreases PTH secretion) Ca level is low P level is normal
279
Effect of renal failure on Ca, P, PTH, Calcitriol
Decreased GFR -> increased P -> increased PTH, decreased D3, decreased Ca (binding) -> more decrease in Ca, more increase in PTH
280
The effect of decreased vitamin D on serum P calcium and PTH
P: low to low-normal Ca: normal PTH: high
281
The age of percentile drop in children with constitutional growth delay
Between 6 months to 3 years of age
282
Cushing disease
ACTH producing pituitary adenoma
283
Normal serum osmolality
275 to 295
284
Normal serum sodium
135 to 145
285
Normal urine osmolality
300 to 900 usually 500 to 800
286
Labs in Primary polydipsia
Hyponatremia (<137) Urine osmolality <100 (<1/2 of plasma) Urine osmolality < serum osmolality
287
Which urine osmolality rules out DI?
>600
288
Serum Na in central vs nephrogenic Na
Central DI: high serum Na (>150 due to thirst impairment) | Nephrogenic DI: nl (intact thirst)
289
HbA1c levels
6.5 and more, DM <5.7, Nl 5.7-6.4, increased risk
290
FBG interpretation
>125, DM 100-125, increased risk <100, Nl
291
Oral hypoglycemic agent helping weight reduction
GLP-1 receptor agonist: | Exenatide, liraglutide
292
OHA after metformin failure
Usually sulfonylurea | But also TZD, GLP-1 inh,...
293
Second agent for metformin failure
Depends on pt’s condition
294
OHA with adverse effect of bone fracture
TZD, pioglitazone
295
OHA with adverse effect of bladder cancer
TZD: pioglitazone
296
Can pioglitazone be used in Renal failure?
Yes
297
Wt neutral OHAs
Metformin | DPP-4 inhibitors (sitagliptin)
298
Sitagliptin
Wt neutral DPP-4 inh Low risk of hypoglycemia Ok in renal insufficiency
299
OHA with adverse effect of pancreatitis
GLP-1 agonist
300
OHA acting via increase of incretin
DPP-4 inh
301
The primary intervention to slow decline in GFR after development of azotemia diabetes mellitus
Intensive blood pressure control
302
Initial risk of initiating ACE inhibitors or ARB in patients with diabetic nephropathy
Acute decline in GFR | Hyperkalemia
303
The amount of daily protein recommended for patience with diabetic nephropathy and azotemia
0.8 mg/kg/d
304
First line antihypertensive treatment in Black pts with or without CKD
With CKD: ACEI, ARB | Without CKD: diuretics, CCB
305
Rx for painful diabetic neuropathy
TCA duloxetine Pregabalin Gabapentin
306
Pregabalin Mechanism of action
It is a structural analog of GABA and decreases pain by inhibiting the release of excitatory neurotransmitters by binding to voltage gated calcium modulators on nerve terminals.
307
Amitriptyline not good for:
>65 y | Cardiac disease
308
Tests for sensory deficits in diabetic foot
``` Sense of pressure: 10 g monofilament Vibration: tuning fork Pain: pinprick Temprature Proprioception Ankle jerk ```
309
Small fiber versus large fiber neuropathy in DM
Small fiber: positive symptoms: pain, paresthesia, allodynia. Large fibers: negative symptoms: numbness, loss of vibration/proprioception, diminished ankle reflexes
310
When to start K in DKA pt?
If levels reach<4.5
311
When to add bicarbonate in DKA pt?
If pH< 6.9
312
When to add P in DKA pt?
If < 1
313
The best markers indicating resolution of ketonemia
Serum anion gap Betahydroxybutirate Also: rise in serum bicarbonate and pH
314
Measurement of parameters in DKA
Glucose: every hour | Electrolytes and anion gap: every 2-4 h
315
When to add dextrose in DKA?
Glucose 200
316
When to change serum in DKA?
First: NS | When glucose reaches 200: HS+ D5% + K 20mEq/L
317
Dx of DKA:
pH: <7.3 Bicarbonate <15-20 BG> 250
318
The most common pattern of sick euthyroid disease
TSH: Nl FT4: Nl Total and FT3: decreased If disease continues: All decrease Recovery: Transient increase in TSH
319
Factors inhibiting peripheral T4 to T3 conversion:
``` Caloric deprivation Increased CS Increased inflammatory mediators Free fatty acids Certain medications ```
320
Positive prussian blue stain in urine indicates
Hemosiderin
321
Diabetic gastroparesis treatment
Metoclopramide Erythromycin (IV in acute exacerbations) Cisaoride (risk of arrhythmia and death)
322
Gaucher manifestations
Severe splenomegaly, hepatomegaly Anemia, thrombocytopenia Bony pain FTT, delayed puberty Glucocerebridase deficiency Tx: enzyme replacement
323
Glucagonoma
NME Mild DM, easily controllable by OHA & diet Wt loss m, diarrhea Ataxia, dementia, proximal muscle weakness VTE Anemia Glucagon >500
324
The major gluconeogenic aa in the body
Alanine
325
Onset of gluconeogenesis
After 12 hour of fasting
326
Von-Gierkes disease
``` Glucose 6-phosphotase deficiency Type 1 glycogen storage disease 3-4 mo of age Liver, kidneys, intestinal mucosa Hypoglycemia Lactic acidosis Hyperuricemia Hyperlipidemia Seizures (hypoglycemic) Doll-like face Thin extremities Short stature Protuberant abdomen (enlarged liver and kidney) Normal heart/spleen ```
327
Type2 glycogen storage disease, pompe
``` Acid maltase deficiency First few weeks of life Floppy baby Macroglossia Heart failure ```
328
Type 3 GSD
``` Deficiency of glycogen debranching enzyme activity Hepatomegaly Hypoglycemia Hyperlipidemia FTT Elevated liver enzymes, fasting ketons Normal lactate, uric acid ```
329
Gynecomasia in pubertal boys
``` In up to 2/3 of boys in mid-late puberty Uni/bilateral Resolves within several weeks to 2 years Due to testicular production of estrogen and peripheral conversion of androgen to estrogen No W/U or Rx ```
330
Normal testis volume
Prepubertal <3 ml | Post pubertal 8-18 ml
331
Androgens in women
Ovary and Adrenal: Androstenedione DHEA Tes Predominantly Adrenal: DHEAS
332
Androgenic activity of DHEA & DHEAS
negligible and due to conversion to Testosterone and androstenedione
333
Effect of oral and transdermal estrogen on TBG levels
Oral, increases TBG (so increased TSH and decreased FT4 in hypothyroid pts who receive Levothyroxin) Transdermal, no change
334
Effect of androgens in TBG
Decrease
335
Confirming the Dx if primary hyperaldostronism
Adrenal suppression test after oral saline load
336
Easily induced hypokalemia after diuretics
Suspect hyperaldostronism | Check A/R ratio
337
Milk alkali syndrome
Excessive intake of Ca & absorbable alkali: CaCO3 Increased risk if: concomitant thiazide diuretic, ACEI/ ARB, NSAIDs Hypercalcemia -> renal vasoconstriction -> decreased GFR Hypercalcemia -> inhibition of Na-K-2Cl cotransporter and impaired ADH function -> increased Na and water loss -> hypovolemia -> increased reabsorption of bicarbonate
338
The most common cause of PTH independent hypercalcemia
Humoral hypercalcemia of malignancy Ca>14
339
Effect of increased/decreased pH on Ca
Increased pH-> H+ leaves albumin, therefore Ca binds to Alb -> hypocalcemia (total Ca level unchanged) Decreased pH -> H+ binds Alb -> Ca leaves alb -> increased ionized Ca
340
Type of hypercalcemia with Li
PTH dependent
341
Effect of PTH on urine Ca levels
Increased urine Ca (despite resorption from distal tubule)
342
Elevated PTH + Hypercalcemia + low urine Ca (<100mg/24h)
Familial hypocalciuric hypercalcemia
343
Neonatal thyrotoxicosis
Only with graves (passage of Ig through placenta) Tx: Self-resolves within 3 mo Methimazole + BB
344
Agranulocytosis with anti-thyroid drugs
``` With both methimazole and PTU Mostly during the first 90 days No need for routine CBC Check CBC if fever/ sore throat D/C promptly If WBC > 1500, fever and sore throat are unlikely to be due to antithyroids ```
345
Tx of thyroid adenoma, multinodular goiter
Initial: BB + methymazole/PTU Definitive: surgery, RIA
346
Ophthalmopathy, neonatal thyrotoxicosis in Thyroid adenoma and multinodular goiter
Not seen
347
Normal TSH levels
0.4-4
348
Normal total T4
4.6-12
349
Treatment that worsens thyroid ophthalmopathy
RIA (Administered withCS if mild ophthalmopathy) Surgery preferred over RAI if mod-sev
350
TFT in suppurative thyroiditis
Nl
351
Tx of thyroid storm
BB PTU ( to decrease hormone synthesis) SSKI (1h after PTU to decrease hormone release) CS ( to prevent T4 to T3 conversion)
352
Thyrotoxicosis with Normal or increased RAIU
Graves Toxic multinodular goiter Toxic nodule
353
Painless thyroiditis
``` Anti TPO+ Variant of Hashimoto Decreased RAIU Excludes pts within a year of delivery A self-limited hyperthyroid phase Then hypothyroid phase (persists or returns to eu) No Tx required except BB for hyper phase ```
354
PVR in hypo vs hyperthyroidism
Increase in Hypo Decrease in Hyper BP rises in both
355
Normal Mg levels
1.5-2.5 mEq/L
356
If hypocalcemia (confirmed with repeat measurement)
``` R/O: Hypoalbuminemia Drugs Mg Transfusion ``` If all Ok, measure PTH
357
Normal P levels
2.5-4.5 mg/dL
358
Mg and PTH
Hypomagnesemia decreases PTH secretion and induces resistance to PTHo
359
Hypoparathyroidism induced by low Mg levels vs hypoparathyroidism induced by other reasons
The first one is not associated with increased phosphate levels P levels are normal or low in Mg deficiency)
360
Injectable drugs that can reduce serum Ca levels
Citrate ( via transfusion with hepatic problems) EDTA Foscarnet Lactate
361
The most common non-surgical reason for hypoparathyroidism
AI
362
At this glucose level there is near complete suppression of insulin
60
363
Secondary hypogonadism in men, evaluation:
PRL +/- MRI (if elevated PRL, mass-effect symptoms, test<150, abn other pituitary hormones) Transferrin
364
Reasons for secondary hypogonadism in men
``` Kallman Hyperprolactinemia GC (cushing) Opiates Tumors damaging gonadotroph cells Pituitary apoplexy Infiltration (hemochromatosis) Systemic disease Morbid obesity DM ```
365
Recovery of HPA function after discontinuation of GC
May take up to 6-12 mo
366
Non-functioning hypophysis adenoma vs prolactinoma
PRL>200 in prolactinoma | Mild-mod elevation in non-functional adenoma
367
Alcohol effect on LH and testo
Suppresses LH | Directly inhibits testo production
368
Hypothyroidism and Serum lipid profile
Increased LDL or | increased LDL and triglyceride
369
Myopathy of hypothyroidism
``` Elevated CK ESR, CRP: normal or mildly elevated Associated Delayed DTR and additional features of hypothyroidism Proximal weakness EMG: normal or non-specific ```
370
Treatment of subclinical hypothyroidism?
Yes if high anti-TPO
371
Normal TFT
``` TSH: 0.4-4 TT4: 4.6-12 microgram/dl FT4: 0.9-1.7 ng/dl TT3: 80-180 ng/dl FT3: 240-480 pg/dl T3RU:24-37% ```
372
Thyroid lymphoma radiology
Donut sign in CT Pseudocystic pattern in US Core biopsy required
373
Evaluation necessary in all patients diagnosed with MTC
RET mutation | Plasma fractionated metanephrine assay
374
TFT during pregnancy
TSH: Decreased (B-hCG stimulates thyroid) TT4: increased FT4: normal or mildly increased TBG: increased
375
Pregnancy in controlled hypothyroidism
Increase dosage of levothyroxin by 30% at the time pregnancy is detected. Then adjusted every 4 wks
376
Gold standard test for detecting DM in PCOS
Oral glucose tolerance test
377
Isolated premature adrenarche is RF for:
PCOS DM2 Metabolic syndrome
378
Symptoms of isolated premature adrenarche
``` Pubic/axillary hair Acne Oily hair and skin Body odor Normal bone age ```
379
W/U for gonadotropin-dependent precocious puberty
Brain MRI with contrast
380
Primary Tx for gonadotropin-dependent precocious puberty
GnRH agonist
381
No Tx in prolactinoma if:
Asymptomatic and <10 mm
382
Tx of prolactinoma
If: > 10 mm or symptomatic microprolactinoma Tx-> cabergoline, bromocriptine Surgery if: >3cm Or increase in size while on treatment
383
If high PRL detected,
``` R/O: Pregnancy Renal failure Drugs Hypothyroidism ```
384
Hyperprolactinemia in prolactinoma vs other pituitary tumors
Prolactinoma >200
385
Deficient electrolytes in refeeding syndrome
Phosphorus is the primary deficient electrolyte Also Mg, K (causing arrhythmia in atrophic malnourished heart) -> cardiopulmonary failure Also B1 decrease
386
The reason behind refeeding syndrome
Increase in insulin
387
Tx of papillary thyroid carcinoma
Surgery (if<1-2cm, partial) + adjuvant radioiodine ablation (if large, extrathyroid invasion, lymph node mets, incomplete resection) + levothyroxin to suppress TSH
388
Invasion of follicular thyroid carcinoma
Capsule Blood vessels Hematogenous spread (not lymphatic)
389
Psammoma bodies in thyroid cancer
Papillary thyroid carcinoma
390
Hürthle cells
Non-specific Follicular thyroid carcinoma Benign adenomas Hashimito Large, polygonal, eosinophilic cytoplasm, large quantities of mitochondria
391
Thyroid nodule ultrasound suspicious for cancer
Hypoechoic Microcalcification Internal vascularity
392
stool osmotic gap
290-(2x stool Na + 2x stool K)
393
VIPoma
``` Pancrease tail Secretory diarrhea (stool osmolar gap<50) Flushing N/V Hypo/achloridia Hypokalemia Hypercalcemia Increased BG Lethargy Muscle weakness/cramp VIP level > 75 pg/ml ```
394
Osteomalacia radiology
Decreased bone density Thinned cortex Codfish vertebral bodies Bilateral and symmetric Pseudo-fractures (Looser zone)
395
Lab findings in osteomalacia
``` Low VitD (primary reason) Low/normal Ca Low P High PTH High ALP Low urine Ca ```
396
Rickets vs osteomalacia
Rickets: Defective mineralization of growth plates Osteomalacia: Ca or P deficiency at the mineralization front
397
A situation where hypophosphatemia is more marked than hypocalcemia:
VitD deficiency
398
Difficulty hearing in crowded or noisy environments
Presbycusis
399
Aspirin ototoxicity
Tinnitus | In very high doses it can cause hearing loss
400
Furosemide ototoxicity
Reversible or permanent hearing loss Tinnitus Hearing loss at lower doses if renal failure
401
HELLP
Severe form of preeclampsia Results from: abnormal placentation, systemic inflammation, Activation of coagulation system and complement cascade
402
Aromatase deficiency
``` In utero: masculinization of mother (resolves after delivery) Virilized XX child Nl internal genitalia Ambiguous external genitalia Clitoromegaly Delayed puberty Osteoporosis Undetectable estrogen High gonadotropins Polycystic ovaries ```
403
Test to assess ovarian reserve
Day 3 FSH
404
Unilateral bloody breast discharge
Intraductal papilloma
405
Irregular and heavy menses in teenagers recently experiencing menarche is due to
Anovulatory cycled
406
Evaluation of guaiac negative bilateral breast discharge
If lump, skin changes, nipple changes, LAP: mamo, sono If non: B-HCG, TSH, PRL, guaiac, +/-MRI
407
Management of suspected ovarian tumor on U/S
Exploratory laparotomy
408
Tx of ovarian cyst rupture
If uncomplicated: conservative with analgesics If fever, hypotension, tachycardia, hemoperitoneum, infection: surgical, AB...
409
Pelvic pain in a pt with a known ovarian mass
Ovarian torsion (esp dermoid tumor)

Med (25 decks)

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