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143 Cards in this Set
- Front
- Back
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meds if surgery doesn't work in acromegaly
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bromocriptine
pegvisoma octreotide |
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test for decreased GH in acromegaly
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T4/TSH
because thyroxin is needed to release GH |
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most accurate test for high GH
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glucose suppression
if no response it means adenoma, acromegaly |
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when to use an insulin stimulation test
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pituitary function
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diabetes tests
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1) 2x>126
2) >200 with sx 3) GTT (for pregnant women) |
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when to use glucose suppression test
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equifocal iGF
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2 big problms with acromegaly
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HTN
diabests dilated cardiomyopathy atherosclerosis |
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what improves in acromegaly after tx
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HTN
diabeetes athero |
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quickest effect of trasnphenoidal surgery for acromegaly
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decreased ADH (hyperNa, central DI)
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why no effect on K when you do transphenoidal surgery in acromegaly
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no effect on aldosterone
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hyperviscosity with IgM, no bone lesions
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Waldenstrohms
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unprovoked rib fractures
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MM, not osteoporosis
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foot with metatarsal seemily missing
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osteo in a diabetc
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marbling of skull
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pagets
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salt and pepper skull
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multiple myeloma
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lytic lesions only (not also regrowth)
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MM
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lytic and blastic lesions
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cancer, pagets
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alk phos is only abnormality
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Pagets
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urine protein electophoresis is for
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bence Jones protein in MM
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most specific test for MM
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serum protein electrophoresism
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multiple spikes
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polyclonal gammopathy of unknown significance = infectious process
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why infection in MM
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1 Ig spiked, others deficient
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rouleaux formation
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MM - Igs stuck to surface of red cells
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red cells with bumps
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malaria
G6PD Heinz bodies rusty red cells |
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red cells with thin line on a blastic cell
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auer rods AML
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dual nucleated cell
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reed sternberg in Hodgkins
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% of mcgus leading to MM
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1% per year
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30% plasma cells in bone marrow as only finding
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MM only
10% of other signs |
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specific test for MM
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30% plasma cells in bone marrow
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sensitive test for MM
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serum electrophoresis
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B2 microglobulin test is for
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assessing prognosis
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findings on technetium bone scan in MM
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none
because it lights up with blastic activity |
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mosaic formatio on xray
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pagest
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epiphysis ights up on bone scan
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normal where osetblasts are
or osteomyelitis (no increased uptake) |
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signs of hyperviscosity
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dyspena
visual disturbance confusion |
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increased IgG but no hyperviscosity
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NOT waldenstroms, in which red cells an't get through the sticky mess
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why doesnt' this happen in MM (no hyperviscosity)
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becuase IgGs are small
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best initial therapy for MM
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thalidomide
+ steroids + ortezemibe |
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ABVD tx
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Hodgkins
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CHOP tx
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non Hodgkins
chop off = none |
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thalidomide mode of action
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TNF inhibitor Wow!
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thalidomide and leolidamide also used in
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myelofibrosis!!! just this year!!! no prior tx!!!
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what is ortezemibe
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protease inhibitor used in MM
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Mm treatment after the thalidomide etc tx is controlling it...
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autologous stem cell transplant up to age 70 (autologous (or allo until age 50)
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chlorambucil used for
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CLL
ChLorambuciL |
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imatinib used for
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cMl
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busulfan trouble
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causes pulm fibrosis so never use
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how to die in MM
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infection (formerly ARF but that's treatable by dialysis now
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why blled in MM
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b/c platelets down't work well when covered with Ig
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to control lesions in MM
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bisphosphanates
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malar rash
fever joint pain |
lupus
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dangerous procedure in RA
what to do instead? |
endotracheal intubation b/c of tilting head back
so do nasotracheal |
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extra tissue between joints in RA
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pannus. too much synovial lining
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envelope shaped crystals
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ethylene glycol posoning
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rhomboid
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pseudo pyro
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association with pseudogout
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hemachromotosis
hper pTH |
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spetic arthritis bug composition
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40 stap
30 strep 20 gram - |
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crystal that looks like a xanax xr
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oxalate crystal in urine with ethylene glycol
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iron studies in RA
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anemia of chronic disease
normal or low MCV ferritin high low TIBC |
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high circulatin g iron
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sideroblastic anemia
(alcohol) |
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microcytic anemia with all normal iron studies
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thalassemia
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low ferritin
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iron deficiency
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which anemia can't be helped by EPO
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any of them unless there's an EPO deficiency
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best test for RA
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CCP
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dsDNA is for
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lupus, scleroderma
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action on anakinra
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interleukin (IN ra) that activates PMNs
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action of abatacept
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T cell activation
abaTecepT |
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first drug for RA when NSAIDS and splinting don't work
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methotrexate
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pencil in a cup deformity
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PsoriatiC
Pencil in a Cup |
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bamboo spine
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ankylosing spondylitis
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bone on bone
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osteo
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thin whinte line along a bone
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osteomyelitis
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bad effect of hydroxychloroquine
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retinal lesion
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what to give first before hydroxychloroquine
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screen eye to make sure no retinal lesions
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what are
adalimumab etanercept infliximab |
TNF inhibitors
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test needed before TNF inhibitor given
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PPD for granulomas
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when is cyclophosphamide used
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lupus nephritis
with prednisone for vasculitis |
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UMN/LMN?
fasciculations increased DTR decreased reflexes |
LMN
UMN for increased DTR LMN for decreased DTR |
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loss of position and vibration sensation
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subacute combined degneration in B12
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spasticity (stifficity)
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MS
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best innitial teset for MS
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MRI
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if no MRI, next beest test
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LP for oligoclonal bands
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when PCR CSF?
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herpec encephalopathy
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what do you see in optic neuritis
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optic nerve pallor
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tx for optic neuritis
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steroids
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one eye not crossing midline and other gets nstagmus
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internuclear ophthalmoplegia
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we
wacky wobbly |
NPH
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complication of optic neuritis
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marcu gunn pupil
(afferent pupillary defect) |
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most accurate test in MS
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MRI
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role of interferon in MS
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prevents progression
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ivig is for
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GB
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plasmapharesis is for
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GB
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which interferon in MS
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Beta
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what else treated by B interferonuse of gludrocortisone
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to replace adrenals
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use of infliximab
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stopes/heals fistulas in Crohns
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another drug to delay progression in MS
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miloxantron
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use of mycophenolate
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lupus nephritis
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use of sirolamus
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on stents in coronary arteries to prevent re stenosis
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another drug for MS
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glatiramer
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side effect of cyclophosphamide
to prevent? |
hemorrhagic systitis
mesna |
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what rx causes PML
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natalizumab
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rx for fatigue in MS
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amantadine
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action of natalizumab
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alpha 4 integrin inhibitor
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rx for spasticity
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baclofen
tizanidine |
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which drugs increase acetylcholine
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dementia drugs
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rx for narcolepsy
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modafinil
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rx for urge incontinency
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oxybutynin
tolteridone TO the toilet |
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rx for atonic bladder
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bethanacol
Bladder atony |
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finasteride is for
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prostate/baldness
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prazosin mechanism
what is it for? |
peripheral alpha blocker for BPH
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kid
fever rash joint pain pericarditis splenomegaly |
JRA
fever and splenomegaly are key |
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decreased Hct/Hbg
joint pain evanescent rash (salmon colored 2 weeks |
parvo
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rash
fever fatigue |
lupus
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joint pain
sinusitis skin lesion resp problems |
wegeners
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best initial test for lupus
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ANA
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dsDNA is bit used as first test for lupus. why?
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misses 40% of cases
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anti-centromere abs
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CREST
crentromere |
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most specific test for lupus
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dsDNA
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anti-histone abs is for?
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drug induced lupus
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what does drug induced lupus spare
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brain
kidneys |
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anti SSA
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anti Ro
sjogrens sicca |
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anti SSb
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anti La
Sjogrens sicca |
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anti SCL-70
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CREST
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therapy for scleroderma
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none
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organs involved in scleroderma
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kidney
heart lungs reynauds |
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red finger except ring and baby
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reynauds
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color progression in reydaunds
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white
blue red |
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tx for reynauds
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ca channel blockers
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decreased whites
decreased reds decreased platelets how does this happen in lupus |
direct effect on marrow
pancytopenia |
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autoimune disease with increased eos
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churg strauss
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decreased red cells but not seen on smear
how do you get evidence of this |
hemolysis in lupus
see on coombs |
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red cell with a little dot. Association?
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DNA chromatin removal
howell jolly body splenectomy and celiac |
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cell with little bumpy spkes around
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burr cells
= acanthocytes = echinocytes not much pathological significance but does yield poikilocytosis |
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fragmented red cells crunchy bunchy
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intravascular hemolysis
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spherocytes - 2 etiologies
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lupus
hereditary spherocytosis |
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how are there spherocytes in lupus
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ab grabs a piece of RBC membrane: cell looks small because of a tight membrane
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finding in PML
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auer rod
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dotsy red cells like pointilism
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basophilic stipling
lead poisoning |
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falsely + VDRL
- FTA PTT falsely hight 2 spontaneous abortions no hx of bleeding |
lupus
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2 types of anti phospholipid abs
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lupus anticoagulant
anti cardiolipin |
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tx to keep pregnancy in anti phospholpid syndrom
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aspirin and heparin during pregnancy
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what to expect in Pt with antiphospholipid syndrome
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clots (not bleeds!!)
clots venous >arterial |
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first test in antiphospholipid
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mixing study
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