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77 Cards in this Set
- Front
- Back
Prostate CA:
Work Up? Dx? MCC? |
perform transrectal US if PSA >10ng/ml or PSA velocity >.75,
o Dx: gold standard US guided biopsy - MC adenocarcinoma |
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Heyde’s syndrome:
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combo of Angiodisplasia colon bleeding and aortic stenosis from calcifications
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radiation sialadenitis:
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dry mouth after treatment CA tx w/ radiation (especially thyroid),
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Breast CA risk factors:
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older age
- nulliparity (no offspring) - early onset menarche - late onset menopause - first pregnancy after 35 - high fat low fiber diet - fam. Hx 1st degree relative - BRCA1 and 2 mutations |
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Breast CA tumor Markers?
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tumor markers CA 27-29
- BRCA1 and 2 mutations |
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Tx for Anal Squamous Cell CA?
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chemo followed by external beam radation
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Pancreatic CA:
Presentation? |
Classically weight loss, dull chronic epi pain, and jaundice in middle age Pancreatic CA until proven otherwise
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Pancreatic CA:
Dx? |
o Dx w/ CT abd, ERCP for CA head of Pancreas
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Pancreatic CA:
Prognostic Factors? Risk Factors? |
- sister mary josephs nodule = poor prognosis
- CA of head (gastroduodenal artery involvement)= best prognosis - RF: smoking, age, obesity, fam hx, NOT ALCOHOL |
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ITP:
Presentation? Cause? |
isolated thrombocytopenia, usually following acute infx
- due to IgG binding to platelets o Purpura, petachia, mucosal bleeding, meno/metorrhagia |
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ITP:
Tx? |
o Tx w/ prednisone if platelet <30,000 or symptomatic
- IVIG then splenectomy if no resolvment |
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TTP:
Presentation? Complications? Tx? |
- thrombocytopenia, petechial bleeding,
- Complications: neurological involvement, renal failure, hemolytic anemia o Tx w/ Steroids |
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neutropenic fever:
Presentation? Tx? |
- fever above 101 w/ neutrophil count <500 in a pt on chemo
- Tx w/ cefepime as a monotherapy, as it covers for pseudomonas |
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Neutropenic Fever on chemo for solid tumor w/o mets, Tx?
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send home w/ PO cipro and ampacillin
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MC Malignant tumor of the urinary tract?
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Bladder CA, MC transitional cell
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RF for Bladder CA?
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- smoking (MC)
- diet rich in meat/fat - schistosomiasis - chronic cyclophosphamide treatment and exposure to aniline dyes (not ACUTE exposure) |
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At what point do you transfuse platelets?
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If count is <50,000 and pt actively bleeding or <30,000
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What tx is contraindicated in Thalassemia and why?
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iron, will cause overload
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Leukomoid reaction:
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leukocytosis, fever
- increased leukocyte alkaline phosphatase |
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What Lymphoma has similar presentation to Leukomoid reaction and how are they different?
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CML
- CML has decreased leukocyte alkaline phosphatase, while Leukomoid reaction has increased leukocyte alkaline phosphatase |
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MC infectious cause of aplastic crisis in sickle cell pts?
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parvovirus B19
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Tx for aplastic crisis in sickle cell pt?
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blood transfusion
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What medication can decrease the incidence of aplastic crisis in sickle cell pts?
what mechanism? |
- Hydroxyurea can be used to decrease incidence of crisis
- increasing HbF levels |
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What hemolytic anemia has a + fragility test?
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Hereditary spherocytosis
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4 types of Microcytic Anemias?
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TICS:
- Thalassemia - Iron-deficiency - Chronic Disease - Sideroblastosis |
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What factor deficiencies are associated w/ each Thalassemai?
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A=factor VIII
B=factor IX C= factor XI D= factor XII |
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What is in Cryoprecipate and when is it used?
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Factor VIII, XIII, vWF, fibrinogen and fibronectin
• Only given DIC |
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Multiple Myeloma (MM):
Presenation? Cause? |
- Back pain, pathologic fractures, fatigue, weight loss
- Proliferation of Plasma Cells, causing abnormal Protein M from heavy IgG and IgA chance (Bence Jones Proteins) |
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Multiple Myeloma (MM):
Radiologic Findings? Electrolyte Changes? Tx? |
- Punch-out lesions in skull and long bones
- High protein M and Bence Jones proteins - Hypercalcemia, hypophosphotemia - Tx w/ ration/chemo, bone marrow transplant |
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what EKG changes can occur from Hypercalemia?
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short QT interval (opposite is true)
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Waldenstrom’s Macroglobulinemia:
Cause? Lab values? Tx? |
B cell disorder that leads to monoclonal gammopathy
- elevated IgM, elevated ESR, uric acid, LDH, - kidney failure and Dutcher bodies (PAS staining IgM around nucleus) o Tx w/ plasmapheresis |
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What Organ is most affected by Waldenstrom's Macroglobulinemia and what is found on Histo?
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kidney failure and Dutcher bodies (PAS staining IgM around nucleus)
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Polycycthemia Vera:
Cause? Presenation? Labs? |
myeloproliferative disorder of bone marrow increasing production of RBC, WBC, and platelets
- HA, Burning in Feet/Hands, Pruritis, Splenomegaly - Increased HbG, Hct, RBC mass, WBC, and Platelets |
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Polycycthemia Vera:
Histo findings? Tx? |
- hypercellular bone marrow
- Tx w/ serial phlebotomy, ASA, Hydroxurea |
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What med should all pt's on Chemo be given and why?
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- allopurinol
- prevent tumor lysis syndrome and decrease chance of uric acid stones from breakdown of bodies cells |
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MC CA present in areas of chronic would drainage/inflammation?
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Squamous Cell CA
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RF for Cervical CA?
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early age of coitus, increased sexual partners
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2 MC testicular CA?
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MC is seminoma, followed by non-seminoma
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MC megoblastic anemia?
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• Folate deficiency MCC megoblastic anemia
o Folate def comes up quicker, B12 has larger store |
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Screening Regimen for Colon CA?
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screen 50 w/ no family hx and no sx’s
o + fam. Hx, 10 years before initial diagnosis in first degree relative |
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ALL:
Age? Presentation? Classic Finding? |
- 2-5, MC CA in children
- anemia (pallor, fatigue), thrombocytopenia (petachia), neutropenia (fever) o Look for blasts on peripheral smear |
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AML:
Age? Presentation? Classic Finding? |
- 5-30
- fatigue, hx chronic infx, fever, easy bruising, hepatosplenomegaly, Painless Lymphadenopathy o Pancytopenia on labs, w/ large myeloblasts w/ notched nuclei (Auer Rods) |
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CML:
Age? Classic Finding? Tx? |
- 30-45
- t(9,22) philidelphia chromosome - Tx w/ Imatinib |
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CLL:
Age? Presentation? Classic Finding? |
- >60
- smudge cells that are CD5 + o CML has decreased leukocyte alkaline phosphatase |
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Burkitt’s Lymphoma:
Genetic Finding? Histo Finding? Common Presentation? Associated disease? Tx? |
- t(8,14) c-myc
- starry night sky on histo (sheets of lymphocytes w/ macrophages) o Found in young adults, presents w/ jaw lesion or abd/pelvic mass - associated w/ EBV in AIDS pt’s o Tx w/ rituximab |
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Hodgkins lymphoma:
Histo Finding? Common Presentation? Associated disease? Dx? |
- B-cell malignancy
- reed-sternberg cells (bilobar nuclei) o MC presents w/ painless lymphadenopathy, sometimes weight loss and night sweats - associated w/ EBV, third or sixth decade o Dx w/ excisional biopsy of lymph node |
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MC type of Hodgkins Lymphoma:
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o Nodular sclerosing subtype MC
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Hairy Cell Leukemia:
Common Finding? |
Malignant B-cell disorder
- + Tartrate resistant acid phosphatase (TRAP) |
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Ewing Sarcoma:
Presentation? Cell Origin? Radiologic Finding? Genetic Finding? |
2nd MC childhood bone CA
- usually found around 15 and has a neural crest origin o “Onion-skin” layering of new bone - associated w/ t(11;22) genetic translocation |
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Osteosarcoma:
Radiologic Finding? MC area found? |
- MC malignant bone tumor
- sunburst radiological pattern, - found in distal femur, proximal tibia, proximal humerus most commonly |
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B12 vs folate deficiency:
Similarities and Differences? |
- Both will have increased homocysteien,
- B12 has increased methylmalonic acid levels |
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Hereditary Spherocytosis:
Cause? Smear Findings? Other Findings? Tx? |
- Caused by Genetic defect in RBC membrane
- Spherocytes on Smear - + osmotic fragility test - Tx w/ Splenectomy |
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Mechanical Hemolytic Anemia:
Cause? Smear Findings? |
- due to turbulent flow, MC from prosthetic heart valve
- Schistocytes on Smear |
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G6PD Deficiency:
Cause? Smear Findings? Tx? |
- Caused by deficiency of G6PD, brought on by ingestion of oxidants (fava beans, ASA, Sulfa drugs)
- Bite cells and Heinz Bodies on Smear - Tx w/ avoidance of precipitating cause |
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What diseases are Sickle Cell Pt's more susceptible to?
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- Salmonella Osteomyelitis
- Encapsulated Organisms such as S. Pneumo, H. Influenza, N. Meningitides, Klebsiella |
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What pathway do Heparin and Warfarin affect?
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Heparin= Intrinsic pathway, monitored w/ PTT
Warfarin= Extrinsic pathway, monitored w/ PT and INR |
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Causes of Hypercalcemia in Malignancy?
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- In cases of mets to bone, osteolysis by Cytokines
- Solid tumors w/o mets can produce parathyroid hormone related peptide (PTHrP), causing hypercalcemia and decreased PTH - Ectopic PTH production can come from Ovarian, Lung, and Neuroectodermal tumors - Hodgins disease can cause hypercalcemia due to production of Calcitriol |
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Hemophilia can cause joint swelling/pain (hemoarthroses) w/ what mechanism?
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- Causes synovial thickening and fibrosis due to iron deposition (2nd to hemosiderin deposition), causing cytokine release and cartilage injury
- chronically leads to hemophilic arthropathy |
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What will be seen on peripheral smear in sickle-cell pt and what does it mean?
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- Howell-Jolly bodies, normally removed by spleen
- Shows that pt spleen isn’t functioning |
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Neurofibromatosis type 2, what is best way to visualize (Dx) acoustic Neuroma’s?
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- MRI w/ gadolinium
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Poor prognostic factor in CLL?
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- Presence of thrombocytopenia
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MCC death in CLL?
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- infx
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What is the Tx for coagulopathy in liver failure pt’s?
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- FFP's
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Elderly pt w/ bone pain, renal failure and hypercalcemia is?
What causes the renal failure? |
- MM until proven otherwise
- Renal failure from obstruction in the tubules due to paraproteinemia (mainly Bence-Jones protiens) |
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MC presentation of Sickle Cell Trait?
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Painless gross hematuria
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Salvage Chemotherapy?
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Extra Tx for a disease when standard therapy fails
- (Ex. Radical Prostatectomy for Prostate CA, w/ PSA recurrence later on that requires Radiation) |
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Adjuvant therapy?
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Given in addition to standard therapy at the same time
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Neoadjuvant therapy?
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Given before standard therapy (radiation before Prostatectomy)
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Why are people w/ MM at an increased risk for infx?
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Inability to produce effective antibodies as bone marrow is destroyed by malignant plasma cells
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How to Dx von Willabrand disease?
Tx? |
- PTT and bleeding time prolonged
- Ristocetin cofafactor assay measures capacity of vWF to agglutinate platelets - Tx w/ Desmopressin (DDAVP) |
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vWF vs. Hemophilia?
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vWF will have prolonged PTT and bleeding time, while Hemophilia only has prolonged PTT
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What diseases predipose to Thrombotic Thrombocytopenic Purpura (TTP)?
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- HUS and HELLP
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What are the 5 signs/Sx's of TTP?
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- low platelet count
- microangiopathic hemolytic anemia - neurologic changes - impaired renal function - fever |
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Tx for TTP?
What should be avoided? |
- Tx w/ steroids and in extreme cases splenectomy
- avoid platelet transfusion |
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Cause of ITP?
Presentation? Dx? Tx? |
- IgG anti-bodies form against platelets
- usually asymptomatic, can have minor bleeding/bruising, hematuria, hematochezia, melena - Dx of exclusion - Steroids, IVIG, or splenectomy (not platelet transfusion) |
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Waldenstrom's Macroglobulinemia:
Dx? |
- elevated levels of IgM
- Bone marrow biopsy shows abnormal plasma cells w/ Dutcher Bodies (PAS + IgM deposits around nucleus) |
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Transplant Tissue:
Autologous? Allogeneic? Syngeneic? |
- Autologous: from pt to himself
- Allogeneic: from donor to different pt - Syngeneic: from identical twins |