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Flashcards in hematology, onc, endocrin, renal Deck (30)
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drugs that impair vit D metabolites

phenytoin, carbamazepine, rifamin --> Vit D def by inducing P450 in the liver, which degrades vit D to inactivate metablites


DVT in patient with renal disease

warfarin with unfractionated heparin
(LMWH and rivaroxaban are contraindicated in renal failure)


how to prevent DVT after surgery

warfarin for 3 months


Acute adrenal insufficiency (adrenal crisis) - etiology

1. adrenal hemorrhage or infraction
2. acute illness/injury/surgery in patiens with chronic adranl insuf or long term glucocorticoid use


Acute adrenal insufficiency (adrenal crisis) - clinical features

- hypotension/shock
- nausea, vomiting, abd pain
- fever
- weakness


Acute adrenal insufficiency (adrenal crisis) - treatment

- hydrocortisone or dexamethasone
- high flow IV fluids


Acute adrenal insufficiency (adrenal crisis) after surgery - doses of cortisone

1. as little as 3 wks in patietns taking prednisone 20 or more mg/day
2. low dose glucocorticoids (5 or less) have minimal risk and usually do not require stress doing
intermediated doses (5-20) can cause suppression and require preopoerative evaluation (with early morning corsitol)


Embryonal carcinoma - markers

if pure (rare) --> high hCG, normal AFP
if mixed with other tumors --> high hCG, increased AFP


1. Leyding tumor produces
2. Yolk sac produces
3. choriocarcinoma produces
4. seminoma

1. estrogens, testosterone
2. AFP
3. HCG
4. placental ALP, mildly HCG


DDX of ANTERIOR mediastinal mass

1 Thymoma
2. Teratoma (and other germ cell tumors)
3. Thyroid neoplasm
4. Terible lymphoma


seminimas vs non seminomas regarding markers

seminomas --> elevated β-HCG (mildly) but normal AFP
nonseminomas --> elevated AFP, with considerable number also having elevated βHCG


how can bladder injury causes peritonitis

rupture of the dome (upper, in contact with peritoneum) --> urine leaking into the peritoneal cavity --. chemical peritonitis


extreaperitoneal bladder injury

contusion or rupture of the neck, anterior wall or anterolateral wall of the bladder --> extravasation of urine into adjacent tissues causes localised pain in the lower abd and pelvic)
pelvis fracture is almost always present with, and sometimes a bony fragment can directly puncture and rupture the bladder
gross hematuria is also usually present, urinary retention may occur (esp if in the neck)


ureteral injury

The mcc is iatrogenic
- rare from trauma
MC site: uteropelvic junctio
- hematuria, fever, flank pain, renla mass (hydronephrosis)


IV cefazolin in trauma

used for antimicrobial prophylaxis before surgery to prevent wound infections (60 mins before the procedure


prerenal acute kidney injury - treatment



initial hematuria - DDX

- urethritis
- trauma (eg. catheterization)


hematuria throughout urinary stream - ddx

1. renal mass
2. glumerulonephritis
3. urolithiasias
4. Polycystic kidney disease
5. pyelonephrittis
6. trauma
7. urothelial ca


terminal hematuria - ddx

(bladder or prostate or ureters)
1. urothelial cancer
2. cystitis
3. Urolithiasias
4. BPH
5. Prostate cancer


urethral injury - characteristics

1. almost exclusively in men
2. suspect if blood seen at urethral meatus/ motile prostate
3. urethral catheterization is relatively contraindicated
4. perform retrograde urethrogram (x-ray during injection) --> extravasasion of inability to reach bladder confirm it


parts of male urethra (and direction)

(AFTER bladder and bladder neck) preprostatic urethra --> prostatic --> membranous urethra (through pelvic floor) --> spongy (penile) within the bulb and corpus sponsgiosum


spongy (penile urethra) is sometimes further divided to

bulbar and penile urethra


male urethral injury - division according to location

posterior urethra - membranous
anterior urethra - bulbar and penile urethra


posterior urethra (membranous) trauma

prone to injury from pelvic fracture --> injury can cause urine to leak into retropubic space


anterior urethra bulbar and penile trauma

at risk of damage due to perineal straddle injury --> urine leak beneath deep fascia of Buck --> if fascia is torn, urine escapes into superficial perineal space


an important step in the management of traumatic spinal cord injuries

urinary catheter placement to assess urinary retention + prevent acute bladder distention + damage


indications for cystoscopy

1. gross hematuria with no evidence of glomerular or infection
2. microscopic hematuria with no evidence og glomerular disease or infection but increaed risk for malignancy
3. recurrent UTI
4. Obstructive symtpoms with suscpicion for stricture, stone
5. irritative symptoms without UTI
7. abnormal bladder imaging or urine cytology


how many months anticoagulation for provoked DVT

at least 3


DVT after surgery - when to start anticoagulation

in stable --> as early as 48-72 hours after surgery


when to give atropine in trauma

if SYMPTOMATIC bradycardia