K Hematology Iii And Gastroenterology I

Front 1

Differences Between HL and NHL

Back 1

Hodgkin lymphoma is usually one group of lymph nodes that centers around the cervical area. On pathology there is a presence of Reed Steinberg cells. Lymphocyte predominante has good prognosis. Lymphocyte depleted worst prognosis.

Front 2

Treatment of HL

Back 2

Radiation for stage 1 and 2.
Stage III, IV, or presence of B symptoms
Doxorubacin, bleomycin, vincristine, dacarazine.

Front 3

Complications of Radiation and Chemotherapy Treatment

Back 3

Radiation increases the risk of solid tumors of lung, or breast. Chemotherapy increases the risk of MDS, NHL, and leukemia, 1% risk per year.

Front 4

Doxorubicin ADE

Back 4

Cardiomyopathy

Front 5

Vincristine ADE

Back 5

Neuropathy

Front 6

Bleomycin ADE

Back 6

Lung fibrosis

Front 7

Cyclophosphamide ADE

Back 7

Hemorrhagic Cystitis

Front 8

Cisplatin

Back 8

Renal and ototoxicity.

Front 9

Multiple Myeloma Presentation

Back 9

Is a plasma cell dyscrasia that results in the overproduction of IgG or IgA. IgM is known as waldrenstrom's macrogloburemia. Presents with back pain from lytic bone lesions that are due to the over secretion of osteoclast activating factor. Also hypercalcinosis, anemia, renal insufficiency from bence-jones protiens, and hyperuricemia from cell turnover. Rouleux

Front 10

Best Initial Test for Multiple Myeloma

Back 10

X-ray followed by serum protein electrophoresis.

Front 11

Anion Gap and Multiple Myeloma

Back 11

Anion gap is smaller due to the positively charged IgG.

Front 12

Dipstick and Bence Jones Proteins

Back 12

Not picked up by dipstick.

Front 13

Technetium Bone Scan and MM

Back 13

Lytic lesions on bone will not be picked up by lytic sites so appears normal.

Front 14

Most Accurate Test for Multiple Myeloma

Back 14

Bone marrow biopsy

Front 15

Best Initial Therapy for Multiple Myeloma

Back 15

Dexamethasone with lenalidomide.

Front 16

MGUS

Back 16

Monogammapathy of unspecified significance is an Ig spike on SPEP. A bone marrow biopsy is done to see if it is mulitple myeloma.

Front 17

Waldenstrom Macroglobulinemia Presenation

Back 17

Is caused by IgM over secretion in a pentad formation. Presents with lethargy, blurry vision, engorged blood vessels of the ye, mucosal bleeding, and raynaud phenomenon. No bone lesions.

Front 18

Best Intial Therapy of Waldenstrom

Back 18

Plasmaphoresis.

Front 19

Other Treatment for Waldenstrom

Back 19

Chlorambucil or fludarabine and prednisone.

Front 20

Presentation: Platelet Bleeding or Factor Bleeding

Back 20

Platelet bleeding is superficial found as epistaxis, gingival, petechiae, purpura, or mucosal surfaces. Factor bleeding is deeper in the joints and muscles.

Front 21

ITP Presentation

Back 21

Idiopathic thrombocytic purpura is the most likely diagnosis when there is isolated thrombocytopenia and spleen is normal.

Front 22

Best Initial Treatment for ITP

Back 22

In minor bleeding prednisone. Major bleeding (GI or CNS) or less than 10,000 then IVIG and Anti-rho. Reccurent episodes splenectomy.

Front 23

Diagnosis of ITP

Back 23

Diagnosis of exclusion. U/S of spleen. Megkaryocytes are elevated in number.

Front 24

Alternate Treatments of ITP

Back 24

Rituximab. Azthioprine. Cyclosporine. Mycophenolate.

Front 25

Vaccines and Splenectomy

Back 25

Give menigococcal, pneumococcal, and h. influenza.

Front 26

Most LIkely Diagnosis Von Willenbrand

Back 26

Bleeding such epistaxis with normal platelet count. Worsened after aspirin use.

Front 27

DIagnostic Tests and Von willendbrand Disease

Back 27

Increased bleeding time with normal platelet count. VWF decrease. Ristocetin cofactor assay.

Front 28

Best Initial Treatment of VWF

Back 28

DDAVP. If fails then Factor VIII or VWF replacement.

Front 29

Hemophillia Presentation

Back 29

Is an x-linked recessive disease caused by factor VIII deficiency. Patient will have normal BT and PT, but prolonged PTT. Mixing with normal plasma will correct PTT.

Front 30

Best Initial Treatment of Hemophillia

Back 30

Desmopressin. IF that fails or severe bleeding factor VIII or IX replacement.

Front 31

Most Accurate Test for Hemophillia

Back 31

Specific assay for Factor IX or VIII

Front 32

Factor XII Deficiency

Back 32

Elevated aPTT, but no bleeding.

Front 33

Presentation of DIC

Back 33

Is due to low clotting factors and thrombocytopenia. Occurs in sepsis, placenta abprupto, burns, snake bites, tissue trauma releasing factor VII, and cancer.

Front 34

DIagnostic Tests and DIC

Back 34

Elevated PT and PTT. Thrombocytopenia. Increased d-dimer and split products. Decreased fibrinogen.

Front 35

Treatment of DIC

Back 35

Fresh frozen plasma. Cryopercipate can help in replacing fibrinogen levels.

Front 36

Factor V Mutation

Back 36

Results in hypercoaguability. Use warfarin to INR of 3 to 2 for 6 months.

Front 37

Heparin Induced Thrombocytopenia Presentation

Back 37

Occurs more with heparin. Will occur within 5 to 10 days of initiation of treatment. Can form venous and arterial thrombosis. Rarely leads to bleeding, platelets just percipate out.

Front 38

Diagnositc Tests for HIT

Back 38

ELISA for Platelet factor 4 antibodies.

Front 39

Treatment of HIT

Back 39

Stop heparin, no LMWH either. Thrombin inhibitors such as lepirudin, argatroban, and bivalirudin, then warfarin.

Front 40

When to Perform Endoscopy

Back 40

Weight Loss. Blood in Stool. Anemia

Front 41

Dysphagia

Back 41

Difficulty swallowing.

Front 42

Odynophagia

Back 42

Pain when swallowing.

Front 43

Achalasia Most LIkely Diagnosis

Back 43

Is when LES constricts to much. Occurs in patients under 50, Difficulty with both liquid and solid diet. No association with alcohol and tobacco use.

Front 44

Most Accurate Test for Achalasia

Back 44

Manometry.

Front 45

Best Initial Test for Achalasia

Back 45

barium esophagram will show bird's beak.

Front 46

Esophagus and Biopsy

Back 46

Only cancer and barretts esophagus are diagnosed via biopsy.

Front 47

Treatment of Achalasia

Back 47

Pneumatic dilation works in 85%. Botulinum injection into LES. Surgical myotomy to alleviate symptoms.

Front 48

Esophogeal Cancer Most Likely Diagonsis

Back 48

Patient is over 50. Initially has difficulty swallowing solids, but then liquid. Usually has history alcohol or tobacco usuage. GERD symptoms for 5 years.

Front 49

Diagnostic Tests and Esophageal Cancer

Back 49

Barium esophogram best initial. Endoscopy is needed for biopsy. MRI, CT tell if the cancer has spread. PET tells if cancer is present in an anatomical lesion.

Front 50

Treatment of Esophageal Cancer

Back 50

Surgery, with out it no cure. Chemo and radiation in addition. Stent placement is pallative.

Front 51

Esophageal Spasm Presentation

Back 51

Patient will present with sudden onset of chest pain not releated to exertion. May be brought on by drinking cold liquid. EKG and stress test will be normal. Esophogram and endoscopy will be normal.

Front 52

DES vs. Nutcracker Esophagus

Back 52

Diffuse endoscopic spasm and nutcracker esophagus can only be distinguished with manometry.

Front 53

Treatment of Esophageal Spasm

Back 53

Calcium channel blockers and nitrates.

Front 54

Best Initial Treatment of Esophageal Candidiasis

Back 54

Fluconazole.

Front 55

Plummer Vison Syndrome

Back 55

Esophageal webs. Glossitis. Iron deficiency anemia.

Associated with squammous cell carcinoma.

Front 56

Schatzki Ring

Back 56

Associated with GERD and hiatal herina. Easily detected on barium studies. Associated with intermittent dysphagia.

Front 57

Treatment of Schatzki

Back 57

Pneumatic dilation.

Front 58

Treatment of Plummer Vision Syndrome

Back 58

Treated with iron supplementation.

Front 59

Zenker Diverticulum Presentation

Back 59

Is an outpocketing of the posterior pharyngeal constrictor muscles resulting in hallitosis, dysphagia, and regurgitation of food particles.

Front 60

Diagnosis of Zenker Diverticulum

Back 60

Barium studies.

Front 61

Manometry Best Test for

Back 61

Achalasia. Scleroderma. Spasm.

Front 62

Mallory Weiss Tear

Back 62

Occurs after repeated vomiting or wretching followed by hematesis and melena.

Front 63

Most Common Cause of Epigastric Pain

Back 63

Non-ulcer dyspepsia

Front 64

Epigastric Pain Worse With Food

Back 64

Gastric ulcer

Front 65

Pain Better With food

Back 65

Duodenal ulcer.

Front 66

Epgastic pain and Weight Loss

Back 66

Cancer. Gastric ulcer.

Front 67

Epgastric pain and tenderness

Back 67

Pancreatitis.

Front 68

Epigastric Pain with Bad Taste

Back 68

GERD

Front 69

Epigastric Pain with Diabetes and Bloating

Back 69

Gastroparesis.

Front 70

Best Treatment for Dyspepsia

Back 70

PPIs. Followed by H2 inhibitors and liquid antacids.