Random Review Flashcards
What is the most common cause of nail clubbing?
Bronchogenic carcinoma/ non small cell lung cancer (54%)
Other causes: tb, interstitial lung disease, mesothelioma, subacute IE, COPD, heart disease….
What is the leading cause of nephrotic syndrome in pediatrics?
Minimal change glomerulonephritis
What is the most common type of glomerulonephritis?
Immunoglobulin A Nephropathy (Bergers disease)
Symptoms appear 1 day post infection
What kind of kidney stones form in acidic urine? In alkaline urine?
Acidic: ca oxalate, cysteine, uric acid
Alkaline: ca phosphate
What kind of kidney stones are not seen on X-RAY?
Uric acid
What is the imaging of choice for kidney stones?
Spiral CT without contrast
What size stones cannot be passed through the ureter?
Anything larger than 5mm
What are symptoms of nephritic syndrome?
PHAROH
Proteiniria Hematuria Azotemia RBC casts Oliguria Htn
What are symptoms of nephrotic syndrome?
PALE
proteinuria
HypoAlbuminuria (<20)
HyperLipidemia
Edema
A moth-eaten kidney on Ultrasound might indicate:
Polycystic Kidney Disease
What is the most common pathogen that causes pyelonephritis?
E. Coli
What antibiotics are used to treat pyelonephritis?
Ceftriaxone 1g IV
Or
Cipro 400mg IV
Waxy casts on urinalysis would indicate:
Chronic kidney disease leading to renal failure
What’s the most common pathogen involved in cystitis?
E. Coli
Other pathogens: KEEPS Klebsiella Ecoli Enterococci Proteus mirabilis, Pseudomonas S. Saprophyticus
What is the gold standard workup to diagnose interstitial cystitis? What would that show?/ what would a positive be?
Cystoscopy would show Hunners ulcers
What dietary recommendation might be made for interstitial cystitis?
Avoid potassium (Also avoid food allergens, although this is not in NPLEX core book)
Sulfsalazine is used to treat:
It depletes levels of what vitamin?
How might you dose that vitamin in patients taking sulfsalazine?
Sulfsalazine is used for Mild-moderate UC, and chrons with ileitis and colitis
It depletes folic acid
Replace with folic acid 800mcg
What homeopathic might be indicated for “honeymoon cystitis”?
Staphysagria
What drugs might be prescribed for menopausal symptoms? (From Boardvitals)
Clonidine and Gabapentin
Also: HRT?
Most (50%) of breast cancers arise from what area of the breast?
Upper outer quadrant
90% of breast cancers are from what cell type?
Ductal epithelium
What is the most aggressive form of breast cancer?
Invasive inflammatory ductal carcinoma
What is the most common type of breast cancer?
Invasive ductal carcinoma of the breast
Of epithelial cells, invading into tissue and ligaments
What are the screening recommendations for breast cancer? (According to Core NPLEX textbook)
Routine mammography every 2-3 years for women ages 50-74
What is the most common benign breast tumor in women?
Fibroadenoma
How might you diagnose suspected Paget’s disease of the breast? What might the results be?
Scrape cytology: large cells with high nuclear:cytoplasm ratio, occasional acinar formation and intracytoplasmic vacuoles is diagnostic
Descending symmetric flaccid paralysis is indicative of:
Botulism (clostridium botulinum)
What is the earliest and most common symptom of infant botulism?
Constipation
Then may note: weakness, weak cry, poor suckling, irritability, lack of facial expressions, loss of head control, difficulty breathing
What is the most common etiology of encephalitis?
Viral
CMV (mc CNS infx in Aids)
HIV (mc cause of AIDS dementia)
Polio
Rabies
The presence of Negri bodies on cerebellar or hippocampal biopsy indicates what?
Rabies encephalopathy
What is the gold standard in diagnosing encephalopathy?
Brain biopsy
What antibiotic is indicated for Rickettsia rickettsii (rocky mountain spotted fever) encephalitis?
Doxycycline
Ascending and symmetrical motor weakness is indicative of:
Guillain-Barré syndrome
How is shingles evaluated/diagnosed? What would the results be?
Tzank smear would show multinucleated giant cells
What drug is indicated for post-herpetic neuralgia?
Gabapentin 300-600mg po tid
What are the 3 main clinical symptoms of meningitis?
Fever, nuchal rigidity and headache
What are laboratory CSF findings in VIRAL meningitis?
Increase CSF protein, total leukocytes
Normal CSF glucose
Gram stain/culture is negative
What CSF lab findings might you find in BACTERIAL meningitis?
Increased CSF protein, total leukocytes
Decreased CSF glucose
Gram stain and cultures will be positive
What is the most common cause of peripheral neuropathy and what is the Pathogenesis?
Diabetes mellitus, suspected to be dt osmotic damage of Schwann cells
Patient presents with a dog bite with suspected rabies. What lab tests would confirm this and what are 2 treatment options?
Labs: biopsy showing negri bodies is pathognomonic, but often done postmortem. A skin scaling for antibodies can also help confirm Dx
Tx with: passive immunization (human rabies antibodies) or active immunization (with killed rabies virus)
What is the most common type of berry aneurysm?
Saccular (berry): at the branch of major cerebral arteries, frequently rupture into subarachnoid space
What is the most common imaging used in the evaluation of patients with suspected ACUTE stoke?
Noncontrast CT (MRI is ideal but may take too long in an acute setting)
What are some reasons to send a patient with Headache to the ER? (6)
Worst headache of life Thunderclap headache Headache with fever Any LOC Morning headache Papilledema
What is the most common type of headache?
Tension-type (70%)
Migraines- 12%; Cluster- 1% or less
Lower motor neuron palsy causing unilateral facial paralysis:
Bell’s palsy (CN VII- facial nerve)
What maneuver is done to assess for BPPV? What maneuver is done to treat BPPV?
‘Dix-hallpike’ is done to assess BPPV
“epley” is done to treat BPPV
What is the first line therapy (drug) for trigeminal neuralgia?
Carbamazepine
What initial workup is done after a seizure vs what is done to definitively diagnose a seizure?
CT done initially after first seizure to r/o space occupying lesion.
EEG and MRI done subsequently to assess etiology
A patient is having a seizure. Other than calling EMS, what do you do?
- lay patient on side, protect without restraining, dont put anything in their mouth!
- administer oxygen
- give glucose
- IV ringers or normal saline
- consider administering IV lorazepam or diazepam or phenytoin
What is the seizure type?
unresponsive for 5-10 seconds, appears staring/blinking, may occur up to 100 times daily
Petit Mal/ Absence Seizure
What is the seizure type?
no LOC, affects one side of the body, may have abnormal head/mouth movements
Focal/Partial Seizure
What is the seizure type?
prodrome present hours to days before attack. tonic contractions of muscles for 10-30 seconds, then violent jerking for less than 90 seconds, ending with LOC, HA, confusion, sore tongue, amnesia. Serum CK may be elvated.
Generalized/ Grand Mal Seizure
disease causing degeneration of anterior horn cells that causes UMN and LMN symptoms, usually inherited.
Lou Gehrigs disease/ ALS
Patient presents with abnormal eye movements and chorea. MRI shoes atrophy of caudate nuclei. Diagnosis?
Huntingtons
What drugs therapy/s might be indicated in Huntingtons disease?
Tetrabenazine is first drug approved to treat H. chorea.
Benzodiazepines and Risperidone (anti-psychotics) may also be indicated for chorea management.
Consider anti-depressants (Burproprion)
What is the most common demyelinating disease?
MS
What is Lhermitte’s signs and what might it indicate?
flexion of the neck causes electric sensation down the spine and into limbs.
Often indicates cervical cord lesion, is also seen in MS
profound asymmetrical permanent muscle weakness from necrosis of anterior horn cells might be due to what post-viral infection?
Poliomyelitis/ Post-polio syndrome
What are the three types of malignant brain tumors? How might they be differentiated?
Astrocytoma: usu involves frontal lobes and cerebellum
Glioma: usu occuring in the brainstem
Meningioma: occuring contiguous to the meninges
MRI is diagnostic for all of these and is usually able to differentiate diagnosis. Tissue biopsy after surgical removal is confirmatory.
Unilateral hearing loss, tinnitus and disequilibrium might indicate:
vestibular shwannoma/ acoustic neuroma (benign)
“bones, stones, abdominal moans and psychic groans” is a pneumonic for symptoms of:
Hyperparathyroidism
Whispered voice test reveals 1/3 hearing on the left, 3/3 hearing on the right. Weber lateralizes to the right. Rinne reveals air conduction is greater than bone conduction BL. What type of hearing loss is occurring and in which ear?
Sensorineural hearing loss in the left ear.
What is Samter’s Triad?
asthma
respiratory symptoms exacerbated by aspirin
nasal/ethmoidal polyposis
What is Li Fraumeni syndrome?
autosomal dominant inherited disorder of p53 characterized by:
sarcoma, breast, leukemia and adrenal gland (SBLA) syndrome
What is neurofibromatosis type 1?
one of the most common genetic disorders, with an increased risk of cancer development. Common symptoms include:
Lisch nodules
neurofibromas, plexiform neurofibromas
scoliosis
learning disabilities, vision disorders, mental disabilities, café au lait spots
epilepsy.
What is neurofibromatosis type 2?
inherited disorder resulting in increased susceptibility to schwannomas, meningiomas, and ependymomas.
Most commonly associated with the development of Acoustic Neuromas
MEN 1
keep it simple, 3 Ps
(one man Pares out the pit, then throws it in the pan)
pituitary adenoma
parathyroid hyperplasia
pancreatic tumors
MEN 2A
just plain cray
parathyroid hyperplasia
medullary thyroid carcinoma
pheochromocytoma
MEN 2B
meant 2 be, tall dark and handsome- but also cray
mucosal neuromas
marfanoid body habitus
medullary thyroid carcinoma
pheochromocytoma
What is the 3rd most common malignancy in women worldwide, the leading cause of cancer deaths among women in developing countries.
Cervical cancer
What is the most common cell type is cervical cancer?
squamous cell (95%)
Other types: small cell and adenocarcinoma (5%)
What are the 4 HPV strains associated with cervical cancer? Which of those are the most high risk?
6, 11, 16, 18
16 and 18 are the high risk strains
What is the most common cell type involved in endometrial cancer?
adenocarcinoma
What is the most common gynecological malignancy in the US?
endometrial cancer
What are risk factors for endometrial cancer?
COLD NUT Cancer (breast/ovarian/colon) Obestiy Late menopause Diabetes Nulliparity Unopposed estrogen (PCOS, anovulation, HRT) Tamoxifen chronic use
What is the most fatal gynecologic cancer in the US?
What is the most common initial symptom for this cancer?
ovarian cancer- most common initial presenting symptom is abdominal enlargement (dt fluid)
What medication has been shown to prevent ovarian cancer?
OCPs!
What type of cell origin do sarcomas come from?
mesenchymal cells (bone, cartilage, muscla, cardiovascular tissue, fat, lymphatic tissue
The majority of vulvar cancers are what type?
squamous cell carcinoma (90%), possibly related to HPV
remaining other types are melanoma, basal cell, Pagets, Bartholins gland carcinoma
What is the primary outpatient treatment for PID?
Ceftriaxone 250mg IM/IV
(Metronidazole 500mg po BID for 14 days)
Doxycycline 100mg po BID for 14 days (OR Azithromycin once)
What is the most common place to find endometrial tissue in endometriosis?
peritoneum
also in ovaries- 60%?
How are cystoceles (bladder prolapse) graded?
1st degree: bladder drops to upper vagina
2nd degree: bladder drops to introitus
3rd degree: bladder drops beyond the introitus
What is the most common infectious vaginitis?
Bacterial vaginosis (Garderella vaginalis)
What are the diagnostic criteria for PCOS?
2 of 3 required:
- oligomenorrhea/ irregular menses for at least 6 months
- hyperandrogenism
- polycystic ovaries on US
What hormone results might you find on labwork in a patient with PCOS?
LH:FSH is greater than 2
LH chronically hgih, with FSH mid to low range
Increased serum testosterone and androstenedione
increased serum estrogen
decreased SHBG
How does a Progestin challenge work and what does it tell us?
helps detemine whether or not a patient has true amenorrhea or if she in anovulatory due to a secondary condition.
give proesterone for one week, then withdraw
If patient has withdraw bleed: estrogen in present, but ovulation is not occuring
If no withdraw bleeding occurs: estrogen levels are low, may be structural issue causing obstrcution of menstruation.
**this test is rarely done now)
What is menorrhagia?
Excessive or heavy bleeding during menstruation
What is metrorrhagia?
Abnormal uterine bleeding that happens between periods
What is oligomenorrhea?
infrequent menstruation (cycle greater than 35 days long)
What are the diagnostic criteria for premenstrual syndrome?
At least 1 affective and one somatic symptoms during 5 days before menses:
(Affective Sxs: depression, angry outbursts, irritability, anxiety, confusion, social withdrawl)
(Somatic Sxs: breast tenderness, abdominal bloating, headache, swelling of extremities)
- symptoms are relieved within 4 days of menses onset
- symptoms present in the absence of any pharmacologic therapy
- symptoms reproducible during 2 cycles of prospective recording
- patient suffers from identifiable dysfunction in social/economic performance
What is the definition of female infertility?
inability to conceive after 1 year of trying ( or after 6 months in women over 35 yo)
Chancroid is caused by what infectious agent?
Haemophilus ducreyi
What antibiotic is used for chancroid?
Amoxicillin
What conditions are caused by C. trachomatis?
nongonococcal urethritis, cervicitis, conjunctivitis, pharyngitis, infant pneumonia, salpingitis, lymphogranuloma venereum, Reiter’s, PID, infertility
Condyloma acuminata area cause by:
Conydloma latum area caused by:
acuminata: HPV
latum: symphillis
Patients with HSV should avoid _______ but should supplement with ______.
Avoid arginine, supplement with Lysine
Primary stage of syphillis looks like:
painless chancre 3-4 weeks after infection
patient is highly infectious
serology is negative
Secondary syphilis looks like:
4-10 weeks after the chancre
widespread mucocutaneous lesions, rash on palsm, soles, extremities
condyloma latum
fever, sore throat, headache, LA, fatigue
positive serology
patient is high infectious
tertiary syphillis looks like:
3-10 years after infection
positive serology
gummas (necrotic nocules of organ tissues)
neurosyphillis
A strawberry cervix is a sign of:
Trichomonas infection
The most common form of malaria is from what infectious agent?
Plasmodium falciparum
How do you treat malaria?
Hydroxychlorquinone
Septicemia is most commonly due to what gram negative pathogen?
E. coli
Lymphangitis is usually caused by what pathogen?
Strep. pyogenes
Filariasis is caused by what pathogen?
Wucheria bancroft
How might aplastic anemia show up on CBC?
pancytopenia, with decreased RBC, WBC and platelets, decrease reticulocytes
In hemolytic anemia, iron overload results from (extra/intra?)vascular hemolysis, while iron deficiency results from (exta/intra?)vascular hemolysis.
iron overload results from extravascular hemolysis
iron deficiency results from intravascular hemolysis.
What are some tests for suspected intravascular hemolysis? extravascular hemolysis?
intravascular hemolysis test: blood film (look for schistocytes), free hemoglobin in serum
Extravascular: direct Coombs/ Indirect Coombs (detects antibodies for RBC antigens)
What are some causes of non-megaloblastic macrocytic anemia?
alcoholism, hypothyroidism
What does Schilling test help rule out?
pernicious anemia
What dose of iron is recommended to correct iron deficiency anemia?
325 mg TID Ferrous sulfate
300mg TID Ferrous gluconate
300mg TID Ferrous fumarate
be sure to take with Vitamin C
What might show on CBC for a-thalassemia? What test confirms a-thalassemia diagnosis?
CBC might show: decreased MCV, Hb, Hct with increased RBC and normal RDW
confirm Dx with gene probe
Heinz cells and bite cells seen on blood smear might indicate:
G6PD deficiency
What kinds of things can precipitate hemolysis in patients with G6PD deficiency?
oxidatie stress, viral infections, certain foods (fava beans), drugs (cholorquine/antimalarials, sulfonamides, nitrofurantoin)
What is the most common genetic disorder of northern european ancestry?
Hemochromatosis
What are signs and symptoms of hemochromatosis?
ABCDH
Arthrlagia bronze skin cardiomyopathy, cirrhosis of liver Diabetes hypogonadism (anterior pituitary damage)
What nutritional supplement might be helpful in sickle cell anemia?
Folic acid
What are the diagnostic criteria for polycythemia vera?
3 major criteria OR first 2 major and 2 minor criteria Major Criteria: Increased RBC mass No cause of secondary erythrocytosis Splenomegaly Mutation known
Minor Criteria: Absolute leukocytosis Thrombocytosis Leukocytosis Low serum EPO Bone Marrow biopsy reveals myelosis with erythroid and megakaryocytic proliferation
How might you differentiate polycythemia vera from secondary polycythemia?
polycythemia vera has normal oxygen saturation whereas secondary polycthemia will likely be cyanotic
Abdominal US to ro tumors/renal abnormalities
What is the treatment for Hemophilia A?
Desmopressin in mild cases
Recombinant Factor VIII and anti-fibrinolytic agents in severe cases
What clotting factor is missing in Hemophilia A? Hemophilia B?
Hemophilia A: Factor VIII
Hemophilia B: Factor IX
What is the most common vasculitis of childhood? and how is it treated?
Henoch-Schonlein purpura
(related to IgA nephropathy)
usu self limiting within 4 weeks
NSAIDs for joint pain and corticosteroids
What is the classic triad of Henoch-Schonlein purpura?
palpable purpura, abdominal pain, arthritis (poly, esp in knees and ankles)
What is the most common cause of thrombocytopenia in children ages 2-6? how is it treated?
Idiopathic thrombocytopenia purpura (spleen makes Ab against platelet membranes.
Is usually self-limiting within 3 months. watch for internal bleeding (may need Ig therapy)
What clotting factors are Vitamin K dependent?/ might be depleted in Vitamin K deficiency?
Factors II, VII, IX, X, Protein C and S
2/7/9/10
What blood work results might you expect in Von Wildlebrand disease (4)? How is it treated?
Increased bleeding time and PTT
Decreased Factor VIII
Normal platelet count
Decreased vWF Antigen
Treated wtih Desmopressin
Conjugated estrogens aso increase vWF
How are attacks in acute intermittent porphyria managed?
400 g/day glucose to inhibit heme synthesis (enzyme for heme synthesis in this condition is sped up, causing increased heme, neurodysfunction, seizures)
Treat seizures with Gabapentin
A patient who reports painful burning and itching of skin that is NOT relieved by corticosteroids, with gallstones found on US ma have what hematologic condition?
Erythropoietic protoporphyria (ferrchetalase deficiency causes build up of protoporphyrin, which causes oxidative damage when exposed to sunlight- hence why it doesnt respond to corticosteroids!)
Tx: oral beta-carotene, use sun-block
What are some causes of porphyria cutanea tarda?
alcohol abuse, DM, increased iron, estrogen therapy, genetic
presents of the Philadelphia chromosome on bone marrow studies or a blood smear indicates:
Chronic Myeloid Leukemia (CML)
What is the most effective cure for CML?
bone marrow transplant (75% effective)
Auer rods on blood smear are pathognomonic for:
Acute myeloid leukemia (AML)
What would a peripheral smear show in AML?
Auer rods
also: high blast count, thrombocytopenia, low neutrophils
What would a CBC with peripheral smear show in CML?
normochromic normocytic anemia, high neutrophils, hypercellular bone marrow,
megakaryocytes
What is the most common leukemia and cancer in children?
Acute lymphoblastic leukemia (ALL)
lymphoblasts replace bone marrow, resulting in decreased production and normal blood cells
What might you note on CBC and bone marrow biopsy in ALL?
leukocytosis, high WBCs
normocytic anemia with thrombocytopenia and neutropnei
What is the most common form of leukemia in the western world?
chronic lymphocytic leukemia (CLL)
progressive accumulation of functionally incompetent B-cells
What might CBC and bone marrow biopsy show in CLL?
Absolute lymphocytosis (lymphcytes are small and mature
Smudge cells
thrombocytopenia, normocytic anemia
bone marrow is usually completely replaced by B cells
Reed-Sternerg cells are pathognomonic for:
Hodgkins Lymphoma
What is the most common type of Hodgkins lymphoma?
nodular sclerosing
Other types: lymphocyte predominant, mixed cellularity, lymphocyte depletion
Hodgkins lymphoma is characterized by contigious or non contiguous spread along nodes?
Hodgkins lymphoma has contiguous spread
NON-Hodgkins lymphoma has NONcontiguous spread
What are the clinical features of multiple myeloma? (CRAB)
Increased calcium
renal failure (nephrocalcinosis)
anemia
bony lytic lesions
What is the diagnostic criteria for multiple myeloma?
- serum or urinary monoclonal protein analysis shows M-spike
- clonal plasma cells found in bone marrow/ plasmacytoma
- presence of related end-organ damage (increased serum Ca, lytic bone lesions, anemia, renal failure)
What is the risk of HIV infection after accidental needlestick?
0.3%
What CD4 counts define HIV latent, early symptomatic phases and AIDs?
Latent: CD4 greater than 500
Early symptomatic: 200-500
AIDS: less than 200 cells/mm3
What is the most common pneumonia infection pathogen in AIDs?
pneumocystis jiroveci
How soon after infection are anti-HIV antibodies detectable on ELISA?
median of 3-weeks. Virtually all cases detectable after 3 months
Patients with selective IgA deficiency are at increased risk of:
recurrent respiratory, GI infections, allergies
at higher risk of developing autoimmune disease
What is the most common extraarticular manifestion of ankylosing sponylitis?
uveitis
Other extraarticular symptoms: aortitis, restrictive lung disease, neurologic symptoms
“Bamboo Spine” on XRAY indicates:
ankylosing spondylitis
What is the first line treatment for ankylosing spondylitis?
NSAIDs (Celecoxib)
What is the most common initial finding in myasthenia gravis?
ptosis
other sxs: muscle weakness worse with exercise, improved with rest, dysphagia
How is myasthenia gravis diagnosed?
Edrophonium (Tensilon) test: Administer acetylcholinesterase inhibitor and observe reversal of symptoms within 2 minutes of injection as Ach levels increase.
Can also do Anti-Ach antibody assay
Patients with myasthenia gravis are at increased risk of?
thymoma/ thymic hyperplasia
What are some conditions associated with increased risk of necrotizing vasculitis? (5)
polyarteritis nodosa rheumatoid arthritis scleroderma SLE Wegeners granulomatosis
What is the diagnostic criteria for Polyarteritis Nodosa?
3 of 10 required:
- weight loss more than 4kg
- myalgias, weakness or leg tenderness
- livedo reticularis
- neuropathy
- testicular pain
- Diastolic BP over 90mmHg
- Elevated Cr or BUN
- Hep B positive
- Arteriographic abnormality (MC aneurysm)
- biopsy of artery shows granulocytes/leukocyte infiltration.
Dermatomyositis is associated with ______-mediated damage, while polymyositis is associated with _______-mediated damage.
Dermatomyositis: antibody-mediated
Polymyositis: T cell-mediated
What are Gottron’s patches and what might they indicate?
purple papules over knuckles and PIP joints, indicating polymyositis or dermatomyositis
(or just having punched a wall?- kidding!)
What is the triad of Reactive Arthritis?
urethritis, arthritis, conjunctivitis
“cant pee, can’t see, can’t dance with me- BC you’ve got the clap!!”
What is the first choice of imaging for rheumatoid arthritis?
XRAY
What is a Boutonniere deformity and what might is suggest?
Extension of DIP with flexion of PIP joints
indicates high likelihood of Rheumatoid arthritis
What type of immune response is implicated in rheumatoid arthritis?
Type III and IV reactions
B and T cells are both activated, leading to synovial damage. RF and IgG complex together to deposit in the joint space (Type III)
Release of cytokines from T-cells leading to excessive collagen synthesis is the mechanism of what condition?
Scleroderma
What is the most common cause of death in patients with scleroderma?
respiratory failure
What is CREST syndrome and what is it seen in?
seen in Scleroderma C- calcification R- Raynauds E- esophageal dysmotility S- sclerodactyly T- telangiectasias
What anti-nuclear antibodies might you see on workup in patients with Sjogrens?
Anti-SSA/Ro and/ro Anti-SSB/La
Positive RF, ANA
What anti-nuclear antibodies might be positive in patients with SLE?
Anti-dsDNA, Anti-Sm
ANA (generally)
What drugs might trigger lupus-like syndrome?
Anticonvulsants (Phenytoin, eg)
Antihypertensives (Hydralazine, eg)
What is the dose and concentration of Epinephrine administered to an adult for anaphylaxis?
0.3-0.5 mL of 1:1000 q5-15mins
pediatric dose is 0.1-0.3 mg 1:1000
Urticaria is due to what type of hypersensitivity?
Type 1 hypersensitivity (IgE mediated, histamine release)
What is the diagnostic criteria for Chronic Fatigue Syndrome?
Must have 4 of the following symptoms for at least 6 months:
- impaired short term memory
- sore throat with tender LA
- muscle pain
- multi-joint pain without swelling or redness
- new headache
- unrefreshing sleep
- post-exertion malaise lasting more than 24hrs
Excessively high hCG levels in pregnancy, with large uterine size, “snow storm” (hydropic villi) and no fetal heartbeat on ultrasound is indicative of what?
Hydatidiform Mole, trophoblastic hyperplasia without fetal parts or fetus. (due to fertilization of ovum by multiple haploid sperm or one diploid sperm)
What kind of effects can Rubella have on a fetus if a mother becomes infected in the first trimester?
sensorineural hearing loss, cataracts, thrombocytopenia (“blueberry muffin” rash), hepatomegaly, patent ductus arteriosus.
Can the Rubella vaccine be administered during pregnancy?
NO- it is a LIVE vaccine
Vertical transmission of Group B Strep can cause what?
neonatal sepsis, meningitis, pneumonia, death
How might Toxoplasmosis infection affect a fetus/infant?
blindness, deafness, CNS calcficiation in basal ganglia, hydrocephalus, hepatosplenomegaly.
When is a OGTT done for gestational diabetes?
28 weeks
What are risks of gestational diabetes?
fetal hyperglycemia, neural tube defects, respiratory distress syndrome,
neonatal hypoglycemia- give glucose at birth
maternal diabetes
How is gestational hypertension defined?
BP over 140/90 AFTER 20 weeks gestation
What drugs are recommended for gestational hypertension?
a-methyldopa
DO NOT USE ACE inhibitors, Propranolol or diuretics
What is polyhydramnios?
amniotic fluid over 2000cc at any stage of pregnancy
MC idiopathic
How is preeclampsia different from eclampsia?
eclampsia is preeclampsia with seizures
What is the most common complication in pregnancy, causing most maternal deaths?
What is the most common complicationin pregnancy not causing deaths?
preeclampsia
UTIs
What are the diagnostic criteria for preeclampsia?
HTN (over 140/90)
Proteinuria over 300mg/24hr
Pitting edema
(may also note, although not in diagnostic criteria: weight gain, increased LFTs, Increased BUN, Cr, PT, PTT)
How is preeclampsia managed?
Amlodipine (CCB)
Phenytoin for seizures
Bed Rest
IV Magsulfate
What antibiotics might you use for a UTI in pregnancy?
Amoxicillin
avoid doxy, TMP
What is the most common cause of placental abruption?
maternal HTN
What is abruptio placenta?
placental abruption after 20 weeks gestation- emergent condition, have mother in trendelenberg position, IV ringers and transport to ER
What are some risk factors for ectopic pregnancy?
smoking PID history tubal damage (surgical, eg) IUD use multiple sex partners
What are the classifications of placenta previa?
Total: placenta completely covers os
Partial: placenta partially covers os
Marginal: placent is within 2cm of os but does not cover os
Low-lying: placenta in close proximity of, but clear of os.
How is post-partum hemorrhage defined?
over 500ml blood loss during first 24 hours postpartum
What is the most common cause of post-partum hemorrhage?
uterine atony
How might you manage a mother with post-partum hemorrhage?
monitor vitals, O2, raise legs, keep patient warm
IV Oxytocin
ER referral
When might you administer RhoGAM?
at 28 weeks, and within 72 hours after deliver of first pregnancy if mother is Rh negative and infant has a chance of being Rh positive.
What is a normal breathing rate for neonates?
40-80/min
How much time should pass between birth of an infant and passage of the placenta?
30-45 mins
If placenta does not pass in 30 minutes, refer to ER to manage likely hemorrhage.
What is the most common manifestation of CMV in patients with HIV?
Retinitis
A “cottage cheese and ketchup” appearance on retinal exam would indicate:
retinal hemorrhage, possibly from CMV or other
How would you manage orbital cellulitis?
refer to ER- medical emergency as it can progress to meningitis, brain abcess, vision loss, death…
surgical abcess drainage and IVs, blood culture and orbital CT
Abx: ceftriaxone, vancomycin
Dacryocystitis is associated with what bacteria?
Strep. pneumonia or S.aureus
Blepharitis is associated with what bacteria?
S. aureus
An inflammation of the meibomian glands is called:
Chalazion
Inflammation of Zeis or Moll glands of the eyes is called:
Hordeolum (stye)
Viral conjunctivitis is usually due to:
adenovirus
What is the most common bacterial conjunctivitis in neonates?
Chlamydia trachomatis
How might you treat bacterial conjunctivitis?
Doxycycline (broad-spectrum antibiotics)
What might you call: a fibrovascular lesion that can distort the cornea, causing vision loss and astigmatism. How is it treated?
Pterygium; treated by excision
What is the most common source of infectious blindness in western countries?
Herpes Simplex Keratitis (HSV1 usually)
What is the most common cause of reversible blindness in the world?
cataracts; MC due to advanced age
What is the most common cause of permanent vision loss in the elderly?
Macular degeneration
What is metamorphosia and what might it suggest?
wavy lines distortion in the center of the fiedl of vision; due to macular edema, macular degeneration
What is the most common etiology of optic neuritis?
MS
A loss of the red light reflex, with a retina that appears dark grey with dark blood vessels, and patient describing loss of central vision would indicate:
retinal detachment- send to ER opthamologist
What is the most common form of glaucoma?
primary open angle glaucome
decrease rate of flow into the canal of Schlemm
What type of glaucoma is painless? Which is painful?
painless: primary open angle glaucoma (MC)
painful: primary angle closure glaucoma (emergency)
AV nicking, blot retinal hemorrhages and cotton wool spots might indicate:
Hypertensive retinopathy
Dot and blot hemorrhages with hard exudates on ophthalmoscopic exam might indicate:
diabetic retinopathy
A patient presents with stridor, wheezing cough and you notice a gray pseudomembran on the back of the throat. What do you suspect and what do you NEED TO DO?
Corynebacterium diptheria
NEED TO REPORT
What is the classic triad of mastoiditis?
otorrhea
tenderness on pressure over the mastoid
retroauricular swelling with protruding ear.
(may also note: fever, hearing loss, possible tympanic membrane perforation)
CT scan is required
What is the protocol for infectious mononucleosis?
Monospot test, with Rapid strep to ro strep
Rest, (self-limiting illness), consider prednisone if tonsil significantly enlarged
Sudden unilateral hearing loss, possibly with severe incapacitating vertigo with nausea and vomiting
Labyrinthitis
What are diagnostic features of Meniere’s disease?
at least 2 episodes of vertigo lasting at least 20 mins, with sudden falls without LOC
hearing loss at low frequencies (sensorineural)
persistent tinnitus, aural fullness
What is the most common pathogen implicated in otitis media?
strep. pneumonia
What antibiotic is most indicated for otitis media?
amoxicillin (azithromycin or TMP if penicillin allergy)
What is Schwartz’s sign? what does it indicate?
faint pink tinge on TM caused by neovascularization of otosclerotic bone;
may indicate otosclerosis
nausea, vomiting and vertigo (vestibular symptoms) without hearing loss; possibly due to HSV and is often preceeded by a cold
Vestibular neuronitis
Which sinus is most often affected in adult sinusitis?
Maxillary
Which sinus is most often affected in child sinusitis?
Ethmoid sinus
How would you treat sinusitis?
NOT with antibiotics! (most cases are viral)
What is the most common oral infection in patients with HIV?
Candidiasis
Tx with Nystatin, Fluconazole if severe
What are etiologies of glossitis? (6)
chronic iron deficiency pellagra (niacin deficiency) B12 or folate deficiency Scurvy (Vitamin C) Scarlet fever EBV-associated hairy leukoplakia
What are the most common causes of herpangina?
Coxsackievirus A16, enterovirus 71, coxsackievirus B
herpangina is self-limiting, supportive therapy indicated only
A white patch with sharply demarcated borders in the oropharynx that canNOT be scraped off is called:
leukoplakia (squamous hyperplasia, related to carcinogenic activities)
Is parotitis/ sialadenitis most commonly viral or bacterial?
viral is most common (mumps)
What is the most common cause of peritonsillar abscess?
Strep. pyogenes
What is the Quinsy triad? what does it indicate?
Trismus (limitation in the ability to open the oral cavity), uvular deviation, dysphonia
What is the Centor Criteria?
For strep throat: absence of cough anterior cervical LA fever tonsillar exudate Age 3-14 (+1) Age 44yo+ (-1)
0-1: no further testing needed (consider EBV monospot or other dx)
1-3: rapid strep test
4+ antibiotic treatment
45% of head and neck cancers are what type?
laryngeal
oral cancer is more likely to be on the anterior or posterior part of the tongue?
50% of oral cancers are on the anterior 2/3 of the tongue
Most common hypothalamic pituitary abnormality is:
pituitary adenoma (10-25% of all intercranial neoplasms) ( most common pituitary adenoma is prolactinoma)
3 types:
benign (MC), invasive and carcinoma (rare- 0.1%)
What size does an adenoma have to be to be classified as microadenoma?
less than 10mm
what is the most common hypothalamic tumor in children?
craniopharyngioma
What is the most common cause of drawfism?
achondroplasia (70%)
What is the primary agent to treat prolactinomas?
Bromocriptine (now replaced with Cabergoline)- dopamine agonists, decreasing prolactin secretion
What is a trendelenberg gait and what might it indicate?
lurching, with drop of pelvis when standing on contralateral leg.
indicative of Leg-Calve-Perthes (avascular necrosis in pediatrics)
What is Trousseaus sign?
An indication of latent tetany in which carpal spasm occurs when the upper arm is compressed, as by a tourniquet or a blood pressure
(may indicate hypercalcemia/hypermagnesemia)
What is Chvosteks sign?
When the facial nerve is tapped in front of tragus the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcemia (i.e. from hypoparathyroidism, pseudohypoparathyroidism, hypovitaminosis D) with resultant hyperexcitability of nerves
What is the most common endocrine disorder after diabetes?
hyperparathyroidism
What is the most common area to find neuroblastoma in children?
adrenal medulla
What is the most common site of metastasis for WIlm’s tumor?
lungs
What is the primary renal tumor in children?
Wilm’s tumor (nephroblastoma)
What is the most sensitive imaging to see if the inferior vena cava has been invaded by WIlm’s tumor?
MRI
What is the most common ocular malignancy of childhood? What symptoms might you note?
retinoblastoma
will note leukoria- white reflex- and strabismus
What is the progression of Fifths disease? What is it also known as?
Fifths disease/ Erythema infectiousum/ Parvovirus B19
- mild prodrome 1 week post-exposure (HA, fever, sore throat, arthralgia, pruritus)
- slapped-cheeck appearance, fades after 2-4 days
- erythematous maculopapular rash extends trunk and proximal extrmities 1-4 days after slapped cheeks fade
- self-limits
Slapped-cheek appearance in children indicates what infection?
Parvovirus B19/ Fifths disease/ erythema infectiosum
What virus causes Hand-Foot-Mouth disease?
Coxsackie
What virus causes Herpangina?
coxsackie A16, enterovirus 71
grey papulovescicles in the mouth of an infant with erythematous base, concomittant sore throat and dysphagia might be:
Herpangina
What causes mumps? What are symptoms of mumps?
Paramyxovirus
Fever, HA, bilateral parotitis, myalgia, malaise
What is the most common pathogen causing otitis media?
strep. pneumonia
whooping cough is caused by:
What antibiotic do you give for this (first line)?
Bordatella pertussis
Azithromycin
What is the most common viral exanthem in children under 2 yo?
Rosaola infantum (HHV 6)
high fever that stops abruptly, then rash develops neck, spreading to face and extremities.
What are Forchheimer spots? What do they indicate?
red spots that develop on posterior hard/soft palate that develop at the onset of the rash of Rubella/German Measles
What is the distribution of the classic measles rash?
starts on hairline, then spreads to neck, trunk and the rest of the body.
What are Koplik spots? What do they indicate?
grey/white papules on buccal mucosa that indicate measles (Rubeola)
What vitamin might you give to children with measles?
Vitamin A
What is strawberry tongue? What condition is it seen in?
beefy red tongue, seen in scarlet fever (GABHS)
What rashes start on the head and spread to the body?
Scarlet fever, measles, german measles
What rash starts on the body, spreads to the head?
Roseola infantum
What is Reye’s syndrome?
rare post-flu emergent condition, in which children may have seizures, diarrhea, weakness.
Associated with Aspirin/ASA use during flu
What pathogens are implicated in croup?
Parainfluenza viruses are most common
RSV, adenovirus also
Inspirtory stridor is a sign of:
Croup (Laryngotracheobronchitis)
Steeple sign on XRAY is a sign of:
Croup (Laryngotracheobronchitis)
How might you treat Croup?
Corticosteroids
Epinephrine (B2 bronchodilation)
What is the most common lung infection in patients with cystic fibrosis?
Pseudomonas aeruginosa
How is cystic fibrosis diagnosed?
sweat chloride test
What is the most common cause of Epiglottitis?
Heamophilus influenza B
What physical exams might you do in suspected Epiglottitis?
DO NOT LOOK IN THROAT
just send to ER (look for thumb-print sign on XRAY)
What is the leading cause of death in infants under 12 months?
SIDS
associated with sleeping prone
breastfeeding reduces risk of SIDS by 50%
What is the leading cause of lower respiratory tract infections in infants and young children?
RSV
may go to sepsis,DX with nasopharyngeal swab
In an infant/neonate, you hear: systolic ejection mumur at the Left 2nd intercostal space. Also a mid-diastolic mumur at the LLsternal border, fixed S2 split. What do you suspect and what workup do you need to order?
Atrial Septal Defect
Doppler Echo
Coarctation of the aorta is associated with what genetic condition?
Turner’s syndrome
In an infant/neonate, you hear: heavy “machinery” murmur during systole and diastole. What do you suspect and what workup do you order?
Patent Ductus Arteriosus
Doppler Echo
What is the Tetralogy of Fallot?
Ventral septal defect
Right ventricular outflow obstruction
overriding aortic root
right ventricular hypertrophy
In an infant/neonate, you hear: harsh systolic ejectionmurmur at L sternal border, systolic thrill, loud S2. What do you suspect and what workup do you order?
Tetralogy of Fallot
Doppler echo, CXR (shows Boot-shaped heart)
A boot-shaped heart on CXR of an infant indicates:
Tetralogy of Fallot
What is the most common congential heart disease? What might you hear?
Ventricular septal defect
holosystolic murmur at LLsternal border with thrill
How is encopresis defined?
fecal incontinence in children over 4yo at least once a month for 3 months
What is Hirschprungs disease?
absence of ganglion cells in Meissner’s submucosal plexi and auerbach plexi, causing contraction without relaxation, causing bowel obstruction.
Diagnose with rectal biopsy and treat with colostomy.
A neonate fails to pass meconium stool within the first 24 hours. What MUST be ruled out first?
Hirschsprungs disease
also r/o cystic fibrosis
What signs might you note on Intussusception. What condition is associated with intussusception?
sausage-shaped mass in RLQ (Dance’s sign)
“red-currant jelly” stools
vomiting, rectal bleeding
associated with Cystic fibrosis
What is “olive sign” and what might it indicate? What is the imaging of choice should this be noted on exam?
Palpation of a lump the size of an olive in the RUQ in an infant. might indicate pyloric stenosis.
Imaging of choice is Abd US.
Are braces, special shoes or exercises effective in treating femoral anteversion?
NO- this tends to resolve on its own. Special support may socially alienate the child and is not otherwise helpful
What is the most common arthritis of childhood? What are the 3 types?
Juvenile Rheumatoid Arthritis
1. Systemic arthritis (Still’s disease): high fever, salmon maculopapular rash, with arthritis occuring later. ANA negative, high ESR, CRP, WBCs
- Oligoarticular arthritis (1-4 joints)
persistent, ANA positive in 80%, RF negative - Polyarticular arthritis (5+ joints)
insidious onset, malaise, fatigue, RF positive, severe, rapid progression
What is nursemaids elbow?
subluxation of the radial head
refer to ER for reduction
When to testes spontaneously descend? What might occur if they don’t descend?
usu descend by 3 months
otherwise increased risk of seminoma or testicular torsion
What is the definition of failure to thrive?
below the 3rd percentile or less than 80th percentile of height and weight.
Hypospadias is an opening on the (ventral/dorsal?) side of the penis.
Epispadias is an opening on the (ventral/dorsal?) side of the penis.
Hypospadias: ventral
Epispadias: dorsal
What is the diagnostic criteria for ADD predominantly hyperactive?
at least 4 symptoms persisted for 6 months that is maladaptive:
- fidgets, squirms
- leaves seat when expected to remain
- runs and climb excessively
- cannot play quietly
- on the ‘go’
- talks excessively
What is the diagnostic criteria for ADD predominantly inattentive?
at least 6 symptoms in the last 6 months that is maladaptive:
- careless mistakes
- cannot sustain attention
- does not listen when spoken to
- fails to complete tasks
- avoids tasks that require sustained mental effort
- disorganized
- loses things
- Distractable
- forgetful
What is the diagnostic criteria for conduct disorder?
3 or more Sxs in the past 12 months, 1 or more in the last 6 months:
- aggression towards people or animals
- destruction of property
- deceitfulness or theft
- violation of rules
After what age in childhood should enuresis be worked up?
over 6 yo
unless causing significant distress
What pharmacologic agent might be used in Tourette’s syndrome?
Clonidine
but tourettes may regress (50%) by age 18, so may not require medication unless significantly affecting daily life)
What is Fanconi syndrome? What nutritional supplements might you recommend for it?
disease of proximal renal tubules in which all substances are passed into urine (inherited or dt heavy metals)
Tx: hydration, phosphate, vitmain D,
bicarb, sodium replacement
Basophillic stippling of RBCs on blood smear is a sign of:
lead poisoning
will also see hypochromic microcytic- siberoblastic- anemia
What drugs might mimic Schizophrenia?
Amantadine, amphetamines, cocaine (Dopamine reuptake inhibitors/ increasing dopamine)
What drugs are indicated for schizophrenia?
Dopamine receptor blockers (Riperidone/Risperidal and Prochlorperazine/Compazine)
What is criteria A for schizophrenia? If this is not met, what other diagnosis might be possible?
Criteria A: 2 or more of the following symptoms present over at least one month
delusions, hallucinations, disorganized speech, disorganized behavior, catatonic behavior, negative symptoms (lack of affect, alogia, avolition)
If criteria A is not met, consider delusional disorder
Howdo we differentiate Bipolar I from Bipolar II and cyclothymia?
Bipolar I: one manic or mixed episode. May have 1 depressive episode, but not required for diagnosis
Bipolar II: at least one major depressive episode and 1 hypomanic episode but NO history of mania or mixed episode
Cyclothymia: periods of hypomania and some depressive symptoms but NO frank depression, or mixed episodes
How is generalized anxiety disorder diagnosed?
anxiety on more days than not for over 6 months associate with at least 3 of the following: 1. restless/feeling on edge 2. easily fatigued 3. difficulty concentrating 4. irritability 5. muscle tension 6. sleep disturbance
When should a patient with anorexia be admitted to the hospital?
if less than 65% of standard weight (less than 85% in adolescents)
HR under 40 bom, abnormal serum chemistry or actively suicidal
What fungal respiratory infections are common in great lakes/mississippi regions?
Blastomyces dermatiditis (Bastomycosis) Presents as: flulike illness, non-productive cough, resolves in days. may have disseminated skin lesions
Also Histoplasmosis (histoplasma capsulatum) fever, malaise, cough, self limiting- althoguh treatment with azoles is recommended.
What fungal respiratory infection is common in the San Joaquin Valley?
Coccidiomycosis (coccidioides immitis)
pesents as: fever, arthralgias, erythema nodosum, cough, chest pain
Tx with fluconazole
what is recommended treatment for influenza?
Oseltamivir (Tamiflu)
What is the most common cause of bronchiectasis in the US? Worldwide?
US: Cystic fibrosis (P. aeruginosa)
Wordlwide: TB
A “signet ring” on high-resolution CT is gold-standard in diagnosing:
Bronchiectasis
Bronchiolitis is usually caused by:
RSV
How is bronchiolitis treated?
Only oxygen has demonstrated improvement in the condition in children. (abx have no therapeutic value, since it is MC dt RSV)
What is the 5th most common diagnosis in family practice? Is it usually viral or bacterial?
Bronchitis (URI) 80% viral (RSV, rhinovirus, adenovirus.
What are the phases of ARDS?
Exudative (first 7 days): endothelial injury causes infiltrate and exudate production, dyspnea, tachypnea
Fibroproliferative phase (after day 7): dyspnea, tachypnea, fatigue and hypoxemia continue but may improve over time as fibrosis continues
What are the steps in managing asthma (from least to most aggressive)?
Albuterol (bronchodilators/ b2-agonist)
if that fails, low potency corticosteroids (Fluticasone)
then mid-strength (betamethasone)
if that fails, then Montelukast (leukotriene inhibitor)
What are the three different types of atelectasis?
(alveolar collapse)
Obstructive (from thick secretions, eg)
Compressive (tumors, eg)
Adhesive (lack of surfactant, eg)
What timeline is required to diagnose chronic bronchitis?
productive cough on most days for at least 3 consecutive months in 2 consecutive years
What is empyema and how do you diagnose it?
pus in pleural space
Dx by sputum culture
Tx: oxygen and send to ER for Abx (4-6 weeks clindamycin/penicillin) and/or drainage
What is the most common type of pneumoconiosis?
asbestosis
CXR shows fibrosis in lower lungs, increasing risk of bronchogenic carcinoma, mesothelioma
What types of individuals are at increased risk of asbestosis/mesothelioma/pneumoconiosis?
sandblasters, miners, quarries, highway workers
After referring to ER and while waiting for ambulance, how much oxygen would you administer to a patient with pneumothorax?
100%
What is the most common cause of pulmonary edema?
LCHF
What is the gold standard workup to diagnose pulmonary embolism, pulmonary infarction?
Pulmonary angiogram
What is the defintion of pulmonary hypertension?
pulmonary arterial pressure over 25mmHg at rest or over 30mmHg during exercise.
A lung biopsy shows non-caseating granulomas. What is the diagnosis and most common course?
Sarcoidosis
commonly remits spontaneously in 2 years without treatment, but may necesitate corticosteroids or methotrexate
What is the most common symptoms of sarcoidosis?
dyspnea
may also have erythema nodosum!
What is the most common site for extrapulmonary TB?
Kidney
What medications are indicated for TB? (4)
Isoniazid, Rifampin, pyrasinamide, ethambutol
What is the most common cause of cancer death in men and women?
Lung cancer
What is the most common site of metastasis for lung cancers?
hilar lymph nodes
What type of lung cancer is more common in women and is least associated with smoking?
adenocarcinoma
What type of lung cancer may secrete PTHrP?
squamous cell carcinoma
What type of lung cancer may secrete ADH or ACTH? What type of symptoms would this cause?
Small cell (oat) lung cancer- may cause cushings syndrome
What is Horner’s syndrome? What should you suspect if you note Horner’s syndrome and what imaging would best work this up?
Ipsilateral lid lag
miosis (pinpoint pupil)
ipsilateral anhydrosis
should work up for Pancoast lung tumor (difficult to see on XRAY, CT or MRI is best to note lytic bone lesions)
What scrotal masses might be painless? What scrtoal masses might be painful?
Painless: hydrocele, spermatocele, varicocele, testicular cancer
Painful: hematocele
What scrotal masses might transilluminate? Which would not?
Does transilluminate: hydrocele, spermatocele
Does NOT transilluminate: Hematocele, testicular cancer
What is the most common cancer in males and what cell type is it usually?
Prostate cancer
usually adenocarcinoma
What testicular cancer types are malignant? Which are benign?
malignant: germ cell tumors (seminomas, teratomas, choriocarcinomas)
benign: leydig or sertoli cell tumors
What tumor marker should you test in a patient with suspected testicular cancer?
b-hCG
What medication is most indicated for Erectile Dysfunction?
Sildenafil (Viagra): Phosphodiesterase inhibitor
What is a major cause of balanitis?
Diabetes
What is Phren’s sign? What does it indicate?
testicular pain that is relieved with elevation of the testicles. Indicates epipidiymitis
What antibiotic is most indicated for epididymitis?
Cipro
What is the most common etiology for orchitis?
Mumps
What type of imaging best rules out testicular torsion?
Doppler US
What is paraphimosis?
foreskin cannot be removed from retraction (try to press head of penis inwards- otherwise refer for emergency circumcision) can progress to gangrene
What is phimosis?
foreskin is not able to be retracted (normal in children)
What is the most common cause of phimosis?
recurrent infections causing fibrosis of the foreskin
A negative Phren’s sign and absent crescenteric reflex with scrotal pain and swelling might indicate:
testicular torsion
What drugs are indicated for BPH?
Tamulosin (alpha-adrenergic agonist)
or
Finasteride- 5-a-reductase inhibitor (to prevent conversion of T to DHT)
What is the most common pathogen in acute bacterial prostatitis? What physical exams would you do? What antibiotics are most indicated?
E. coli
DO NOT DO DRE- increases risk of sepsis
Abx: Cipro
What is the most common form of prostatitis?
chronic pelvic pain syndrome (pain in the last 3 months of 6 months)
Tx with SSRIs, Abx…
What 2 hormones are released by the posterior pituitary?
oxytocin and ADH
What medication is indicated from central diabetes insipidus? nephrogenic diabetes insipidus?
central: desmopressin
nephrogenic: HCTZ
How might toxic multinodular goiter be differentiated from Grave’s disease?
toxic goiter will lack exopthalmos and pretibial myxedema
What dietary recommendations would you give a patient with non-toxic goiter?
avoid goitrogens (brassicas)
A patients blood test shows increased calcium, increased alk phos and decreased phosphorous. What do you suspect and what additional blood test would you want to run?
hyperparathyroidism- check PTH
What vitamin deficiency can cause secondary hyperparathyroidism?
Vitamin D
What is the most common cause of hypoparathyroidism?
magnesium deficiency (used to be dt surgical removal)
Patient complains of muscle tetany/spasms, irritability, anxiety. Blood tests show decreased calcium, decreased vitamin D and increased phosphate. What do you suspect? What test do you run next? How do you treat?
check PTH- suspect hypoparathyroidism
treat with calcium, vitamin D supplementation
consider PTH injections
What is Waterhouse-Friedrichsen syndrome?
endotoxic shock from N.meningitidis septicemia, leading to DIC and bilateral adrenal hemorrhage (adrenocortical hypofunction)
21B-hydroxylase deficiency is a cause of what endocrine disorder?
hypoaldosteronism (cannot make gluco and mineralocorticoids!) treat with gluco and mineralocorticoids
What is the most common cause of hyperaldosteronism? What are the symptoms?
Aldosterone-secreting adrenal adenoma (Conn’s syndrome)
Sxs: HTN, polyuria, polydipsia, nocturia, fatigue, weakness, HA, paresthesia, muscle weakness, tetany
lab work in a patient with tetany, fatigue, HTN, polyuria shows: decreased potassium, increased sodium. You suspect_______ and follow-up by testing _______.
suspect hyperaldosteronism (Conn's) test 24 hour urine or plasma aldosterone
How do you calculate pack-years of smoking?
number of packs smoked per day x number of years
What is the most common congenital adrenal hyperplasia?
21-B-hydroxylase deficiency
This causes androgen excess, decrease in mineralocorticoids causing salt wasting, vomiting in infancy or precocious puberty in males, masculinization, PCOS in women
(11B-deoxy is 2nd MC)
What bony lesion is associated with Codmans triangles and a “sunburst” pattern on XRAY? Usually in metaphysical region of long bones and associated with prior radiation?
Osteosarcoma
What pharmacologic agent is most likely to induce acute gout?
aspirin
