Endoc/hemat

Question 1

Pituitary def

Decreased ACTH level test?

Answer 1

response to cosyntropin in the beginning(increased cortisol)
İn chronic cases: no response to the test, adrenal goes atrophy

Question 2

Hypotyroidsim
Na?
k?
Ca?

Answer 2

Hyponatremia
K normal since aldesteron still exists in hipopituitarism
Ca npt related😁

Question 3

Metyrapone test

Answer 3

İnhibit 11 beta hydroxylase
Decrease cortisol profuction
Should increase levels of ACTH RİSE

Question 4

İnsulin stimulation

Answer 4

When blood glucose decreases, GH should rise

For pituitary insuff

Question 5

Diseases causing nephrogenic DI

Answer 5

Chronic pyelonephritis
Myeloma
Amyloidosis
Sickle cell disease
Hypercalcemia
Hypokalemia

Question 6

Central DI tx

Answer 6

Desmopressin

Question 7

Nephrogenic DI tx

Answer 7

Hydroclorothiazide
Amiloride
NSAIDs

Question 8

Acromegaly part of which disease/syndrome?

Answer 8

Pituitary-MEN 1
Lymphoma
Bronchial carcinoid

Question 9

Menly problem in Acromegaly men

Answer 9

Erectile dysfunct due to co- secreted prolactin with GH

Question 10

Acromegaly diagnosis
Best initial
Most accuraye test

Answer 10

IGF-1 level: best initial
Glucose supression: most accurate
Do mrı after lab results

Question 11

Acromegaly tx

Answer 11

Surgery: transsphenoidal
Medical: cabergoline, octreotide, pegvisomant
RT: if not respond either tx

Question 12

Pegvisomant: ?

Answer 12

GH antagonist, inhibit IGF release from liver

Question 13

One drug raising prolactin levels other than psychotic ones

Answer 13

Verapamil🎉🎉

Question 14

Drugs causing increased levels of prolactin

Answer 14

Antipsikotik
Methyldopa
Metoclopromide
Opioid
TCA
Verapamil

Question 15

After prolactin is found to be high:

4 tests you should do?

Answer 15

1. pregnancy
2. TRH level
3. BUN/cr
4. LFT( cirrhosis)

Question 16

Mrı done in high prolactin only after:

Answer 16

1. Blood test
2. Sec causes (pregnancy))
3. Medications

Question 17

Hyperprolactinoma:

Tx?

Answer 17

Fırst cabergoline ( better tolerated than bromocriptine)

Transsphenoidal surgery then

Question 18

HypotyroidismAll body slows down except:

Answer 18

Menstrual flow

Question 19

When TSH is double the upper limit and T4 is normal

Managmnt?

Answer 19

Give tyrpxine

Question 20

When TSH high but not double

What to do?

Answer 20

Look antityroid peroxidase and tyroglobulin ab
İf positive
Give tyroxine

Question 21

Which drugs causes folate def?

Answer 21

Sulfa
Metotraxate (RA)
Phenytoin

Question 22

B12 and folate tx side effect?

Answer 22

Hypokalemia: sudden increase of production of cells

Question 23

Only microcytic anemia with increased reticulocytes??

Answer 23

3 alpha gene deleted thalasemia

HbH

Question 24

Sickle cell hastaisnda aniden dusen htc??

Answer 24

Parvo-B 19infection
Sudden drop in reticulocyte level seen 💕💕❤️
Tx : ivig

Question 25

Autoimm hemolysis warm causes

Answer 25

CLL lymphoma SLE penicillin methyldopa, rifampin, phenytoin, allopurinol

Question 26

Cold agglutinin dx

Answer 26

Infectious mono Mycoplasma Waldenstrom hmacroglobulinemia

Question 27

In warm agg Vs Cold agglutinin Cryoglobunemia tx differenxe?

Answer 27

In warm: steroid In later: NO STEROID NO SPLENECTOMY

Question 28

Cold agg disease tx

Answer 28

``` Stay warm Rituximab, sometimes plasmapheresis Mostly in liver: cyclophosphamide, cyclosporine NO STEROID NO SPLENECTOMY ```

Question 29

Cryoglobulins

Answer 29

``` IgM Not responding steroid Seen in: 1. Joint pain 2. GN 3. Hep C ( hep c var kelimelerde)🙄💃🏻💃🏻 ```

Question 30

TTP seen in?

Answer 30

T: ticlopidine, clopidigrel T: t cell, cyclosporine, AIDS P: pancytopenia: SLE

Question 31

Ttp tx

Answer 31

Plasmapheresis | If will be late, infuse FFP

Question 32

Autoimmune hemolysis Vs Ttp/hus

Answer 32

AI: extracellular hemolysis no schistocyte in smear Vs Trp/hus: ++smear of fragmented red cells

Question 33

Pnh most common cause of death?

Answer 33

``` Stem cell defect Pig-a defective Daf( cd55-59 def) Mc cause of death: THROMBOSIS Mostly in mesenteric or hepatic veins ```

Question 34

PNH tx?

Answer 34

Prednisone for acute hemolysis Allogenic bone marrow tx only cure Eculizumab: inactivate C5, comp inhibitor Give folic acid and iron with transfusion as needed

Question 35

Aplastic anemia causes

Answer 35

``` Phenytoin Carbamazepine Sulfa Chloramphenicol Tyroid drugs Viruses Alcohol NSAID PNH SLE Toluene, DDT, benzene ```

Question 36

PV | Can convert to ??

Answer 36

>%60 htc, JAK2 mutation:most accurate test B12 high, iron levels low O2 levels normal( exclude hypoxia) Can convert to AML!

Question 37

PV tx?

Answer 37

``` Phelebotomy Asprin for thrombosis Hydroxyurea to decrease cell count Allopurinol rasburicase Antihistamines ```

Question 38

ET | Tx?

Answer 38

Above 1 million, thrombosis+bleeding Jak2 mut If pt1.5 million: begin hydroxyurea Use anagrelide when there is supresiion of red cells

Question 39

Erytromelalgia Seen where? Tx?

Answer 39

Painful red hands ET asprin

Question 40

Myelofibrosis

Answer 40

Old patient Spleen and liver production: megaly Tx: thalidomide, lenalidomide (TNF inh to increase bone marrow production) Under age 50,55:allogenic BMT

Question 41

TdT | CALLA positive

Answer 41

ALL

Question 42

Myeloperoxidase | Esterase

Answer 42

AML

Question 43

M4-M5 AML? Ehich type? Most commonly present with?

Answer 43

Acute monocytic leukemia | CNS INVOLVEMENT

Question 44

ALL AML tx?

Answer 44

Induction of remission with CT first Then: If prog poor: go BMT directly If prog good: give more CT

Question 45

Ondicator of prognosis in all aml?

Answer 45

Cytogenetics: Good cytogenetics: more chemo YOU HAVE CHANCE 🎉 Bad cytogenetics: BMT

Question 46

ALL specific tx?

Answer 46

Intracranial methotraxate to prevent brain metastasis( superior to RT)

Question 47

Greatest likelihood to convert AML?

Answer 47

CML | If untreated , %20 of patients every year

Question 48

Myelodysplasia

Answer 48

5q deletion: characteristic, good prognosis Preleukemic Pancytopenia despite hypercellular marrow Can go to AML but mostly pat dies from infection and bleeding before it Old pt >60 y

Question 49

Myelodysplasia lab values | MCV

Answer 49

MCV increased, nucleated red cell Pelger Huet cells: distinct finding bilobed neutrophil Ringed sideroblast Folate, b12 azalir

Question 50

Give lenalidomide to M

Answer 50

Mm Myelofibrosis Myelodysplasia (5q deletion)

Question 51

Ringed sideroblast Mcv increased Pelger huet cells ??which disease

Answer 51

MDS | Severity based on blasts

Question 52

Richter phenomenon

Answer 52

CLL can transform to high grade lypmhoma in 5% of patients

Question 53

CLL tx

Answer 53

``` Stage0 and 1 (Lap): no tx stage 2 hsm, 3 anemia, 4 thrombocytopenia: Fludarabine+rituximab ( for sympt also) Cyclophosphamide: recurrent Mild: chlorambucil Infection: ivig Autoimm anemia thrombocytopenia Give prednisone ```

Question 54

Hairy cell leukemia:

Answer 54

Pancytopenia Massive splenomegaly Monocytopenia dry tap despte hypercellular marrow Initial test: smear, best accurate flow cytomet cd 11c Tx: cladribine, pentostatin

Question 55

Reason of hypercalcemia in MM?

Answer 55

Osteoclast activating factor (OAF): causes lytic lesions in bone Made by plasma cells, do not seen in bone scan

Question 56

Mm | What shows severity of dx?

Answer 56

Beta2 mocroglobulin corresponds to severity of dx

Question 57

Nuclear bone scan in Mm

Answer 57

Normal since it shows osteoblast activty

Question 58

Most accurate test for multip myleoma

Answer 58

Bone marrow biopsy | >10 percent plasma cells

Question 59

MM tx

Answer 59

Dexamethasone Lenalidomide Bortezomib ( recurrent cases or combinations drug) Melphalan old fragile patinets cannot tolerate other drugs

Question 60

Gh deficiency which test?

Answer 60

Arginine stimulation test | No response to GHRH infusion