Renal/GYN/Endo

Question 1

57 yo male comes in complaining of bloody urine. 1. What questions to ask 2. DDx? 3. Test?

Answer 1

1. OLDCARTS 2. Bladder Cancer, Nephrolithiasis/Urolithiaisis, BPH, Prostate Cancer, Renal Cell Carcinoma, Glomerulonephritis, UTI 3. Genital exam, Rectal Exam, CBC, BMP, UA, Urine Culture, Urine Cytology, PSA, US- Renal, Cystoscopy, CT Abdomen/Pelvis

Question 2

54 yo male with HTN follow up and has decreased libido. 1. What questions to ask? 2. Important physical exam maneuvers?. 3. DDx? 4. Test?

Answer 2

1. When your diagnosed, Medications, Side effects, Compliance, Regular Home BP check, Last medical BP check, Diet and Exercise. Libido- Scale, Early morning and nocturnal erections, marital or work problems, Depression, Stress, Anxiety, Leg and buttock pain, DM, HLD, TIA, Stroke, Alcohol/Tobacco. 2. HEENT - Carotids, All pulses, DTRs, Strength, Babinski. 3. Drug induced ED, Hypogonadism, Vascular ED, Depression, Alcohol related ED, Peyronie disease. 4. Genital exam, Rectal exam, BUN/Cr, BMP, Lipid Panel, Glucose, Testosterone, LH/FSH, Prolactin, TSH, Ferritin, MRI brain, Doppler US penis, Dynamic Cavernosography.

Question 3

30 yo female complaining of weight gain. 1. What questions to ask? 2. Physical Exam maneuvers? 3. DDx? 4.Test?

Answer 3

1. Weight amount, Cold intolerance, Skin/hair/Nail Changes, Constipation, Diarrhea, Hot flashes, Appetite, Fatigue, Anxiety, Depression, Sleeping Problems, LNMP, Frequency of periods, Change in cycle, Pads used, Age of Menarche, Pregnancies, Miscarriages, Abortions, Hirsutism 2. Thyroid Gland, DTRs 3. Smoking cessation, Hypothyroidism, Lithium induced obesity or hypothyroidism, Familial Obesity, Pregnancy, Cushing Syndrome 4. Pelvic Exam, Lithium Level, TSH, Prolactin, HCG, Dexamethasone Suppression test, 24 urinary cortisol, Glucose, Cholesterol, Triglycerides.

Question 4

36 yo female complaining of amenorrhea. 1. What questions to ask? 2. Physical Exam maneuvars? 3.DDx? 4. Test?

Answer 4

1. Menstrual hx (length, Frequency, Pads, Age of Menarche) Thyroid (Weight Changes, heat and cold intolerance, Skin/Hair/Nail Changes, Voice changes, constipation/diarrhea) Eating Disorder (Appetite, Fad diet/Exercise,) Depression/Stress (Fatigue/Depression/Anxiety/Stress/Sleep,) Pituitary tumor (Nipple Discharge, Vision, HA) Sexual Hx, Obsteric hx, Pap smear hx. 2. Pelvic, Breast exam, thyroid gland, Visual fields, Extraoccular movements, DTRs. 3. Pregnancy, Hyperprolactinemia, Polycystic Ovary Syndrome, Thyroid Disease, Premature Ovarian Failure, Asherman Syndrome 4. Pelvic Breast and Exam, CBC, Glucose BMP, Urine HCG, LH/FSH, TSH, Prolactin, AST/ALT/Bili/Alk Phos, MRI-Brain, Hysteroscopy.

Question 5

28 yo complaining of pain during sex. 1. What questions to ask? 2. DDx? 3. Test?

Answer 5

1. Onset, Describe Pain, Location, Discharge, Color/Amount/Smell, Itching, Douching, Menstural hx, Postcoital/Intermenstrual bleeding, Menopause (Vaginal dryness/Hot flashes,) Depression/Anxiety/Stress, Sexual Hx, Safety, Physical, Sexual, Emotional abuse, Pap smear hx, UTI (Pain Urination/Frequency), Obsteric Hx. 2. Vulvovaginitis, Cervicitis, Endometriosis, Vulvodynia, Vaginisumus, Domestic Violence, Pelvic Tumor. 3. Pelvic Exam, Wet mount, KOH Prep, Whiff Test, Cervical Cultures, U/S pelvis, MRI- Pelvis.

Question 6

Mother brings 8 yo child concerned because son continues to wet bed. 1. What questions to ask? 2. DDx? 3. Test?

Answer 6

1. Frequency, Time of day, Onset, Tried any interventions or drugs in the past, How has Behavior affected the child, How has behavior affected you, Ever punished or rewarded, Alleviating/Excerbating factors, Period of continence, Does the problem increase with stress, late night eating/drinking, Volume, Urgency, Dysuria, Fever, Urine Color, Hematuria, Abdominal Pain, Constipation, Snoring, Nighttime awakening, Environmental changes, Major Stress, Family Hx of enuresis, Neuro Hx, Birth Hx. 2. Monosymptomatic Primary Nocturnal Enuresis, Secondary Enuresis, Urinary Tract Infection, DM1?, Constipation, Sleep Apnea, Functional Bladder disorder. 3. Genital Exam, UA, Urine Culture, First morning urine specific gravity (ADH), US-Renal, BUN/Cr.

Question 7

28 yo female comes to clinic with positive pregnancy test. 1. What questions to ask? 2. DDx? 3. Test?

Answer 7

1. Duration, LNMP, Menarche, Menstrual Hx, Pain with periods, Spotting btw periods, Contraception, Pregnancies/abortions/miscarriages, Sexual Hx, STD Hx, Postcoital Bleeding, N/V/D, Abdominal Pain, Appetite changes, Weight Changes, Fatigue, Breast Enlargement/Discharge/Tenderness, Last pap smear, Fever,, Urinary frequency. 2. Normal Pregnancy, Ectopic Pregnancy, Molar Pregnancy 3. Breast/pelvic exam, Urine hCG, US-pelvis, CBC, Serum glucose, TSH, RPR, Rubella IgG, HBsAg, HIV Antibody, Blood Type, Rh, Antibody screen, Pap smear, Cervical G and C DNA Testing, UA, Urine culture.

Question 8

Mother brings 10 yo female because she is concerned that daughter was diagnosed with diabetes. 1. What questions to ask? 2. DDx? 3. Test?

Answer 8

1. Type of DM, Onset, Presenting symptoms, Effect on Child/Family, Depression, Irritability, Medication, Site of injection, Who injects, Schedule, Compliance, Glucose readings, Recent Level, lowest levels, Symptoms of hypoglycemia, Urination, Thirst, Hunger, Weight and Height, Tingling/Numbness, Skin infections, Diet, Exercise (Hypoglycemia), Weight, Height and language development. 2. Type 1 DM, Type 2 DM, Secondary causes of diabetes. 3. BMP, AIC, UA, Urine microalbumin, Insulin and C-peptide, Islet cell antibodies, 24-hr urine free cortisol.

Question 9

1. What questions to ask for suspected domestic violence? 2. DDx? 3. Test?

Answer 9

1. Relationship composed of physical, sexual, emotional abuse, Anger, Injuries, Fear, Safety Plan, Mental illness, fire arms in house, drugs 2. Domestic Violence, Substance abuse, Consensual violent sexual behavior. 3. XR-Skeletal survery, CT-Maxillofacial, Urine tox, CBC, Electrolytes.