1. Colic - presents at 3 weeks of age, lasts 3 months. Crying >3 hours a day for >3 days/week for >3 weeks/month
2. Progestin-only pills preferred during lactation as they do not affect milk production, are not known to affect infant and do not carry DVT risk
3. ITP in kids (usually age 2-5) typically self-resolves in 6 months. You're not supposed to treat cutaneous bleeds, no matter the platelet count, although I have seen it be treated when the platelet count was low enough. If the patient experiences bleeding, you can treat with IVIg or steroids.
- ITP in adults - doesn't tend to self resolve as much, treat when platelets < 30,000
4. Varicocele: dilation of pampiniform plexus of veins around spermatic cord and testis from compression of venous drainage. More common on L as gonadal vein enters renal vein at right angle -- L renal vein often compressed by aorta and SMA
- Soft mass, "bag of worms, does NOT transilluminate
- Worse with standing, valsalva
- Improved with lying supine
- May have no symptoms or a dull scrotal ache
- May lead to testicular atrophy due to increased temperature - for young people who want to maintain fertility, can treat with surgical ligation of gonadal vv vs symptomatic management for older people.
5. DDx testicular mass:
- varicocele (see above)
- spermatocele (painless, fluid filled cyst at head of epididymis full of nonviable sperm - do not change with position)
- hydrocele (fluid between parietal and visceral layers of tunica vaginalis, usually present in infancy and can change in size with valsalva - typically transilluminate)
- hernia - +/- pain, can worsen with valsalva and improve with lying supine; more common on R side (later descent of R testicle) - associated with patent processus vaginals (indirect hernia) or weakened femoral ring (femoral hernia).
6. Androgen producing adrenal hormones - DHEA-S is produced in adrenals only, so is most specific this kind of tumor. Andostenedione (AS), DHEA, and T are all made by both adrenals and ovaries.
7. Treatment of psoriatic arthritis - NSAIDs, MTX, anti-TNF agents - systemic steroids relatively CI because of a theoretical risk of rebound symptoms with dose reduction or withdrawal, but according to this paper there is little published data on whether or not these events occur.
8. Vagal maneuvers affect both SA node automatism and AV node conductivity; it the latter effect that is believed to break PSVT, as that is believed to be an aberrant re-entrant rhythm.
9. Acanthosis nigricans
- Benign - younger people, associated with insulin resistant states (DM, PCOS)
- Malignant - older people, associated with GI/GU malignancy
10. Review of indication for statin: (original post Feb 13, 2014)
- Anyone with LDL > 190
- Diabetics with LDL > 70
- 10 year cardiovascular risk > 7.5% and LDL > 70
- Anyone with clinically significant heart diseaes
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