Endo Ddx
Your asymptomatic patient brings the following labs to you for your advice. What do you diagnose?
TSH: 7.5 mIU per L (nl: 0.4-4.5)
Free T4: 1.2 ng/dL (nl: 0.8-1.8)
Subclinical Hypothyroidism
You see a kid with lice and prescribe treatment. When can they go back to school?
as soon as treatment has begun
What is the recommended treatment for H Pylori?
Quadruple Therapy: pepto bismol, ppi, tetracyclin, metronidazole
A 50 year old man with bmi of 35 is treated for an unprovoked DVT. What is the optimal duration of therapy?
obesity and male gender are risk factors for recurrence - consider lifelong anticoagulation for all unprovoked DVTs
Men in this age group who have ever smoked should be screened for AAA – abdominal aortic aneurysm
65-75 yo
35 year old G2P2002 presents 4 weeks pp for painful lump in throat and palpitations, weight loss and difficulty sleeping. on exam you note a painful swollen goiter
TSH: <0.000015
Free T4: 4.6 ngl/dL (nl 0.8-1.8)
Postpartum Thyroiditis
hyper --> hypo --> recovery
You diagnose a mildly inflamed ingrown toenail what are 2 treatment options
loose foot ware
warm soaks
topical steroids
what are indications for chronic PPI usage?
complex GERD - erosive esophagitis, esophageal ulcer, peptic stricture
Barrett's, EoE, idiopathic pulmonary fibrosis
These children should receive iron supplementation from age 1 month – 12 month
pre-term infants who are exclusively breastfed
poly-vi-sol with iron, 2mg/kg of iron up to 15mg/day
32 year old F comes to your office with her husband after a recent weeklong episode of elevated mood and energy that meets the diagnostic criteria for a manic episode. They both say that she has never had any episodes of depression, low mood, or anhedonia.
What is your diagnosis
bipolar 1
does not require a hx of a major depressive episode and may be diagnosed and treated based on just 1 manic episode
bipolar II requires at least 1 hypomanic and 1 major depressive episode
How do you diagnose osteoporosis ?
T score of -2.5 or less or fragility fracture
a healthy 12 year old is brought to your office by a parent because the child has had an itchy scalp for the last 2 months. Patient has tried multiple dandruff shampoos and is now using tea tree oil without relief. On exam you note several 1-2 cm annular lesions on the scalp with small black dots and scale. There is tender lymphadenopathy of the occipital scalp.
What is the next appropriate step?
Initiating oral terbinafine
pruritic annular scalp lesions with hair loss, scale, and tender lymphadenopathy should prompt a diagnosis of tinea capitis
tx: oral terbinafine or griseofulvin
shortest course is terbinafine at 2 weeks but usually 3-12 weeks
fungal culture can be negative if pt have used emollients or oils in the week prior to testing
topical does not penetrate the hair shafts
name 3 Red Flag symptoms for dyspepsia / GERD
GI bleeding, anemia, odynophagia, recurrent vomiting, weight loss, pain, choking, chest pain
How much cow's milk should a 1 year old drink and why?
20z (max 24 oz) per CDC due to increasing risk of iron deficiency with more milk
how do you monitor for amiodarone toxicity?
pulmonary function testing for pulmonary fibrosis
A 32-year-old woman presents with weight loss, palpitations, heat intolerance, and anxiety. On exam, she has a fine tremor, tachycardia, and a diffusely enlarged thyroid. Labs show:
TSH: <0.01 mIU/L (low)
Free T4: elevated
What is the most appropriate next step?
initiate methimazole and a beta blocker followed by additional work up
A 30 year old F with obesity and tobacco use disorder presents for evaluation of a persistent painful lump in her axilla. After an appropriate evaluation you diagnose mild hidradenitis suppurativa
what is first line treatment
topical clindamycin
patients with HS who have overweight and smoke should be advised that weight loss and smoking cessation have been shown to decrease severity of disease and improve treatment response
moderate disease: oral tetracycline + topical clindamycin
intralesional triamcinolone may be considered for procedural management of mild HS, topical tiramcinolone is not recommended
What are the benefits and risk of Rotavirus vaccine?
all children should receive an oral live, attenuated rotavirus vaccine to reduce the incidence of hospitalization, severe gastroenteritis, and death from rotavirus infection
the risk: intussusception, this risk increases if vaccination is delayed (and the benefit also decreases)
Age range for Universal HIV screening
Age 15-65 once - as needed based on RF
a 42 year old female who has undergone a bilateral prophylactic mastectomy and bilateral salpingo-oophorectomy due to a known BRCA mutation sees you for follow up. She is experiencing symptoms of vasomotor instability and dyspareunia. She asks about hormone replacement therapy.
what is the best evidence based recommendation for this patient?
Hormone therapy until age 50 has been shown to mitigate some of the health outcomes of early menopause and is the most effective treatment for menopausal symptoms and improve quality of life. combined HRT with estrogen and progesterone is indicated for women with a uterus, while estrogen monotherapy is indicated for women without a uterus.
hormone therapy does not have a relevant effect on cancer risk in BRCA Mutation carriers
List all the diagnostic criteria for diabetes
a1c >= 6.5 OR
FPG >= 126 mg/dL. Fasting is defined as no caloric intake for at least 8 hours. OR
2-hr plasma glucose >= 200 during an OGTT OR
in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glcusoe >= 200
What is the most effective topical treatment for post inflammatory hyperpigmentation in persons with Fitzpatrick skin types IV, V, and VI?
topical therapies include: hydroquinone, fluocinolone/hydroquinone/tretinoin, and azelaic acid
adapalene, tretinoin, and tazarotene are acceptable options for hyperpigmentation associated with acne
To diagnose MASLD, hepatic steatosis must be present along with at least one of these four metabolic syndrome traits....
BMI > 25 (or by waist circumference)
DM or PreDM
HTN (130/85)
TG > 150, HDL < 40 / 50 F
Which pregnant patients should get a hemoglobin electrophoresis?
ACOG recommends universal screening. Check prior results
Laser-assisted in-situ keratomileusis (LASIK) surgery is performed to treat what condition?
Myopia and other refractive errors (hyperopia and astigmatism)
surgery involves removal of an anterior corneal flap, stromal ablation, and replacement of the flap