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ismailalmokyad's version from 2018-01-05 11:47

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Question Answer
wt is labs and clinical characteristics of subclinical hyperthyroidism1-Suppressed TSH
2-Normal thyroid hormone levels
3-Hyperthyroid symptoms may or may not be present
what is causes of Subclinical hyperthyroidism1-Exogenous thyroid hormone
2-Graves disease
3-Nodular thyroid disease
what is indications for treatment in Subclinical hyperthyroidism1-TSH persistently <0.1 µU/mL
2-TSH 0.1-0.5 µU/mL plus additional risk factors:
-Age >65
-Heart disease
-Osteoporosis
-Nodular thyroid disease
what is the best imaging to screen for gallstones1- we always pick US (better than CT), but MRCP is the highest sensitivity test followed by HIDA
5-how to manage uncomplicated gallstones1-Gallstones on imaging without symptoms
-No specific treatment necessary in most patients

2-Gallstones on imaging with typical biliary colic symptoms
-Acute pain management
-Prophylactic cholecystectomy (usually elective & laparoscopic)
-Possible UDCA in poor surgical candidates or patients refusing surgery

3-Gallstones with atypical symptoms
-Empiric UDCA followed by cholecystectomy in patients whose symptoms improve with UDCA
-Evaluate for other causes in patients not responding to UDCA

4-Typical biliary colic symptoms without gallstones on imaging
-(HIDA) to evaluate for functional gall bladder disorder
-Cholecystectomy in patients with low gall bladder ejection.

***UDCA = ursodeoxycholic acid***
6-Chronic prostatitis symptoms and signsManifestations include >3 months of dysuria, pain in the genitourinary region, and/or pain during ejaculation.

Prostate examination is usually normal but may show hypertrophy, tenderness, or edema.
7-how to work-up pt with Chronic prostatitisFirst make sure it is not UTI with urinalysis and urine culture before and after prostate massage.

**chronic prostatitis is generally made when urinalysis after prostate massage reveals >20 leukocytes/hpf.

Urine culture results then differentiate patients as having either:

-Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) - urine culture results are aseptic

or

-Chronic bacterial prostatitis – urine culture results show bacteriuria (>10 fold increase after prostate massage)

***CP/CPPS occurs far more commonly than chronic bacterial prostatitis***
8-wt is ttt of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)there is much uncertainty about the ideal approach to treatment.

Most patients receive a combination of therapies including
1-medications for prostate enlargement (eg, alpha blockers).
2-antibiotics.
3-anti-inflammatories.
4-and/or psychotherapy.
9-wt is mixed cryoglobulinemia syndromevasculitis due to the deposition of immune complexes (polyclonal IgG and IgM rheumatoid factor) within the vascular wall of small- and medium-size vessels. mainly in pt with chronic hepatitis C virus
10-how does pt with mixed cryoglobulinemia syndrome presenttriad of
1-Palpable purpura
2-Weakness
3-Arthralgias
11-wt is labs in mixed cryoglobulinemia syndromeLaboratory examination typically reveals
1-elevated RF
2-hypocomplementemia.
3-Approximately 20% of patients develop glomerulonephritis (red cells, red cell casts, proteinuria) with or without renal insufficiency.
12-what is the treatment of mixed cryoglobulinemia syndromedivided into 2 stages:

1-Initial immunosuppressive therapy
– stabilizes end-organ damage (eg, glomerulonephritis) using rituximab plus prednisone

2-Treatment of underlying disease – targeted therapy against the condition that triggered the cryoglobulinemia (as using antiviral therapy for hep c virus)
13-what is the most common causes of Mixed cryoglobulinemia syndrome1-HCV
2-HBV
3-HIV
4-malignancy
5-rheumatologic disease
14- Labs finding in pt with thalassemia minor (ie, thalassemia trait)1-microcytic, hypochromic anemia
2-mildly elevated ferritin due to RBC turnover
3-RBC count may be normal or increased
4-RDW is normal
5-Hgb electrophoresis to confirm the diagnosis and distinguish α- from β-thalassemia minor. normal in α-thalassemia but elevated Hgb A2 in β-thalassemia.
15-how to work-up pregnant women with labs point toward thalassemia minor.1- confirm with Hgb electrophoresis
2-paternal Hgb electrophoresis to determine baby risk for thalassemia major
16-Maternal conditions requiring partner testing to determine the infant risk-maternal hemoglobinopathies (eg, SS, SC, hemoglobin S/β-thalassemia)
-carrier states (α- and β-thalassemia minor).
17-wt is the complication of breech presentation1- umbilical cord compression
2- fetal head entrapment

both result in fetal asphyxia and neurological injury.
18-when does breech baby spontaneously convert to cephalic.before 37 weeks
19-how to manage breech presentation, wt is the possible complication of the treatment1-External cephalic version if breech persist after 37 weeks.
-May cause nonreassuring fetal heart rate abnormalities (due to abruptio placentae) that necessitate an emergent cesarean delivery.

2-CS.
-If failed ECV
-If have a contraindication to ECV (eg, active herpes, placenta previa, multifetal gestation, fetal growth restriction).

NB: footling breech presentation is an absolute contraindication to vaginal delivery. (highest risk of complications
20- indicatioin for ERCP vs MR cholangiopancreatography in pts with choledocholithiasisIndication for ERCP
1-Visualized choledocholithiasis
2-High-risk features (dilated CBD on imaging, elevated serum bilirubin)
3-Evidence of acute cholangitis (fever, right upper-quadrant pain, jaundice, hypotension, confusion) – these patients also require intravenous antibiotics and treatment of sepsis.

In patients in whom choledocholithiasis is suspected but who have none of the above criteria, a less invasive procedure (eg, MR cholangiopancreatography(MRCP) highest senstivity) should be considered.
21- wt is the indication for Immediate cholecystectomy for pt with choledocholithiasis ?hemodynamic shock or gallbladder perforation, who are at low risk for surgery
22- wt is the indication for Cholescintigraphy uses technetium-labeled hepatic iminodiacetic acid (HIDA)to evaluate for patency of the cystic duct, CBD, and ampulla.
-It is useful for diagnosing suspected cholecystitis in patients with negative or inconclusive ultrasound findings.
23- choledocholithiasis VS cholelithiasisboth have biliary colic symptoms. but choledocholithiasis (CBD stone) has cholestatic liver function abnormalities (elevated bilirubin, alkaline phosphatase out of proportion to aminotransferases), and more prolonged pain
24- wt cause hypoxia in pt with COPD.primarily by ventilation/perfusion (V/Q) mismatch. Loss of elastic tissue and small bronchiolar collapse result is numerous localized areas of lung that have a low V/Q ratio.

-Low V/Q regions undergo hypoxic vasoconstriction to improve overall gas exchange, providing oxygen to COPD pt will alleviate vasoconstriction and increase Q so improve gas exchange.
25- wt is the clinical features of migraine headache1- F>M
2-Family hx usually positive
3-have variable onset
4-often unilateral
5-pulsatile & throbbing
6-last 4-72 hours
7-associated with auras, photophobia, phonophobia and nausea.
26- wt is Cluster headache features1- M>F
2- No Family hx
3-onset can be during sleep
4-often unilateral and behind one eye
5-Excruciating, sharp & steady
6-last 15-90 minutes
7-associated with Sweating, facial flushing, nasal congestion, lacrimation & pupillary changes
27- wt is Tension headache features?1- F>M
2- No Family hx
3-Onset happens under stress
4-Band-like pattern around the head (bilateral)
5-Dull, tight & persistent
6-Last 30 minutes to 7 days
7-Associated with muscle tenderness in the head, neck, or shoulders
28- wt is Tibial tuberosity apophysitis, or Osgood-Schlatter diseaseoveruse injury in pubertal children and causes chronic anterior knee pain. Physical examination may show tenderness or prominence of the tibial tubercle, but range of motion and joint stability are preserved.
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