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174 Cards in this Set

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next step in mgmt:
25 y/o man dx'd with a solitary testicular mas by US

orchiectomy
classic findings of HSP
palpable purpura

GI sx's (e.g. abd'l pain, vomiting, guaiac+, intussusception)

renal disease

transient arthritis/arthralgias
What variables shift the Hb-O2 dissociation curve to the right
"CADET-face RT"

C: incr'd
A: incr'd altitiude/acid (i.e. decr' pH)
D: incr'd DPG3
E: exercise
T: incr'd temp
what effect does a right shift on Hb-O2 curve have
Incr'd delivery of O2 to peripheral tissues
what is cause of anemia that develops after taking a sulfa drug
G6PD deficiency
what lab markers suggest anemia due to hemolysis
decr'd H&H with incr'd retics
normal MCV
decr'd haptoglobin
incr'd indirect bilirubin
incr'd LDH
in hemolytic anemia, why is serum haptoglobin level der'd & serum LDH increased
Haptoglobin binds free Hb in blood

LDH spills out of hemolyzed RBC's
characteristic findings in hereditary spherocytosis
jaundice & gallstones (2nd/2 elevated bilirubin)

splenomegaly

anemia with incr'd retics & MCHC

spherocytes on peripheral smear

positive osmotic fragility test
spherocytosis is a/w higher incidence of what lab abnormality
pseudohyperkalemia
(2nd/2 K+ spilling into blood when RBC's lyse after blood draw)
tx of hereditary spherocytosis
folic acid 1mg qD

splenectomy (moderate to severe cases)

RBC transfusion (extreme cases)
Rx for diarrhea 2nd/2 E. histolytica
metronidazole (+ hydration)
Rx for diarrhea 2nd/2 G. Lamblia
metronidazole (+ hydration)
Rx for diarrhea 2nd/2 salmonella
quinolones or TMP-SMX (+ hydration)
Rx for diarrhea 2nd/2 shigella
quinolones or TMP-SMX (+ hydration)
Rx for diarrhea 2nd/2 campylobacter
erythromycin (+ hydration)
Rx for mild persistent asthma
ACUTE TX:
short-acting B2-agonist (i.e. albuterol)
IV corticosteroids (for persistent sx's)

LONG-TERM CONTROL:
albuterol, prn
inhaled glucocorticoid
+/- leukotriene inhibitor (e.g. cromolyn)
what is charcots triad indicative of & what are the components
Dx: cholangitis

TRIAD:
jaundice
RUQ pain
Fever
what is reynold's pentad indicative of & what are the components
Dx: cholangitis

PENTAD:
jaundice
RUQ pain
Fever
hypotension
AMS
Iron Def Anemia:
serum iron
ferritin
transferrin
Fe/TIBC
serum iron: decr'd
ferritin: decr'd
transferrin: incr'd
Fe/TIBC: < 12%
Anemia of chronic disease:
serum iron
ferritin
transferrin
Fe/TIBC
serum iron: decr'd
ferritin: incr'd
transferrin: decr'd
Fe/TIBC: > 18%
what is seen on blood smear of a patient with lead poisoning
microcytic

hypochromic

basophilic stippling
RBC disorder a/w:
schistocyte (fragmented RBC)
hemolytic anemia
DIC
TTP
HUS
RBC disorder a/w:
acanthocyte (spur cell)
abetalipoproteinemia
RBC disorder a/w:
bite cell
G6PD def
RBC disorder a/w:
basophilic stippling
lead poisoning
B-thalassemia
alcohol
RBC disorder a/w:
peripheral neuropathy and ringed sideroblastic in BM
lead poisoning
RBC disorder a/w:
hypersegmented neutrophils
folate/B12 def
RBC disorder a/w:
heinz bodies (denatured Hgb in RBC)
G6PD def
RBC disorder a/w:
burr cells
uremia
MCV & anemia a/w:
mental status changes, neuropathy, constipation
microcytic

lead poisoning
MCV & anemia a/w:
heavy menses, strict vegetarians, ice pica
microcystic

iron def
MCV & anemia a/w:
dark urine, jaundice, hepatosplenomegaly
normocytic

hemolytic anemia
MCV & anemia a/w:
alcoholic, malnourished
macrocytic

folate/B12 def
what virus can cause aplastic anemia as well as erythema infectiosum disease (i.e. "fifth disease")
Parvovirus B19
what test is used to rule out urethral injury
retrograde cystourethrogram
lipid-lowering agent:
SE = facial flushing
niacin
lipid-lowering agent:
SE = elevated LFT's, myositis
statins

fibrates
lipid-lowering agent:
SE = GI discomfort, bad taste
bile acid sequestrants
(e.g. cholestyramine)
lipid-lowering agent:
best effect on HDL
niacin
lipid-lowering agent:
best effect on TG's
fibrates
lipid-lowering agent:
best effect on LDL/cholesterol
statins
lipid-lowering agent:
binds C. Diff toxin
cholestyramine
which types of thalassemias are most commonly a/w pts of Mediterranean & AA/Asian descent
MEDITERRANEAN: B-Thal

AA/ASIAN: a-Thal
What complication occurs in 10% of pts with sideroblastic anemia
myelodysplastic syndrome (aka "refractory anemia)
--> acute leukemia
Besides Staph Aureus, which organism may be responsible for osteomyelitis in a sickle cell pt
salmonella
Which vaccines are particularly important in children with sickle cell disease
HiB

Pneumoccal

Meningococcal

Influenza

Hep B
What medication is used in the long-term management of sickle cell anemia
Hydroxyurea
drugs a/w elevated prolactin levels
METHYLDOPA

PSYCHIATRIC DRUGS
phenothiazines
haloperidol
risperidone
what substances cause hemolysis in px with G6PD def
primaquin
dapsone
sulfonamides
fava beans
isoniazid
nitrofurantoin
high-dose ASA
when would you expect eosinophillic casts in urine
acute interstitial nephritis, AIN
(i.e. allergic interstitial nephritis)
differential dx for eosinophilia
"DNAAACP"

D = drugs (e.g. NSAIDS, PCN's/Ceph's)
N = neoplasms
A = allergies/asthma (churg-strauss), allergic bronchopulmonary aspergillosis
A = adrenal insufficiency (Addison's)
A = AIN (allergy-induced)
C = CVD's (e.g. PAN, dermatomyositis)
P = parasites (e.g. strongyloides, Ascaris --> Loeffler's eosinophilic pneumonitis)
what is the management in a px with febrile neutropenia due to chemo
admit
culture
start broad-spectrum antibiotics
(e.g. cefepime/ceftazidine)
what type of infection causes eosiniphilia
parasitic
immunoglobulin a/w eosinophilia
IgE
what type of hypersensitivity is good pasture
type II HSN
what is the treatment for type II hypersensitivity
anti-inflammatories

immunosuppressives (e.g. corticosteroids)

possibly plasmaphoresis
most important medication for anaphylaxis
epinephrine
Tx for anaphylaxis
ABC's
stop offending agent
epinephrine IM or IV (for AW obstruction)
H1/H2 blockers (for cutaneous sx's)
bronchodilators
steroids
IVF's (for hypotension)
Dx
45 yo with acute flank pain and hematuria
nephrolithiasis
MCC of aortic stenosis in 50 y/o
congenital bicuspid aortic valve
MOA:
streptokinase
activates tissue plasminogen --> cleaves fibrin clots
MOA:
aspirin
Cox-2 inhibitor --> blocks plt aggregation
MOA:
clopidogrel
inhibits ADP receptor
MOA:
abciximab
Gp2b3a Inhibitor
MOA:
tirofiban
Gp2b3a Inhibitor
MOA:
ticlopidine
inhibits ADP receptor
MOA:
enoxaparin
LMWH --> inhibits CF Xa
MOA:
eptifibatide
Gp2b3a Inhibitor
classic triad of HUS
hemolytic anemia
uremia
thrombocytopenia
what is the pentad of TTP
hemolytic anemia
uremia
thrombocytopenia
neurologic sequelea
fever
lab test to monitor:
warfarin
PT/INR
lab test to monitor:
heparin
PTT
lab test to monitor:
LMWH
doesn't need monitoring
(h/w it can be monitored with anti-CF Xa)
drugs known to cause thrombocytopenia
heparin (HIT)

abciximab (GP2b3a inhibitor)

carbamazepine, phenytoin, valproate

cimetidine

acyclovir, rifampin

sulfonamides
(e.g. sulfasalazine, TMP-SMX)

procainamide, quinidine

quinine, gold compounds
1st line Rx for vWD
desmopressin, DDAVP (increases vWF secretion)
Rx for vWD that is severe or refractory
cryoprecipitate or Factor VIII
Rx for vWD with menorrhagia
OCP
MCC's of DIC
"STOP Making Thrombi"

S = sepsis
T = trauma
O = OB complications
P = pancreatitis

M = malignancy

T = transfusions
PLT's, BT, PT, PTT:
HUS/TTP
PLT's: decr'd
BT: incr'd
PT: normal
PTT: normal
PLT's, BT, PT, PTT:
hemophilia A or B
PLT's: normal
BT: normal
PT: normal
PTT: incr'd
PLT's, BT, PT, PTT:
vWD
PLT's: normal
BT: incr'd
PT: normal
PTT: incr'd
PLT's, BT, PT, PTT:
DIC
PLT's: decr'd
BT: incr'd
PT: incr'd
PTT: incr'd
PLT's, BT, PT, PTT:
warfarin use
PLT's: normal
BT: normal
PT: incr'd
PTT: incr'd
PLT's, BT, PT, PTT:
aspirin
PLT's: normal
BT: incr'd
PT: normal
PTT: normal
PLT's, BT, PT, PTT:
end stage liver disease
PLT's: normal/decr'd
BT: normal/incr'd
PT: incr'd
PTT: incr'd
what is the MC mutation that predisposes white pt's to venous thrombosis
Factor V Leiden mutation
Dx & Tx:
post-op pt with poor urine output, BUN 85, Cr 3 & clear lungs
Dx: Prerenal azotemia (2nd/2 dehydration)

Tx: IVF's
what infection causes aplastic crisis in sickle cell pt's
Parvovirus B19
Dx:
pt presents with glomerulonephritis plus b/l sensorineural deafness
Alport's Syndrome
Tx of shock
IVF's & pressors

blood, urine, & sputum cultures (BEFORE starting antibiotics)

CXR

empiric antibiotics

insulin drip

continuous cardiac monitoring & central venous pressure measurments
man returns from African safari c/o periodic fevers, chills, diaphoresis, muscle aches, & fatigue; how could he have avoided illness
prophylactic anti-malarials
Tx for infectious mononucleosis
rest & plenty of fluids

NSAIDS or Tylenol (for fever, sore throat, & malaise)

gradual return to sports
(incr'd risk of splenic rupture):
NONCONTACT: 3 wks after sx onset
CONTACT: 4 wks after sx onset
what is the spectrum of conditions related to blood infections
bacteremia

SIRS

sepsis

severe sepsis

septic shock

multiple organ dysfxn syndrome
definition:
bacteremia
bacteria of any amount in the blood that does not meet criteria for SIRS
definition:
SIRS
Systemic Inflammatory Response Syndrome (SIRS) WITHOUT an identified source of infection

(NOTE: criteria may be met due to other causes independent of infection or source may never be found)
what are the 4 categories for SIRS criteria
temperature

tachycardia

tachypnea

WBC's
how many of the SIRS categories must be present to meet the SIRS criteria
2 or more
What is the SIRS "temperature" criteria
> 38.3C or < 36.0C
What is the SIRS "tachycardia" criteria
HR > 90 bpm
What is the SIRS "tachypnea" criteria
RR > 20 bpm or PaCO2 < 32
What is the SIRS "WBC's" criteria
ANY 1 OF THE FOLLOWING:

> 12,000
> 10% bands
< 4,000
Criteria:
SIRS
CRITERIA: 2 or more of the following:

TEMPERATURE:
> 38.3C
< 36.0C
TACHYCARDIA:
HR > 90
TACHYPNEA:
RR > 20 bpm
PaCO2 < 32
WBC'S:
> 12,000
> 10% bands
< 4,000
definition:
sepsis
SIRS WITH an identified source of infection;

(FYI: if SIRS criteria met & there is no obvious source of infection, w/u should include urine, blood, & sputum cultures)
definition:
severe sepsis
SEPSIS + 1 OF THE FOLLOWING:

organ dysfxn
hypotension
hypoperfusion
what signs are evidence of organ dysfxn, hypotension &/or hypoperfusion seen in severe sepsis
lactic acidosis

SBP < 90 mmHg

SBP drop > 40 mmHg
definition:
septic shock
SEVERE SEPSIS + hypotension , despite adequate fluid resuscitation
definition:
multiple organ dysfxn syndrome
SEPTIC SHOCK + evidence of 2 or more organs failing
SUMMARIZE the spectrum of conditions related to blood infections with definition of each
BACTEREMIA: bacteria in the blood that does not meet criteria for SIRS

SIRS: 2+ criteria met WITHOUT source of infection identified

SEPSIS: SIRS + source of infection identified

SEVERE SEPSIS: sepsis + organ dysfxn, hypotension, or hypoperfusion

SEPTIC SHOCK: severe sepsis + hypotension, despite adequate fluid resuscitation

MULTIPLE ORGAN DYSFUNCTION SYNDROME:
septic shock + evidence of 2+ organs failing
classic EKG finding in PE
"S1Q3T3"

wide S in Lead I

large Q in lead III

inverted T wave in lead III
Dx:
post op px with pain presents with hyponatremia and normal volume status
SIADH (2nd/2 stress)
Rx for mild unconjugated hyperbilirubinemia
phototherapy
Rx for severe unconjugated hyperbilirubinemia
exchange transfusion
what is the initial HAART regimen
2 NRTI's + EITHER:

1 protease inhibitor

1 NNRTI

may be add ritonavir
antiretroviral a/w:
SE of lactic acidosis
NRTI'S
antiretroviral a/w:
SE of GI intolerance
protease inhibitors
antiretroviral a/w:
SE pancreatitis
zalcitibine
didanosine
stavudine
ritonavir
antiretroviral a/w:
SE of peripheral neuropathy
zalcitibine
didanosine
stavudine
antiretroviral a/w:
SE of megaloblastic anemia
zidovudine
antiretroviral a/w:
SE of rash
NNRTI's
antiretroviral a/w:
SE of hyperglycemia, DM, lipid abnormalities
protease inhibitors
(e.g. indinavir, sequinavir, amprinavir)
antiretroviral a/w:
SE of BM suppression
zidovudine
antiretroviral a/w:
given to pregnant woman with HIV
HAART regimen with zidovudine
antiretroviral a/w:
regimen for occupational HIV exposure
LOW-RISK: zidovudine + lamivudine

HIGH-RISK: 3-drug HAART regimen
what bugs are tx prophylactically in AIDS pt's with CD4+ < 200 and what is rx is given
PCP: TMP-SMX

TOXOPLASMOSIS: TMP-SMX

MAC: Macrolide (e.g. clarithromycin or azithromycin)
Tx for acute toxoplasmosis in AIDS pt
pyrimethamine or sulfadiazine
HIV prophylaxis for TB
INH
AIDS criteria
ANY OF THE FOLLOWING:

HIV+ with CD4+ < 200
HIV+ with CD4+ < 15% of total lymphocytes
HIV+ with "AIDS-defining illness"
what are some examples of "AIDS-defining illness"
THERE ARE MANY (refer to SU p.144-145):

esophageal candidiasis
PCP
toxoplasmosis
MAC
tumor marker:
hepatocellular carcinoma
AFP
tumor marker:
colon cancer
CEA
tumor marker:
gastric cancer
CEA
tumor marker:
pancreatic cancer
CA 19-9

CEA
tumor marker:
ovarian cancer
CA-125
dx:
young black man with painless hematuria
sickle cell trait
MCC of aortic stenosis in a 70 y/o
senile (i.e. degenerative) calcifications
labs in DIC
ELEVATED:
fibrin-split products
D-dimers

DECREASED:
fibrinogen
platelets
hematocrit
which type of RTA is a/w abnormal H+ secretion & nephrolithiasis
RTA I
what is the classic presentation of polycythemia vera
thrombosis

erythromelalgia (i.e. burning pain in hands & feet)

pruritis (esp after warm bath/shower)

facial plethora

hepatosplenomegaly

visual disturbances

abnormal labs
what visual distrubances are seen with polycythemia vera
blurred vision

amaurosis fugax

scintillating scotoma

ophthalmic migraine
what lab abnormalities are seen with polycythemia vera
elevated H&H

elevated red cell mass

basophilia

leukocytosis

thrombocytosis
what is the Rx for polycythemia vera
phlebotomy
(FYI: induces a desirable iron def anemia --> DO NOT supplement with iron)
what is used in px with polycythemia vera with high risk of thrombosis; which pts are considered "at risk"
hydroxyurea

"AT RISK":
h/o thrombosis
plts > 1,500,000
CV RF+
> 70 y/o
what is used in px with polycythemia vera with refractory pruritis or refractory erythrocytosis
IFN-a
what tests will help in dx of MM
SPEP: monoclonal AB spike

UPEP: bence-jones proteins

BM BX: incr'd plasma cells
Dx
px with weight loss, pruritis, night sweats, hepatosplenomegaly, nontender cervical lymphadenopathy
Hodgkin's lymphoma
Dx:
3 y/o girl presents with abd'l mass, hematuria, & HTN
Wilm's tumor
Dx & Tx:
recent Cuban immigrant with sx's of malabsorption is found to also have megaloblastic anemia
Dx: Tropical sprue

Tx: folate & antibiotics (e.g. tetracycline or sulfa)
cell pathology a/w:
EBV
Burkitt's lymphoma
cell pathology a/w:
reed sternberg cell, cervical lymphadenopathy, night sweats
Hodgkin's lymphoma
cell pathology a/w:
bence jones proteins, osteolytic lesions, high Ca2+
MM
cell pathology a/w:
translocation 14:18
follicular lymphoma
cell pathology a/w:
MC lymphoma in US
diffuse large B cell lymphoma
cell pathology a/w:
translocation 8:14
burkitt's lymphoma
cell pathology a/w:
translocations 9:22
philadelphia (CML or ALL)
cell pathology a/w:
MC hodgkin lymphoma
nodular sclerosing
cell pathology a/w:
starry sky pattern due to phagocytosis of apoptotic tumor cells
burkitt's lymphoma
cell pathology a/w:
high H&H, pruritis (esp after hot bath or shower), burning pain in hands or feet
polycythemia vera
cell pathology a/w:
white cells with hair-like projections & splenomegaly
hairy-cell leukemia
cell pathology a/w:
macrocytosis, hypogranular granulocytes with bilobed nuclei
myelodysplastic syndrome
Rx for CML
imatinib
leukemia a/w:
MC in children (peak age 3-4 y/o)
ALL
leukemia a/w:
MC in adults (avg age of onset 50 y/o)
CLL
leukemia a/w:
philadelphia Chromosome is always present
CML
leukemia a/w:
smudge cells
CLL
leukemia a/w:
peripheral blasts are PAS+ and TdT+
ALL
leukemia a/w:
peripheral blasts are PAS-, MPO+ and have Auer rods
AML
leukemia a/w:
pancytopenia in a down syndrome px
ALL
lung cancer a/w:
elevated ACTH --> glucocorticoid excess --> Cushing's
small cell lung cancer
lung cancer a/w:
elevated PTH related peptide --> hypercalcemia
squamous cell lung cancer
lung cancer a/w:
elevated ADH --> SIADH --> hyponatremia
small cell lung cancer
lung cancer a/w:
antibodies to presynaptic Ca2+ channels --> Lambert-Eaton syndrome
small cell lung cancer
disease that causes glomerulonephritis with deafness
Alport's syndrome
MC adrenal tumor in children; lab study used to dx
MC = neuroblastoma

Dx'c = 24-hr urine --> incr'd VMA & HVA
Dx:
4 y/o girl with URI & dangling thumbs, short stature, & hypopigmentation of some skin areas; labs reveal pancytopenia
fanconi's anemia