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85 Cards in this Set

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1.How can you tell an anaphylactic rxn to blood transfusion?
2.what condition can predispose to this
3.Tx
1.rapid onset of symptoms
2.IgA def.
3. stop transfusion, Epi, IVF, Vasopressor
*HY*
causes of folic acid deficiency
1. MCC of poor diet &/or ROHism
2. Drugs: phenytoin, TMP-SMX
sickle cell spherocytosis and folic acid relationship
any pt. with a chronic hemoytic anemia and compensatory reticulocytosis has >ed demand for folic acid and will have folic acid def.
So, supplement with folic A.
Anemia of chronic kidney dz
1. Tx
2. why would you see microcytic anemia
1. EPO +Iron supplement
2. because EPO -> surge in iron use. so, need to supplement the body's iron stores
Pt. w/ DVT started on LMWH or heparin.
1. what could the med predispose her to?
2. Tx for this
1. Arterial or venous thrombosis = HIT
2. discontinue current tx! and begin anticoagulation w/ a direct thrombin inhibitor (ex argatroba or lepirudin)
Pt. underwent GI Qx and has been kept NPO for several days. Begins bleeding from venipuncture site. ^PT>>^PTT.
1.what's the cause?
2.Tx?
1. Cause is Vt. K def from pt. being NPO for pronlonged period of time and receiving broad spec abx
2. FFP for management of acute hemorrhage + K supplement.
What does warfarin cause a decrease in (clotting factors)?
10, 9, 7, 2, and prot C and S
tumor lysis syndrom:
1. what causes it?
2. Labs
3. Tx
1. lymphomas (burkitt's) and leukemias (esp. ALL)
2. "PU!": PPU: Hyperkal, hyperphos (bc. they're both intracellular ions that are released with the breakdown of cells), hypocal (bc. phos binds to it), hyperuricemia (from degradation of cell's proteins)
3. Allopurinol to < urate nephropathy and Tx the electrolyte abnormalitites to prevent fatal arrhuthmias, acute renal failure, and sudden death
if you suspect bone mets (ex. prostate mets to spine -> cord compression)
what do you do?
MRI to confirm Dx and glucorticoid tx while awaiting test results (in order not to risk permanent neurologic damage)
Basal cell CA
1. warning signs
2. Tx
1. (1) open sore that bleeds, oozes or crusts
(2) shiny bump or pearly nodule
(3) poorly defined borders
2. burning it freezing it or cutting it off
Impotant: with 1-2 mm of clear margins!
competitive athlete with elevated hematocrit level?
illegal doping with androgens, autologous blood transfusions, or EPO abuse.
androgens will have addtional SEs: gynecomastia, decreased teste size, hepatotox
How to tx maltoma
they regress after eradicating H. pylori w/ abx therapy
antiphospholipid ab syndrome
1. labs
2. what does this syndrome cause?
3. Tx
1. false pos VDRL, prolonged PTT, and thrombocytopenia
2. arterial and venous thromboses -> spont abortion
3. prophylaxis with low does ASA and LMWH to avoid pregs loss
differential dx for anterior mediastinal mass :
(4Ts):
thymoma, teratoma, thyroid neoplasm, terrible lymphoma
In what coagulation cofactor(s) is a person with CF deficient?
10, 9, 7, 2, and proteins C and S
bc Vit K (fat absorbed vit) def.
1.what kind of CA should you suspect in an alcoholic smoker who presents with a palpable cervical lymph node?
2. best initial test?
1.squamous cell carcinoma of the mucosa of head and neck
2. panendoscopy = esophagoscopy, bronchoscopy, laryngoscopy
anemia of chronic dz (ACD)
1. how do you treat it?
1. tx underlying disorder. ex. in rheumatoid arthritis treat the underlying disorder with infliximab for example
2. chronic inflamm dz. rheumatoid arthritis (not osteoarth which isn't an inflam dz) , infxns, CA, autoimmune disorders
what should you suspect and do in pt. who smokes that presents with Horner's syndrome?
1st step is CXR to check for lung CA
giant cell tumor of bone
1. who is it in?, where in the bone?
2. histo description
3. is it dangerous?
4.Tx?
1. 20-40 yo women,in epiphyseal end of long bone
2. oval or spindle shaped cells mixed in with multinuclear giant cells in fibrous stroma.
3. benign but locally aggressive~
refer to orthopedic surgeon (refer all bone tumors to orthopedist)
trousseau's syndrome:
1. =
2. MC tumor assoc.d with
3. where is the CA found (Most likely to least)
4. im;portant clue for the underlying carcinoma
5. 1st step to Dx
1. migratory thrombophlebitis usually assoc. w/ occult tumor
2. adenocarcinoma
3. pancreatic > lung > stomach > leukemia > colon
4. thrombophlebitis of atypical sites ex. thrombophleb in arm and chest w/ GI symptoms would clue you into pancreatic CA
5. CT scan abdomen
classic radiologic findings of bone tumors:
1. osteosarcoma
2. Ewing's
3. giant cell tumors
1. codman's triangle and sunburst appearance
2. onion screening in diaphysis
3. soap bubble appearance
1. what is senile purpura
2.cause of senile purpura
1. bruises on dorsum of hands and forarms commonly
2. perivascular connective tissue atrophy
Febrile neutropenia:
1. is it dangerous?
2. what do you do?
3. definition
4. who is it seen in?
1. it's a medical emergency
2. admit pt., get blood Cx, start empiric abx (IV ceftazidime or cefepime: should cover pseudomonas)
3. single temperature of > 101.3 F or sustained low grade in a neutropenic (absolute neutrophol count < 500 cells/mm3) pt.
4. immunocompromised (ex. pt. undergoing chemo)
How to prevent pneumococcal sepsis in patients with sickle cell anemia
Pneumococcal vaccine + penicillin prophylaxis to kids until 5 yrs old
SCD pt getting splenectomy. how long will they have worry *HY*
about risk for pneumococcal sepsis?
current recommendations to prevent it?
>30 years
should receive anti-pneumo, haemophilus, and miningococcal vaccines several weeks b4 operation and daily oral penicillin prophylaxis for 3-5 years after splenectomy
*HY*
1.Management of solitary brain Mets with stable extracranial dz.
2. management of multiple brain mets
1. surgical rsxn followed by whole brain radiation
2.whole brain radiation
what causes pancytopenia in SLE?
formation of autoAbs against blood cells - Type II hypersensitivity rxn
Glucagonoma:
1. triad
2. dangerous?
3. how to dx
4. Tx?
1. (1) hyperglycemia, (2) necrotizing dermatitis (3) wt. loss
2. usually malignant w/ mets to liver
3. ^fasting glucose and serum glucagon levels + pancreatic tumor on CT
4. Qx (it doesn't respond to chemo)
1.How do you test for spherocytes
2.difference btwn autoimmune hemolytic dz (AIHI) vs hereditary spherocytosis
1. osmotic fragility test
2. both are extravascular hemolytic anemias. both show spherocytes.
AIHI - is acquired, positive coomb's test
spherocytosis - auto dom., Neg coomb's test
CML
1. chromosome, translocation, gene
2. what does the gene mutation cause
3. Tx
4. LAP?
1. philadelphia chromo, (9,22), BCR-ABL
2. abnormal tyrosine kinase activity
3. tyrosine kinase inhibitors (imatinib, gleevec
4. LAP low (leukocyte alka phosphatase) (in normal individual LAP is high in infection)
1. how to treat nausea in chemo pt.s
2. how to treat anorexia in chemo pt.s
1. ondansetron (5-HT3 receptor antagonist)
2. progestins and corticosteroids
trastuzumab
1. aka
2. txs what?
3. SE
4. what do you do before beginning tx
1. herceptin
2. Her2 pos breast CA
3. cardiotoxicity
4. echocardiogram to make sure pt. doesn't have low Ejxn Frxn
young woman with cystic, firm, moveable rubbery mass in her breast. what do you do?
1. FNA
2. if clear fluid from FNA and FNA causes mass to disappear then next step is to: observe for 4-6 weeks
macro-ovalocyte
megaloblastic anemia (also hypersegmented PMNs)
acanthocyte
ie spur cell
spiny appearance
(diff btwn spur and burr cell: burr cells have central pallor, spurs don't)
target cell
HALT:
HbC dz, Asplenia, liver dz, thalassemia
poikilocytes
TTP/HUS, DIC
Burr cells
spiky with central pallor
TTP/HUS
ITP vs. TTP
TTP = low platelet, low brain, low kidney. vWF esterase def.
ITP = low platelet. dx of exclusion. autoimmune: antiplately Abs
(PT and PTT not affected in either: doesn't affect clotting factors)
Hemophilia A
factor Ate (8) deficiency
Desmpopressin (ADH) treats it
^PTT
Hemophilia B
factor 9 deficiency
christmas dz
^PTT
vWF dz
von willibrand factor dz, factor 8 affected and defect in platelet adhesion
treated by OCPs or ADH
^BT and ^PTT
Factor V Leiden mutation
-> Pulmonary embolism
Multiple Myeloma
CRAB
Calcemia
Renal failure
Anemia
Bone lesions
Dx: w/ serum protein electroporesis
Mspike of gamma globulin. Ig light chains in urine (Bence Jones protein)
Waldenstrom's macroglobulinemia
IgM spike -> hyperviscosity symptoms (no bone lesions)
Microcytic anemia
MCV<80
LITtle CS = Lead, Iron, Thallessemia, Chronic dz, Sideroblastic
Basophilic stippling
TAAIL = Thallessemia, Alcohol, Anemia of chronic Dz, Iron, Lead
Acquired sideroblastic anemia
Cider and Ale = Sider and AIL
Alcohol, Isoniazide, Lead
Tx for acquired = EPO
Tx for hereditary = Vit B6
who has elevated reticulocytes
thalassemia and SCD
what is salvage therapy
tx for dx. when the standard therapy has failed. ex. radiation therapy for prostate-specific Ag recurrence after radical prostatectomy for prostate CA
Adenocarcinoma of the lung
- MC type of lung CA in nonsmokers and smokers
-has the least assoc. w/ smoking
-peripheral location in lungs
-bronchoalveolar is most important: related to pulmonary scars like in fibrosis
- Mets early to adrenals, bone, CNS
Multiple hamartoma syndrome
- ie Cowedn syndrome
-assocd w/:
GI tract hamartomas + breastCA + thyroid CA+ nodular gingival hyperplasia
Cronkhite-Canada syndrome
assoc. w/ juvenile polyps + alopecia+hyperpig+nail loss (onycholysis)
Polycythemia
1. def
2. MCC in infants
1. HCT > 65%
2. transient respiratory distress or CNS disturbance <- excess transfer of placental blood <- delayed clamping of umbilical cord
CD4 < 200
Cs:
Candida esophagitiis, Cervical CA, PCP, Tb, bacterial pneumonia (strep pneumo, H. influe)
CD4<500
Kaposi's , parasitic diarrhea (isospora, crypto sporidium),
CD4 < 150
HIstoplasmosis
CD4 < 100
toxoplasmosis, lymphoma (CNSor non-Hoddgkin's), JC virus
CD4 < 50
crypto meningitis, CMV, MAC
ALL
PAS +
TDT +
abundant blasts
imatinib
AML
stains with myeloperoxidasse
> 30% Blasts
aur rods
retinoic acid receptor Tx with vit A
Cytarabine, Ara-C
PML : the only leukemia assoc.d w/ DIC
CLL
> 65 yr old
smudge cells
aka small lymphocytic lymphoma
Dx confirmed with flow cytometry
thrombocytopenia indicates a poor prognosis
HNPCC : hereditary nonpolyposis colorectal cancer criteria:
3 relatives, 2 generations, 1 case dxed @ < 50 yo
MCHC
elevated: spherocytosis
low: microcytic anemias
Tx in SCD pt. w/ stroke
exchange transfusion and continue hydroxyurea
dx ing Multiple myeloma
serum protein electrophoresis (ie serum immunoelectrophoresis) and urine protein electrophoresis : detect high M protein and Bence Jones protein
48 yo Pt. comes in w/ microcytic anemia and depressed serum iron and ferritin levels. what do you do?
Test for occult blood in stool
MCC of iron-def anemia in adult male or post menopausal woman = chronic GI blood loss
post splenectomy pt.s are increased risk from encap orgs (exs) why?
strep pneu, H influ, N. gono
because of impaired Ab-mediated opsonization in phagocytosis
post splenectomy pt.s are increased risk from encap orgs (exs) why?
strep pneu, H influ, N. gono
because of impaired Ab-mediated opsonization in phagocytosis
hemolytic anemia:
1. labs
2. causes
1. <ed haptoblovin, >ed LDH and bili
2. microangiopathic : DIC, HUS, TTP
and due to destruction by prosthetic cardiac valves or calcified valves
howell-jolly bodies
single, round, blue inclusions on Wright stain
suggesting splenectomy
Splenomegaly:
when do you see it?
-hemolytic anemais
-portal HTN (when combined w/ caput medusa)
-leukemias and lynphomas
-etc.see wiki
Myasthenia Gravis is suspected what do you do in sequence
1. electromyography and nerve stim
2. acetycholine receptor Ab test
3. CT of chest (possible thymoma)
Hairy cell leukemia
-TRAP stain (tartrate-resistant acid phosphatase)
-CD11c marker
-cladribine ie chlorodeoxyadenosine (2CDA)
MGUS
-dx criteria
-what is the risk of MM?
-what is in indicator of MGUS?
-criteria for dx are the absence of findings suggestive of multiple myeloma:
absence of anemia, lytic bone lesions, hypercalcemia, and renal insufficiency (CRAB)
-risk progression to MM
-monoclonal IgG on serum protein electrophoresis
-why will you see possible DVT or misscarriages in a SLE pt.
-what will lab test show?
-specific test for this ?
lupus anticoagulant is an IgM or IgG immunoglobulin that binds phospholipids (hence antiphosph)
-prolonged PTT
-Russell viper venom test
Pt. w/ breast cancer has carcinoma removed and is having breast conserving surgery. What's next and to be expected
-since it is breast conserving surgery she'll need radiation therapy and adjuvant chemo
-FISH (fluorescent in situ hybridization) or IHC (immunohistochemical) staining---- to tell you the level of HER2 expression
which tells you to use trastuzumab and anthracycline chemo
squamous cell carcinoma
1. how do you confirm dx
2. causes
3. type of cell
1. punch bx
2. arsenic, burns, carcinogens (tobacco), sun
3. keratinocytes
leukocyte alkaline phosphatase score
-high in leukemoid rxns due to infxn or inflammation
- generally low in CML unless infxn also present (check for phil chromo)
Pt. w/ advanced prostate CA w/ bony mets complaining of back pain . what do you do?
Radiation therapy- manages bone pain in pts with prostate CA who've undergone orchiectomy
TTP-HUS
1.characteristics
2. next step
3. cause
4. Tx
1. fragmented cells in peripheral smear suggests microangiopathic hemolytic anemia- a characteristic finding
thrombocytopenia+renal failure+neuro symptoms
2. peripheral blood smear looking for schistocytes
3. def. of autoAb against vWf protease (ADAMTS-13)
4. emergent plasmapheresis -removes offending Abs
Pernicious anemia
-happens in setting of other autoimmune conditions (ex. vitiligo, autoimm thyroid dz)
- Can't happen with veganism alone!
osler weber rendu
AD, telangiectasias+ recurrent epistaxis + AVMs
Paget's dz of the breast
1. when do you suspect it?
2. what is pt. at risk for?
3. what do you see on histology
1. pt. w/ no prior history of skin dz who presents with eczematous rash near the nipple that doesn't improve w/ topical tx.s
2. breast adenocarcinoma
3. large cells surrounded by clear halos
heterophile Ab test
test for mononucleosis
EBV - (+) test
CMV- (-) test