10⼀Heme-Onc/TOX I Flashcards

Question

**Inhibitors** of Cytochrome P450 Enzymes (11)

Answer 1

**A**AA **RACKS I**n **GQ M**agazine *INHIBIT me from doing my job!* **A**cute Alcohol Abuse **R**itonavir (HIV Protease inhibitor) **A**miodarone [**C**imetidine & Ciprofloxacin] **K**etoconazole **S**ulfonamides [**I**NH Isoniazid] [**G**rapefruit Juice] **Q**uinidine [**M**acrolides *(except Azithro)*]

Answer 2

**C**an **A**lways **T**hink **W**hen **O**utdoors, **S**on...*.i need it!* ## Footnote [**C**yclosporine (Liver AND small intestine)] **A**ntiEpileptics **T**heophylline **W**arfarin **O**CP [**S**tatins (*NOT PRAVASTATIN*)]

Answer 3

20 [Nystagmus on far lateral gaze] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *other signs: [diplopia, ataxia ➜ coma]* [_Phenytoin10-(therapeutic)-**20** \< (TOXIC)]

Answer 4

1. [Equine Heptavalent **Anti- _Botulinum_ ^*_toxin_*** _{(passive immunity)}] 2. [Ig **Anti- _Botulinum_**] 3. Guanidine

Answer 5

*Jimson Weed = AntiCholinergic* "Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel & bladder lose their tone, and the heart runs alone....." 1. Blind as a bat = [**Mydriasis and [cycloplegia** (blurry vision especially when focusing on near objects)] 2. Mad as a hatter= **Agitation & Hallucinations** 3. Red as a Beet = **Cutaneous flushing** despite vasoconstriction 4. Hot as a hare = **Hyperthermia** from DEC ability to sweat 5. Dry as a bone= **DEC Secretions** (including sweat) 6. **Bladder & Bowel lose tone** 7. Heart runs alone = No vagal tone at SA --\> **Tachycardia**

Answer 6

After giving [**inhaled anesthestics** vs **succinylcholine**] to genetically predisposed (AUTO DOM) pts develop ➜ ## Footnote **M**alignant = **M**uscle Rigidity **Malignant** = Malignant Unstable Vitals **Hyperthermia** = Fever

Answer 7

Dantrolene ## Footnote *TREAT PROMPTLY! AS THIS IS LIFE THREATENING CONDITION!*

Answer 8

plasma **EXCHANGE** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _{*(Tx = _EXCHANGE_ plasma containing anti-A13vM or deficiency of A13vM for normal plasma)*} | A13vM= [ADAMTS-13-vWF Metalloprotease]) ## Footnote _{TTP etx: [A13vM❌^{(or inhibition by shiga toxin in HUS)}] →uncontrolled vWF chain cleavage → widespread platelet traps/activation → thrombocytopenia + microagio hemolytic anemia → _FMNRT_ TTP cp ^{⚠️TTP cp (aside from +Neuro and plasma EXCHANGE tx) = HUS cp}. ⼀ *(TTP Tx = _EXCHANGE_ plasma containing anti-A13vM or deficiency of A13vM for normal plasma)*}

Answer 9

① *{[**A13vM** (ADAM**T**S13\_vWF Metalloprotease)] (responsible for degrading vWF Multimers)}* ② A13vM❌ ^{= [acquired A13vM inhibition^{(by shiga toxin in HUS)}] or [ acquired A13vM deficiency] *(2/2 CLOpidogrel | tiCLOpidine | cyCLOsporine | AIDS )*} ③ ➜ allows ⇪ vWF Multimers to circulate and start cleaving large chains of von Willebrand factor from the vascular endothelium ➜ *cleaved* vWF ➜ widespread platelet traps and platelet activation ➜severe thrombocytopenia ④ +{RBC shearing ➜ [Schistocyte helmet cells], [INC Direct bilirubin], [microangiopathic hemolytic anemia]} * * * ☞ TTP Symptom PENTAD (**FMNRT)** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = plasma **EXCHANGE** {(exchanges [anti-A13vM] and/or [low A13vM])for [more A13vM])}* ## Footnote _{*💡in HUS, shiga toxin inhibits A13vM → similar TTP (but w/out neuro sx or plasma EXCHANGE tx) clinical presentation*}

Answer 10

_{hgbA_ADULT}[αα⼀αα / β⼀β] _{hgbF_fetal}[αα⼀αα / γ⼀γ] * * * [point mutations in splice & promoter sequences]; 11; [underproduced or ABSENT] * * * [αα⼀αα / ❌⼀β] = **βT^minor**(➜ β-chain underproduced= *asx, [⇪ HgbA₂= dx],* ) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [αα⼀αα / ❌⼀❌] = **βT^MAJOR**(➜ β-chain ABSENT = *early death , ⇪ HgbF|| temp tx = Hypertransfusion*) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * \*αα (2 genes) = 1 α globin chain\* | βT = βeta Thalassemia* * causes microcytic hypOchromic anemia*

Answer 11

_{hgbA_ADULT}[αα⼀αα / β⼀β] _{hgbF_fetal}[αα⼀αα / γ⼀γ] [αlpha allele deletion (2 alleles per parent);] chromo 16 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _I:[⬜α⼀αα / β⼀β] ➜ [**αT**⼀silent carrier] * * * _II:[⬜α⼀⬜α / β⼀β] ➜ [**αT**⼀***trait*****^TRANS**] _II:[⬜⬜⼀αα / β⼀β] ➜ [**αT**⼀***trait*****^{CIS(worst for offspring)}**] * * * _III:[⬜⬜⼀⬜α / β⼀β] ➜ [**αT**⼀**hb**] * * * _IV:[⬜⬜⼀⬜⬜/ β⼀β] ➜ [**αT**⼀**🅱🅶**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**αT**⼀**hb**] = Hb(h)****tetramer of beta]** [**αT**⼀**🅱🅶**]= {[h🅱:T🅶 :HFD]**} = {Hgb**** 🅱ART tetramer of 🅶amma (Hydrops Fetalis^{(DIES IN UTERO)})**]} *\*αα (2 genes) = 1 α globin chain\* | αT = alpha Thalassemia*

Answer 12

[*Beta* Thalassemia MAJOR [αα⼀αα / ❌⼀❌]] ; Hypertransfusion tx overcomes effects of anemia and extramedullary hematopoiesis **BUT** also ➜ iron overload ➜ severe organ damage from iron deposition

Answer 13

Thalassemia

Answer 14

Beta thalassemia MAJOR (BOTH _{Mom and Dad} [chromo 11 β-globin genes] have [splice/promoter point mutations] →2 out of 2 ABSENT β-globin → [⇪ HgbF (a2g2)] = SEVERE COOLEY ANEMIA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx = [chronic blood transfusion **with deferadirox iron chelator**]

Answer 15

Target cells = **HALT** 1. **H**bC 2. **A**splenia 3. **L**iver disease 4. **T**halassemia (usually asx and REQUIRES NO TX if asx - occurs in Mediterranean people)

Answer 16

Thalassemia ## Footnote *image shows teardrop cells (Thalassemia also has Target cells)*

Answer 17

hypOkalemia! (within 48h of VB12 tx) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ VB12 supplement in moderate/Severe Megaloblastic macrocytic anemia will ➜ newly formed RBC ➜ **RAPID INTRACELL UPTAKE OF K+ by new RBC** ➜ hypOkalemia! So... [transfuse pRBC before VB12 ➜ blunts new RBC synthesis ➜ prevents hypOkalemia] + [monitor K+ 48h]

Answer 18

1. neonatal [**PERIPHERAL** venous hct \> 65%] 2. \*\*[ASX v 24h self limited] \*\* 3. [+/- life threatening apnea] 4. [+/- hypOglycemia] 5. [+/- hyperviscosity (*causes hypOperfusion ➜ lethargy, hypOtonia*)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *1st hct comes from heel prick but = unreliable / confirmed by peripheral venous if abnml*

Answer 19

1. [**HYDRATION]** **2. CORRECT METABOLIC DERANGEMENT** 3. --(if persist)--\> [Partial exchange transfusion]

Answer 20

[Whole-Body-Cross-Sectional] eval with **[low-dose CT no contrast]** \> MRI or PET

Answer 21

excessive production of **monoclonal IgM** (Waldenstrom Macroglobulinemia \> Multiple Myeloma) ➜ congestion of brain's microcirculation➜ [neuro ∆ /hearing ∆ /vision ∆] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ neuro ∆ = somnolence/coma/HA ## Footnote *tx = plasmapheresis*

Answer 22

4-6 wks; ## Footnote 1. [CP/CPPS] 2. BPH 3. Prostate CA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ^{*(Chronic Prostatitis⼀Chronic Pelvic Pain Syndrome)*}

Answer 23

["memory booster" (2/2 to its suggested propensity for ⇪ cerebral blood flow)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Bleeding⁽*^{inhibits platelet-activating factor + potentiates anticoagulants}*⁾ (especially if combined with ASA/antiplatelet drugs) | *"[herbs **GSG**] cause Bleeds"*

Answer 24

Chemotherapy commonly ➜ {TLS = [⇪PU**K**ED (and ⬇︎Ca+)]} --(if SEVERE hyperKalemia)--\> [sine wave Wide QRS] ➜ VENTRICULAR ASYSTOLE ➜ CARDIAC ARREST *PUK = Phosphate/Uric acid/K+*

Answer 25

1. DIC 2. ^{*2nd line tx for*}[Vitamin K deficiency coagulopathy^{(i.e. warfarin OD INR ≥2)}] ; ## Footnote _{*(2nd line tx for Warfarin OD because FFP requires large volume > 2L)*}

Answer 26

[**platelet < 50K**]

Answer 27

* **PAN**cytopenia * Macrocytic anemia * low reticulocyte count ## Footnote *common cause of delirium/dementia in elderly!*

Answer 28

[Cobalamin B12] deficiency!

Answer 29

[Cobalamin VitB12 deficiency] ➜ defective DNA synthesis in bone marrow ➜ [Erythroid hyperplasia but with no maturation] = **RBC megaloblastic transformation** ➜ [intramedullary RBC hemolysis] ➜ [⇪ hemolysis markers ⼀indirect bilirubinemia, LDH, (low haptoglobin)] and no reticulocyte response

Answer 30

**[PCC +KIV]** \> ffp \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * PCC = Prothrombin Concentrate Complex (contain VitK factors and normalizes INR\<10m) / KIV = Vitamin K IV(takes 12h to onset)* * ffp= fresh frozen plasma(2nd line due to large volume \>2L required)*

Answer 31

**WARFARIN** **[PCC +KIV]** \> ffp \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ a. PCC = contain [VitK factors^2/7/9/10] and normalizes INR\<10m b. KIV = takes 12h to onset c. ffp = 2nd line for warfarin reversal due to [large volume \>2L required]

Answer 32

[Hold Warfarin x 1-2d] | [DEC dose]

Answer 33

- Hold Warfarin ➜ Resume when INR therapeutic - [vitK_{Ld 1- 2.5mg} PO]*^{(If INC risk of bleeding)}*** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[vitK_Ld PO]: vitamin K oral (Low dose = 1-2.5mg)*

Answer 34

- Hold Warfarin ➜ Resume when INR therapeutic - ***GIVE*** [vitK**_HD**_{2.5 - 5 mg} PO] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[vitK_HD PO]: vitamin K oral (HIGH Dose =2.5 -5mg)*

Answer 35

- Hold Warfarin ➜ Resume when INR therapeutic - ***GIVE*** [vitK**_UHD**_{10 mg} IV] - ***GIVE*** [PCC] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[vitK_UHD IV]: vitamin K IV(ULTRA HIGH Dose = 10mg)*

Answer 36

[**Anti-ParietalCell** and **Anti-IntrinsicFactor**] autoimmune destruction ➜ AMAG ➜ no IntrinsicFactor to facilitate {[Cobalamin VB12] terminal iLeum absorption} ➜ [mAcrocytic megaloblastic anemia] dx = elevated Anti-IF | AMAG = Autoimmune Metaplastic Atrophic Gastritis

Answer 37

AMAG = autoimmune destruction against intrinsic factor and oxyntic cells ➜ gastric **fundus** and gastric **body** destruction with: 1. glandular atrophy 2. intestinal metaplasia 3. intestinal inflammation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *AMAG = Autoimmune Metaplastic Atrophic Gastritis*

Answer 38

{[cytotoxic chemotherapy] or [high grade lymphoma]} ➜ rapid lysis of neoplastic cells ➜"*pt* **PUKED**" - **P**hosphate INC (⇪ [serum/urine *P*] binds [serum/urine *Ca+*] ➜ [⬇︎serum *Ca+* and CaPhosphate renal stones]) - {**U**ric acid INC from pUrine DNA bases (serum and [urine ➜ Uric Acid stones]) = (px=allopurinol and IVF)} = DIAGNOSIS - **K**+ INC ( ➜ arrhythmia) - [**E**levated ^{(Ca+P & Uric Acid)}renal stones ➜ AKI (IVF px)] - [**D**NA base *Purines*] INC → Uric acid INC

Answer 39

[urate oxidase*^{(not naturally in humans)}* recombinant] = catalyzes conversion of [INC Uric acid^{(i.e. from Tumor Lysis Syndrome)}] ➜ [allantoin (excreted in urine)] for Tumor Lysis Syndrome px \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 40

* Cancer = chemo ➜ [_TLS**PUKED**] ➜ [**E**levated ^{(Ca+P & Uric Acid)}renal stones ➜ AKI] * Rasburicase only ⬇︎Uric Acid renal Stones. AKI can still be caused by Ca+P stones

Answer 41

[60% Head/Neck CA are locally advanced at time of dx = inoperable] ➜ CRT as a duo INC the 5 year survival rate

Answer 42

*Violent* PCP = [**BENZO** sedation] *Mild* PCP = [low stimulation environment +/- benzo sedation] *** *[PCP (Phencyclidine)] is a [NMDA R Blocker hallucinogen]*

Answer 43

* physician should* 1. explain risks of herbal preparations 2. **document** that you counseled patient to avoid herbal prep 3. **document** patient refusal/response to avoid herbal prep 4. follow patient closely for adverse effects

Answer 44

PICC has [**HIGHER** UE DVT] but… PICC has **lower** - infections - procedural complications - patient discomfort

Answer 45

*Total Iron Binding Capacity = TIBC = "**T**ransferrin **I**n **B**lood **C**alculation"* = [**TOTAL amount of transferrin***^{(transports iron)}* **in serum**] (by calculation)

Answer 46

## Footnote _{{ACD🔧: chronic/inflammation→IL6 secretion → [hepatic hepcidin secretion]→ [^{macrophage/intestinal}ferroportin]❌ from *transfering* Fe from FerriTin to Transferrin ➜ {[ **↧** Transferrin Saturation _{**with an accompanying** Transferrin "activity pause" *= stops Transferrin from scavenging blood for more Fe*} → ⬇︎ **T**ransferrin **I**n **B**lood (⬇︎TIBC)] , [**↥** FerriTin],} and _ultimately [⬇︎Fe_{**in circulation*}],}

Answer 47

⬇︎MCV ⬆︎Iron

Answer 48

[HgbBarts tetramer of gamma (Hydrops Fetalis)] | *Intrauterine death 2/2 CHF*

Answer 49

- less severe variant of [Sickle Cell Disease_{(Hgb_SS & Hgb_SC)}] - ➜ mild normocytic anemia - electrophoresis = [equal Hgb\_S = Hgb\_C]

Answer 50

[FerriTin \< 15] = IDA ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Most pts with [FerriTin 15-30] realistically are also iron deficient = Traditional rule can only **rule IN IDA**

Answer 51

1. [BorTezomib proteasome inhibitor] OR 2.{[LD _{*and if \<70 yo*}(➜ BMT)} *** ## Footnote _{*[Lenalidomide + Dexamethoasone] --\> [Bone Marrow Transplant]}*}

Answer 52

This does **NOT** automatically mean Multiple Myeloma. This can be seen in MGUS-Monoclonal Gammopathy of Unknown Significance which = common in older pts and only transforms to Multiple Myeloma 1%/year

Answer 53

Multiple Myeloma plasma cells overproduce Ig**M** specifically --\> hyperviscosity sx (HA, tinnitus) 1. Neuropathy 2. Engorged blood vessels 3. HA 4. tinnitus 5. Raynaud Phenomenon

Answer 54

1. **PLASMAPHERESIS initially** 2. Chlorambucil + Prednisone = long term OR 3. Fludarabine + Prednisone = long term

Answer 55

DDAVP desmopressin --(refractory)--\> Factor 8 or vWF concentrate ## Footnote _{*DDAVP → ⇪Factor 8 → ⇪ vWF*} (DDAVP releases subendothelial stores of vWF)

Answer 56

CefTriaxone (*Strep Pneumo*) + Azithromycin (*Mycoplasma PNA*)

Answer 57

therapeutic phlebotomy

Answer 58

metastatic SQC

Answer 59

**MELAS** [**M**itochondrial **E**ncephalopathy + **L**actic **A**cidosis + **S**troke-like episodes] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. stroke-like episodes, lactic acidosis, seizures, m weakness, hearing loss 2. onset LOE40 yo 3. maternally transmitted only

Answer 60

[Non-Hodgkin Lymphoma: (DLBL)] *Diffuse Large B-Cell* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ***RAS_{_HH_} O_{_RR_} PAI_{_NN_}***

Answer 61

*"Frostbite **numbs**_{your body}, **scars**_{your body}, _then **Kills**_{your body}"* ## Footnote 1st: **numbs** ^{= [(Pallor +/- Thrombosis) + Anesthesia]} 2nd: **scars**^{= [blister + eschar]} 3rd: **Kills** ^{= [Deep Tissue Necrosis, Mummification]}

Answer 62

[Rapid rewarming in water bath at 37-39C] ; * * * *Thrombolysis is considered in patients who:* 1. have absent perfusion on angiography or technetium-99m scan 2. amputation would be suboptimal 3. seek care within 24h of injury *(typically only used in these pts)*

Answer 63

1. [FEVER + HA + THROMBOCYTOPENIA] in travelers returning from sub-Saharan Africa 2. Dx = peripheral blood smear 3. Plasmodium falciparum 4. [Antimalarial prophylaxis before, during and after]

Answer 64

BPH | *"GSG cause Bleeds"*

Answer 65

Hyper**C**holesterolemia | *"[herbs **GSG**] cause Bleeds"*

Answer 66

Osteoarthritis

Answer 67

Osteoarthritis

Answer 68

Depression ## Footnote _{**Chronic alcohol**ics **St**eal **Phen-Phen** & **N**ever **R**efuse **Gr**easy **Carb**s *which keeps them UP*}

Answer 69

*"[herbs **GSG**] ... Bleeds"* ## Footnote -**G**inkgo biloba -**S**aw Palmetto -**G**arlic

Answer 70

Carbon & Nitrogen ; PLASTIC | Polyurethane foam ## Footnote _{*{{CYanide is released from [burning PLASTIC] or [Nitroprusside_Rx]} | Tx = Hydroxocobalamin_{+/- Sodium thiosulfate}}*}

Answer 71

[CYanide^{(*released from burning PLASTIC|using Nitroprusside_Rx*)}] inhibits [mitochondrial oxidative phosphorylation] ➜ forces cell to switch to anaerobic metabolism ➜ lactic acid formation = [^{lactic acid}metabolic acidosis]. unused arterial oxygen remains in blood ➜ unused venous oxygen = [*bright ^CHERRY**Red** skin*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx = [Hydroxocobalamin +/- Sodium thiosulfate] ## Footnote _{*{CYanide tox sx = [*bright ^_CHERRY_**Red** skin*], Yucky bitter almond breath, brain⇪^*seizure*, brain⬇︎^{*CNS depression*} , [lung⇪ _f/b lung⬇︎*]^{*[tachypnea f/b bradypnea]*}}

Answer 72

1. [CYanide (*released from burning PLASTIC*)] inhibits [mitochondrial oxidative phosphorylation] vs [CO binds hgb with higher affinity than O₂ ➜ DEC oxygen delivery] 2. [CO = Carboxyhemoglobin \> 25%] vs [CYanide = nml Carboxyhemoglobin] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote _{*{{CYanide is released from [burning PLASTIC] or [Nitroprusside_Rx]} | Tx = Hydroxocobalamin_{+/- Sodium thiosulfate}}*}

Answer 73

1. Bright CHERRY Red Skin (*also seen in CO poisoning*) 2. Yucky Bitter Almond breath 3. brain⇪^*seizure* 4. brain⬇︎^{*CNS depression*} 5. [lung⇪ _f/b lung⬇︎]^{*[tachypnea ➜ bradypnea]*} 6. [^lacticmetabolic acidosis] | *🧠inhibits oxidative phosphorylation → anaerobic metabolism → lacticMA* ## Footnote _{*{{CYanide is released from [burning PLASTIC] or [Nitroprusside_Rx]} | Tx = Hydroxocobalamin_{+/- Sodium thiosulfate}}*}

Answer 74

CYanide; ▶Nitroprusside (rapid short acting vasoDilator) metabolizes into both: - Nitric Oxide ➜ vasoDilation - **CYanide ➜ converted to thioCYanate ➜ RENAL excreted** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶Patients with renal insufficiency = unable to excrete thioCYanate ➜ CYanide toxicity ## Footnote _{*{{CYanide is released from [burning PLASTIC] or [Nitroprusside_Rx]} | Tx = Hydroxocobalamin_{+/- Sodium thiosulfate}}*}

Answer 75

Factor 5 Leiden

Answer 76

*blood is ordered for transfusion:* **T**ype **S**erum **C**arefully, **D**ude 1st: **Ty**pe: [Recipient patient's] blood is *typed* = ABO and Rh determined \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2nd: [**S**creen (PTAS)]: Recipient's serum **_S_**creened for [unexpected *preexisting* autoantibodies (*previously made* against RBC antigens E, L or K from previous transfusions)] = [**_P_**re**_T_**ransfusion **_A_**b **_S_**creen] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3rd: **C**rossmatch Recipient's blood with [blood they will be receiving] in-vitro first \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4th: **D**ecide: [**_✅Transfuse(***⊕unexpected _e/l/kRBC AutoAntibodies or ⊕Crossmatch rejection?***)^{🚫Transfuse ➜ Identify Ab}**]

Answer 77

Bone marrow; Organ ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ T ; 1. Skin 2. Liver 3. GI *This occurs because [Graft\_Donor] T-cells recognize major and minor HLA antigens of the [Host_Recipient Skin//Liver/GI]*

Answer 78

Leukoreduction of [graft\_donor] blood \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *this will also ⬇︎ risk of HLA alloimmunization and CMV transmission*

Answer 79

*[Leukoreduction of [graft\_donor] blood] will ⬇︎ risk of:* 1.**[Febrile nonhemolytic transfusion reaction]**, 2.[HLA alloimmunization]✳ 3.CMV transmission^{*(CMV resides in Leukocytes)*} ## Footnote ✳alloimmunization: ^{= *host_recipient immune response to otherwise [foreign antigens (blood group ag|histocompatibility ag) from ANOTHER PERSON] [⼀usually from incidental exposure like transfusion] *}

Answer 80

Cyanide toxicity ## Footnote _{*{{CYanide is released from [burning PLASTIC] or [Nitroprusside_Rx]} | Tx = Hydroxocobalamin_{+/- Sodium thiosulfate}}*}

Answer 81

“superficial cut using **_DAG_** on it !” 1st: [a**D**herence] *of circulating [inactivated platelet's Gp1B] to exposed vWF of subendothelial collagen* →2nd: [a**A**ctivation & secretion] = *Activated platelet → secretes fibrinogen and {[ThromboxaneA2 & ADP] → [INC (Gp2b/3a\_platelet fibrinogen R) expression on platelets]}* *→* 3rd: [a**G**gregation] *of platelets via fibrinogen binding them together via [Gp2b/3a\_platelet fibrinogen R]* = [*weak* 1*º* PLATELET PLUG] *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

Answer 82

platelet; * CKD patient * [1HS❌ *(⇪ **mucosal bleeding/bruising**)*] * [platelet count nl] * [PT/INR nl] * [aPTT nl] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *1HS: [Primary Hemostasis platelet plugging]*

Answer 83

a. platelet; [1HS❌ *(⇪ **mucosal bleeding/bruising**)*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *1HS: [Primary Hemostasis platelet plugging]*

Answer 84

a. platelet; [1HS❌ *(⇪ **mucosal bleeding/bruising**)*] * * * c. 1. Sx = [desmopressin dDAVP *(INC vWF secretion from endothelial cell)*]^{IV or SQ} 2. Asx = observe \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *1HS: [Primary Hemostasis platelet plugging]*

Answer 85

a. platelet; [glanzmann thrombasthenia] ; a**G**gregates platelets (---by binding [*Activated* platelet Gp2b/3A receptor] with a another [*Activated* platelet Gp2b/3A receptor] via fibrinogen) * * * b. “he **ATE** my Gp2b/3A”: [**A**bciximab, **T**irofiban, **E**ptifibatide] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 86

a. platelet ^{*[inactivated circulating platelets]*}; [Bernard-Soulier syndrome] ; [_{[inactivated circulating platelets]} a**D**heres to [vWF_{*Gp1b Receptor*} ^{*(since vWF will already be bound to the exposed subendothelial collagen)*} ## Footnote _{→platelet [**A**ctivation & secretion^{*(of "F.A.T." stuff)*}] → platelet a**G**gregation = [**DAG** 1HS]}

Answer 87

ASA inhibits ***COX*** * * * ✏️ { [platelet Arachidonic Acid] ---(via ***COX***)-→ converted to [TXA2 (thromboxane)] → [platelet TXA2 (ADP also)] INC expression of [Gp2b/3A\_platelet fibrinogen R] which enables→ [platelet aGgregation] } ✏️ASA inhibits ***COX*** → No [TXA2 (thromboxane)]= No platelet aGgregation = No Clotting ("thins" your blood)

Answer 88

1. reversible or 2. time limited 3. (*ex:* surgery, pregnancy, OCP, trauma) 4. _[Warfarin tx for_ **_only_** _3-6 months_ *_(_ ≥6 mo for [1° idiopathic])*]

Answer 89

* depressed brain,* *[= Somnolent/AMS]* * depressed blacks,* *["-pupils" = miosis])* * depressed breath* *[= shallow bradypnea ≤12 RR]*

Answer 90

[potent inhibitors of ACh**E**] → [No ACh*--breakdown*] → [ACh accumulation] → hyperactivation of *mCN* receptors = {[“*OTC* **dUMBBELLS C**reate **M**uscle”] ? …….**PAID**} * * * [agricultural pesticides], [sarin_{(WARFARE AGENT)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *mCN: muscarinic | CNS | Nicotinic*

Answer 91

ACh**E** ; [ACh accumulation] → {[“*OTC* **dUMBBELLS C**reate **M**uscle”] ? …….**PAID**} * * * [“*OTC* **dUMBBELLS C**reate **M**uscle”] *_O_*rganophosphate ***_T_**oxic* *_C_*holinergic : 1. [**_d_**iarrhea/**U**rination/**M**iosis/**B**radycardia/**B**ronchospasm_{( → Respiratory failure)}/**E**mesis/**L**iquid lung bronchorrhea /**L**acrimation/**S**alivation]*^muscarinic* 2. [**_C_**oma/Seizure]*^CNS* 3. [**_M_**uscle(weakness/paralysis/fasciculation)]*^Nicotinic*

Answer 92

ACh**E** ; [ACh accumulation] → {[“*OTC* **dUMBBELLS C**reate **M**uscle”] ? …….**PAID**} * * * **PAID** 1. [**P**ralidoxime ⼀*reactivates ACh**E***] 2. [**A**tropine anticholinergic⼀ *competitively inhibits ACh*] 3. [**I**ntubation prn + ABCs (*give activated charcoal if exposure ≤1h)*] 4. [**D**econtamination]

Answer 93

**DDDD**^{*(AKA Pellagra)*} **D**ementia [**D**ry mouth^{STOMATITIS / CHEILOSIS}] **D**iarrhea [**D**ermatitis^{symmetrical/blister vesicles in sunexposed areas}] | *💡Niacin uses _Tryptophan_ for synthesis, & CaRcinoid tumors do also*

Answer 94

areas of INC bone turnover; osteo**BLASTIC***^{(prostate/SOLC/Hodgkin)}*

Answer 95

Prostate / SOLC / Hodgkin * * *

Answer 96

* nMn* * N*onSOLC / *M*ultiple Myeloma / *N*onHodgkin * * *

Answer 97

BREAST * * *

Answer 98

1.^{Dehydration =}[**IV Hydration + IV Analgesia**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2.^{[Infxn (⊕fever|⊕WBC)] =}**cefTriaxone** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3.^Cold🌡=**[Transfusion_{*(if ⊕CVA|Retinal infarct|aCS| Priapism)*}** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4.^{"Kan't breathe_hypoxia" =}**[O2 + Hydoxyurea *to carry more O2*_*⇪HbF*]** | *treat the 4 SCD triggers (DICK)* ## Footnote *aCS = acute Chest Syndrome*

Answer 99

1. [Folic acid B9] chronically 2. Splenectomy (stops hemolysis)

Answer 100

**NEVER!!!** | *give plasma EXCHANGE^{TTP tx}|supportive_{HUS tx}* ## Footnote _{TTP etx: [A13vM❌^{(or inhibition by shiga toxin in HUS)}] →uncontrolled vWF chain cleavage → widespread platelet traps/activation → thrombocytopenia + microagio hemolytic anemia → _FMNRT_ TTP cp ^{⚠️TTP cp (aside from +Neuro and plasma EXCHANGE tx) = HUS cp}. ⼀ *(TTP Tx = _EXCHANGE_ plasma containing anti-A13vM or deficiency of A13vM for normal plasma)*}

Answer 101

*_1-6h*[**Febrile Nonhemolytic** **transfusion reaction**] = F/C from cytokine accumulation during blood storage]

Answer 102

[*DAT*] and [fam hx] * * * AIHA = [**⊕***DAT*] (negative fam hx) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Hereditary Spherocytosis = [⊝*DAT*] (positive fam hx) * * * * DAT* = [*_Direct_*(Coombs) *AntiHumanGlobulin Test*]

Answer 103

**IAT** = [**I**ndirect\_*Coombs **A**ntiHumanglobulin **T**est*] = ## Footnote ▶Uses [*IAT* and test blood] in lab to determine if h\_r serum contain [preformed IsoAgglutinins^(IgM>IgG)] that agglutinate to common RBC antigens = “Antibody Screen” **▶I**ndirectly In Vitro: Mixes [test blood^{(which contain RBC loaded with common RBC antigens)}] with host\_recipient's [plasma w/antibodies]. ⼀ The *IAT* will bind to any {h_r [Ab|compliment (IgM/IgG/C3d/C3/etc.)} that have inappropriately agglutinated to RBC common antigens→ *IAT* is visualized to identify the RBC antigens (if any) h_r Ab are sensitized to. * * * *[IAT = Indirect CAT]*: *CAT: *Coombs AntiHumanglobulin Test] // [g\_d: graft\_donor] // [h\_r: host\_recipient]*

Answer 104

**DAT** = [**D**irect\_*Coombs **A**ntiHumanglobulin **T**est*] = ## Footnote *[CAT*: *Coombs AntiHumanglobulin Test] // [gd\ : graft\_donor] // [hr\: host\_recipient]* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **DAT** ▶Uses *CAT to determine* if [^gd\RBC] are *_ACTIVELY_* being Sensitized (and ultimately hemolyzed) by [Transfusion/Drug-Induced/ ^hr\Ig**_M_**] * * * ▶**D**IRECTLY EN VIVO: host\_recipient blood is taken and given *CAT* **D**IRECTLY → which will bind to (and allow us to visualize/identify) any {[hr\Ab|compliment ^{(IgM>>IgG/C3d/C3/etc)}] *_ACTIVELY_* agglutinating gd\RBC} ▶[⊕DAT is ALWAYS ABNORMAL] and usually comes from [host\_recipient Ig**_M_** *and* compliment] ^*(*^{but incomplete DAT comes from IgG | compliment acting alone)}*

Answer 105

**DAT** = [**D**irect\_*Coombs **A**ntiHumanglobulin **T**est*] = ## Footnote *[CAT*: *Coombs AntiHumanglobulin Test] // [gd\ : graft\_donor] // [hr\: host\_recipient]* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [⊕DAT occurs in \_\_\_] - [Acute Intravascular Transfusion Hemolysis] - [Delayed IgG EXtravascular Transfusion Hemolysis] - [Drug-Induced IgG EXtravascular Transfusion Hemolysis] - [Autoimmune Hemolysis] - [HDN (Hemolytic Disease of Newborn)]

Answer 106

*_≤minutes*[Anaphylaxis (IgA-deficient pts' anti-IgA antibodies attack donor IgA)] = [Respiratory Distress, Angioedema]^{tx = Epi, antihistamine, CTS, [CardioPulm support]} * * * *_{≤1 hr}*[Acute Hemolytic Reaction (ABO mismatch 2/2 clerical error vs chronic transfusions) → [Preformed IgM using compliment (will have ⊕DAT)] → Intravascular hemolysis ] = ^[**^T**^achycardia/**^L**^umbarPain/**^H**^gbnuria/**^B**^{leeding_hypOtension_DIC/}**^C**^{hestConstriction/}**^F**^luLikeSx]^{tx = [NORMAL SALINE IVF]}

Answer 107

*_≤minutes*[Anaphylaxis (IgA-deficient pts' anti-IgA antibodies attack donor IgA)] = [Respiratory Distress, Angioedema]^{tx = Epi, antihistamine, CTS, [CardioPulm support]} * * * * _{≤1 hr}*[Acute Hemolytic Reaction (ABO mismatch 2/2 clerical error vs chronic transfusions) → [Preformed IgM using compliment (will have ⊕DAT)] → Intravascular hemolysis ] = [**T**achycardia/**L**umbarPain/**H**gbnuria/**B**leeding\_hypOtension\_DIC/**C**hestConstriction/**F**luLikeSx]tx = [NORMAL SALINE IVF]

Answer 108

[monoclonal B-lymphocyte leukemia]; **LATO** sx **L**AD **A**nemia **T**hrombocytopenia **O**rganomegaly^Liver/Spleen * * * [smudge cells_{(peripheral smear)}] and [flow cytometry]

Answer 109

Patients with ▨[limited CA: solely Organ/Organ's lymph nodes] → limited bx^{organ or organ LN}] * * * ▩ [EXTENSIVE CA: metastasis/involves supraclavicular LN → EXTENDED bx^{of one of the metastasized sites instead [(supraclavicular (if involved)] > other sites}] = this is because metastasized sites (like Supraclavicular LN excisional bx) tend to be ⬇︎invasive and ⬇︎complications for biopsy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ex: Pts with suspected metastatic Lung cancer _{(if possible)}**should have initial bx from one of the metastatic sites^{(SCLV-if involved) > other}**

Answer 110

[**NON**-IgE] drug rxn involving vancomycin binding directly/activating mast cells → histamine release → [diffuse pruritus, erythema] ⼀proportional to infusion rate and resolved with d/c

Answer 111

*s_x: "Monixide hurts my [**MIND'S → SSSH**]* **M**alaise **I**rregularly SHARED HEADACHE (w/roommate, housemate, etc) **N**ausea **D**izziness **S**kin ∆^{[PINK-*like cYanide tox*] or [BLUE-*like methemoglobinemia tox*]} * * * **S**eizure/**S**yncope/**S**leepy-COMA/**H**eart❌ ## Footnote *tx: high-flow O2 via nonrebreather → hyperbaric oxygen*

Answer 112

[high flow O2 via nonrebreather] --*(if severe)*--\> hyperbaric oxygen

Answer 113

a. *^{(often confused for allergic rxn**)}*in seafood stored at temperatures \> 15C, histidi**n**e undergoes decarboxylation → hista**M**ine = b. [flushing |throbbing HA|palpitations|abd cramps|diarrhea|(oral burning +/- “bitter taste”)] 10-30m after ingesting *_(usually)_FISH_*

Answer 114

\*perioral tingling \*paralysis \*poor coordination

Answer 115

1. [type 3 immune complex-mediated hypersensitivity rxn] 2. primarily occurs after receiving [antibodies*_{Monoclonal/Chimeric}*] or [antitoxins*_heterologous*] 3. SSLR = gzd urticaria + fever_{low grade} + arthralgia + LAD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *SSLR: Serum Sickness-Like Reaction*

Answer 116

{ [allogenic hematopoietic stem cell transplant] \< *[**age 60**]*\< [palliative care] }

Answer 117

**PAN**cytopenia ; [aPL ⼀acute PROMyelocytic Leukemia M3 (T15/17)] *Dx = smear showing [myeloblast\>20%] --\> flow cytometry for confirmation*

Answer 118

[mild/moderate depression] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ It **upregulates** [CYP P450] ➜ ⇪ metabolism ## Footnote _{**Chronic alcohol**ics **St**eal **Phen-Phen** & **N**ever **R**efuse **Gr**easy **Carb**s *which keeps them UP*}

Answer 119

[somatostatin 14 analogue] ; [Somatotrope - Functional Pituitary Adenoma] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ inhibits [pituitary somatotrope] from releasing Growth Hormone in a [functional pituitary adenoma]

Answer 120

congenital bone marrow failure in infancy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. absent thumbs 2. craniofacial abnormalities 3. [SEVERE Macrocytic anemia (hgb \< 9 at birth)] 4. reticulocytopenia

Answer 121

6 ^{*= (this is the expected # lifetime Tetanus vaccines)*} _{*#5 if 18 yo*} ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [DTaP = (2 / 4 / 6 / 15 ) months old] + [TDaP at 11 years old] *+ TDaP _booster @ 21 years old*

Answer 122

**S**teroids **M**ake **P**eople **D**epressed! 1. **S**uicidality 2. **M**ania 3. **P**sychosis 4. **D**epression

Answer 123

"*SSRI... {Sexually Slows & Really Impairs LEO*" ⬇︎Libido | ⬇︎Orgasm | [⬇︎Ejaculation (delays)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - [**SWITCH** to non-SSRI (buproprion/mirtazapine) ^{⚠️{DOSAGE reduce cautiously for pts on high-dose/long term SSRI)}]} *or* - [**AUGMENT** with sildenafil]

Answer 124

LCIS is nonmalignant, but still has ⇪ risk for development into [invasive breast CA or DCIS] = **excisional biopsy** + lifetime surveillance

Answer 125

d/c **ALL**forms of Heparin ➜ alternate anticoagulants (i.e. *direct thrombin inhibitors*) [even if no thrombosis present] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ platelet \> 150K

Answer 126

## Footnote [inhibits aldehyde dehydrogenase ➜ [**SEVERE NV** with any _EtOH intake_] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Disulfiram for* [Die-Hard ABSTINENTS who want to stay Abstinent] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Naltrexone ( ⬇︎EtOH cravings) for [moderate/SEVERE Alcoholism in opioid-free patients that are Alcoholic] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[acamprosate (glutamate modulator)] is also used in Alcoholism*

Answer 127

BRCA mutation \> \> \> Klinefelter Syndrome ## Footnote \> [**LAME** (**L**iver failure/(**A**lways Eating {Obese})/**M**arijuana/(**E**strogen:androgen ratio ⇪ {gynecomastia})] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ BRCA = auto DOM mutations ➜ [⇪ Male Breast CA risk x 100] [klinefelter syndrome XXY] = male having extra "X" chromo ➜ [Estrogen:androgen ratio ⇪] ➜ [⇪ Male Breast CA risk x 20]

Answer 128

60-100 ## Footnote *(some can go down to 45 with no sx)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Whipples = [low BG] + [*PUSH* low BG sx] + [*PUSH* low BG sx improve after glucose administration] = **true hypOglycemia** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *hypOglycemia sx = need **PISH** juice = **P**alpitations/**U**neasy Irritable/**S**weating/**H**A*

Answer 129

**AF** ➜ **RF** px = **A****F**: [**A**llopurinol (xanthine oxidase inhibitor)] +**F**luids IV] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ TX (for AKI 2/2 TLS) = **RF**: [**R**asburicase (urate oxidase analogue)] + **F**luids IV] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **[A**llopurinol prevents *A*dditional serum uric acid formation] whilst [**R**asburicase metabolizes *R*ealtime (already existing) serum uric acid]

Answer 130

Sickle Cell **TRAIT** = ASYMPTOMATIC (does not cause Anemia)

Answer 131

⭐caused by **IL6 chronic inflammation** → liver secretes hepcidin → [blocks ^{🆚 suspend}] {[DJ enterocyte *ferroportin*] and [macrophage *ferroportin*]} from *transfering* iron ^{from FerriTin_*storage*} to Transferrin_*transport* ⭐^{*(→🔻TS_{(if ferroportin _blocked_)} 🆚 normal TS_{(if ferroportin only _suspended_)})*}, ⭐and exact opposite for FerriTin^{= 🔺_{*(ferroportin _blocked_) *} 🆚 nml_{*(ferroportin suspended*} FerriTin} ⭐but additionally❗️ all this hoopla also *paradoxically* keeps Transferrin out of circulation (^{*which → ⬇︎TIBC (but with 🔻^/normalTransferrin Saturation)) = rare*\*} ⭐AND ULTIMATELY this ➜ {[(Normo*^initially*→micro*^later*)cytic] normochromic anemia} | \*Typically *Transferrin Saturation* and *TIBC* are inverse related ## Footnote so.... \_\_\_\_\_\_\_\_\_=\_\_\_\_\_\_\_\_ ^{*iron studies =*}{[_**↧**Transferrin Saturation _{**with** *paradoxic*}⬇︎TIBC]\*, [_**↥**FerriTin], [⬇︎iron_{*in circulation*}*^{iron in circulation is low because it's still being sequestered to FerriTin by Hepcidin}*]} = {[_**🢗**MCV^{*Normo --(to)--> micro*} -CYTIC ] [**Normo**CHROMIC] } \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *🔎DJ = Duodenal-Jejunal* *🔎↧ = (DEC _or normal)* *🔎↥ = (INC _or normal)* *🔎TS = Transferrin Saturation*

Answer 132

killing bacteria could ➜ ⇪ release of Shiga toxin \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SUPPORTIVE CARE ONLY (*fluid/electrolyte mgmt | blood transfusions | dialysis*)

Answer 133

[ dopamine🟥 ] ; Huntington's disease

Answer 134

SKIN \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **S**weating = **S**timulant tox **A**LL Dry = **A**nticholinergic tox

Answer 135

⭐[B Cell CA (Multiple Myeloma)] ➜ Monoclonal immunoglobulins that aggregate at low temp \< 37C = Cryoglobulins. ⭐Cryoglobulin precipitation ➜ noninflammatory microvascular occlusion and hyperviscosity sx when CG are high ## Footnote _{*hyperVIScosity sx = Vertigo, Imbalance/ataxia, Sight blurry*}

Answer 136

FALSE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Varenicline + NRT = ✔︎*

Answer 137

_{osteoclast activating factor ➜}**CUBP**_*sx* 1.[(***C**RAB*) - end organ damage] _{*hyper**c**alcemia*^{(→ vertebral dark lytic lesions/bone fx, constipation, depression)}

*R*enal failure^{(2/2 Ig and Bence Jones proteinuria --\> DEATH)}

*A*nemia normocytic

[*B*ack pain i\ vertebral dark lytic lesions and bone fx]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2.[**U**rine IgG or Urine IgA] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3.[**B**one marrow with ≥10% clonal plasmacytosis/plasmacytoma ^{(*If Infection → DEATH!*)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4.[**P**rotein (M Protein) in serum]

Answer 138

[Chronic Viremia/Autoimmune disease] ➜ [B cell hyperactivation] ➜ forms IgM which bind to IgG = ⇪ mixed circulating immune complexes these [circulating immune complexes] desposit in small vessels ➜ INFLAMMATORY vasculitis (*glomerulonephritis*) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 139

1. Livedo reticularis 2. digital ischemia 3. retiform purpura (net like reflect of vasculature - *image*)

Answer 140

**[1H-6H]** ; [Fever / Chills / Malaise] _{(NO HEMOLYSIS)} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Leukoreduction = ⬇︎[Febrile nonhemolytic _{transfusion rxn}] ⬇︎HLA alloimmunization✳ [⬇︎CMV transmission ^{*(since CMV resides in Leukocytes)*}] ## Footnote ✳alloimmunization: ^{= *host_recipient immune response to otherwise [foreign antigens (blood group ag|histocompatibility ag) from ANOTHER PERSON] [⼀usually from incidental exposure like transfusion] *}

Answer 141

[HEMOLYSIS WITH UNCONJUGATED HYPERBILIRUBINEMIA → JAUNDICE] [SUDDEN BACK PAIN] FATIGUE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *X-linked RBC G6PD defect in African/Middle Eastern/Southeast asian ➜ ⇪ RBC hemolysis from* [**DASANI** H₂O₂ oxidant stress]

Answer 142

✏️ [X-linked RBC (G6PD\_Glutathione reductase) deficiency] in African/Middle E/SE asian * * * ✏️= ["**DASANI**" H2O2 oxidant stress] → [RBC H₂O₂ ⇪ ^{*(since there's no G6PD to drive GSH buffer rxn which normally takes up oxidant stress)*}] → [Oxidation denaturation of Hgb Sulfhydryl groups] = Formation of Heinz bodies in RBC→ [RBC damage and ⬇︎ membrane flexibility] = sx : * * * ⬇︎ ✏️a.. 🅸¹ = Intravascular hemolysis from [*Oxidized denatured Hgb Sulfhydryl group* membrane damage] → *[HEMOLYSIS WITH **UN**CONJUGATED HYPERBILIRUBINEMIA → JAUNDICE]** ✏️b.🅸²: [Heinz body RBC^{*(RBC with oxidized denatured Hgb Sulfhydryl groups)*}] travel thru splenic cord and splenic macrophages BITE out Heinz body] → [Bite *RBC*] --(eventually after enough bites) forms into→unstable Spherocyte} → 🅸 ✏️c. 🄴Xtravascular hemolysis from [Heinz body-RBC] suddenly getting stuck in spleen → removed by splenic macrophages → [*SUDDEN BACK PAIN] + FATIGUE* ## Footnote *🔎 🅸 = Intravascular hemolysis from membrane damage → [HEMOLYSIS WITH **UN**CONJUGATED HYPERBILIRUBINEMIA → JAUNDICE]**

Answer 143

[X-linked RBC (G6PD\_Glutathione reductase) defect] in African/Middle E/SE asian * * * 1.[measure G6PD activity] 2.[_{peripheral smear}:bite RBCs] 3.[_{peripheral smear}:[heinz body RBCs]^{(= accumulated “**SHODE** =byproducts of INC H2O2 on RBC)}] *** **SHODE**: [Sulfhydryl Hgb ⼀ *Oxidized, Denatured* entities]

Answer 144

[Heinz body RBCs^{*(accumulated oxidized denatured hgb sulfhydryl groups)*}] in **G6PD** ## Footnote ***GLUCOSE 6 PHOSPHATE DEFICIENCY***

Answer 145

**Spherocytes**^{(Hereditary Spherocytosis | G6PD)} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Osmotic Fragility test

Answer 146

1. anemia that is 2. ⼀microcytic (*low mean corpuscular volume*) 3. ⼀hypOchromic (*low mean corpuscular hgb*) 4. [⇪ ferriTin (*INC RBC turnover ➜ more iron to Tuck into storage*)] 5. [normal RDW (*all RBC uniformly made microcytic*)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Hgb electrophoresis: [βT minor = ⇪ Hgb**A2**]

Answer 147

anti-**platelet** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** ***"**I **ATE** [Gp2b/3A] for breakfast"* [**A**BCiximab / **T**irofiban / **E**pTiFibatide]

Answer 148

hgb: M \>18.5 | W\>16.5 measure Erythropoietin \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *polycythemia? ➜ [**low EPO = polycythemia vera] vs [HIGH EPO = 2° polycythemia (chronic hypoxia or Renal Cell Carcinoma)]*

Answer 149

hgb: M \>18.5 | W\>16.5 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ CHRONIC HYPOXIA (consider carboxyhgb and sleep apnea) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *polycythemia? ➜ [**low EPO = polycythemia vera] vs [HIGH EPO = 2° polycythemia (chronic hypoxia or Renal Cell Carcinoma)]*

Answer 150

Doesn't grow Diaper rash Dermatitis perioral Diarrhea

Answer 151

ACh**E** inhibitor --\> TOO MUCH ACh in cleft --\> [“*OTC* **dUMBBELLS C**reate **M**uscle”] ? …….**PAID** * Organophospahtes are used in Agricultural Pesticides* * TX = Atropine + [Pralidoxime (reactivates ACh**E**)]*

Answer 152

STATIN \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * [LDL ≥190] * [age ≥40 + DM] * [(10y ASCVD risk) ≥7.5%] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *THIS IS REGARDLESS OF BASELINE LDL*

Answer 153

▶[X-linked **recessive** 1° immunodeficiency] ▶defect in [neutrophil (NADPH oxidase*^{resp. burst}*)] ➜ impairs neutrophil superoxide formation ➜ [impaired neutrophil intracellular killing^{(neutrophils can eat BUT NOT KILL)}] ▶ = defective granuloma formation ➜ recurrent [catalase positive infections^{*from "**SPACE B**ugs"*}] (**Aspergillus** = MAJOR COD / **Staph A**=liver/skin abscess/adenitis) ## Footnote _{▶*(catalase+) infections = **SPACE B**ugs^{StaphA&Serratia/Pseudomonas/Aspergillus&Nocardia/Candida/Enterobacter/Burkholderia-cepacia}}

Answer 154

[(SMXTMP) + itraconazole]_px \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [interferon-2]_tx ## Footnote _{▶*(catalase+) infections =* **SPACE B**ugs^{*StaphA&Serratia/Pseudomonas/Aspergillus&Nocardia/Candida/Enterobacter/Burkholderia-cepacia*}
▶*dx = nitroblue tetrazolium test*}

Answer 155

▶*(catalase+) infections = **SPACE B**ugs^{_StaphA_&Serratia/Pseudomonas/_Aspergillus_&Nocardia/Candida/Enterobacter/Burkholderia-cepacia*dx = nitroblue tetrazolium test*}

Answer 156

Metronidazole has Disulfiram-like activity --\> _*(toxic)*Acetaldehyde accumulation --\> Flushing/NV/Cramps after drinking

Answer 157

[Activated Charcoal (if within 4 h post ingestion)] ## Footnote *NAC is most effective when given **within 8 hours post ingestion** prior to hepatoxicity*

Answer 158

during APAP OD, APAP --(*via CYP**2E1***)--\> [toxic NAPQI] and [toxic NAPQI] depletes intrahepatic glutathione as it's ➜ [NON-TOXIC cysteine & mercapturic acid] once intrahepatic glutathione is all depleted [toxic NAPQI] accumulates ➜ hepatotoxicity \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Activated Charcoal (if within 4h post ingestion)]- *binds APAP* [NAC (most effective within 8 hrs post ingestion)] ⇪ intrahepatic glutathione and restores [(toxic NAPQI) ➜ (nontoxic cysteine & mercapturic acid)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *protective \< [EtOH chronicity] \< exacerbant*

Answer 159

during APAP OD, APAP --(*via CYP**2E1***)--\> [toxic NAPQI] and [toxic NAPQI] depletes intrahepatic glutathione as it's ➜ [NON-TOXIC cysteine & mercapturic acid] once intrahepatic glutathione is all depleted [toxic NAPQI] accumulates ➜ hepatotoxicity \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *acute EtOH competes for *CYP**2E1*** ➜ DEC [toxic NAPQI] = protective* *CHRON**IC** EtOH upregulates *CYP**2E1*** ➜ **INC** [toxic NAPQI] = exacerbant* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Activated Charcoal (if within 4h post ingestion)]- *binds APAP* [NAC (most effective within 8 hrs post APAP ingestion)] ⇪ intrahepatic glutathione and restores [(toxic NAPQI) ➜ (nontoxic cysteine & mercapturic acid)]

Answer 160

*suspected Alcoholic with:* AG met acidosis INC osmolar gap ⊕ketones variable blood glucose (DKA has BG \> 250) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx = [THIAMINE^**1ST** → Dextrose IVF^2nd] | *dextrose will➜ insulin secretion ➜ metabolism of ketone bodies to HCO3*

Answer 161

*MentzeR Index = MCV/RBC* thalassemia \< [MentzeR Index of 13] \< IRON DEFICIENCY ANEMIA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 162

Carcinoid tumors utilize Tryptophan to secrete tons of Serotonin. Tryptophan is also needed to make Niacin B3. This can --\> Pellagra DDDD ## Footnote *Do not confuse Carcinoid Syndrome with VIPoma which presents similarly but VI**P**oma affects **P**ancreas while Carcinoid affects small intestine*

Answer 163

**BEN** **B**asophils **E**osinophils **N**eutrophils *Clozapine also causes Metabolic Syndrome X, Seizures and Myocarditis*

Answer 164

1. [Actinic⼀Solar Keratosis] 2. [HAWCA] 3. [^superficialBCC] ## Footnote _{*🔎HAWCA = HPV Anogenital Warts Condylomata Acuminata* || *🔎BCC = Basal Cell Carcinoma*}

Answer 165

Buspir**one** = [5HT**1**α R partial agonist] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ GAD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[slow onset] and [lacks muscle relaxant/anticonvulsant properties]*

Answer 166

*s_x: "Monixide hurts my [**MIND'S → SSSH**]* **M**alaise **I**rregularly SHARED HEADACHE (w/roommate, housemate, etc) **N**ausea **D**izziness **S**kin ∆^{[PINK-*like cYanide tox*] or [BLUE-*like methemoglobinemia tox*]} * * * **S**eizure/**S**yncope/**S**leepy-COMA/**H**eart❌ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Dx = [ABG Carboxyhemoglobin levels] ## Footnote ⚠️ _{Monoxide tox can present very similarly to [cYanide tox (which is also [PINK SKIN **BUT with Yucky bitter almond breath**)] and [Methemoglobinemia tox (BLUE SKIN)] so be careful!}

Answer 167

{carbon Monoxide tox^{*(MIND'S → SSSH)*} ➜ [PINK SKIN]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {C**Y**anide tox ➜ [PINK SKIN with **Y**ucky **BITTER ALMOND BREATH**]}

Answer 168

1978 ## Footnote *false positives occur so be sure to confirm with venous blood draw!*

Answer 169

"cYaMonoxide toxicity **N**eeds **O**vert **S**moke **H**elp" *empiric tx for cYanide and ^(carbon)Monoxide toxicity* 1. [**N**itrites^{*(induces methemoglobinemia)*}] 2. **O**xygen 100% (*CO tx*) 3. [**S**odium thiosulfate] 4. [**H**ydroxoCoBalamin^{(*binds cYanide ➜ excretable cYanocobalamin*)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *empircally treat smoke inhalation pts for **CY**anide tox!*

Answer 170

[SEVERE \<28C (or unresponsive Moderate)]: [ACTIVE CORE REWARMING *(WARM PERITONEAL LAVAGE, WARM HUMIDIFIED O2)*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {*"(_C__ut ) BLM!"*_{--tx--> [ACTIVE CORE🔥]}} | BLM = Brain/Liver&heart/Muscle ## Footnote {*"(Cut) BLM"*_{--tx--> [ACTIVE CORE🔥]}} = 🧠 *Brain*^{= _C_OMA} 🫁*Lungs/heart*^{= _C_ardiac _Vt_ arrhythmia} 💪*Muscle*^{= _C_V Collapse}

Answer 171

[Moderate 28-32C (or unresponsive mild) hypOthermia]: [ACTIVE e🅇ternal warming*^{(heated blankets, heated baths, heated forced air)}*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {*"(slow) BLM"*_{--tx--> [ACTIVE^🅇🔥]}} | BLM = Brain, [Lungs&heart, Muscle] || 🅇=E🅇ternal ## Footnote {*"(slow) BLM"*_{--tx--> [ACTIVE^🅇🔥]}} = 🧠 *Brain*^lethargy [🫁&🩷]*Lungs&heart*^{hypOventilation, bradycardia/_atrial_ arrhythmia,} 💪*Muscle*^{DEC shivering}

Answer 172

[mild 32-35C hypOthermia]: [passive external warming *^{( warm blankets & remove wet clothes)}*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {*"(FAST) BLM"*_{--tx--> [passive^🅇🔥]}} | BLM = Brain, [Lungs&heart, Muscle] || 🅇=E🅇ternal ## Footnote {*"(FAST) BLM"*_{--tx--> [passive^🅇🔥]}} = 🧠 *Brain*^{ataxia, dysarthria} 🫁*Lungs/heart*^{tachypnea/tachycardia} 💪*Muscle*^{INC shivering}

Answer 173

b. Streptokinase , Urokinase c. Aminocaproic acid

Answer 174

[^{*(_mild_ ⬇︎ only)*}anxiety^{][*(_mild_ ⬇︎ only)*}insomnia ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [LIVER FAILURE weeks after starting it]

Answer 175

[**NaHCO3 IV**] ➜ [HemoDialysis (if severe)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [NaHCO3 IV] Alkalinizes Blood and Urine ➜ basic blood/urine environment ➜ deprotonation of Salicylates ➜[Salicylate *ion*] inability to be reabsorbed into CNS or into [blood from renal tubules] ➜ [⇪ salicylate ion excretion] *severe = cerebral/pulmonary edema | renal failure*

Answer 176

venous lead level \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *lead tox ➜* *neurobehavioral impairment. tx = AVOID LEAD EXPOSURE*

Answer 177

1. **[isolated** stomach fundal varices] -\> variceal hematemesis 2. [splenomegaly] -\> anemia/thrombocytopenia ## Footnote *Splenic Vein Thrombosis is commonly a/w pancreatitis*

Answer 178

Can cause **SIGNIFICANT K+ RELEASE --\> VFIB** in pts at high risk for Hyperkalemia

Answer 179

Aerobic = **32** AnAerobic = [2 + Lactate]

Answer 180

[FGFR3/cyclin D1 and D3 gene defects] → abnml [*bone marrow* monoclonal plasma cell proliferation] → produces useless immunoglobulin (IgG , IgA) --\> [Osteoclast Activating Factor] which → **CUBP** | *When MM produces IgM = WaldenstroM Macroglobulinemia* ## Footnote **CUBP** 1.{[**C***RAB* end organ ❌]_{(hyper*C*alcemia), *R*enal Failure 2/2 bence jones proteinuria, *A*nemia_normocytic, *B*ack pain i\lytic bone fx}} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2.[**U**rine IgG/IgA]^{*get urine immunoelectrophoresis*} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3.⚠️ [**B**one marrow >10% plasmacytosis]^{CONFIRMS MM DX} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4.[**P**rotein^{(*serum:* M protein, IgG, IgA [monoclonal "M" spike if MGUS & *smear:* Rouleaux )}]

Answer 181

**CUBP** 1.{[**C***RAB* end organ ❌]_{(hyper*C*alcemia), *R*enal Failure 2/2 bence jones proteinuria, *A*nemia_normocytic, *B*ack pain i\lytic bone fx}} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2.[**U**rine IgG/IgA]^{*get urine immunoelectrophoresis*} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3.⚠️ [**B**one marrow >10% plasmacytosis]^{CONFIRMS MM DX} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4.[**P**rotein^{(*serum:* M protein, IgG, IgA [monoclonal "M" spike if MGUS & *smear:* Rouleaux )}]

Answer 182

1. Prostate 2. Renal 3. Lung 4. Breast 5. Multiple Myeloma

Answer 183

[Thiamine B1]

Answer 184

**ATP**; *Think **ATP***: [Thiamine B1] is needed to catabolize _{glucose → **ATP**} with the "*αTP*" enzymes : [α-ketoglutarate dehydrogenase (TCA)], [Transketolase (HMP shunt)], [Pyruvate dehydrogenase (TCA)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _{💡so... if [Thiamine B1] deficient ➜ "*αTP*" enzyme [impaired glucose metabolism → ATP depletion] which → [Wernicke Korsakoff Syndrome] and [BeriBeri]} ## Footnote _{📖[**BeriBeri** falls into 3 subtypes ^{(*WET, DRY, BOTH)*}] :

1.[High Output Dilated HF + edema] = ***WET***

2.[Symmetrical Peripheral Neuropathy + muscle wasting] = ***DRY***

3.[***WET*** and ***DRY***]^*(BOTH)*}

Answer 185

a. \>100 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b. 1st: _ASA-induced[AG metabolic acidosis] ➜ 2nd:_{*compensatory*}[respiratory alkalosis] = 3rd: [MIXED *AG metabolic acidosis* WITH respiratory alkalosis] | "***A**ir HOT/[**S**ound ringing-stomach sick]/**A**ir fast*"

Answer 186

_Acute_ Aspirin ingestion ➜ **vomiting** | "*acute A _S_ A* gets you *_S_*ick to ur Stomach^(vomiting)!"

Answer 187

**ASA** --\> [Mixed Respiratory alkalosis + AG metabolic acidosis] (Normal pH/DEC PCO2/DEC HCO3) 1. [**A**ir is Fast (*Tachypnea*)] 2. {[**S**ound ringing (*Tinnitus*)] ... _and [Stomach Sick (*Vomiting*)]} 3. [**A**ir is Hot (*Fever*]

Answer 188

ASA; COX inhibitor --\> DEC [Thromboxane A2] --\> DEC Platelet **aggregation** and **vasoconstriction** ## Footnote _{✏️*Activated platelet → secretes fibrinogen and {[ThromboxaneA2 & ADP] → [INC (Gp2b/3a\_platelet fibrinogen R) expression on platelets]}*}

Answer 189

⏸️[COMPENSATED arterial PaCO2^{*(compensating for acute metabolic∆|acute renal∆)*}] ⏸️*should* be within ⏯️ {^{***+/- 2 of***}**[1.5 x HCO3 + 8]**} ... ⏏️...If not = [*mixed* acid/base picture]

Answer 190

*"treating unknown OD ingestion is a **BITCH**"* 1. **B**icarb IV ^{(NaHCO3 IV → ⇪ ASA excretion)✏️} 2. [**i**Pecac syrup (if alert)]^{= induces emesis} 3. **T**oss out Gastric contents with [Gastric lavage (if within 1 hr of ingestion)] 4. [**C**harcoal activated]^{= absorbs ingested toxin} 5. **H**emodialysis ## Footnote ^{📝<(NaHCO3 IV alkalinizes urine and blood → deprotonates salicylate → salicylate *ion* can't cross membrane = no renal reabsorption or BBB crossing}

Answer 191

1. [initial salicylate \> 160] mg/dL 2. [6 hr salicylate \> 130] 3. persistent acidosis pH \< 7.1

Answer 192

Anticholinergism! *1.mad\hatter{delirium, seizure}, 2.blind\bat, 3.dry\bone{dry mouth} 4.hot\hare{HYPERthermia} 5.bowel-bladder lose [contraction] tone{urinary retention} 6. heart runs **LONG***{[6a. Widened QRS \> 100ms ➜ Arrhythmia]_{*NaHCO3^IVtx*}] & 6b.Prolonged intervals}

Answer 193

* [NaHCO3]^IV = for QRS widening or Ventricular arrhythmia * Activated charcoal **if within 2h ingestion** * Intubation/oxygenation * IVF

Answer 194

In Cardiac tissue, *Sodium Bicarb* [⬆︎extracellular sodium] and [⬆︎ extracellular pH] to alleviate TCA's cardio-depressant action on sodium channels

Answer 195

**QRS duration** \_\_\_\_\_\_\_\_\_\_\_ QRS \> 100ms --\> INC Vt arrhythmias and seizures (tx: NaHO3^IV)

Answer 196

## Footnote _{DVT #1 = {[*rafX* Factor 10a inhibitor] x ≥3mo}_tx}

Answer 197

**FALSE!!!!!!!!** PATIENTS WITH HITT ARE HEPARIN-BANNED FOR LIFE!!

Answer 198

**DAB** 1. **D**abigatran 2. **A**rgatroban 3. **B**ivalirudin ## Footnote -bivalirudin is related to hirudin (anticoagulant leeches use) -Use [Direct Thrombin Factor 2a inhibitors] in patients with HIT

Answer 199

1. DISCONTINUE ANY HEPARIN 2. start _*DAB*[Direct Thrombin Factor 2a inhibitors] or 3. start [fondaparinuX_{(factor 10a inhibitor)}]

Answer 200

HITT2 = all 4T score 1. **T**hrombocyte DEC GOE30-50% 2. **T**iming onset 5-10d after Heparin exposure (or 1d if previous exposure) 3. **T**hrombosis present 4. **T**ook Out other thrombocytopenia causes

Answer 201

[HITT1] = **NONIMMUNE** Heparin-Platelet clumping] ➜ [platelet \> 100K] and resolves spontaneously

Answer 202

WHITE EYE REFLEX; Retinoblastoma

Answer 203

**DECREASED** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** Liberated Hgb (after RBC hemolysis) BINDS to serum Haptoglobin --\> HgbHaptoglobin complex --\> Cleared by Liver *Haptoglobin picks up Haphazard hgb*

Answer 204

FALSE! *NonSOLC _{brain metz} = NONchemoSensitive*

Answer 205

A-I-P causes **N-A-P** 1. Psychosis *acute onset* 2. **Abd pain *acute onset*** 3. Neuropathy *acute onset* *Fam hx of this is VERY suggestive of AIP*

Answer 206

Answer 207

Sideroblastic anemia

Answer 208

Thalassemia (except 3 gene deletion alpha thalassemia) ## Footnote *Dx = Hgb electrophoresis with genetic studies if alpha thalassemia*

Answer 209

Pyridoxine B6

Answer 210

1. **PERNICIOUS ANEMIA = MOST COMMON CAUSE** 2. Vegan/Vegetarian 3. Blind loop syndrome (Gastrectomy or RYGB) 4. Diphyllobothrium latum 5. Pancreatic Insufficiency 6. Terminal iLeum damage (Crohns)

Answer 211

Folate deficiency has [NO CNS🧠∆] -------- Vitamin B12 isomerizes **methymalonyl coA** in the spinal cord myelin ---\> succinyl coA. Without it --\> suBACute combined degeneration *usually manifest as paresthesia/peripheral neuropathy*

Answer 212

**Pigmented bilirubin** gallstones

Answer 213

Howell Jolly Bodies = [^RBCbasophilic nuclear remnants*(usually removed by spleen macrophages*)] = Pts with autosplenectomy/asplenia^{(i.e. from Sickle Cell Disease)} = will **not** be able to remove [Howell Jolly Bodies]

Answer 214

Ehrlichia infection

Answer 215

1. Hep C 2. Joint Pain 3. Glomerulonephritis

Answer 216

TTP etx: [A13vM❌^{(or A13vM inhibition by shiga toxin in HUS)}] →uncontrolled vWF chain cleavage → widespread platelet traps/activation → severe thrombocytopenia + [RBC shearing ⼀ microangiopathic hemolytic anemia]) → _FMNRT_ TTP sx ^{⚠️TTP cp (aside from +Neuro and plasma EXCHANGE tx) = HUS cp}. *(TTP Tx = _EXCHANGE_ plasma containing anti-A13vM or deficiency of A13vM for normal plasma)*

Answer 217

1. **CLO**pidogrel 2. ti**CLO**pidine 3. cy**CLO**sporine 4. AIDS ^{*"**CLO**set gay"*} 5. {Pregnancy^{*TTP can onset anytime during [gestation or postpartum pregnancy]*}} ^{*"**CLO**set Mom"*} *Unlike HUS, [TTP = (neuro sx^{(confusion/seizure)}) / fever / (plasma EXCHANGE _tx)]* ## Footnote _{TTP etx: [A13vM❌^{(or inhibition by shiga toxin in HUS)}] →uncontrolled vWF chain cleavage → widespread platelet traps/activation → thrombocytopenia + microagio hemolytic anemia → _FMNRT_ TTP cp ^{⚠️TTP cp (aside from +Neuro and plasma EXCHANGE tx) = HUS cp}. ⼀ *(TTP Tx = _EXCHANGE_ plasma containing anti-A13vM or deficiency of A13vM for normal plasma)*}

Answer 218

1. Prednisone 2. Bone Marrow Transplant = cure 3. Eculizumab *(inactivates C5 complement)*

Answer 219

Polycythemia Vera \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ JAK2 mutation (r/o hypoxia) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Remember: PV ⬆︎ALL 3 cell lines but places focus on RBC more* *You must exlude Hypoxia as a cause of ⬆︎RBC*

Answer 220

1. phlebotomy 2. hydroxyurea^{*Inhibits [Ribonucleotide Reductase] --\> inhibits [DNA thymine] synthesis*→ ⬇︎cell synthesis} 3. . [ASA ^{for erythromelalgia (painful red hands from ET or PCV)}]

Answer 221

ONLY when ## Footnote 1. pt\>60 yo with sx OR 2. pt\>60 with [platelets\>1.5million]

Answer 222

1. **HYDROXYUREA**^{*Inhibits [Ribonucleotide Reductase] --\> inhibits [DNA thymine] synthesis*} 2. [Anagrelide ^{when RBC is suppressed from Hydroxyurea}] 3. [ASA ^{for erythromelalgia (painful red hands from ET or PCV)}]

Answer 223

1. ALL 2. AML 3. [aPL_{- acute Promyelocytic Leukemia M3 (chromo T15/17)}] 4. Aplastic Anemia^{(Radiation|drugs|Viruses|Fanconi|Idiopathic)} 5. [CIPM - Myelofibrosis (dry tap and tear drop cells)] 6. [Myelodysplastic Syndrome (hypercellular bone marrow with ringed sideroblast RBC *with Prussian blue* )] 7. [Hairy Cell Leukemia (dry tap with hypercell bone marrow)]

Answer 224

**PAN**cytopenia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [aPL - acute Promyelocytic Leukemia M3 (chromo t1517)] *Dx = smear showing blast --\> flow cytometry for confirmation*

Answer 225

❗️[CML^{(9/22 BCRABL)}] ⇪ Granulocyte proliferation ⼀ ❗️[infection (Leukamoid Stress Reaction)] also ⇪ Granulocyte proliferation ⼀ ❗️but [CML Leukemia CA cells] do **NOT** have high levels of *[Leukocyte Alkaline Phosphatase]* and ❗️ ❗️ so… ⇪Granulocytes? Check LAP ⭐[**_CML(***LAP elevated?***)^INFECTION**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *CML: Chronic Myelogenous Leukemia*

Answer 226

tx = [tyrosine kinase inhibitors ( x-tinib)] such as .. 1. imatinib 2. dasatinib 3. nilotinib Cure = Bone marrow transplant (NEVER the first therapy though)

Answer 227

✏️[neutrophils with **2-lobe nuclei**^{(instead of the normal 3-lobe nuclei)}] 2/2 [de novo mutations vs exposure^{(radiation, benzene, chemotherapy)}] → dysfunctional hematopoiesis (defective cell maturation) of Myeloid cells^{(risk of transformation to AML :-( )} ✏️MyeloDysplastic Syndrome

Answer 228

proliferation of **normal and mature** (but dysfunctional) B lymphocytes with **smudge cells**

Answer 229

conversion of *CLLSLL*--\> [high grade lymphoma^{(DLBL or Prolymphocytic Lymphoma)}] which happens in 5% of *CLLSLL* patients \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *CLLSLL pathology = mature lymphocytes and smudge cells*

Answer 230

[2CDA\_Cladribine_{adenosine analog}]

Answer 231

NHL = solid mass (lymph nodes and spleen) CLL = Circulating liquid mass (so use flow cytometry of peripheral blood to diagnose)

Answer 232

nHL Dx = [**Xbx with CTS ➜ Bbx ^{*for tx*}**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [EXCISIONAL bx with CT staging] _and [B_oneM_arrowbx to determine tx] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ nHL dx = HODGKIN LYMPHOMA dx- (except HL *also* requires [⊕ReedSternberg CD15 & CD30 owl eye cells]) = HL Dx = i\⊕CD15 and ⊕CD30[**Xbx with CTS ➜ Bbx ^{*for tx*}**]

Answer 233

*1* = **R**_{adiation_local} *2* = **R**_{adiation_local} *3* = **CHOPX** *4* = **CHOPX**

Answer 234

*1* = **R**_{adiation_local} *2* = **R**_{adiation_local} *3* = **BHOD** *4* = **BHOD**

Answer 235

**STAGING^{= MOST IMPORTANT PGN}** > [(Lymphocyte *RICH*) ^{= GOOD Pgn}] ## Footnote [(Lymphocyte *mixed*) and (Lymphocyte *poor*))]^{= poor pgn}

Answer 236

determines cardiotoxicity for [**HAD**] tx ^{*used in {[Hodgkin Lymphoma] and [NonHodgkin Lymphoma]}*} | *🔎HAD = [Hydroxydaunorubicin Adriamycin Doxorubicin]*

Answer 237

"his DIC **SCABS T**erribly!" 1. **S**epsis 2. **C**A 3. **A**bruptio placenta or Amniotic fluid embolus 4. **B**urns 5. **S**nake bites 6. **T**rauma --\> tissue factor release *DIC activates primary AND secondary coagulation*

Answer 238

1. [FFP^{*(contains clotting factors but req 2L dose)*}] 2. [Cryoprecipitate^{*(contains clotting factors, vWF, and replaces fibrinogen if FFP doesn't work)*}] 3. Platelets if \< 50K | "his DIC **SCABS T**erribly!"

Answer 239

Venous \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Platelet factor 4 Ab on ELISA] or [Serotonin release assay]

Answer 240

PCN PO QD x 5 years

Answer 241

1. Superficial Bleeding out of proportion to the degree of thrombocytopenia 2. GIANT platelets *etx = absent [platelet glycoprotein 1B R] for von willebrand factor to bind to*

Answer 242

stabilizes bony metastatic lesions which 1. prevents _CAhypercalcemia 2. prevents _CA fx

Answer 243

Megestrol^{*progesterone analogue*} ## Footnote >\>\>\> CTS *Marijuana is only useful in HIV anorexia*

Answer 244

Hgb **< 10** (use EPO with hct goal of 35%) ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. **HTN** 2. HA 3. Flu-like sx 4. *ischemic stroke^{EPO given i\ [hgb > 13]}* 5. *thrombosis^{EPO given i\ [hgb > 13]}* 6. *⇪all cause mortality^{EPO given i\ [hgb > 13]}*

Answer 245

[Fanconi ^*P-A-N* anemia] = DNA repair defect that → [CP**M**SC❌ ^{(failure/destruction/suppression)}) = Aplastic Anemia] → 1. [**^{Aplastic Anemia}PANcytopenia** marrow failure] → [mucosal bleeding/petechiae], [*NORMO*cytic but hypOproliferative anemia], infection 2. **morphological changes** 3. **growth stunt** ## Footnote *🔎CPMSC = [Common Progenitor **Myeloid** Stem Cell]* *🔎P-A-N = [**P**ancytopenic-**A**plastic-**N**ormocytic]*

Answer 246

1. ⬆︎***ABSOLUTE* BASOPHILIA** 2. ⬆︎⬆︎⬆︎LEUKOCYTOSIS 3. shift tward precursor cells (myelocytes or promyelocytes) 4. ⬇︎Leukocyte Alkaline Phosphatase (LAP) Cure = Bone marrow transplant (NEVER the first therapy though) etx = 922 BCRABL philadelphia chromosome

Answer 247

*"CML has L-L-L-"* [Leukocytosis _with **LOW** *LAP*] ## Footnote ❗️ *LAP = *Leukocyte Alkaline Phosphatase = marker of [natural *leukomoid *neutrophil activity]. leukomoid rxn → ^HIGH*LAP*

Answer 248

AUTO DOM point mutation in Factor 5 gene --\> **RESISTANCE TO PROTEIN C** (which is supposed to inactivate Factor 5). This --\> Hypercoagulability aPTT AND PT/INR may both be normal!

Answer 249

*E5 with Acid* [Eosin 5 maleimide binding flow cytometry] **WITH** [Acidified glycerol lysis test] OR Osmotic fragility test but it has low sensitvity Lab findings = ⬆︎Mean Corpuscular Hgb Concentration

Answer 250

*_{[🩸 = "RBC membrane"]*}* 🟠[🩸*Spectrin*'s inability to anchor [AUTO DOM defective 🩸*Ankyrin*] → [🩸 *bleb formation*] --> splenic macrophages remove but hemolyze/damage RBC in process➜ [**_JAUNDICE_** unconjugated hyperbilirubinemia], \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 🟠 over time, splenic macrophages hypertrophy → [**_SPLENOMEGALY_**]. And [RBC∆^{(⬇︎MCV with ⇪MCHC, biconcave → spherical)} → [High RDW] = ["SPHEROCYTE" RBCs] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 🟠 ULTIMATELY, [SPHEROCYTE RBC ∆ ^{*(small, spherical, no central pallor)*}] → [splenic macrophage *_premature removal altogether_* → [*eXtravascular **_hemolytic anemia_** ] ^{Tx = Splenectomy} | *🔎MCHC = Mean Cell Hgb Concentration* ## Footnote *_Triad_ = Jaundice, Splenomegaly, Hemolytic Anemia*

Answer 251

{[**Hereditary Spherocytosis**_{_Chronic Hemolysis_}] | *Triad = Jaundice, Splenomegaly, Hemolytic Anemia* ## Footnote _{HS --(*pigmented bilirubin gallstones*)-->[Acute Cholecystitiss]}}

Answer 252

because **ONLY** **in the petri dish,** it causes prolonged aPTT

Answer 253

hypercoagulable disorder --\> recurrent migratory superficical thrombophlebitis at unusual sites (arm, chest) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Pancreatic Cancer (or sometimes stomach, lung or prostate)

Answer 254

GENETIC! Whites of Northern European ancestry naturally develop **Pernicious Anemia** ## Footnote *also, Pernicious Anemia ⬆︎ risk for gastric ADC*

Answer 255

▶Warfarin inhibits epoxide reductase (which reduces⼀activates Vitamin K^{(K is responsible for maturing [2, 7, 9, 10, Protein C and S])}→ ⬇︎[2,7,9,10, Protein C and S] ▶2,7,9,10 = ⬆︎Clotting ▶[Protein C and S] = anti-Clot = Bleeding. **⭐But since Protein C and S are the first to be affected by warfarin**, allowing 2,7,9,10 to roam freely and ⬆︎Clotting

Answer 256

Gastric ADC

Answer 257

Diamond Blackfan Syndrome (DBS) ## Footnote *intrinsic defect in erythroid progenitor cells --\> ⬆︎apoptosis*

Answer 258

Atypical Reactive CD8 T cells; Infectious Mononucleosis

Answer 259

B cell neoplasm that infiltrates bone marrow ^{*→Pancytopenia*}, spleen and peripheral blood ; Bone Marrow Biopsy

Answer 260

Gaucher ; lysosomal storage disease

Answer 261

"*_T_ ransferrin _I_n _B_lood _C_alculation*" -TIBC gives a snapshot ^{*(for that that moment in time)*} of how much iron the body: -*can* carry ^{(TIBC indicates total capacity [for that moment] the body has to transport iron). ⇪ capacity/TIBC may indicate ⇪ demand)} -*wants to carry* (demand)

Answer 262

⬇︎MCV ⬆︎Iron

Answer 263

1._{peripheral blood FLOW CYTOMETRY}proliferation of [**normal, mature** (but dysfunctional) B lymphocytes] with 2._{peripheral blood smear}**smudge cells** * * * ## Footnote _{*Suspect CLLSLL in any elderly with dramatic leukocytosis primarily made of lymphocytes*}

Answer 264

Phlebotomy (tx for PV) removes **cells** while Plasma exchange only removes substances (Antibodies, immune complexes, toxins)

Answer 265

Leydig ; Testosterone AND Estrogen ## Footnote *All Solid Testicular Tumor Masses should be treated with Radical Orchiectomy*

Answer 266

*"Discern {[**EBR**^{[Echinocyte/Burr=Renal🌀]} _from **ASL**^{[Acanthocyte/Spur(ky)=Liver🌀]}] _{⼀red blood cells}}!"* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**A**canthocyte **S**pur_*ky* RBC] = [**L**_{iver🌀 | Cholesterol❌}] | [**A**canthocyte ***S**pur* RBC] are *Spurky = Spiky!* ## Footnote *🌀 = disease*

Answer 267

Hereditary Spherocytosis

Answer 268

Osler Weber Rendu likes to **EAT** 1. **E**pistaxis recurrently 2. **A**V malformations 3. **T**elangiectasia

Answer 269

[Pyridoxine B6] **with** [Folate B9]

Answer 270

[ferro**us** sulfate 2+ _ *heme iron*] *”give ***us 2*** more iron”*

Answer 271

Polycythemia Vera \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Heat ⬆︎Basophils (rare but can become AML) --\> ⬆︎Histamine release \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Remember: PV ⬆︎ALL 3 cell lines but places focus on RBC more*

Answer 272

[TRAP-Tartrate Resistant Acid Phosphatase] or CD11c

Answer 273

1. pain**LESS** LAD 2. B sx (Fever, Night sweats, Wt Loss) *Dx = EXCISIONAL bx with staging via CT and BMbx to determine tx* THIS IS THE SAME AS HODGKIN LYMPHOMA - except HD has ReedSternberg owl cells

Answer 274

[(⬆︎Porphobilinogen) in Urine] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fam hx of similar sx

Answer 275

(**UROPorphyrinogen)** ⬇︎ \<**U**ROPorphoDeCarb | PCT\> “*UPDC PCT”* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *AAP**U**F* *enzyme is associated with [| x]*

Answer 276

{[**CoproPorphyrinogen***^{in cytoplasm}* (enters mitochondria)→ **Protoporphyrin***^{in mitochondria}***] + Fe²⁺ }** ⬇︎ \<**F**errochelatase | lead tox\> ⬇︎ ⭐HEME⭐ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *AAPU**F*** *enzyme is associated with [| x]*

Answer 277

(**ALA)** ## Footnote ⬇︎ \<**A**LAD | lead tox\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *A**A**PUF* *enzyme is associated with [| x]*

Answer 278

(**Porphobilinogen)** ⬇︎ \<**P**orph | AIP\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *AA**P**UF* *enzyme is associated with [| x]*

Answer 279

[(**Glycine)** + (**Succinyl CoA) + (Pyridoxine B6)]** ## Footnote ⬇︎ \<**A**LAS | Sideroblastic\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ***A**APUF* *enzyme is associated with [| x]*

Answer 280

cp = **HOT** [**H**ead ❌(CNS dysfxn/confusion/weakness/seizures)] [**O**rgan ❌(ARDS/Pulm Edema/NV/Liver Injury/AKI/Rhabdomyolysis/DIC)] **[T**emp core \> 40C (104F)]

Answer 281

cp = **HOT** tx = evaporative /convective cooling with water misters and fan

Answer 282

herbal teas;

Answer 283

⬇︎O2 carrying capacity in blood * * * C^LDP **LDP** [**L**oss of RBC Blood Volume]^{(Melena, Hematochezia, Ulcers, Fibroids)} [**D**estruction of RBC (Hemolytic Anemia)]^{Intrinsic|Extrinsic in Intravascular|Extravascular} [**P**oor production of RBC (⬇︎Erythropoiesis)]

Answer 284

⬇︎O2 carrying capacity in blood * * * *i*\_**TAILS** \_\_\_\_\_\_\_\_\_\_\_ m*_i_*crocytic

Answer 285

⬇︎O2 carrying capacity in blood * * * *am*\_**FOB** *an*\_**LAR** \_\_\_\_\_\_\_\_\_\_\_ m*_a_*crocytic

Answer 286

⬇︎O2 carrying capacity in blood * * * m*_a_*crocytic ; 1. MOD: [auto recessive **defective UMP synthase**] → inability to convert orotic acid to UMP during pyrimidine synthesis. = 2. [macrocytic Megaloblastic anemia (*am\_FOB*)] in kids that ultimately → Failure to Thrive 3. can NOT be cured with *F*olate or *B*12 4. NO hyperammonemia^{(ornithine transcarbamylase deficiency = ⇪ orotic aciduria WITH hyperammonemia)}

Answer 287

⬇︎O2 carrying capacity in blood ## Footnote [Nn **CATIA**] [Nhi **GHSPCP**] [Nhe **MAIM**]

Answer 288

varying sizes of RBC

Answer 289

varying sha**P**es of RBC

Answer 290

[*Thrombocyte platelet*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [endothelial tissue injury in 1º hemostasis] ; [*Thrombocyte platelet*] plug after aggregating with other [*Thrombocyte platelets*] and interacting with fibrinogen *⅓ platelets are stored in spleen*

Answer 291

***N**eutrophils **L**ike **M**aking **E**verything **B**etter* ## Footnote **N**eutrophils **L**ymphocytes **M**onocyte\_macrophages **E**osinophils **B**asophils

Answer 292

start with *cell age* * * * *Acute* 1. [Acute\>Lymphoid]= **ALL** 2. [Acute \>Myeloid]= **AML** * * * *Chronic* 1. [Chronic\>Lymphoid\>Chronic Leukemia= **C|H|A**] 2. [Chronic\>Lymphoid\>Lymphoma={**Hodgkin** vs [**NonHodgkin*****^"***^{🆃all 🅱}*^{rian Forgot Mr Burkitt's Dogg"}*^|**]} 3. [Chronic\>Lymphoid\>Plasma cell disorders=**MultipleMyeloma** | **Waldenstrommacrogloulinemia**, **MGUS**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4. [*Chronic*\>Myeloid\>Myeloproliferative disorders\* (*Constitutively Activated Tyrosine Kinase → Myeloproliferative disorder*) = **1**|**P**|**E**|**C**]^([**^1º**^{Myelofibrosis/CIM] | [}**^P**^{olycythemia Vera] | [}**^E**^{ssential Thrombocytosis] | [}**^C**^{hronic Myelogenous Leukemia]}

Answer 293

immature neutrophils; { [⇪ **mYeloblast** (*precursor to BEN_granulocytes*)] **proliferation**^{( = bacterial infections or CML)}]}

Answer 294

"**NAACP** for *E-Osar-N-Phil*" **N**eoplasia **A**sthma*^{(limits rxn after mast cell degranulation + produces Histamine)}* **A**llergy **C**onnective tissue disease **P**arasites\_invasive*^{(targets Major Basic Protein = protects from Helminth)}*

Answer 295

**basophil** ; Tryptase *Histamine & Heparin are also released*

Answer 296

[8^cMyc ➜ 14^{IG-Heavy Chain}]; [cMYC*^{(and EBV INC B- cell proliferation-->INC translocation risk)}*] = [Endemic\_Africa (latent infection w/EBV) → Mandibular lesion] vs [Sporadic\_USA → abd/pelvis lesion] ## Footnote Histo = - "**Starry Sky appearance**" - [Diffuse mid-sized lymphocytes with interspersed macrophages (arrows) - basophilic cytoplasm - and high [Ki-67 fraction-proliferation index]

Answer 297

- binds Fc portion of [IgE⼀antigen complex] → cross-links → degranulation^{(releases histamine, heparin and eosinophil chemotaxis factors)} - mediates allergic reaction / [Type 1 hypersensitivity] - [Cromolyn sodium (asthma px)] prevents mast cell degranulation

Answer 298

auto recessive; [HgB electrophoresis^{( will show HgbS with NO_HgbA)}] determines carrier status *[Gluta**MATE** --\> Valine @ 6th position of the [β-chain globin]*

Answer 299

1.**Sickle Cell Anemia** (INC Fetal HgbF synthesis) 2.**AML** ⼀^{(Rapidly ⬇︎WBC)} 3.[**CML_{with blast crisis}** (**Chronic Myelogenous Leukemia w/blast crisis**)]⼀^{(Rapidly ⬇︎WBC)} * * * *Inhibits [Ribonucleotide Reductase] --\> inhibits [DNA thymine] synthesis*

Answer 300

[A**-** or B**-** Mothers] have mostly [anti-Rh Ig**M** antibodies]--Ig**M** ^{*"stays in **M**om"*}does NOT cross placenta \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[TYPE O **^-**MOTHERS] HAVE MOSTLY* [anti-Rh Ig**G** antibodies] --Ig**G**^{*"**G**oes across placenta"*} will cross placenta! --\> ⇪ HDN^EF* | *Ig**G** crosses Placenta*

Answer 301

a. enteric bacteria synthesizes [*oxidized\_inactive* vitamin K] ( this means neonates will not have Vitamin K and need px!) b. [*oxidized\_inactive* vitamin K] is [reduced⼀activated] by [epoxide reductase _{(inhibited by Warfarin)}] → [reduced\_ACTIVATED vitamin K] c. [_**reduced\_**_ACTIVATED vitamin K] acts as cofactor for maturing _factors[2,7,9,10,C,S] during synthesis which → [^(2,7,9,10)**Pro**\_2ºCoagulation] and [^{(Protein C,S)}**Anti**coagulation*(EARLY Warfarin☠️)*] --------------- ☠️: [^{(Protein C,S)}**Anti**coagulation* are *(EARLY Warfarin Victim☠️)] ➜ 1st to ⬇️ when Warfarin inhibits epoxide reductase = IMPORTANT SINCE ALLOWS FOR 1 WEEK/TEMPORARY UNINHIBITED → [^(2,7,9,10)**Pro**\_2ºCoagulation] -➜ = [Warfarin induced skin necrosis]

Answer 302

**anti** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1-{[endothelial cell thrombin-thrombomodulin complex]} activates [Protein C] 2-[activated Protein C] uses [Protein S] to [cleave ( = inactivate)] 5a and 8a of coagulation cascade

Answer 303

During [Primary hemostasis platelet plugging] vs lab diagnostics, **Ristocetin** activates [vWF ^{(which is already bound to subendothelial collagen exposed from injury})] to bind to [Gp1b\_platelet aDherence R]

Answer 304

[Erythrocyte Sedimentation Rate] is used because [Acute-phase reactants (i.e. fibrinogen)] cause RBC to aggregate → higher density than plasma → [⇪ RBC Sedimentation] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. **infections** 2. SLE 3. RA 4. temporal arteritis 5. malignant CA 6. Ulcerative Colitis IBD 7. Pregnancy

Answer 305

▶[Erythrocyte Sedimentation Rate] = **# of RBC that sediment out of plasma in 1 time unit** ▶certain conditions ^{*[like ⇪ Acute-phase reactants (i.e. ⇪fibrinogen)]*} cause RBC to aggregate → [RBC-aggregates] have higher density than plasma →⇪ [# of RBC that sediments out of plasma in 1 time unit] = ⇪ESR \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote _{*🔲⬇︎ESR*}... - polycythemia - Sickle Cell Anemia - CHF - microcytosis - hypOfibrinogenemia

Answer 306

*"Discern {[**EBR**^{[Echinocyte/Burr=Renal🌀]} _from **ASL**^{[Acanthocyte/Spur(ky)=Liver🌀]}] _{⼀red blood cells}}!"* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**A**canthocyte **S**pur_*ky* RBC] = 1. [**L**_{iver🌀 ^{:Liver Disease}] or
2. [Cholesterol❌^{:abetaLipoproteinemia cholesterol dysregulation}}] | [**A**canthocyte ***S**pur* RBC] are *Spurky = Spiky!*

Answer 307

[Schistocyte helmet *RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. DIC 2. TTP 3. HUS 4. [traumatic hemolysis*^{(i.e. mechanical heart valve )}*]

Answer 308

[Spherocyte *RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Hereditary Spherocytosis 2. G6PD deficiency 2. autoimmune hemolysis

Answer 309

[Macro-ovalocyte (macrocyte) *RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Megaloblastic anemia ^(am_FOB) 2. Nonmegaloblastic anemia^(an_LAR)

Answer 310

[Ringed sideroblast _in*RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Sideroblastic anemia^{(pathologic excess iron in mitochondria)}

Answer 311

[Teardrop *RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1º Myelofibrosis ^{(bone marrow infiltration → forces RBC out of bone marrow → tear shape)}

Answer 312

[Bite *RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ G6PD deficiency ^{(RBC oxidation of hgb sulfhydryl groups ^{< 2/2 loss of G6PD buffer system >} → [denatured hgb precipitation (AKA Heinz bodies)]. [Spleen macrophage Phagocytic damage] of these [Heinz bodies] →RBC membrane damage → [Bite}*^RBC*^]

Answer 313

[howell Jolly bodies _in*RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Spleen❌ *^{(functional hypOsplenia/asplenia)}* ^{(basophilic nuclear remnants in RBC that are usually removed by spleen macrophages)}

Answer 314

[Heinz bodies _in*RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ G6PD deficiency ^{(oxidation of hgb sulfhydryl groups → [denatured hgb precipitation (AKA Heinz bodies)]. [Splenic macrophage Phagocytosis] of these [Heinz bodies] →RBC membrane damage → [Bite}*^RBC*^{]^{*(and after so many bites → unstable Spherocyte RBC)*})}

Answer 315

[Basophilic stippling _of*RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"**_Basi_**cally, **AC**id **alcohol** is **Le**-**Thal*** 1. **A**nemia of **C**hronic Disease 2. **alcohol** abuse 3. **Le**ad poisoning 4. **Thal**assemia

Answer 316

[Target *RBC*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *“**HALT**! said the LIVid hunter to his _target_"* 1. **H**bC 2. **A**splenia 3. **L**IVER disease 4. **T**halassemia

Answer 317

*“PVS is* *IDA* *as **IEA**”* [iron deficiency anemia ^{(microcytosis, hypOchromia)}] that manifest as … ⼀**I**ron deficiency anemia ⼀**E**sophageal webs ⼀**A**trophic glossitis

Answer 318

[Normal **_A_**dult Hgb *(Hgb A)*] = ## Footnote * * * [4 globin chains: (α₂ β₂)] = * * * ^globin:[\< 2 x **α**^{(chromo 16: 2 alleles per 1 globin)} \> + \< 2 x **β**^{(chromo 11: 1 allele per 1 globin)} \>] = * * * ^alleles: [^{chromo 16}\<αα / αα \> + ^{chromo 11}\<β / β \>]

Answer 319

★ → defect in **_ALAS_** of heme synthesis →[*isolated* elevated iron^{*(specifically in mitochondria)*}] → [*Bone Marrow* Ringed sideroblast RBC (that contain iron-laden mitochondria)] ➜ ★ [⇪ iron / ⇪ FerriTin / nl\_TIBC] * * * ★ [X-linked], ★ [acquired (myelodysplastic syndromes)], ★ {reversible (BAIL Out the Copper) with *[Pyridoxine B6 (cofactor for ALAS) tx]*}

Answer 320

1. [HgbA gene point mutation causes [Glutamic acid → Valine] at [position 6 of the β chain monomer] = HgbS = 2. [*DICK*/DeOxygenation] of HgbS → [*CAP*-_{(crystallization aggregative polymerization)}] → [HgbSS|SC Sickle Shaped RBC]. 3. Will Un-sickle once O2 is bound again but eventually → RBC Membrane stiffness → a. Chronic Hemolytic Anemia - Intravascular hemolysis 2/2 membrane instability - Extravascular hemolysis 2/2 **red** pulp splenic sequestration of sickles → ultimately causes splenic hypoxia/fibrosis → [auto/functional splenectomy] b. Small Vessel Occlusion by sickles → Vasoocclusive Pain Crisis c. Aplastic Crisis (2/2 Parvo B19 ⬇︎ erythroid precursors) d. [Sickle RBC = ⬇︎1/2 life] → Anemia 4. HgbF is protective

Answer 321

Preferential vasodilation of arteriole–>increased capillary hydrostatic pressure–>increased fluid movement into interstitium

Answer 322

*dana * anti**dsDNA** (indicates and tracks development of lupus nephritis)

Answer 323

[anti-platelet Ab^{(against platelet_Gp2b/3A)}] start binding to [Platelet R 2b/3A] = forms [Antibody/Platelet complex] *(no obvious cause \> precedes viral/HIV?HCV? infxn)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ → splenic macrophages removes [Ab/Platelet complex] from circulation ➜ [_isolated_ thrombocytopenia \<100K] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - → superficial/mucosal bleeding - [⇪ megakaryocytes on bone marrow biopsy] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ -NORMAL SPLEEN -normal clotting factors -normal clotting PT/aPTT ## Footnote *Strongly associated with HIV and HCV*

10⼀Heme-Onc/TOX I Flashcards

(383 cards)