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72 Cards in this Set
- Front
- Back
T/F Splenectomy is frequently followed by a marked increase in platelets in a normal patient
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TRUE
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What are the functions of the spleen?
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Hematopoiesis(before birth)
Blood Filtration Immune modulation: IgM production |
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What is Kehr's sign?
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shoulder pain secondary to diaphragmatic irritation
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What are the 3 mechanisms of splenic injury?
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Penetrating
Blunt compressive Blunt deceleration |
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MC reason for splenectomy?
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Trauma
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What are apsonins?
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Part of the nonspecific immune response of the spleen
1. Properdin-activates complement 2. Tuftsin- facilitates macrophage phagocytosis 3. Fibronectin |
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Most useful study to determine splenic size and dectect injury?
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CT scan
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What grade is a splenic injury with:
Subscapular hematoma <10% Laceration < 1cm deep |
Grade I
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What grade is a splenic injury with:
Subscapular hematoma 10-50% Laceration 1-3 cm deep not involving trabecular vessels |
Grade II
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What grade is a splenic injury with:
Subscapular hematoma >50% Laceration > 3cm deep or involving trabecular vessels |
Grade III
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How is hypersplenism characterized?
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By Cytopenia (anemia, leukopenia, and thrombocytopenia)
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Splenectomy may be helpful in which hematologic disorders?
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Hemolytic anemia
ITP Cytopenia assoc with secondary hypersplenism |
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What is Felty's syndrome?
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Arthritis
Splenomegaly Neutropenia |
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In these patients, circulating antibodies against neutrophils are found
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Felty's syndrome
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Which diseases are assoc with hypersplenism?
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Leukemias
Lymphomas Cancers Portal HTN Splenic vein thrombosis Felty's syndrome Sarcoidosis Porphyria erythropoeitica |
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Which hemolytic anemias do not respond to splenectomy?
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Metabolic abnormalities:
G6PD deficiency Pyruvate kinase deficiency |
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Splenectomy is deferred until what age?
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5 yrs because risk of sepsis
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Splenectomy is helpful in which?
Warm reactive antibodies or Cold reactive antibodies |
Warm- IgG: Splenectomy is helpful
Cold- IgM: hemolysis occurs in peripheral locations; splenectomy is NOT helpful |
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Treatment for ITP?
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Corticosteroids 6wks -2 months
If no improvement, perform splenectomy |
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Fever, purpura, hemolytic anemia, neurologic manifestations, and signs of renal disease
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TTP
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Treatment for TTP
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Plasma Pheresis
If no improvement, do splenectomy |
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When is splenectomy indicated for patients with hypersplenism?
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a) if the platelets <50,000
b) if the WBC count < 2000 with or without frequent intercurrent infection (c) if there is anemia requiring blood transfusion |
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What does a peripheral smear show after splenectomy?
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Howell-Jolly bodies
Absence of these suggest that an accessory spleen was missed |
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What test is useful for identifying retained splenic elements?
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Radionuclide spleen scan
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What is the body's response to splenectomy?
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Elevation of WBCs and Platelets
Usually returns to normal after 1-2 wks |
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What is a complication of post-splenectomy thrombocytosis? How do you treat?
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Thrombosis and Pulmonary embolism (MC with myeloproliferative disorders)
Treat with aspirin and dipyridamole(aggrenox) Avoid heparin or warfarin |
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Which pts are at highest risk of post-splenectomy infection?
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Hematologic disorders:
Thalassemia |
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What organisms cause the majority of post-splenectomy infections?
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Encapsulated organisms:
S.pneumo (75%) H.flu N.meningitidis GABHS S.aureus E.coli Psuedomonas Also viral: Herpes zoster Parasitic: Babesiosis Malaria |
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What vaccines are given to splenectomy patients?
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Polyvalent pneumococcal
H.flu type B N.meningitidis |
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What is the only indication for splenectomy in leukemia patients?
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hypersplenism
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What is the most common pulmonary problem after splenectomy
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Atelectasis
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Name viruses of the herpes family
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Herpes simplex
CMV EBV Varicella Roseolovirus |
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the combination of severe obesity and obstructive sleep apnea causing hypoxia and hypercapnia resulting in marked daytime somnolence and chronic respiratory acidosis
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Pickwickian syndrome
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Distention and dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney.
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Hydronephrosis
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How do you diagnose testicular torsion?
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Doppler ultrasound
Absent cremasteric reflex |
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What turmor markers are specific for yolk salk testicular tumors?
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AFP, Beta-HCG, LDH
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What are causes of urethral strictures?
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Iatrogenic
Infectious (STDS) |
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High levels of FSH and LH are usually associated with?
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Testicular failure
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Which drugs are assoc with Male sexual dysfunction?
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Antihypertensives:
Diuretics Beta-blockers CCBs ACE inhibitors Alpha-blockers Alcohol Antiandrogens: Digoxin H2-receptor blockers Ketoconazole Illicit drugs Psychiatric medications: Antipsychotics Antidepressants |
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Name some PDE-5 inhibitors
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Sildenafil (Viagra)
Levitra Tadalafil (Cialis) Longer acting |
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What are first, second, and third line therapies for ED?
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1st- Vacuum devices
2nd- Intracavernosal Therapy 3rd- Penile Prostheses |
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Treatment for premature ejaculation
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Clomipramine
SSRIs (eg, fluoxetine, sertraline, paroxetine) |
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Chancroid is caused by?
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Haemophilus ducreyi
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Fracture of the penis damages this structure
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corpora cavernosa
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How do you diagnose a urethral stricture?
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Retrograde urethrogram and cystoscopy are diagnostic
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When do you start screening for prostate CA?
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Age 40 in Blacks
Age 40 in Patients with a Family Hx Age 50 in all other men |
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What are common sites for prostate metastasis?
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Pelvic Lymph Nodes
Bone Lung Liver |
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MC type of prostate CA
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Adenocarcinoma (90%)
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What is the most sensitive and specific marker to detect prostate cancer
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Prostatic Specific Antigen (PSA)
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Where is prostate cancer most likely to occur?
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Peripheral Zone 70%
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Most common region of BPH
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Transition Zone
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What is the medical therapy for BPH?
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Alpha Blockers (Terazosin
Doxazosin) 5 Alpha-reductase Inhibitors |
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What are symptoms of bladder cancer?
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Hematuria
Dysuria Polyuria |
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What is the treatment for bladder cancer?
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TURBT- trans-urethral resection of bladder tumor
Radical Cystectomy and Ileal Conduit diversion/Neobladder |
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MC type of bladder cancers?
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Transitional Cell Carcinoma(90%)
Squamous Cell Carcinoma Adenocarcinoma Rhabdomyosarcoma |
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Pt born in Greece with a positive Nikolsky's sign
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Pemphigus
Treat with steroids |
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Dysphagia, low grade fever, tenderness under the chin
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Ludwigs's Angina
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What is a Gleason score?
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A Gleason score is given to prostate cancer based upon its microscopic appearance
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These stones are assoc with the presence of urea-splitting bacteria, most commonly Proteus mirabilis (but also Klebsiella, Serratia, Providencia species).
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struvite stones
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stones assoc. with hyperparathyroidism and renal tubular acidosis
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calcium phosphate stones
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Omega shaped ipiglottis
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laryngomalacia
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Most common organisms that cause sinusitis
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H.flu 38%
S. pneumoniae 37% S. pyogenes 6% M. cat 5% |
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Treament for sinusitis
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Mild:
Amoxicillin Erythromycin Bactrim Moderate to severe: Augmentin Cephs FQs (not for kids) |
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What is the nerve supply to the genitourinary area?
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Pudendal nerve
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MCC of angioedema and treatment?
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Ace inhibitors
Treat: H1- antihistamines H2- antacids |
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Name 2 tests for allergies
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RAST- radio allergosorbent test
SET- skin endpoint titration (more sensitive/specific) |
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What is the treatment of tonsilitis?
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Treatment
Augmentin(rule out mono) Cephs Clindamycin (Cleocin) Consider cortisteriods |
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MCC of periodontal abscess and treatment?
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MCC Staph. aureus, Strep. pyogenes
TX Clindamycin or Unasyn IV |
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These stones are assoc. with UTIs and alkalinic urine
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Staghorn stones, aka struvite stones aka magnesium ammonium phosphate stones
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Injury caused by the rupture of the tunica albuginea,
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Penile fracture
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What does a positive PSA indicate?
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Possible presence of prstate cancer
It can also be positive in cases of BPH and prostatitis |
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What screening tests are done for prostate cancer?
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PSA
DRE Trensrectal ultrasonography |