Tx By Dz

Front 1

Inguinal Hernia

Back 1

a. Labs
i. None; usually a clinical diagnosis
b. Imaging
i. Herniography, ultrasound, MRI
c. Treatment
i. Truss, reduction, or surgery

Front 2

Epididymitis/orchitis

Back 2

a. Labs
i. CBC (leukocytosis)
ii. Urinalysis, urine culture (pyuria in epididymitis)
iii. Gram stain, culture, nucleic acid amplification for STDs
b. Imaging
i. Doppler ultrasonography, scintigraphy (for perfusion)
c. Treatment
i. Gonorrhea: ceftriaxone 125mg IM; azithromycin 2g PO
ii. Chlamydia: azithromycin 1g IM; doxycycline 100mg PO bid

Front 3

Hydrocele/varicocele

Back 3

a. Labs
i. None; usually a clinical diagnosis
b. Imaging
i. Doppler ultrasonography, scintigraphy (for perfusion)
c. Treatment
i. Varicocele: observation; ligation of gonadal vein
ii. Hydrocele: excision of hydrocele sac

Front 4

Meckel's diverticulum

Back 4

a. Labs
i. None; usually a clinical and radiographic diagnosis
b. Imaging
i. Small bowel (barium) follow-through
ii. Enteroclysis (fluoroscopy of small bowel)
iii. CT shows mass with air/fluid level
c. Treatment
i. Surgical excision

Front 5

GI duplication

Back 5

a. Labs
i. None; usually a clinical and radiographic diagnosis
b. Imaging
i. CT scan, not barium studies as these usually do not communicate with bowel lumen
c. Treatment
i. Surgical excision

Front 6

Intussusception

Back 6

a. Labs
i. None; usually a clinical and radiographic diagnosis
b. Imaging
i. Ultrasonography – shows “bull’s eye” or “coiled spring” lesion
c. Treatment
i. Fluoroscopic-guided hydrostatic/pneumatic enema

Front 7

Juvenile polyps

Back 7

a. Labs
i. None; usually a clinical and radiographic diagnosis
b. Imaging
i. Colonoscopy; flexible sigmoidoscopy; hydrocolonic ultrasound (US after warm saline enema)
c. Treatment
i. Removal at colonoscopy; recurrence < 5%

Front 8

Gastroenteritis

Back 8

a. Labs
i. Fever suggests infection with invasive bacteria or viruses; onset after food is clue
ii. Stool cultures; fecal lactoferrin (for fecal leukocytes, controversial); occult blood
b. Imaging
i. Endoscopy can help distinguish IBD from infectious enteritis/colitis
c. Treatment
i. Oral rehydration solutions; abx; loperamide (in absence of fever, bloody stools); bismuth; probiotics

Front 9

Irritable bowel disease

Back 9

a. Labs
i. Routine blood chemistries are normal
ii. Stool cultures to rule out GI infection; lactose breath testing
iii. C-reactive protein elevated in IBD, Crohn’s > UC
b. Imaging
i. Colonoscopy including terminal ileum; biopsy confirmatory rather than diagnostic
c. Treatment
Anti-inflammatory, steroids, MABs

Front 10

Peptic ulcer disease

Back 10

a. Labs
i. Urea breath test for H. pylori infection
b. Imaging
i. Endoscopy; barium radiography if ineligible for endoscopy
c. Treatment
i. Thermal coagulation for bleeding ulcers; absolute alcohol or epinephrine injection
ii. Fibrin sealant, endoclips introduced by endoscopy
iii. Acid inhibition: PPIs >> H2 receptor antagonists
iv. Somatostatin, octreotide

Front 11

Celiac disease

Back 11

a. Labs
i. Second-generation anti-gliadin antibody test, Deamidated Gliadin Peptide (DGP)
b. Imaging
i. Upper endoscopy with 2nd/3rd portion duodenal biopsy
c. Treatment
i. Eliminate gluten from diet

Front 12

Cholecystitis

Back 12

a. Labs
i. CBC (leukocytosis), fever; LFTs elevated; amylase and lipase
b. Imaging
i. Ultrasound: gallstones, thickened gallbladder wall (>3mm), pericholecystic fluid
ii. Hepatobiliary iminodiacetic acid (HIDA) scan: acute if no uptake of radiolabeled bile
c. Treatment
i. Surgical excision, preferably laparoscopy

Front 13

Cholangitis

Back 13

a. Labs
i. CBC (elevated WBCs), elevated alkaline phosphatase, GGT, bilirubin
ii. Serum amylase elevation may suggest associated pancreatitis
b. Imaging
c. Treatment
i. Charcot’s triad: RUQ pain, fever, jaundice
ii. Reynold’s pentad: Charcot’s triad + hypotension and mental status change
1. Heralds significant morbidity and mortality
ii. Carbapenem; 3rd gen cephalosporin and metronidazole

Front 14

Hepatitis

Back 14

a. Labs
i. Chronic LFT elevation, think medications, ETOH, viral
ii. Isolated elevation in bilirubin, get CBC to check for hemolysis
iii. Elevated alkaline phosphatase may herald PSC or PBC, antimitochondrial antibody (AMA) suggests PBC
b. Imaging (ultrasound)
c. Treatment

Front 15

Pancreatitis

Back 15

a. Labs
i. CBC: WBCs elevated, Hct depressed in setting of hemorrhage
ii. Amylase elevated more than lipase
b. Imaging
iii. CT with oral, IV contrast (presence of pseudocysts, necrosis, masses)
c. Treatment
i. Aggressive fluid and electrolyte replacement; surgery only for infection or severe pancreatic necrosis

Front 16

Appendicitis

Back 16

a. Labs
i. Mild fever, CBC shows mild leukocytosis
b. Imaging
i. CT with oral, IV contrast
c. Treatment
i. If presenting 24-72 hours since onset of symptoms, surgery
ii. If greater than 5 days since onset of symptoms, wait 6 months then remove

Front 17

Pyelonephritis

Back 17

a. Labs
i. Urinalysis for pyruia, white cell casts (if no pyuria, consider obstruction)
ii. Urine culture, antimicrobial susceptibility; urine gram stain
b. Imaging
i. Only in severe or refractory cases: ultrasound, CT (obstruction, abscesses)
c. Treatment
i. Levofloxacin 500-750mg PO qd; ciprofloxacin 500mg PO bid

Front 18

Pneumonia

Back 18

a. Labs
i. Outpatients: usually unnecessary due to effectiveness of empiric treatment
ii. Inpatients: sputum for gram staining, blood and sputum cultures
b. Imaging
i. Chest radiograph – lobar consolidation, interstitial infiltrates, and/or cavitation
c. Treatment
i. Hospitalization if can’t maintain oral intake, substance abuse, cognitive impairment
ii. Azithromycin 500mg qd x3 days or 2g IM

Front 19

Pelvic inflammatory disease

Back 19

a. Labs
i. Urine beta-hCG; urinalysis; stool hemoccult
ii. CBC not very useful, less than half of PID patients have elevated WBCs
iii. Vaginal fluid: gram stain, WBC elevation
b. Imaging
i. For very ill patients; transvaginal ultrasound shows thickened, fluid-filled oviducts
c. Treatment
i. Abx as dictated by culture results

Front 20

Ovarian torsion/ruptured ovarian cyst

Back 20

a. Labs
i. Urine beta-hCG
ii. Hemorrhage = anemia; ovarian necrosis = leukocytosis; vomiting = electrolyte abnormalities
iii. Ovarian torsion associated with elevated IL-6
b. Imaging
i. Ultrasound (+/- Doppler) for lesions; CT or MRI to detect torsion
c. Treatment
i. Laparotomy and detorsion; removal if obvious necrosis

Front 21

Nephrolithiasis/ureterolithiasis

Back 21

a. Labs
i. Urinalysis for hematuria in patients with unilateral flank pain
b. Imaging
i. Non-contrast helical CT scan; ultrasound for patients who must avoid radiation; abdominal plain film will miss small or radiolucent stones
c. Treatment
i. Many stones pass on their own
ii. Shock wave lithotripsy (SWL), ureteroscopic obliteration, percutaneous nephrolithotomy, laparoscopy

Front 22

Lung cancer (1˚ or 2˚)

Back 22

a. Labs
i. Sputum cytology (screening)
ii. BMP, LFTs for metastatic workup (increased Ca2+ may indicate bone metastasis)
b. Imaging
i. Chest X-ray, chest CT
ii. PET, radionuclide bone scintigraphy for metastasis
c. Treatment
i. Lobectomy or other resection when possible, concurrent chemotherapy for more advanced
ii. Prophylactic radiation for SCLC may reduce brain metastasis
iii. SCLC is usually disseminated at presentation; NSCLC may be local

Front 23

Diverticulosis/-itis

Back 23

a. Labs
b. Imaging
i. CT scanning with oral and IV contrast: bowel wall thickening, increased soft tissue density within pericolic fat; phlegmon, abscess ID
c. Treatment
i. Uncomplicated: bowel rest, abx (Cipro+metro PO; Zosyn IV); clear liquids, high fiber (1/3 recurrence)
ii. Complicated (peritonitis, obstruction, perforation, abscess): amp/gent/metro
iii. Percutaneous drainage then surgery for abscess

Front 24

Acute myocardial infarction

Back 24

a. Labs
i. ECG: ST elevation, ST depression, T-wave inversion
ii. Elevated troponin I/T (within 2-3 hours) more specific than creatine kinase-MB (CK-MB)
b. Imaging
i. None
c. Treatment
i. Medical treatment including aspirin