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82 Cards in this Set
- Front
- Back
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Corhns disease
Sx / Ex Dx |
- Thin with temporal wasting have RLQ tenderness / fullness, perianal fistula
- GI: Colicky RLQ pain, Low grade fever, erythema Nodosum - Imaging - Skip lesions on colonoscopy; cobble stoning |
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Crohn's Tx
Mild Moderate Refractory |
- 5 - ASA
- Oral corticosteroids, +/- azathioprine, 6-mercaptopurine or methotrexate - IV steroids +/- immunomodulators (anti-TNF) R/O perforation |
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Ulcerative Colitis
Sx Dx |
- Cramping abdominal pain, urgency, bloody diarrhea, wt loss, fatigue
- Labs - Normocytic, nomochromic anemia or Fe deficiency anemia, +p-ANCA, Colonoscopy - Friable mucosa, lead-pipe colon |
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Ulcerative colitis
Mild Moderate Refractory |
- 5 - ASA
- Oral corticosteroids, +/- azathioprine, 6-mercaptopurine or methotrexate - IV steroids +/- immunomodulators (anti-TNF) R/O perforation |
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Celiac sprue associated with what
- Skin deformity - GI malignancies |
- Dermatitis herpetiformis
- Small bowel lymphoma |
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Diagnosis of Celiac sprue
- Histology - Antibody assay |
- Flattening or loss of villi
- Antiendomysial antibody or anti-tissue transglutaminase antibodies |
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Causes of Acute Pancreatitis
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GET SMASHD
Gallstones - ETOH, ERCP Trauma -Steroids Mumps Autoimmune Scorpion bites Hyperlipidemia Drugs |
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Physical Exam for Pancreatitis
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- Cullen's Sign - - Periumbilical ecchymoses
- Grey Turner's sign - - Flank ecchymoses, Midepigstric tenderness |
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HAV
Transmission Clinical / Lab Tx |
- Fecal-Oral, contaminated food, water, milk and sellfish.
- No chronic infection - Supportive, immunoglobulin to close contacts without HAV |
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HBV
Transmission Clinical / Lab Tx |
- Infected blood, Sexual contact, perinatally
- Prostitutes and IV drug users - Interferon decrease viral load |
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Which Hepatitis is associated with polyartheritis nodosa
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- HBV
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HCV
Transmission Clinical / Lab Tx |
- Blood or IV drug
- Waxing and waning Aminotrasferases - Interferon + Ribavirin - Cryoglobulinemia -- Membrenoproliferative glomerulonephritis |
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HAD
Transmission Clinical / Lab Tx |
- Coexistent HBV, IV drug users
- Anti-HDV IgM in acute, immunity to HBV implies immunity to HDV - Increase risk of hepatocellular carcinoma |
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Primary Biliary Cirrhosis
- Destruction of ? - Sx - Dx - Tx |
- Destruction microscopic intrahepatic bile ducts
- Fatigue, pruritus, jaundice, fat malabsorption and osteoporosis - Increased Alk Phosphatase, Antimitrocohondrial (AMA) - Ursodeoxycholic acid. |
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Primary Sclerosing Cholangitis
- Destruction of ? - Sx - Dx - Tx |
- Idiophathic intra and extrahepatic fibrosis of bile ducts.
- IBD, usually ulverative colitits - RUQ - Incrased bilirubin and alkaline phosphatase + ASMA, +p-ANCA - Urodeoxycholic acid, cholestryamine |
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Causes of microcytic Anemia
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- Thalassemia
- Iron Deficiency - Chronic disease - Sideroblastic Anemia |
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Mentzer index
- Formula - Purpose |
- MCV / RBC
- Mentzer index > 13 the condition is more likely to be Fe deficiency Anemia |
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Causes of Sideroblastic Anemia
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- Basophilic stippling -- ETOH , Anti tubercular, chloramphenicol, lead poisoning
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Beta thalassemia major Features
BETA THAL D |
- Basophilic stippling
- Excess iron from transfusion - Trasplant, bone marrow - HbA decreased - Tower skull and bony abnormalities - Heart Failure - Anisocytosis - Liver and spleen enlargement - Deferoxamine |
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Folate deficiency common causes
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- Poor dietary intake (Alcoholics)
- Drugs -- Phenytoin, zidovudine, TMP-SMX, methotrexate - |
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B12 Deficiency commonly caused by
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- Vegan diet, Pernicious anemia, gastrectomy, PPIs, ileal dysfunction - IBD, surgical resection.
Look out for neurologic deficits - Liver disease, hypothyroidism, ETOH abuse, myelodysplasia, reticulocytosis |
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Describe lab findings for microangiopathic hemolytic anemia
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Increase Reticulocyte count, increase LDH, increase unconjugated bilirubin, decreased haptoglobin, shistocytes or helmets cells on blood smear
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Describe lab findings for Hereditary spherocytosis
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Increase Reticulocyte count, increase LDH, increase unconjugated bilirubin, decreased haptoglobin, spherocytes, positive family history and negative Coombs test
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Describe lab findings for Autoimmune hemolytic anemia
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Increase Reticulocyte count, increase LDH, increase unconjugated bilirubin, decreased haptoglobin, spherocytes and positive coombs test
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Describe lab finding for G 6 PD
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Increase Reticulocyte count, increase LDH, increase unconjugated bilirubin, decreased haptoglobin, look for infection or drugs, acteristic bite cells
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Describe lab findings of Myelofibrosis
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Increase Reticulocyte count, increase LDH, increase unconjugated bilirubin, decreased haptoglobin,Abnomally activated marrow fibroblasts with subsequent medullary fibrosis, Hepatosplenomegaly, reticulocytosis, teardrop RBCs
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Paroxysmal nocturnal hemoglobinuria mnemonic
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FITS
Flow cytometry to diagnose Intravascular hemolysis Thrombosis Supportive treatment for complications |
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DIC
Defn Causes |
- Systemic activation of the coagulation system stimulated by serious illness
- Sepsis, shock, malignancy, obstetric complications and trauma |
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HUS Triad
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- Hemolytic anemia
- Thrombocytopenia - ARF |
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TTP pentad
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Hemolytic anemia
Thrombocytopenia ARF Fever Fluctuating Neurologic signs |
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Treatment of DIC
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- Treat the underlying condition
- Transfuse platelet, - Give Protein C concentrate or cryoperecipitate - FFP to replace coagulation factors |
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Treatment of HUS
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- Dialysis
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Treatment of TTP
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- Plasmapheresis
- Urget situation give FFP |
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What vaccines should you administer for patient with Spleenectomy
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- Neisserai meningitidis, streptococcus preumoniae, H. Influenzae type B
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Treatment for Acute chest syndrome in Sickle cell disease
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TO AID
Transfusion Oxygen Antibiotics (2nd or 3rd generation chephalosporin with macrolide such as erythromycin) Incentive spirometry Dilators |
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How to Distinguish polycythemia vera from other causes?
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Erythropoietin level - Elevated erythropoietin level excludes the diagnosis of PCV
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Symptoms / exam of PCV
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- Malaise, fever, pruritus, vascular sludging - stroke, angina, MI, claudications)
- Plethroa large retinal veins on funduscopy - Splenomegaly |
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Tx of PCV
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- Serial phlebotomy until hematocrit is <45
- Daily ASA - Hydroxyurea is appropriate for those at high risk of thrombosis Anagrelide - used to decrease platelets in refractory patients |
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Increase in thrombin suggets
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Defects in cross-linking of fibrin such as dysfibrinogenemia or DIC
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Heparin Induced thromocytopenia
- Occurrence - Diagnosis |
- 4-14 days after initiation of heparin
- Platelet factor-4 - Stop heparin and use laternative anticoagulation -- lepirudin, argatroban or danaparoid sodium (not warfarin) |
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Differentials when there is increase aPTT and normal PT
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Heparin use
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Differentials when there is increase PT and normal PTT
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- Early DIC
- Liver disease - Warfarin use - Vitamin K deficiency |
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Differentials when there is increase PT and aPTT
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- Heparin use
- Severe DIC - Severe liver disease - Severe vitamin K deficiency |
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Treatment for von Willebrand's disease
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- No treatment is routinely aquired except before surgical procedures or in the setting of bleeding
- Desmopressin - first line of therapy |
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Screening for Factor V leiden
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- Screened with an activated protein C (APC) and confirmed with Factor V Leiden genotypic mutation assay.
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Indications for lifelong warfarin use
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- 2 or more spontaneous thromboses
- Antithrombin deficiency - Antiphospholipid syndrome - Spontaneous life threatening thrombosis - Thrombosis |
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Treatment for Homocystinemia
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- Vitamin B12 and Folate
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Acute leukemia defn
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- Proliferation of minimally diffrentiated cells - myeloblasts, lymphoblasts and defined as > 20 % blasts in bone marrow ( <20% blasts is defined as myelodysplastic syndrome)
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Chronic leukemia defn
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- Proliferation of more mature diffrentiated cells - metamyelocytes / myelocytes, lymphocytes
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ALL
Symptoms |
- Viral like prodrome -- fever, sore throat and lethargy
- Children present with limpness and refusal to walk - bone pain, easy bruising and fever - Widespread petechiae / purpura - Extramedullary spread -- adenopathy, hepatosplenomegaly, |
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ALL
Dx |
- Leukocyte may be increased or decreased
- Decreased in Platelets - Increased in LDH and uric acid - Blood smear -- predominace of lymphoblasts - Bone marrow biopsy necessary to confirm the diagnosis - CALLA + TdT |
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ALL
Tx |
- Chemotherapy but remember to administer Allopurinol to prevent Tumor lysis syndrome.
- Induction therapy - Vincristine + Prednisone + Daunorubicin - Consolidation thearpy - High dose methotrexate - Maintenance therapy - Methotrexate, 6-mercaptopurine |
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ALL Tx for neutropenia
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- Recombinant human hematopoietic growth factors - G-CSF, GM-CSF
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AML
Symptoms |
- Fatigue, easy bruising anemia, fever, leukemia cutis (small, raised, painless skin lesions), Hx of frequent Infection
- DIC, gingival hyperplasia, petechiae / purpura |
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AML
Dx |
- Increase in myelocytic cell lines, decrease LAP. Hyperuricemia
- Perpheral blood smear predominace of myeloblasts, distinguished by presence of Auer Rods - Confirm via bone marrow biopsy + myeloperoxidase staining |
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AML
Tx |
- All-trans-retinoic acid
- Allogenic bone marrow transplantation considered for patient with poor prognostic factors |
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CLL
Symptoms |
- Usually Indolent disease, diagnosed by incident
- Lymphadenopathy - fatigue and hepatosplenomegaly - Isolated lymphocytosis - Confirm by biopsy - CD5+ expression, smudge cells |
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CLL Tx
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- No treatment for asymptomatic patients
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CML
Sx |
- Look prior radiation and benzene exposure
- CBC - Leukocytosis with myeloid precursors - Fatigue, fever, malaise, - Blast crisis - fever, bone pain, wt loss and splenomegaly |
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CML
Dx |
- Peripheral smear reveals increase WBC, prominent myeloid cells with basophilia
- Decreased LAP and increased B12 levels - Confirm - t (9;22) philadelphia chromosome bcr-abl gene |
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CML Tx
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- Imatinib mesylate (Gleevec)
- Allogeneic BMT in chronic phase |
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Hairy cell leukemia character
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- Malignancy of B cells characterized by cells with hairy cytoplasmic projections.
- Pancytopenia in elderly - CD11c positive - Aplastic anemia and mylofibrosis -- dry bone marrow tap |
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Hodgkin's lymphoma Character
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- Maligancy of neoplastic Reed-Sternberg cells (Bcells)
- EBV infection play a role in pathogenesis |
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Hodgkin's Sx
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- Cervical lymphadenopathy and spreads in a predictable manner along the lymph nodes
- Wt loss in six months, night sweats, fever |
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Hodgkins Dx
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- Biopsy of an enlarged lymph node
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Hodgkin's Tx
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ABVD cocktail
Adriamycin - Doxorubicin Bleomycin Vinblastine Dacarbazine |
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Non-Hodgkin's lymphoma
Associated with |
- EBV with Burkitt's lymphoma;
- HIV with CNS lymphoma - HTLV - T-cell lymphoma - H pylori with gastric MALToma |
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Non-Hodgkin's lymphoma
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- CHOP Thearpy
- Cyclophosphamide, - Hydroxydoxorubicin - Vincristine - Prednisone R-Chop - Rituximab |
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Multiple Myeloma is
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Malignancy of plasma cells within bone marrow, often with unbalanced excessive production of immunoglobulin heavy /light chains
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Multiple myeloma Sx
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- Back pain, hypercalcemic symptoms, pathologic fractures, fatigue and frequent infections
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Waldenstrom's macroglobulinemia is
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A plasma cell disroder that si similar to MM but has predominance of IgM, presents with visual disturbance, dizziness, headache
Tx: Urgent plasmapheresis |
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Multiple Myeloma Dx
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- Bence jones proteins
- Full body skeletal survey - Punched out osteolytic lesions |
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Multiple Myeloma Tx
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- Chemotherapy -- Melphalan and steroids +/- thalidomide or bortezomid
- Autologous stem cell trasplantation more than 60 years - Hypercalcemia - Hydration glucocoritocids and diuresis - Bone pain / distruction / fractures -- Bisphosphonates and local radiation - Renal failure -- Hydration - Anemia -- Erythropoietin |
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Inflammatory breast Cancer is
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A highly aggressive, rapidly growing cancer that invades the lymphatics and causes skin inflammation
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Paget's disease is
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Ductal carcinoma in situ of the nipple with unilateral itching, burning and nipple erosion.
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Lobular Carcinoma in situ Tx
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- Matectomy or use of Tamoxifen for prophylaxis
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Pancoast's syndrome is
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- Shoulder pain
- Horner's syndrome - Miosis, ptosis, anhidrosis) - Lower brachial plexopathy |
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The 3 C's of squamous cell Carcinoma
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- Central
- Cavitary - HyperCalcemia |
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Non-small cell lung Cancer types
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- Adenocarcinoma
- Adenocarcinoma, bronchoalveolar - Squamous cell carcinoma - Large cell Carcinoma |
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Characterized by swelling on the face and arm, most often on the right side, elevated JVP. Treated with Radiation therapy
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- Superior vena cava syndrome
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Paraneoplastic syndromes
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CLASH
Carcinoid Lambert-Eaton syndrome ACTH SIADH Hypercalcemia |
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Carcinoid tumor Tx
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Surgical resection
Octreotide for symptomatic control |
