Common causes of Dyspareunia are: Atrophic Vaginitis, Endometriosis, Vulvar Vestibulitis.
Today, we are moving on the Pediatric topics...that are always covered on the exams.
Q: What CRITERIA are required to make the diagnosis first episode of RHEUMATIC
FEVER?
A: The revised JONES CRITERIA is divided into Major and Minor subtypes.
One is required to have either TWO MAJOR or ONE MAJOR and TWO MINOR
components....to establish the diagnosis.
Q: What are the revised MAJOR and MINOR JONES CRITERIA?
A: MAJOR CRITERIA are: Carditis/Chorea/Erythema Marginatum/Polyarthritis
and Subcutaneous Nodules
MINOR CRITERIA are: Arthralgia/Elevated ESR or CRP/Fever/PR Prolongation.
Q: What does PROGNOSIS depend on in patiens affected by Rheumatic Fever?
A: The SEVERITY of initial CARDITIS. (So, of all the criteria...this is the most important).
Q: What is the MOST COMMON organism causing Rheumatic Fever?
A: GROUP A STREPTOCOCCUS (GAS).....Usually occurs 2-4 weeks after a bout of
pharyngitis.
Q: What is the most common AGE GROUP affected by Rheumatic Fever?
A: Ages 5 to 15.....It is rare under 3 and over age 21.
Q: What is the BEST diagnostic tool to establish NEUROFIBROMATOSIS?
A: CLINICAL OBSERVATION....tumors and Cafe au Lait spots will be most evident
to the naked eye....in adolescence...the most common age group affected.
Q: How many TYPES of NEUROFIBROMATOSIS are known?
A: TWO.....Type I is most common (90%) of cases.
Type II....about (10%).... is associated with ACOUSTIC NEUROMAS.
Q: What is LEGG-CALVE-PERTHES DISEASE?
A: ASEPTIC NECROSIS OF THE FEMORAL CAPITAL EPIPHYSIS...which occurs
spontaneously....causing hip pain and limping. Most common age groups affected
are 5-10 years old. MRI is the BEST diagnostic tool.
Q: Which CONGENITAL CONNECTIVE TISSUE DISORDERS can cause AORTIC
DISSECTION....in a younger patient presenting with chest and back pain to the ER?
A: MARFAN'S SYNDROME
EHLER'S-DANLOS SYNDROME
Thanks for your time....it was good to depart from adult subjects to the field of Pediatrics.
Saturday, February 27, 2010
Monday, February 15, 2010
WOMEN'S HEALTH....PART TWO
The answer: "What is the Hallmark of Osteoporosis"?......is LOSS OF BONE MASS.
This condition occurs due to an imbalance between bone resorption and formation, as
diagnosed by DEXA imaging.
Q: What are the major risk factors for OSTEOPOROSIS?
A: Menopause...Glucocorticoid use...White/Asian race...Low Ca intake
Tobacco/Alcohol use....Family History...Frequent Falls
Q: What is FITZ-HUGH-CURTIS SYNDROME?
A: Acute PERIHEPATITIS occuring only in sexually active women. Symptoms
resemble cholecystitis (fever/RUQ pain/) along with clinical findings of salpingitis.
The majority are due the Chlamydiae Trachomatis. The LFT's and RUQ Sonogram
are normal. Treatment: is of the underlying infection.
Q: In which conditions is pregnancy CONTRAINDICATED?
A: Eisenmenger's Syndrome...Marfan's Syndrome...Primary Pulmonary Hypertension
Severe Mitral Stenosis.
Q: Which physical condition is associated with ENDOMETRIAL CANCER?
A: OBESITY
Q: Which laboratory test is HIGHLY suggestive of PREECLEMPSIA in a hypertensive
pregnant woman, with proteinuria, edema.
A: Plasma URIC ACID level >4.5 md/dl.
Q: Which type of breast examination is better BSE (Breast self examination) or
CBE (Clinical breast examination) in SCREENING for breast cancer.
A: CBE...Though not standardized, CBE has about a 50% sensitivity, whereas
BSE has not been shown to have real benefit.
To ponder until next time: What gynecologic conditions can cause DYSPAREUNIA?
Thanks again for your time, we'll be back shortly.
This condition occurs due to an imbalance between bone resorption and formation, as
diagnosed by DEXA imaging.
Q: What are the major risk factors for OSTEOPOROSIS?
A: Menopause...Glucocorticoid use...White/Asian race...Low Ca intake
Tobacco/Alcohol use....Family History...Frequent Falls
Q: What is FITZ-HUGH-CURTIS SYNDROME?
A: Acute PERIHEPATITIS occuring only in sexually active women. Symptoms
resemble cholecystitis (fever/RUQ pain/) along with clinical findings of salpingitis.
The majority are due the Chlamydiae Trachomatis. The LFT's and RUQ Sonogram
are normal. Treatment: is of the underlying infection.
Q: In which conditions is pregnancy CONTRAINDICATED?
A: Eisenmenger's Syndrome...Marfan's Syndrome...Primary Pulmonary Hypertension
Severe Mitral Stenosis.
Q: Which physical condition is associated with ENDOMETRIAL CANCER?
A: OBESITY
Q: Which laboratory test is HIGHLY suggestive of PREECLEMPSIA in a hypertensive
pregnant woman, with proteinuria, edema.
A: Plasma URIC ACID level >4.5 md/dl.
Q: Which type of breast examination is better BSE (Breast self examination) or
CBE (Clinical breast examination) in SCREENING for breast cancer.
A: CBE...Though not standardized, CBE has about a 50% sensitivity, whereas
BSE has not been shown to have real benefit.
To ponder until next time: What gynecologic conditions can cause DYSPAREUNIA?
Thanks again for your time, we'll be back shortly.
Friday, February 12, 2010
WOMEN'S HEALTH .....
The answer to what is the most life threatening complication
of Hypothyroidism......is MYXEDEMA COMA.
Today we'll cover a topic encountered in practice and on board exam questions,
that is somewhat of a departure for me....but important, nonetheless.
Q: What is the use of Rho-Gam?
A: Rho-Gam is given to the Rh Negative mother to PREVENT a secondary immune
response by the fetal Rh Positive RBC's.
Q: What is the time definition of infertility?
A: By definition, infertility exists after failure to conceive for ONE YEAR of
unprotected intercourse.
Q: Which type of virus is mainly associated with CERVICAL CANCER?
A: HPV(Human Papillomavirus), especially HPV16 and 18 subtypes.
Other risk factors are: multiple partners/early age sexual activity/smoking
co-existing STD's/low socioeconomic status and HIV.
Q: What are the recommended SCREENING INTERVALS for cervical cancer?
A: Sexually active person WITHOUT risk factors....it is EVERY 3 YEARS.
Sexually active person WITH risk factors........... it is ANNUALLY.
Q: What is AMNIOTIC FLUID EMBOLISM SYNDROME?
A: It is a CATASTROPHIC event at time of LABOR/DELIVERY...like a massive PE.
Leading to sudden onset HYPOXIA/DYSPNEA/CYANOSIS/HYPOTENSION
and occasionally DIC/COMA...due to uterine manipulation. MORTALITY 50%!!!
TREATMENT: Supportive....Intubation/rapid delivery/IV Fluids.
Q: What is Beta-TOCOLYTIC INDUCED PULMONARY EDEMA?
A: Occurs about 12 HOURS POST DELIVERY. It is UNIQUE to PREGNANT WOMEN.
Sudden onset of PULMONARY EDEMA...due to either TERBUTALINE,
SALBUTEROL, ISOXSUPRINE or RITODRINE......fortunately rare!
TREATMENT: Supportive and diuretics.
Until next time.....What is the HALLMARK feature of OSTEOPOROSIS?
Thanks again for your time....be back soon.
of Hypothyroidism......is MYXEDEMA COMA.
Today we'll cover a topic encountered in practice and on board exam questions,
that is somewhat of a departure for me....but important, nonetheless.
Q: What is the use of Rho-Gam?
A: Rho-Gam is given to the Rh Negative mother to PREVENT a secondary immune
response by the fetal Rh Positive RBC's.
Q: What is the time definition of infertility?
A: By definition, infertility exists after failure to conceive for ONE YEAR of
unprotected intercourse.
Q: Which type of virus is mainly associated with CERVICAL CANCER?
A: HPV(Human Papillomavirus), especially HPV16 and 18 subtypes.
Other risk factors are: multiple partners/early age sexual activity/smoking
co-existing STD's/low socioeconomic status and HIV.
Q: What are the recommended SCREENING INTERVALS for cervical cancer?
A: Sexually active person WITHOUT risk factors....it is EVERY 3 YEARS.
Sexually active person WITH risk factors........... it is ANNUALLY.
Q: What is AMNIOTIC FLUID EMBOLISM SYNDROME?
A: It is a CATASTROPHIC event at time of LABOR/DELIVERY...like a massive PE.
Leading to sudden onset HYPOXIA/DYSPNEA/CYANOSIS/HYPOTENSION
and occasionally DIC/COMA...due to uterine manipulation. MORTALITY 50%!!!
TREATMENT: Supportive....Intubation/rapid delivery/IV Fluids.
Q: What is Beta-TOCOLYTIC INDUCED PULMONARY EDEMA?
A: Occurs about 12 HOURS POST DELIVERY. It is UNIQUE to PREGNANT WOMEN.
Sudden onset of PULMONARY EDEMA...due to either TERBUTALINE,
SALBUTEROL, ISOXSUPRINE or RITODRINE......fortunately rare!
TREATMENT: Supportive and diuretics.
Until next time.....What is the HALLMARK feature of OSTEOPOROSIS?
Thanks again for your time....be back soon.
Friday, February 5, 2010
THYROID TRIVIA......
Apathy....surprisingly, is the major symptom of APATHETIC HYPERTHYROIDISM.
The disorder occurs in elderly/debilitated patients in whom progressive apathy is the presenting
chief complaint. Mistakenly depression or dementia is often diagnosed.
Today, we'll continue with common thyroid related issues, encountered in practice
and for certain, on your boards.
Q: What is the drug of choice for the treatment of THYROID STORM?
A: PTU...(Propylthyouracil) is the preferred drug, as it has additional benefit over
Methimazole(MMI), by decreasing the peripheral converion of T4 to T3.
Q: Which THYROID NODULES are usually MALIGNANT...Cold or Hot?
A: COLD NODULES....(HINT: Cold=Cancerous). About 15-20% of Cold nodules
are malignant, while only about 1% of the Hot nodules are....good to know!!!
Q: Which type of PRIMARY thyroid cancer is the MOST COMMON?
A: PAPILLARY type...has an excellent prognosis with >95% 10 year survival
for early stage disease.
Q: Which type of PRIMARY thyroid cancer has WORST PROGNOSIS?
A: ANAPLASTIC type...it usually affects older men and women....since cell
types are undifferentiated...survival is dismal.
Q: Which type of THYROIDITIS causes CONSTITUTIONAL SYMPTOMS...fever/chills
with a tender-enlarged thyroid gland and an elevated ESR?
A: SUBACUTE (DeQUERVAIN'S) THYROIDITIS...a self limited, probable viral
disorder, usually treated with NSAID's and steroids.
To ponder until the next posting:....What is the major LIFE THREATENING complication
of HYPOTHYROIDISM, requering emergency diagnosis and treatment?
Again, thanks for your time.
The disorder occurs in elderly/debilitated patients in whom progressive apathy is the presenting
chief complaint. Mistakenly depression or dementia is often diagnosed.
Today, we'll continue with common thyroid related issues, encountered in practice
and for certain, on your boards.
Q: What is the drug of choice for the treatment of THYROID STORM?
A: PTU...(Propylthyouracil) is the preferred drug, as it has additional benefit over
Methimazole(MMI), by decreasing the peripheral converion of T4 to T3.
Q: Which THYROID NODULES are usually MALIGNANT...Cold or Hot?
A: COLD NODULES....(HINT: Cold=Cancerous). About 15-20% of Cold nodules
are malignant, while only about 1% of the Hot nodules are....good to know!!!
Q: Which type of PRIMARY thyroid cancer is the MOST COMMON?
A: PAPILLARY type...has an excellent prognosis with >95% 10 year survival
for early stage disease.
Q: Which type of PRIMARY thyroid cancer has WORST PROGNOSIS?
A: ANAPLASTIC type...it usually affects older men and women....since cell
types are undifferentiated...survival is dismal.
Q: Which type of THYROIDITIS causes CONSTITUTIONAL SYMPTOMS...fever/chills
with a tender-enlarged thyroid gland and an elevated ESR?
A: SUBACUTE (DeQUERVAIN'S) THYROIDITIS...a self limited, probable viral
disorder, usually treated with NSAID's and steroids.
To ponder until the next posting:....What is the major LIFE THREATENING complication
of HYPOTHYROIDISM, requering emergency diagnosis and treatment?
Again, thanks for your time.
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