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72 Cards in this Set

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T/F Splenectomy is frequently followed by a marked increase in platelets in a normal patient
TRUE
What are the functions of the spleen?
Hematopoiesis(before birth)
Blood Filtration
Immune modulation: IgM production
What is Kehr's sign?
shoulder pain secondary to diaphragmatic irritation
What are the 3 mechanisms of splenic injury?
Penetrating
Blunt compressive
Blunt deceleration
MC reason for splenectomy?
Trauma
What are apsonins?
Part of the nonspecific immune response of the spleen

1. Properdin-activates complement
2. Tuftsin- facilitates macrophage phagocytosis
3. Fibronectin
Most useful study to determine splenic size and dectect injury?
CT scan
What grade is a splenic injury with:
Subscapular hematoma <10%
Laceration < 1cm deep
Grade I
What grade is a splenic injury with:
Subscapular hematoma 10-50%
Laceration 1-3 cm deep not involving trabecular vessels
Grade II
What grade is a splenic injury with:
Subscapular hematoma >50%
Laceration > 3cm deep or involving trabecular vessels
Grade III
How is hypersplenism characterized?
By Cytopenia (anemia, leukopenia, and thrombocytopenia)
Splenectomy may be helpful in which hematologic disorders?
Hemolytic anemia
ITP
Cytopenia assoc with secondary hypersplenism
What is Felty's syndrome?
Arthritis
Splenomegaly
Neutropenia
In these patients, circulating antibodies against neutrophils are found
Felty's syndrome
Which diseases are assoc with hypersplenism?
Leukemias
Lymphomas
Cancers
Portal HTN
Splenic vein thrombosis
Felty's syndrome
Sarcoidosis
Porphyria erythropoeitica
Which hemolytic anemias do not respond to splenectomy?
Metabolic abnormalities:

G6PD deficiency
Pyruvate kinase deficiency
Splenectomy is deferred until what age?
5 yrs because risk of sepsis
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
Treatment for ITP?
Corticosteroids 6wks -2 months

If no improvement, perform splenectomy
Fever, purpura, hemolytic anemia, neurologic manifestations, and signs of renal disease
TTP
Treatment for TTP
Plasma Pheresis

If no improvement, do splenectomy
When is splenectomy indicated for patients with hypersplenism?
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
What does a peripheral smear show after splenectomy?
Howell-Jolly bodies

Absence of these suggest that an accessory spleen was missed
What test is useful for identifying retained splenic elements?
Radionuclide spleen scan
What is the body's response to splenectomy?
Elevation of WBCs and Platelets

Usually returns to normal after 1-2 wks
What is a complication of post-splenectomy thrombocytosis? How do you treat?
Thrombosis and Pulmonary embolism (MC with myeloproliferative disorders)

Treat with aspirin and dipyridamole(aggrenox)

Avoid heparin or warfarin
Which pts are at highest risk of post-splenectomy infection?
Hematologic disorders:

Thalassemia
What organisms cause the majority of post-splenectomy infections?
Encapsulated organisms:

S.pneumo (75%)
H.flu
N.meningitidis
GABHS
S.aureus
E.coli
Psuedomonas

Also viral:
Herpes zoster

Parasitic:
Babesiosis
Malaria
What vaccines are given to splenectomy patients?
Polyvalent pneumococcal
H.flu type B
N.meningitidis
What is the only indication for splenectomy in leukemia patients?
hypersplenism
What is the most common pulmonary problem after splenectomy
Atelectasis
Name viruses of the herpes family
Herpes simplex
CMV
EBV
Varicella
Roseolovirus
the combination of severe obesity and obstructive sleep apnea causing hypoxia and hypercapnia resulting in marked daytime somnolence and chronic respiratory acidosis
Pickwickian syndrome
Distention and dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney.
Hydronephrosis
How do you diagnose testicular torsion?
Doppler ultrasound
Absent cremasteric reflex
What turmor markers are specific for yolk salk testicular tumors?
AFP, Beta-HCG, LDH
What are causes of urethral strictures?
Iatrogenic
Infectious (STDS)
High levels of FSH and LH are usually associated with?
Testicular failure
Which drugs are assoc with Male sexual dysfunction?
Antihypertensives:
Diuretics
Beta-blockers
CCBs
ACE inhibitors
Alpha-blockers
Alcohol
Antiandrogens:
Digoxin
H2-receptor blockers
Ketoconazole
Illicit drugs
Psychiatric medications:
Antipsychotics
Antidepressants
Name some PDE-5 inhibitors
Sildenafil (Viagra)
Levitra
Tadalafil (Cialis) Longer acting
What are first, second, and third line therapies for ED?
1st- Vacuum devices
2nd- Intracavernosal Therapy
3rd- Penile Prostheses
Treatment for premature ejaculation
Clomipramine
SSRIs (eg, fluoxetine, sertraline, paroxetine)
Chancroid is caused by?
Haemophilus ducreyi
Fracture of the penis damages this structure
corpora cavernosa
How do you diagnose a urethral stricture?
Retrograde urethrogram and cystoscopy are diagnostic
When do you start screening for prostate CA?
Age 40 in Blacks
Age 40 in Patients with a Family Hx
Age 50 in all other men
What are common sites for prostate metastasis?
Pelvic Lymph Nodes
Bone
Lung
Liver
MC type of prostate CA
Adenocarcinoma (90%)
What is the most sensitive and specific marker to detect prostate cancer
Prostatic Specific Antigen (PSA)
Where is prostate cancer most likely to occur?
Peripheral Zone 70%
Most common region of BPH
Transition Zone
What is the medical therapy for BPH?
Alpha Blockers (Terazosin
Doxazosin)
5 Alpha-reductase Inhibitors
What are symptoms of bladder cancer?
Hematuria
Dysuria
Polyuria
What is the treatment for bladder cancer?
TURBT- trans-urethral resection of bladder tumor

Radical Cystectomy and Ileal Conduit diversion/Neobladder
MC type of bladder cancers?
Transitional Cell Carcinoma(90%)
Squamous Cell Carcinoma
Adenocarcinoma
Rhabdomyosarcoma
Pt born in Greece with a positive Nikolsky's sign
Pemphigus

Treat with steroids
Dysphagia, low grade fever, tenderness under the chin
Ludwigs's Angina
What is a Gleason score?
A Gleason score is given to prostate cancer based upon its microscopic appearance
These stones are assoc with the presence of urea-splitting bacteria, most commonly Proteus mirabilis (but also Klebsiella, Serratia, Providencia species).
struvite stones
stones assoc. with hyperparathyroidism and renal tubular acidosis
calcium phosphate stones
Omega shaped ipiglottis
laryngomalacia
Most common organisms that cause sinusitis
H.flu 38%
S. pneumoniae 37%
S. pyogenes 6%
M. cat 5%
Treament for sinusitis
Mild:
Amoxicillin
Erythromycin
Bactrim

Moderate to severe:
Augmentin
Cephs
FQs (not for kids)
What is the nerve supply to the genitourinary area?
Pudendal nerve
MCC of angioedema and treatment?
Ace inhibitors

Treat:
H1- antihistamines
H2- antacids
Name 2 tests for allergies
RAST- radio allergosorbent test

SET- skin endpoint titration (more sensitive/specific)
What is the treatment of tonsilitis?
Treatment
Augmentin(rule out mono)
Cephs
Clindamycin (Cleocin)
Consider cortisteriods
MCC of periodontal abscess and treatment?
MCC Staph. aureus, Strep. pyogenes
TX Clindamycin or Unasyn IV
These stones are assoc. with UTIs and alkalinic urine
Staghorn stones, aka struvite stones aka magnesium ammonium phosphate stones
Injury caused by the rupture of the tunica albuginea,
Penile fracture
What does a positive PSA indicate?
Possible presence of prstate cancer

It can also be positive in cases of BPH and prostatitis
What screening tests are done for prostate cancer?
PSA
DRE
Trensrectal ultrasonography