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148 Cards in this Set

  • Front
  • Back

What is the most likely cause of aortic stenosis in a 50yo pt?

Congenital bicuspid aortic valve
What is the mcc of aortic regurgitation in a 70yo pt?
Senile or degenerative calcification

What is the classic (but rare) EKG finding in a pt with a pulmonary embolism?

Wide S in Lead 1
Large Q & inverted T waves in lead 3

What is the most likely cause of 2° hypertension if pt has:
HTN measures in arms but low BP in lower extremities

Aortic Coarctation
What is the most likely cause of 2° hypertension if pt has proteinuria?
renal disease
What is the most likely cause of 2° hypertension if pt has hypokalemia?
What is the most likely cause of 2° hypertension if pt has tachycardia, diarrhea, heat intolerance?
What is the most likely cause of 2° hypertension if pt has hyperkalemia?
renal failure or renal artery stenosis
What is the most likely cause of 2° hypertension if pt has periodic sweating, tachycardia

• An elderly F with h/o cholelithiasis presents with 5 day h/o vague, recurrent abdominal pain & vomiting. What diagnosis do you immediately suspect?

Gallstone ileus

A pt presents to the ER with a very painful irreducible inguinal mass. What is the next step in management of this pt?

OR for surgical correction
A 4mo old child presents with nonbilious vomiting despite changing formulas from milk-based to soy-based. What is the most likely etiology?
Congenital pyloric stenosis
A pt presents to the clinic for follow-up and is found to have a BP of 150/85. You note in the chart that during his last visit 1 mo ago, his BP was 145/90. What is the next step in management of this pt?

Recheck the BP in 2-4 wks (need 3 elevated BPs to make dx)

What are the characteristic findings of hereditary spherocytosis?

Jaundice & gallstones
Anemia with reticulocytosis and ↑MCHC
Higher incidence of pseudohyperkalemia as RBCs lyse after blood draw and intracellular potassium leaks
Peripheral smear reveals spherocytes
(+) osmotic fragility test

What is the treatment for hereditary spherocytosis?

Folic acid 1mg daily
pRBC transfusion in cases of extreme anemia
splenectomy in moderate to severe disease
Increased body temp, acidosis, and exercise shift the hemoglobin-oxygen dissociation curve in which direction? What effect does this have on oxygen delivery to the tissues?
Rightward shift
Enhances O2 delivery to peripheral tissues

An elderly man is seen in the ER with a chief complaint of headache. Further questioning reveals that since the weather has turned cold and he had to begin using his kerosene heater, he has felt fatigued and a little nauseated along with the headache. On exam the man’s lips seem remarkably red. What do you expect the pulse ox reading to be? How will you tx?

Dx: Carbon monoxide poisoning
Will have normal pulse oximeter reading
Tx: 100% O2, hyperbaric oxygen chamber if available

Will anemia of chronic disease give a microcytic or normocytic anemia?

Initially anemia of chronic disease is normocytic but can be microcytic

- microcytic with high ferritin and low TIBC

In hemolytic anemia, why is the serum haptoglobin level decreased? Why is the serum lactate dehydrogenase (LDH) increased?

Haptoglobin binds free Hg in the blood
LDH is found inside RBCs, so when cells lyse, free LDH is released

- labs: deb hapto, inc LDH, inc reticulocytes

25yo F is seen in the clinic with c/o fatigue and chronic joint pain. Exam and routine labs reveal a malar rash, mildly elevated temperature, and anemia. It is unclear whether this woman’s anemia is caused by autoimmune hemolytic anemia or from her recent menstruation. What test can distinguish btw possible autoimmune mediated hemolytic anemia vs other causes of anemia including non-immune mediated hemolytic anemia?

Direct Coombs test (looks for antibodies attached to RBC)

- SLE causes hemolytic anemia, and thrombocytopenia

what is this?

sideroblast:nucleated RBC with rings of iron granules ("ring" sideroblasts) - seen in sideroblastic anemia (mcc alcohol, also asst'd with lead)

What conditions are a/w Basophilic stippling?

Lead poisoning
Alcohol use

An elderly man is in the office for evaluation of fatigue and exertional SOB. He is fit for his age but he says that he isn’t able to be as active recently. He has no fever or symptoms suggesting infection. On exam his conjunctivas are pale and a stool guaic is positive. Until proven otherwise, this pt should be considered as having what disease?

Colon cancer
Need to start screening for CRC at age 50yrs

What type of anemia is most likely?

Mental status changes, neuropathy, constipation

Lead poisoning anemia (microcytic)

- Adults:

What type of anemia is most likely?
Heavy menses, strict vegetarian, ice pica

Iron Deficiency anemia (Microcytic)

What type of anemia is most likely?
Dark urine, Jaundice, hepatosplenomegaly

Hemolytic anemia (normocytic)
What type of anemia is most likely?
alcoholic, malnourished
B12/Folate Deficient anemia (macrocytic)
What virus can cause aplastic anemia as well as erythema infectiosum (“fifth disease”)?
Parvo B19

When using the Schilling test, excretion of the radiolabeled Vit B12 in the urine indicates what?

Indicates absorption of the radiolabeled Vit B12

A pt that is given radiolabeled B12 (Schilling test) – but does not excrete any of it in his urine. He is then given radiolabeled B12 with intrinsic factor and still does not excrete any of it. What inflammatory bowel disease (IBD) might this pt have?

Crohn’s Disease (impacting the terminal ileum)

Both folate deficiency and Vit B12 deficiency can result in a megaloblastic anemia. How can they be differentiated?

Folate def → no neurologic symptoms
B12 def → neurological symptoms

Basophilic stippling
Lead poisoning
Given the blood smear, what type of anemia is most likely?


Given the blood smear, what type of anemia is most likely?

Sideroblastic anemia

- ringed sideroblasts with prussian blue staining

Given the blood smear, what type of anemia is most likely?


Given the blood smear, what type of anemia is most likely?


Given the blood smear, what type of anemia is most likely?
Sickled cells & target cells

Sickle Cell

List 3 acquired causes of sideroblastic anemia:

Alcoholism (MC)
Isoniazid (B6 def)
Lead Poisoning

you have in your heme notes from MS 2 ringed sideroblasts (nucleated RBCs w/ excess iron) → myelodysplastic syndromes (MDS) ??

Besides Staph. Aureus, which organism may be responsible for osteomyelitis in sickle cell pts?

What would be the concern in a sickle cell pt with a high fever and slapped cheek rash

Aplastic crisis due to the action of Parvo B19

In α-thalassemia, how many genes can be potentially mutated? List in order of ↑ severity the variants of α-thalassemia:

4 genes

-4 = Hydrops fetalis

- 3 = HbH disease (Beta tetrads, inc retic ct)
- 2 = α-thal minor, minor anemia normal electrophoresis

-1 = α-thal minima/ trait → silent carrier

In β-thalassemia, how many genes can be potentially mutated? List in order of ↑ severity the variants of beta-thalassemia:

2 genes
minor < major (make alpha 4 tetrads)

Other than vaccination, how is pneumococcal infection prevented in children with sickle cells disease?

Penicillin until age 5

HYQ: What medication is used in the long-term management of sickle cell anemia?

Hydroxyurea - increase the portion of HbF

- decreases vasoocclusive crisis

- rare myelosuppression

HYQ: A teenage African American M presents to the ER with right hip pain & Hct of 25%. What is the most likely dx?

Sickle cell disease & osteonecrosis

HYQ: What is the next step in the management of a pt with febrile neutropenia due to chemotherapy?

Admit to hospital
Blood culture
IV broad spectrum antibiotics (Cefepime, Ceftazidime - both also cover pseudomonal)

HYQ: What is the mcc of anemia in elderly pts?

Iron Deficiency

HYQ: What is the cause of anemia that develops after taking a sulfa drug?

G6PD deficiency

- MCC is infection, also sulfa, dapsone, quinidine, primaquine, nitrofurantoin, fava beans

HYQ: Compare the serum iron, ferritin, and transferrin levels in iron deficiency anemia to anemia of chronic disease
What lab markers suggest anemia due to hemolysis?

Low H/H
Normal MCV
↑ reticulocyte ct
↑ indirect bilirubin
↓ haptoglobin

Which RBC disorders are a/w
Shistocytes (fragmented RBCs)?

hemolytic anemia

Which RBC disorders are a/w
Acanthocyte (spur cell)


Liver disease

Which RBC disorders are a/w bite cells?
G6PD deficiency
Basophilic stippling of RBCs
#1 Lead Poisoning
Alcohol use
Which RBC disorders are a/w
Peripheral neuropathy + sideroblastic RBCs
Lead Poisoning

Which RBC disorders are a/w
Hypersegmented neutrophils

B12 or Folate Def

Which RBC disorders are a/w
Heinz Bodies (denatured Hg in RBC)?

G6PD deficiency

Which vaccines are particularly important in children with sickle cell disease?

Hep B
Haemophilus Influenza type B
Neisseria meningococcal

What complication occurs in 10% of pts with sideroblastic anemia?

Acute leukemia
What is the differential diagnosis for serum eosinophilia?

What is the treatment for anaphylaxis?

Intubate (if worsening resp failure)
Stop the inciting agent
DOC = Epinephrine (alpha1, beta2)
Antihistamines, bronchodilators, steroids
Fluids (for hypotension)

What type of infection will cause an eosinophilia?

Parasitic infections – strongyloides, ascaris

Goodpasture’s glomerulonephritis results from auto-antibodies targeting the glomerular basement membrane (GBM). Which type of hypersensitivity reaction is this, and how can it be tx?

Type II Hypersensitivity
Tx: Plasmapheresis, anti-inflammatory agents, antisuppressants

An elderly woman is brought to the ER after she fell and struck her head. She has not lost consciousness, but she is on chronic warfarin therapy to treat her atrial fibrillation. A non-contrast head CT reveals a small subdural hemorrhage. What clotting factors are depleted in warfarin treated pts? How will you treat this pt now to prevent further bleeding?

Clotting factors: 2,7,9,10; Protein C &S
Tx: Vit K+ & FFP

What are the indications for:
Aspirin as anticoagulant

Post-MI & h/o CAD, ischemic stroke (no dual platelet in stroke), TIA, angina

What are the indications for:

Clopidogrel (Plavix)
Ticlopidine (Ticlid)

Post-MI (more effective than aspirin alone)
Preventing stroke

What are the indications for Abciximab (Reopro)

Unstable angina
Coronary vessel intervention procedures

What are the indications for
Dipyridamole (Persantine, Aggrenox)?
Stroke prevention
Artificial heart valves
When should heparin be used as anticoagulant?
DVT & PE prophylaxis
Immediate post-MI
When should Enoxaparin (Lovenox) be used for anticoagulation?
DVT & PE prophylaxis
Immediate post-MI
Note: don’t have to monitor PTT

When should Fondaparinux (Arixtra) be used for anticoagulation?

DVT prophylaxis/ treatment
When should warfarin (coumadin) be used for anticoagulation?

Long-term anticoagulation
Atrial fibrillation
Artificial valves

An intern is writing an order for heparin. What lab study does she need to order to properly monitor the heparin therapy?
What drugs are known for causing thrombocytopenia?

What is the treatment for the most common inherited bleeding disorder?

Mc bleeding disorder → Von Willebrand Factor Deficiency
Desmopressin (DDAVP): induces endothelial cells to release vWF – is first line drug for acute bleeding
Cryoprecipitate or Factor 8 concentrate for severe or refractory bleeding
OCPs for menorrhagia
Avoid aspirin and other platelet inhibitors

What coagulation factor is deficient in Hemophilia A? What factor is deficient in Hemophilia B?

Hemophilia A = Factor EIGHT (VIII) deficiency

Hemophilia B = Factor NINE (IX)

What are the most common causes of DIC?

Risk factors for DIC → “STOP Making New Thrombi”
Sepsis (gram neg)
Obstretic complications,
acute Pancreatitis
Nephrotic syndrome

What are the inherited diseases of hypercoagulation?

Factor 5 Leiden Mutation – most common (40-50%)
Antithrombin III deficiency
Protein C def
Protein S def
Prothrombin gene mutation (prothrombin G20210A)
Hyperhomocysteinemia (MTHFR gene mutation)
Rarer disorders: dysfibrinogenemia, plasminogen deficiency

A trauma pt has been recovering in the hospital for a week after fracturing his pelvis and femur in a motorcycle crash. He is unable to walk, so he has been on heparin therapy for DVT prophylaxis. Routine labs show a startling drop in his previously normal number of platelets. What steps should be taken now?

Dx: Heparin-induced thrombocytopenia (HIT)
Tx: stop heparin, substitute with argatroban or one of the other direct thrombin inhibitors

A 44yo M is recovering postoperatively from surgical fixation of a severe open femur fracture. Overnight the pt’s mental status declines and exam reveals multiple petechiae, bleeding from the surgical site, confusion, oligouria, tachycardia, and hypotension. What labs would you order to aid in confirming the diagnosis, and how would you treat the pt?

Dx: DIC (from fat emboli)
Labs: ↑ D-dimer, ↑ fibrin split products, ↓ platelets, ↓ H/H, ↓fibrinogen, ↑ PT/PTT
Tx: Platelets, FFP, Cryoprecipitate, Heparin, find underlying disorder

20yo F is being evaluated for newly acquired menorrhagia. Previously her menses were of normal duration and volume. She has also experienced gingival bleeding and nose bleeds, which are also new for her. Exam reveals bruises and petechiae. Labs reveal platelet ct <50,000. What is the mechanism of her disease? What treatment does she need?
pathophys: B-cell autoimmune Abs to platelets
tx: corticosteroids, IVIG, Plasmapheresis

22yo F is sent to your office for evaluation for excessive bleeding after a dental extraction. She has since stopped bleeding, but her dentist recommended that she see a doctor. Hx & PE reveals that she has heavy periods and easy bruisability. Labs reveal a low normal Hct, ↑ bleeding time, ↑PTT, ↓ ristocetin cofactor assay. What pharmacologic interventations can be prescribed to this woman? What drug should be avoided?

Dx: Von Willebrand’s Disease
Tx: Desmopressin (DDAVP) & OCPs
Avoid: aspirin & other platelet inhibitors

A male infant is circumcised and uncontrolled bleeding results. While resuscitation ensues, labs are drawn and the results show normal ristocetin cofactor assay, normal platelet level, ↑PTT, normal PT, and a normal bleeding time. What additional labs are needed, and what will be the treatment for this pt?

Dx: hemophilia
Labs: concentration of Factors 8 & 9
Tx: transfusion & Desmopressin (DDAVP)
Lifelong prophylactic factor 8/9 administration

What are the criteria for the diagnosis of Systemic Inflammatory Response Syndrome (SIRS)?

- Sign of sepsis or septic shock

Need at least 2 of the following:
Fever >38°C (100.4°F) or hypothermia < 35°C
Tachypnea (RR>20 bpm or PaCO2 < 32 mmHg)
Tachycardia (HR > 90bpm)
Leukocytosis (WBC > 12,000), Leukopenia (WBC< 4,000) or bandemia (>10% bands)

What is the treatment for infectious mononucleosis?
There is no antiviral medication available for “mono” (acyclovir is of no benefit)
NSAIDs or Tylenol for fever, sore throat, malaise
Encourage rest & plenty of fluids
Return to sport (risk of splenic rupture):
May return gradually to noncontact sports 3wks after symptom onset
May return gradually to contact sports 4wks after symptom onset
Steroids only helpful if impending airway compromise due to enlarged tonsils or if life-threatening sequelae develops (ie fulminant liver failure, hemolytic anemia, thrombocytopenia)
A hospitalized pt is suspected of having an infection. What should be done before empiric antibiotics are started?
Blood, urine, sputum cultures
A man returns from a safari in Africa and now has periodic fevers, chills, diaphoresis, muscle aches, and fatigue. How could this man have avoided this illness?
Dx: Malaria
Prevention: prophylactic antimalarials
HYQ: What is the classic pentad for thrombotic thrombocytopenic purpura (TTP)?
HUS Triad: Hemolysis, Uremia or acute renal failure, Thrombocytopenia


Altered mental status
HYQ: What is the most common mutation in white pts that predisposes to venous thrombosis?
Factor 5 Leiden Mutation
What is the MOA of:
Streptokinase (streptase)
Converts plasminogen → plasmin
[thrombolytic, cleaves fibrin clots]
What is the MOA of:
Irreversibly inhibits COX-1
What is the MOA of:
Clopidogrel (Plavix)
Blocks ADP receptors
What is the MOA of:
Abciximab (Reopro)
glycoprotein IIb/ IIIa inhibitor
What is the MOA of:
Tirofiban (Aggrastat)
glycoprotein IIb/ IIIa inhibitor
What is the MOA of:
Ticlopidine (Ticlid)
Blocks ADP receptors
What is the MOA of:
Enoxaparin (Lovenox)
Anti-Factor 10a & anti-thrombin(2a)
What is the MOA of:
Eptifibatide (Integrilin)
glycoprotein IIb/ IIIa inhibitor
What lab test is used to monitor warfarin vs heparin vs LMWH?
Heparin: PTT
Warfarin: PT/ INR
Enoxaparin: Factor 10a activity
What is the treatment for von Willebrand’s disease?
Desmopressin (DDAVP): induces endothelial cells to release vWF
Cryoprecipitate or Factor 8, OCPs
Avoid aspirin or other antiplatelet agents
What lab changes would you see in the following diseases?

Hemophilia A or B
Von Willebrand’s dz
Warfarin Use
End Stage Liver Disease
Aspirin use
What are the criteria for the diagnosis of SIRS?
Need at least 2 of the following:
Fever >38°C or hypothermia < 35°C
Tachypnea (RR>20 bpm or PaCO2 < 32 mmHg)
Tachycardia (HR > 90bpm)
Leukocytosis (WBC > 12,000), Leukopenia (WBC< 4,000) or bandemia (>10% bands)
What is the most important medication in the treatment of anaphylaxis?
What are the most common causes of DIC?
Risk factors for DIC → “STOP Making New Thrombi”
Sepsis (gram neg)
Obstretic complications,
acute Pancreatitis
Nephrotic syndrome
An HIV(+) pt is seen in the ER with SOB. He reports that over the past few wks it has become increasingly difficult to breathe when exerting himself. He has a cough, fever, and you notice white plaques on the tongue and visualized pharynx. He admits to also having pain with swallowing too. You fear this pt’s disease has advanced, so you order a CD4 ct. What do you expect the CD4 ct to be?
Dx: thrush & PCP
Expect CD4 ct <200
39 yo M HIV pt receives a head CT for headache and new onset confusion & slurring of words. The imaging revelas a ring-enhancing lesion. What is the suspected diagnosis? How could that diagnosis be confirmed?
Dx: cerebral toxoplasmosis
Confirmatory testing: toxoplasma IgG antibody
25yo M is diagnosed with HIV & must begin a HAART regimen. What classes of drugs should his regimen include initially?
2 NRTIs + a Protease Inhibitor or an NNRTI
The CD4 ct of a 41yo HIV pt has fallen to 190 despite HAART treatment for many years. What prophylactic antibiotics should be started?
TMP-SMX (Bactrim): for PCP & toxoplasmosis prophylaxis
Clarithromycin or Azithromycin (z-pack): for MAC prophylaxis (both clarithromycin & azithro are macrolides)
Isoniazid: if concern for TB contacts
What is the rate of transmission of HIV thru a needle stick incident? What drugs should be given in the case there is appreciable risk of transmission of HIV in this setting?
HIV transmission thru needle stick: 0.3%
Tx: Zidovudine & Lamivutine
What is the classic presentation of Polycythemia vera?
What is the treatment for polycythemia vera?
70yo F is seen in the clinic with the chief complaint of itchiness in her hands occurring after washing them in warm water. She also has occasional burning in the feet accompanied by erythema. What would you expect to see on CBC? What treatment can you offer in the meantime before her labs return (in a few days) and the diagnosis is confirmed? After the diagnosis is confirmed?
Dx: Polycythemia Vera
CBC: ↑ H/H, ↑ red cell mass
Empiric tx: antihistamine, Aspirin
Tx once dx is confirmed: serial phlebotomies, hydroxyurea
66yo F fractures her hip after falling from standing. Radiographs reveals “punched out” lesions in the vertebrae, hips, and femurs. The pt says that she has had increasing back pain, weakness, and fatigue, but she has attributed all of that to aging. Labs show anemia, hypercalcemia, ↑BUN & Cr. What studies would help to find the diagnosis and what would expect to be seen?
Suspected dx: multiple myeloma
Studies & findings:
Serum Protein Electrophoresis (SPEP): monoclonal antibody spike
Urine Protein Electrophoresis (UPEP): Bence-Jones proteins
Marrow biopsy: ↑ plasma cells
Compare characteristics of hematologic neoplastic conditions:

Hair Cell
23yo M is seen in the office with the c/o weight loss. The pt is a fit young man that has been trying to add muscle mass and is surprised b/c he seems to look scrawnier now. Further questioning reveals that he has night sweats as well. PE reveals an elevated temperature, nontender lymphadenopathy, and an easily palpable liver & spleen. Lab w/u shows Reed-sternberg cells from the lymph node biopsy. What therapy is recommended, and what is the prognosis?
Dx: Hodgkin’s lymphoma
Tx: Radiation & chemo
Prog: 80% cure rate
What diagnosis is a/w translocation of chromosomes 9 & 22?
Philadelphia chromosome → CML
HYQ: A pt’s peripheral smear shows macrocytosis and hypogranular granulocytes with bilobed nuclei. What is the dx?
Dx: Myelodysplastic syndrome
An Rh(+) mother had a pregnancy with an Rh-negative fetus, but began to have vaginal bleeding and so was admitted to the hospital. Unfortunately, the pt had a spontaneous complete abortion. What should be given to the mother in case of another pregnancy.
Rhogam NOT needed in this case
Just give Folate & Iron
A 5 yo boy is brought in with a “swollen leg”. The child has not had any recent trauma according to the parents & the PE confirms that. However, the swollen area actually is a mass that seems imbedded within the vastus medius of the right thigh. What is the next step in the management?
Dx: rhabdomyosarcoma
Management: CT or MRI to show extent of mass & biopsy
What is the most common adrenal tumor in children? What lab studies can be used to diagnose this?
Dx: Neuroblastoma – most common tumor of adrenal medulla in kids
Labs: same as pheochromocytoma → 24hr urine will show ↑ vanillylmandelic acid (VMA) & homovanillic acid
A 4yo girl is brought into the county clinic with an URI. The mother reports that this child seems to get sick more often than her friends’ kids of the same age. PE is remarkable for dangling thumbs, short stature, and hypopigmentation of some skin areas. Labs reveal a pancytopenia. What is the likely diagnosis?
Dx: Fanconi’s anemia
A 3month old child is brought to the office with difficulty breathing, fatigue, and pallor. He has a heart murmur and abnormal thumbs. Labs: Hg 4 Hct 12% WBC 8 Platelets 300 MCV 99. What is the dx? What would you expect the level of erythropoietin to be?
Dx: Diamond-blackfan anemia
Finding: ↑ erythropoietin
Most common leukemia in kids
Most common leukemia in adults in US
Philadelphia Chr is almost always seen
Smudge cells on peripheral smear
Peripheral blasts are PAS(+) and Tdt(+)
Peripheral blasts are PAS(-), myeloperoxidase(+) and have Auer rods
Pancytopenia in a Down Syndrome pt
HYQ: What medication is a/w remission in 95% of CML pts?
A 21 yo M pt presents with recent weight loss, pruritis, and night sweats. PE reveals hepatosplenomegaly and a nontender cervical lymphadenopathy. What do you immediately suspect?
Hodgkin’s Lymphoma
Most common lymphoma in US
Diffuse large B-cell lymphoma
Assoc with Epstein-Barr virus (in Africa)
Burkitt’s Lymphoma
Reed-Sternberg cells, cervical lymphadenopathy, night sweats
Hodgkin’s lymphoma
Most common form of Hodgkin’s lymphoma
Nodular Sclerosis
Bence-Jones proteins, osteolytic lesions, high calcium
Multiple Myeloma
Translocation 14;18
Translocation 8;14
Translocation 9;22
Translocation 14;18 = Follicular lymphoma

Translocation 8;14 = Burkitt’s Lymphoma

Translocation 9;22= CML (and 15% of adult ALL)
“Starry sky” pattern due to phagocytosis of apoptotic tumor cells
Burkitt’s lymphoma
High hematocrit/Hg, pruritis (esp after hot bath or shower), burning pain in hands or feet
Polycythemia Vera
Blood smear (hair-like projections), splenomegaly
Hairy Cell Leukemia
Which antiretroviral:
SE: lactic acidosis
Which antiretroviral:
SE: GI intolerance
Protease Inhibitors
Which antiretroviral:
SE: pancreatitis
Zalcitabine, Stavudine, Didanosine, Ritonavir
Which antiretroviral:
SE: peripheral neuropathy
Which antiretroviral:
SE: megaloblastic anemia
Which antiretroviral:
SE: rash
Indinavir, Saquinavir, Amprenavir
Which antiretroviral:
SE: hyperglycemia, diabetes mellitus, and lipid abnormalities
Which antiretroviral or antiretroviral class is given to pregnant women with HIV?
HAART (Zidovudine during labor)
Which antiretroviral regimen is given for occupational HIV exposures?
Zidovudine + Lamivudine
Regarding antibiotic prophylaxis in HIV pts, when, with what, and for what organisms?
CD4 <200: TMP-SMX (Bactrim) or Dapsone → to prevent PCP
CD4 <100: Azithromycin or clarithromycin→ to prevent MAC
2yo boy presents with high-grade fever that has not responded to tylenol. He has been irritable & not eating well. Exam reveals enlarged cervical lymph nodes & splenomegaly. Hg 8.0, Hct 25%, Platelets 16,000 Blast forms 80%, prolymphocytes 10%, lymphocytes 10%
The blast cells have condensed nuclear chromatin, small nucleoli & scant agranular cytoplasm. Subsequent histochemical staining reveals strongly (+) periodic acid Schiff (PAS) reaction. No auer rods were seen. What's the likely dx?
Acute lymphoblastic leukemia (ALL) - most common in kids

notes: lymphoblasts lack peroxidase (+) granules but often contain cytoplasmic aggregates of periodic acid Schiff (PAS) positive material

Immunostaining for terminal deoxynucleotidyltransferase (TdT) is positive in more than 95% of pts. TdT is expressed only by pre B & pre T lymphoblasts

How are you gonna remember this?

Kids are more likely to have the cells that "light up with TNT (TdT)" & you always have to tell kids to be quiet "shhh/ schifffff"