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Family Medicine - COMLEX/USMLE Step 3

Terms in this set (115)

MC Headache!
- Bilateral, band-like and often dull in quality
-Worsens with stress
- Tx?
- PPx?
Tension HA, remember to evaluate for MDD (co-morbidity)
- Tx = NSAIDs, ASA, APAP are all effective
- PPx not really, but can use antidepressants or β-blockers. NSAIDs are good for menstrual HA
This HA, is way more common in Males (6:1) and is usually unilateral with peri/retro-orbital pain.
- Associated with ipsilateral lacrimation (85%), ptosis, nasal congestion and rhinorrhea

Abortive Tx?
Prophylaxis?
Cluster HA

Abort with 100% O₂ + Triptan (1st line))* or can use ergot (2nd line)

PPx = Verapamil (1st line)
- 2nd line can include Li, methysergide, or ergotamine
Classically more common HA in Females (3:1) usually unilateral with aura (15%).
- Visual aura: Scotomas, teichopsia, photopsias, or rhodopsias
- Accompanying nausea and photophobia
- Triggers include stress, foods, odors, alcohol, periods or sleep deprivation

Abortive Tx?
Prophylaxis?
Migraine HA

Abortive Tx → Sumatriptann*, NSAIDs. (2nd line ergots, zofran)

Prophylaxis = β-blockers (Propanolol) is 1st line* >> CCB
F > 50 yo with a unilateral HA that has jaw claudication and pain with palpation of forehead.
- ESR _________
- 50% associated with _______ ________
- If not treated can lead to optic neuritis and blindness
- Screen with _____. Dx definitively with _______.

Tx?
Temporal Arteritis (Giant Cell)
- ESR ≥ 50
- 50% associated with polymyalgia rheumatica
- Screen with ESR; Definitive Dx = Temporal artery biopsy

Tx = high-dose corticosteroids ASAP, aka even before biopsy!
Episodic, severe shooting pain from side of mouth to ipsilateral ear, eye, or nose.

Its complain about electric shocks when they are shaving, brushing teeth

Dx needs a _____/_____ to rule out sinusitis, cerebellopontine angle CA, MS or herpes zoster

Tx?
Trigeminal Neuralgia.

Dx requires head CT/MRI

Tx = Carbamazepine (1st line) (or phenytoin, clonazepam, valproic acid)
"Worst HA of my life"
- MCC is ________
- Dx requires confirmation via _________ or ________ or ________.
- Spontaneous cause is associated with?
Subarachnoid Hemorrhage
- MCC = Trauma
- Dx requires either CT Head w/o contrast or LP or Xanthochromia
- If stem has spontaneous SAH, think of a berry aneurysm rupture.
- Get that Neurosurgery consult dude! Give Nimodipine to ↓ post-rupture vasospasm
Suspect an intracranial lesion causing a HA in (2)
- Patients > 50 yo
- Patients with HAs immediately on waking up
Suspect ↑ ICPP* in patients that have (3).

You should obtain a ____ ____.
- Pts awakened in middle of night by HA
- Those who have projectile vomiting
- Anyone with a FND

Obtain a Head CT
People with DM when they have otitis externa, you have to do what?
Get CT/MRI temporal bones to r/o osteomyelitis and malignant otitis externa (aka mastoiditis)
- if ⊕, you need surgical debridement
-Complication of otitis media and/or mastoiditis
- Osteomyelitis of petrous apex bone
- Sxs include same side otorrhea, eye pain, abducens (CN VI) paralysis and double vision.
- Tx?
Gradenigo Syndrome

Tx = emergent Neurosurgery referral
Medications associated with tinnitus
ASA, Digoxin
Sudden, episodic vertigo with head movement lasting seconds
- Dx?
- Tx?
BPPV

Dx = Dix-Hallpike

Tx = Epley
Path: Dilation from excess endolymph

Presentation: Classically have aural fullness (hearing loss), tinnitus, and vertigo lasting hours

Dx = Clx

Tx = ?
Meniere's disease

Tx = low Na and caffeine diet.
- can give meds like HCTZ or antihistamines/anticholinergics to help
- Surgery is last resort
Path: Viral illness

Presentation: Pt will tell you that he had URI sxs earlier, now has vertigo lasting days to weeks

Dx = Clx

Tx = ?
Viral labyrinthitis

Tx = Meclizine
Path: A CN VIII schwannoma

Pt: complains of vertigo, sudden deafness, and tinnitus

Dx = ?

Tx = ?
Acoustic neuroma

Dx = MRI of cerebellopontine angle

Tx = Radiation +/- Surgery
________ hearing loss is commonly associated with drugs
Bilateral

The associated drugs include:
- Loop diuretics
- Aminoglycosides
- Salicylates
- Cisplatin
_________ is a gradual loss of high frequency hearing which is normal as a person ages
Presbycusis
Path: XL dominant inheritance

Pt: Young Amish kid whose doing poorly in school. Can see lens dislocation as well as hematuria (painless) and proteinuria.

Renal bx will show a _________ glomerular BM and _________.
Alport's syndrome

Bx shows thinning glomerular BM and glomerulonephritis
_______ test:
Lateralization of hearing to 1 ear more than other. (2) findings.
Weber test:
- IPSIlateral conductive loss
OR
- CONTRAlateral sensorineuronal loss
_______ test:
Comparison of AC to BC.

⊕ test = ___ > ____ indicating...

⊗ test = ___ > ____ indicating...
Rinne test:

⊕ Rinne = AC > BC which is a normall* finding

⊗ Rinne = BC > AC which indicates a conductivee* hearing loss in that ear
Epistaxis
- MC involve ______ _______
- 90% occur at _________ plexus in the _______.
- ________ bleeding is MC seen in elderly
- #1 cause in Peds is _______
- MC involve nasal septum
- 90% occur at Kiesselbach's plexus in the anterior nasal septum.
- Posterior bleeds = MC in elderly
- #1 cause in Peds = RHINOTELLEXIS (nose picking)
Tx for Epistaxis
1. Direct pressure
2. Topical nasal vasoconstrictors (i.e. oxymetazoline, phenylephrine) -- unless HTN because CI
3. Consider packing if unable to stop
4. If posterior, need to pack/balloon and admit for airway ohs as ↑ risk for hypoventilation
5. IR embolization
6. Surgical ligation of IMA, ethmoidal arteries to stop bleeding
7. Pts need anti-Staph ppx while nose is packed
8. Repeat bleeders needs workup for possible hemophilia, vWF, platelet function
MC organisms responsible for acute bacterial sinusitis (<4 wks)
- Strep pneumo
- H. flu (non-typable)
- Moraxella catarrhalis
MC organisms responsible for chronic bacterial sinusitis (*> 3m)
- Bacteroides
- Staph aureus
- Pseudomonas
- Streptococci spp.
Fungal sinusitis usually is from _______. But you must be vigilant in DM because of risk for _________.
Usually Aspergillus, but in DM gotta watch out for Mucormycosis

The above are seen in those who are immunocompromised (AIDS, CA patients, etc).

(Black nasal turbinates = Mucor)
Path: Thrombophlebitis of the IJ vein from oropharynx infxn of Fusobacterium necrophorum, a GNR.

Pt: Painful swallowing, fevers, neck swelling with a palpable cord along the IJ vein. You can see Septic emboli in lungs.

Tx?

F/U?
Lemierre's Syndrome

Tx with antibiotics, with possible F/U for surgical I&D if unresponsive
Pharyngitis with high fever, severe sore throat without cough, edematous tonsils with white/yellow exudate and cervical LAD

Dx criteria?
- Best initial step?
- Gold standard?

Tx?

F/U?
Group A Strep Pharyngitis (S. pyogenes)

Dx criteria = Centuar criteria
- Best initial = Rapid antigen test
- Gold standard = Throat Cx

Tx = Penicillin (usually Amoxicillin)

F/U = if untreated, can lead to Rheumatic Heart Disease
Patient with tonsillitis, palatal petechiae, splenomegaly, and generalized LAD. Got a SKIN RASH when given Ampicillin for supposed Strep pyogenes.

Dx?

Tx?

F/U?
Mononucleosis (from EBV)

Dx = Monospot or a ⊕ Heterophile AB

Tx = Supportive

F/U = ∅ contact sports for a few weeks to avoid splenic rupture
See a child with weakness, FTT, and growth retardation

Has pruritic, red papulovesicular lesions on the shoulders, elbows, knees

Associated with a Gluten allergy (wheat, oats, rye, barley)

Dx?
- Which antibodies do you test?
- Confirmatory step?

Tx?
Celiac Sprue

Look for antibodies:
- Anti-endomysial
- Anti-tissue transglutaminase
- Anti-gliadin

Confirmed with small bowel biopsy showing blunting of villi (pathognomonic)

Tx = Avoid gluten
Path: Infection by T. whippelii

Pt: Diarrhea, arthritis, anemia. Can have endocarditis or encephalitis

Dx via biopsy showing _________ in the intestines

Tx =
Whipple's Disease

Bx finding of PAS⊕ macrophages

Tx = PCN or tetracycline
Patient comes to you with symptoms of bloating after eating just 30 min ago, complaining of excessive flatulence with abd pain and diarrhea

Dx?
- Test?

Tx?
Lactase deficiency

- Dx is usually Clx, but can get a Hydrogen breath test which will be ⊕ in this disease

- Tx = avoid lactose foods or take exogenous lactase
People with ________ deletions of _____ are highly resistant to infection with HIV, not so much the heterozygotes.
Homozygous deletions of CCR5
Genital warts are MC associated with HPV _______
HPV 6 and 11
Cervical CA is associated with HPV _______.
HPV 16, 18, 31, 33
Most common CA in males by incidence
Prostate, Lung, Colon
Prostate CA causes ________ lesions in bone
Osteoblastic lesions
Transient visual disturbances (a "Blue Hue") is very rare, but a notable board AE of _______
PDE5 inhibitors like sildenafil
L5 sensory loss
Large toe/medial foot
S1 sensory loss
Small toe/lateral foot
Radiculopathy can show weakness of L1-4 manifesting as
Quadriceps weakness
Radiculopathy can show weakness of L5 manifesting as
Foot dorsiflexion
Radiculopathy can show weakness of S1 manifesting as
Foot plantarflexion
Radiculopathy can show ↓ reflexes at L4
↓ patellarr* reflex
Radiculopathy can show ↓ reflexes at S1
↓ Achilless* reflex
MC Shoulder dislocation is _______ (95%) usually as a result of _______ dislocation.
Anterior (95%) from subcoracoid.
Classically see pain with overhead reach and pain q HS

Dx with ______?

Tx?
Rotator Cuff Tear
- get an MRI

Tx
- Partial tears are conservative aka RICE, NSAIDs and PT
- Complete tears get surgery
Usually seen as a result of a full-frontal football tackle. Pain and deformity at the clavicle

How to Dx?

Tx?

F/U?
Clavicle fracture

Dx = AP view XR

Tx = sling until ROM is painless (2-4 wks)

F/U = Since it's clavicle and it is so close must:
- r/o subclavian injury by checking pulses.
- r/o brachial plexus injury with neuro exams
- r/o PTX by checking for breath sounds
Tennis elbow is ________ epicondylitis.

Get pain 2-5cm distal and anterior to ______ epicondyle, reproduced with wrist ________ while elbow is _______.
Lateral epicondylitis

Pain is distal and anterior to lateral epicondyle

Reproduced with wrist EXTENSION while elbow is extended.
Golfer's elbow is _________ epicondylitis.

Acute onset of ______ elbow pain and swelling 1-2 cm distal to ________ epicondyle; reproduced with wrist ________ and ________ against resistance.
Medial epicondylitis

Acute onset of *medial* elbow pain and edema 1-2 cm distal to medialmedialset of *medial* elbow pain and edema 1-2 cm distal to *medial* epicondyle

Reproduced with wrist FLEXION + PRONATION against resistance
Path: Direct trauma to elbow after fall on flexed UE

Tx?
Olecranon fracture

Tx = long-arm cast in 45-90° flexion for ≥ 3 weeks. Displaced fracture needs ORIF
MC joint dislocated in children, 2nd MC in adults (next to shoulder)
Elbow
FOOSH with fully extended elbow gives you a _______ dislocation. While a direct blow to the posterior elbow gives you an ________ dislocation.
FOOSH = posterolateral

Direct blow = anterior dislocation
Child's arm is jerked or they are swung around by arms you get ________.
Nursemaid's elbow, it's a subluxation not dislocation. Tx with pronation of arm.
Colles fracture is a _______ ________ fracture after FOOSH.
distal radius
______ fracture occurs after a direct blow and is seen commonly in hockey, lacrosse, or martial arts
Ulnar fracture
Dx + Tx for ulnar and Colles fractures?
Dx = XRs and H&P

Tx = Cast immobilization for 2-4 weeks followed by bracing
- 2° to falls usually, people think it is a wrist* sprain
- Pain in snuffbox (pathognomonic)
- Dx?
- Tx?
- F/U
Scaphoid fracture

Dx = XR to confirm, but film may lag. If the stem says "Athlete" get the bone scan/MRI because they are more important than you or anyone else.

Tx = Thumb splint for 10 weeks

F/U: ↑ risk for avascular necrosis
What is the most specific PE test for carpal tunnel syndrome?
Tinel's sign (pathognomonic) = tapping median nerve on palmar aspect of wrist producing a "shooting sensation"

(Not as sensitive, but still should remember is Phalen's test, which is the "Prayer" test)

Tx = Splint wrist QHS with possible steroid injection. Surgery last resort. May require 1 yr before resolution
Path: Inflammation

Pt: Pain over lateral trochanter which is reproducible by pressing right over trochanter, and will NOT radiate to groin.

Dx = Clx

Tx?
Trochanteric bursitis

Tx = NSAIDs
Path: Wear and tear with age, vitamin D deficiency

Pt: Pain in groin area, often worse in AM (stiffness < 1 hr), but gets worser with activity/walking as the day goes on.

Dx?

Tx?
Hip osteoarthritis

Dx = Clx. Can confirm with XR

Tx = rest, NSAIDs, ultimately joint replacement
Hip dislocations are usually from significant trauma (MVAs), they are usually _______ and occur in kids

Concern for _______ ________ injury which requires a careful ________ exam.

Dx?

Tx?

F/U?
Posterior hip dislocations

Concern for Sciatic nerve injury, so careful neuro exam warranted.

Dx = XR, consider CT for any other associated fractures

Tx = Ortho EMERGENCY requiring reduction under sedation (possibly open)
- Light traction for > 5d
- No weight bearing for 3 wks minimum, followed with 3-4 weeks of light weight-bearing activities

F/U = imaging required q 3-6 months for 2 years! Major complication is AVN of Femoral Head
Like the hip dislocation, this also requires significant force

Pt will have severe hip and ground pain, worse with movement and their leg may be ER

Dx?

Tx?
Femoral Neck Fracture

- Dx = XR

- Tx = ORIF needed
Posterior herniation of tense knee effusion causing acute edema behind knee or down to mid-calf. Often seen in patients with OA or meniscal injuries
Baker's cyst
DDx of Baker's cyst includes _____, so you must r/o with ______!
DVT; Doppler Utz
Pain over patella caused by kneeling on hard surfaces.

Dx?

Tx?
Prepatellar bursitis

Tx
- RICE and NSAIDs
- Arthrocentesis if questionable infection
- Consider steroid inj if pain is refractory to treatment
Pain occurs on the medial side of the tibia several inches below knee joint which is often worse going upstairs

Dx?

Tx?
Pes anserine bursitis

Tx
- RICE and NSAIDs
- Arthrocentesis if questionable infection
- Consider steroid inj if pain is refractory to treatment
Injury when foot is planted and a sideways force is directed at knee

Pt will have pain w/ ambulation but often little/no edema

Dx = Clx, but confirm with _____.

Tx = ?
MCL and LCL injury

Confirm with MRI

Tx = RICE, NSAIDs, consider knee immobilizer
Injury when foot is planted with a force applied to the front or back of the knee.

Pt: State there was a "pop" with complaints of knee instability or giving way. Difficulty walking with edema present.

Dx
- PE findings
- Confirmatory

Tx?
Anterior Cruciate Ligament tear (ACL)

Dx
- Lachman and/or anterior drawer tests, stating anterior tibial translation
- Confirm full extent of injury with MRI

Tx is either conservative or arthroscopic. Often surgery is necessary.
Tear is seen during falls on flexed knee and dashboard injuries in MVAs.

Dx?

Tx?
Posterior Cruciate Ligament tear (PCL)

Dx
- XR to r/o associated injury/fx
- MRI to determine full extent
- PE can show posterior drawer test, and posterior tibial translation

Tx
- Arthroscopic vs Conservative
MC collateral ligament tear vs least commonly injured

Usually seen after a direct blow to the lateral knee. Commonly the patient will also injure ACL or PCL

Dx?

Tx?
MC = Medial collateral ligament

Least = Lateral collateral ligament

Dx
- XR to r/o associated inj/fx
- MRI to determine full extent

Tx
- Hinge brace
This knee injury can be due to acute trauma, but is MC seen 2° to aging* aka degeneration injury

_______ ________ injured 3x more often in males > females

Dx?

Tx?
Meniscus tears

Medial meniscus injured 3x more often in males > females

Dx = McMurray test
- pt supine with hips flexed 90° and knee fully extended
- maneuver foot into ABd-ADd and ER-IR while palpating joint line for click
- MRI is gold standard

Tx
- Rest (> 50% fail rate)
- Consider arthroscopy
Injury 2° to overuse; commonly seen in runners, gymnasts, cyclists

Pt presents with edema or erythema along their Achilles tendon with tenderness proximal to calcaneus

Dx?

Tx?
Achilles Tendonitis

Dx = Thompson test
- squeeze leg with passive plantar flexion
- ⊕ only with completee* tears (specific)

Tx = RICE, NSAIDs, taping/splinting
- Rupture = short leg cast for 4 wks then heel lift for 4 wks
- Open repair has ↓ re-rupture rate and is recommended with complete tears in youngg* patients
Ankle is more stable in _________
Dorsiflexion
90% of ankle sprains occur when the ankle is _______ and this is usually a ______ sprain
plantar flexed; lateral sprain

(medial is rare, because ligament is stronger)
Dx an ankle sprain with _________ done with the foot in 10-15° plantar flexion

Consider ___________ imaging both _____ and _______ to rule-out fracture
Anterior drawer sign

multiple view XRs both free and weight-bearing to rule out fracture
_________ rules to determine need for XR in ankle sprain
Ottawa rules:
- pain in the malleolar zone
- tenderness at posterior edge of distal 6 cm or tip of lateral malleolus
- unable to bear weight
- cannot walk 4 steps in ED

If any of above are ⊕, you will obtain XRR* to r/o fracture
BMI ranges
< 19.0 (look out for anorexia)

19.0 - 26.0 is normal

26.1 to 29.0 is overweight

> 30 is considered obese

> 40 is considered morbidly obese

[Formula: BMI = Weight (kg)/Height (m²)]
________ feeding is the preferred method of nutritional supplementation, as it maintains ______ _______ and reduces the risk of _______ from its bacteria.
Enteral feeding; maintains gut integrity; ↓ risk of sepsis
Enteral feeds carry risk of aspiration PNA but ________ has the lowest risk
Jejunostomy
When discontinuing TPN, you should _____ ______. This will prevent ______ by allowing the pt's ______ levels to slowly return to normal
slowly taper off; hypoglycemia; insulin levels
Vitamin B1 (aka _______)
- Deficiency?
Vit B1 aka Thiamine

Deficiency:
- Dry beriberi → neuropathy
- Wet beriberi → high-output HF
- Wernicke-Korsakoff syndrome
Vitamin B2 (aka _______)
- Deficiency?
Vit B2 aka Riboflavin

- Cheilosis (mouth fissures)
Vitamin B3 (aka _______)
- Deficiency?
Vit B3 aka Niacin

Deficiency = Pellagra
- 4 Ds of *D*ementia, *D*iarrhea, *D*ermatitis and DD4 Ds* of *D*ementia, *D*iarrhea, *D*ermatitis and DD4 Ds* of *D*ementia, *D*iarrhea, *D*ermatitis and *D*eath

Also seen in Hartnup's dz (dealing with tryptophan metabolism)
Vitamin B5 (aka _______)
- Deficiency?
Pantothenate

- Enteritis
- Dermatitis
Vitamin B6 (aka _______)
- Deficiency?
Pyridoxine

- Neuropathy (freq caused by INH tx for TB)
Vitamin B12 (aka _______)
- Deficiency?
Cyanocobalamin

Deficiency = Pernicious anemia (lack of intrinsic factor)
- sxs of neuropathy, megaloblastic anemia, glossitis
Biotin deficiency
Dermatitis, enteritis

(caused by consumption of raw eggs, due to the avidin in raw eggs blocking biotin absorption)
Chromium deficiency
Glucose intolerance (cofactor for insulin)
Copper deficiency
Leukopenia, bone demineralization
Folic acid deficiency
NTD, megaloblastic anemia
Iodine deficiency
- Hypothyroidism
- Cretinism
- Goiter
Iron
- deficiency
- excess
Deficiency = PV Syndrome
- Esophageal webs, spoon nails

Excess = Hemochromatosis
- Bronze DM
Selenium deficiency
Myopathy

Keshan's dz = childhood cardiomyopathy 2° to selenium deficiency, very common in China
Vitamin A deficiency
- Respiratory metaplasia (seen in CF)
- Xeropthalmia (night blindness, lack of retinal in rods)
- Acne
- Bitot's spots
- Freq respiratory infxns (epithelial defects)
Vitamin A excess
Pseudotumor cerebri (can be caused by consuming polar bear livers)
- HA
- N/V
- Skin peeling
Vitamin C deficiency
Ascorbic acid

Def = Scurvy
- Poor healing
- Hypertrophic bleeding gums
- Easy bruising
- Deficient osteoid mimicking rickets
Vitamin D deficiency and excess
D₃ (cholee*calciferol)
D₂ (ergoo*calciferol)

Deficiency
- Rickets in Pediatrics
- Osteomalacia in IM

Excess
- Kidney stones, dementia, constipation, abdominal pain, depression
Vitamin E deficiency
γ-Tocopherol

- Fragile RBCs
- Sensory and Motor peripheral neuropathy
Vitamin K deficiency
Koagulation (Dutch apparently)

Clotting deficiency
Zinc deficiency
- Poor wound healing
- ↓ Taste + smell
- Alopecia
- diarrhea, dementia, dermatitis (similar to Pellagra)
Calorie deficiency
Marasmus = total calorie malnutrition
- Pts look deceptively well but are immunosuppressed
- poor wound healing
- impaired growth
Protein deficiency
Kwashiorkor = protein malnutrition
- edema/ascites
- immunosuppression
- poor wound healing
- impaired growth and development
Path: Psych vs Organic cause

Pt: Difficulty achieving/maintaining erection

Dx?

Tx?
- Psych
- Organic
Erectile Dysfunction

Dx = Night-time tumescence
- if the tape breaks = Psych
- if tape ∅ break = Organic

Tx
- Psych: psychotherapy vs changing partner
- Organic: treat underlying problems first (DM, HTN, atherosclerosis)
- Sildenafil (PDE5i)
- Surgery (Penile implants) as last resort
Path: Circumferential enlargement of the prostate crushing urethra

Pt: Has sxs of urgency, frequency, but ∅ dysuriaa*. Has trouble starting/maintaining stream, dribbling

Dx?

Tx?
BPH (Benign Prostatic Hypertrophy)

Dx:
- UA, Urine Cx (r/o infxn)
- get Cr (assess obstruction)
- DRE: Smooth, rubbery prostate

Tx:
- α-blockers* like terazosin, doxazosin (AE = ortho HoTN)
- 5-α-reductase inhibitors* like Finasteride
- In/Out Foley, post void residual
- Surgery (TURP) if refractory or obstructive nephropathy. Open prostatectomy for larger glands > 75g
[Epididymitis]

Path: STD if < __ yo, or E. coli if > __ yo

Pt: Sudden onset pain w/o urg/freq/dysuria. Bacteriuria without f/c/n/v.
Testicle is in _______ ____.
Epididymis tender

Dx?

Tx?
[Epididymitis]

STD if < 40 yo and E. coli if > 55 yo

Testicle present in vertical lie (vs torsion). Cremasteric reflex is intact

Dx is Clx, but can get US

Tx:
- < 40 = Think Gc/Chla → Ceftriaxone + Doxy
- > 55 = E. coli → FQ aka Cipro
Twisting testicle that strangulates vascular supply

Testicle is in ______ ______. Cremasteric Reflex?

Dx?

Tx?
Testicular Torsion

Is in Transverse lie. ∅ Cremasteric reflexx*

Dx = Doppler US

Tx = Emergent Surgery to untwist
- if it pinks up = bilateral orchiopexy
- if it ∅ = orchiectomy

F/U = Semen analysis to assess viability.
Old man who develops symptoms of Pyelo and has a tender, boggy, fluctuant, swollen prostate

Labs will show → leukocytosis, pyuria, bacteriuria

Dx?

Tx?
Bacterial Prostatitis

Dx = UA, Urine Cx

Tx:
- NEVER REPEAT DRE
- Bacterial = FQ (Cipro)
- Non-bacterial = NSAIDs
Path: Obstructive nephropathy

Pt: Presenting with colicky, flank pain with hematuria. Very painful to urinate.

Dx?

Tx?

F/U?
Nephrolithiasis (Kidney Stones)
- MC stone = Calcium oxalate

Dx = CT Abd/Pelvis w/o contrast
- if the patient is preg = Renal US

Tx
- < 5mm = IVF, Analgesics
- Between = MET (CCB), Lithotripsy, Stents
- > 3cm = Surgery with nephrostomy tubes placed

F/U: 24hr urine, strain for stone
Peds newborn which has undescended testes on PE.

Management
- If undescended by 6m, bring it down w/ surgery
- Pre-pubertal = Surgically tether
- Post-pubertal = Surgically remove

F/U monitoring for testicular CA as there is now a ↑10x moree* risk of development!
Epispadias = urethral opening on ______ surface

Hypospadias = urethral opening on ______ surface

Is circumcision attempted?
Epi = Dorsal (Pees in face)

Hypo = Ventral (Pee to floor)

NO circumcision because you need the foreskin to rebuild the shaft.
Hematuria in child after trauma, safe to insert catheter?
HOLD IT
- attempt an US of the bladder, or get a Post-void urethrogram
Teenager with colicky abdominal pain that spontaneously resolves, reports this after his first EtOH binge
Ureteropelvic Junction

Dx = IVP (or US)

Tx = Stenting/Surgery
Young girl who can normally void, but she has a constant leak

Management
Low Implantation of the Ureter.

Dx = IVP

Tx = Reimplant
Peds patient who presents with frequent UTIs or ANY pyelonephritis. What should you think of?
Vesicoureteral Reflux, basically the valves on bladder are 2-way allowing for bacteria ascent

Dx = Voiding Cysturethrogram showing reflux

Tx =
- Empiric Abx ppx, can wait to see if outgrows it
- Surgery definitive
Path: 5-DHT (Testosterone)

Pt: Presenting with obstructive nephropathy symptoms similar to BPH, however DRE is firm + nodular

Labs: ↑ PSA on stem

Dx?

Tx?
Prostate CA
- MC male CA by incidence
- ∅ Asx screening! (unless the patient had a 1st degree relativee* with prostate CA)

Dx =
- 1st get diagnostic PSA to get a baseline
- 2nd need to get confirmatory transrectal/transurethral (urethral = superior) biopsy
- Calculate Gleason score (out of 10, 10 being worst)

Tx based on symptom control (as most ppl die with it, than from it)
- #1 GnRH analogs like Leuprolide
- Flares can use additional anti-androgens (Flutamide)
- Orchiectomy to ↓ flares
- Surgical resection + radiation if prognosis otherwise dire.
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