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20 Cards in this Set
- Front
- Back
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bone pain from a fracture under normal use, think
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multiple myeloma
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Dx testing for suspected multiple myeloma
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skeletal survey, to detect punched out osteolytic lesions.
SPEP, looking for monoclonal spike, usually IgG UPEP, looking for BENCE-JONES PROTEIN peripheral smear, looking for rouleaux ELEVATED CALCIUM, because of OSTEOLYTIC LESIONS Beta 2 microglobulin level (prognostic) BUN, Cr, to check for renal insufficiency which often accompaines MM. |
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Tx of multiple myeloma
don't forget to treat the related problems |
melphalan
steroids autologous BMT hypercalcemia: hydration, diuresis fractures: bisphosphonates anemia (erythropoetin) vaccinations, flu, pneumovax, tetanus, etc |
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hyperviscosity from IgM overproduction
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Waldenstrom's macroglobulinemia
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Aplastic anemia, BMT not possible. What is second line tx?
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antithymocyte globulin + cyclosporine
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Enlarged cervical lymph nodes, think ?
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Hodgkin's lymphoma
It often starts at neck and spreads peripherally, wherease NHL more often presents as widespread dz. |
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Best initial test for lymphoma (both Hodgkins and NHL)
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excisional lymph node biopsy
NOT needle biopsy |
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Can you use a needle biopsy to diagnose NHL?
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NO!
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Reed-Sternberg cells
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Hodgkin's disease
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After a + lymph node biopsy diagnoses lymphoma, what is the next step?
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Staging:
CXR CT with contrast of chest, abdomen, pelvis, head bone marrow biopsy |
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[Hodgkin's, non-Hodgkins} lymphoma usually presents in early stages (I or II).
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Hodgkin's
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[Hodgkin's, non-Hodgkins] lymphoma usually presents in late stages (III or IV)
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non-Hodgkin's
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Stages I and II of lymphoma are usually treated with ?
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radiation
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Stages III and IV of lymphoms are treated with ?
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chemo
ABVD, CHOP regimens |
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What drugs are part of the ABVD regimen?
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adriamycin (doxorubicin
bleomycin vinblastine dacarbazine |
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What drugs are part of the CHOP regimen?
What adjunct increases efficacy of the regimen? |
cyclophosphamide
hydroxyadiamycin ONCOVIN (vincristine) prednisone rituximab is often added as an adjunct |
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HIT presents with a drop of platelets of more than ? percent.
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50%
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What should be substituted if a patient gets HIT?
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lepirudin or argatroban
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What is the FIRST test used to diagnose a suspected factor deficiency causing joint bleeding, hematoma, or post-surgical bleeding?
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Mixing study
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What is the tx for lupus anticoagulant / anticardiolipin antibodies, protein C deficiency, antithrombin III or factor V Leiden mutation?
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HEPARAIN, followed by warfarin
can use direct thrombin inhibitor instead of heparin for AT III deficiency. |
