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hammer16 Flashcards

1
Q

What is the most distinct lab abnormality in MDS?

A

Pelger Huet cells which have a bilobed nucleus

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2
Q

What is the lab findings in CLL? What is treatment?

A

WBC is atleast above 20000 with 80-98% lymphocytes. Half of patients are hypogammaglobulinemic. If patients have anemia or thrombocytopenia, treat with fludarabine, cyclophosphamide and rituximab.

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3
Q

What drugs do you use for CLL when fludarabine fails? For refractory cases? For mild cases?

A

Alemtuzumab, cyclophosphamide for refractory cases and chlorambucil for mild cases

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4
Q

What is the characteristics, diagnosis and treatment for hairy cell leukemia?

A

Pancytopenia, massive splenomegaly, monocytopenia, dry tap. Flow cytometry for immunotyping (CD11c). Treat with cladribine or pentostatin

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5
Q

What is the best initial test for non Hodgkin lymphoma? Treatment?

A

For advanced disease, stage 3 (both sides of diaphragm) and 4 or any B symptoms, use combination chemo with CHOP (Cyclophosphamide, adriamycin, vincristine, prednisone) and rituximab.

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6
Q

What are characteristics and treatment for Hodgkin’s disease?

A

Most are stage 2 (2 or more lymph nodes on same side of diaphragm), centers around cervical area, reed sternberg cells, lymphocyte predominant has best prognosis and lymphocyte depleted has worst prognosis. Stage 3 and 4 or anyone with B symptoms gets ABVD(Adrinamycin, bleomycin, vinblastine, dacarbazine). Stage 1/2 local radiation witha a small course for chemo.

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7
Q

What is the toxicity of adrenomycin?

A

Same as doxorubicin. Cardiotoxic so have to do a MUGA or nuclear ventriculogram to assess LVEF.

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8
Q

What is the most accurate diagnostic test for multiple myeloma? What is seen on SPEP? What defines myeloma? What is the anion gap? Treatment?

A

Bone marrow biopsy. IgG in 60% or IgA spike in 25%. Monoclonal M spike. Greater than 10% plasma cells. Decreased anion gap because IgG is cat ionic and increases chloride and bicarbonate levels. BMT if under 70, lenalidomide and dexamethasone.

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9
Q

What is the pathophysiology, presentation and treatment of Waldenstrom macroglobulinemia?

A

IgM overproduction from malignant B cells leading to hyperviscosity. Lethargy, blurry vision and vertigo, engorged blood vessels in the eye, mucosal bleeding, Raynaud phenomena. Plasmaphersis to remove IgM. Long term treatment with Rituximab or prednisone cyclophosphamide. Decrease cell production with lenalidomide as in myeloma.

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10
Q

What is the presentation of ITP? Treatment?

A

Isolated thrombocytopenia with normal spleen. Give prednisone.

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11
Q

What is the inheritance mode of Von Willebrand disease and what values are elevated?

A

AD and aPTT and bleeding time.

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12
Q

What coagulation factor is raised in Hemophilia? Factor X1 and factor XII deficiency?

A

APTT

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13
Q

What is the treatment for HIT?

A

Argatroban, lepirudin, bivalirudin, fondaparinaux.

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14
Q

What are the signs and symptoms of cavernous sinus thrombosis? How is it diagnosed and treated?

A

Headache, CN signs, feve, eye swelling, diplopia.
Proptosis, EOM impairment, papilledema, ptosis, mydriasis
Diagnosed with CT/MRI
Treated with ABX, LMWH & corticosteroids

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15
Q

What is the most sensitive test for Subarachnoid hemorrhage within 24 hours? After 24 hours? What kidney disease is it associated with?

A

CT within 24 hours and LP with CSF spectrophotometery that shows xanthochromia. Polycystic kidney disease leading to aneurysm formation.

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16
Q

What is the manifestation of dengue fever?hemorrhagic dengue? Treatment?

A

Acute fever, retroorbital pain, rash, GI symptoms, marked myalgia followed by fatigue. Hemorrhagic form causes dehydration, hemoconcentration, thrombocytopenia, spontaneous bleeding and hemorrhage. Supportive treatment

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17
Q

What is the management for BPP score if it is 8/10, 6/10 4/10?

A

Normal. 6/10 should be repeated within 24 hours, the lower scores indicate high risk for fetal asphyxia within 1 week

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18
Q

What is the first line treatment for acute pulmonary edema? Second line if patient doesn’t respond?

A

Furosemide, nitrates. Dobutamine if patient doesn’t respond, decreases afterload and increases CO. If it causes hypotension, treat with Dopamine to increase afterload and increase BP.

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19
Q

What is the most common complication of inferior wall MI and how is it treated?

A

Third degree AV block. Administer atropine and next step is transcutaneous pacemaker if it doesn’t work.

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20
Q

What is the workup of Raynaud phenomenon?

A

History, PE, nail fold microscopy to determine if it is primary vs secondary Raynaud.

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21
Q

What are the specific lab findings in metabolic syndrome?

A

High triglycerides and low HDL, hyperglycemia, high CRP, high fibrinogen

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22
Q

What is expected disease when pregnant woman has pruritis and elevate bilirubin? Treatment?

A

Intrahepatic cholestasis of pregnancy which carries significant risk for fetus. Immediate delivery.

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23
Q

What drug should you avoid in patients with COPD and left ventricular diastolic dysfunction? Best initial diagnosis test?

A

Avoid betablockers because it causes bronchoconstriction. Use calcium channel blockers instead. Or ACEI or ARB. Echocardiogram.

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24
Q

What are the signs and symptoms of epidemic typhus? Treatment?

A

Caused by rickettsia prowazekki. Prodrome of headache, backache, arthralgia, chest pain, cough and malaise. Classic macular rash that starts at the trunk and spreads to the extremities, sparing palms and soles. Treat with tetracycline or chloramphenicol.

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25
Q

Which is the most commonly injured tendon in rotator cuff injuries? Symptoms?

A

Supraspinatus tendon. Shoulder pain that is worse at night, limitation of abduction from 60 to 120 degrees and positive drop test.

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26
Q

What is the hallmark of chronic granulomatous disease? How is it tested?

A

Inability of phagocytic cells to produce an oxidative burst that would typically result in hydrogen peroxide production. Confirmed by negative nitroblue tetrazolium test.

27
Q

What should yo suspect if yo see abdominal contents in the chest Ina newly born infant? How do you treat?

A

Congenital diaphragmatic hernia. No suction and immediate intubation.

28
Q

What are signs and symptoms of Ileus? What can cause it?

A

N/v/abdominal distension, obstipation and hypoactive bowel sounds. Uniformly distended, gas filled loops of both small and large intestines. Retroperitoneal/abdominal hemorrhage or inflammation, intesitinal ischemia and electrolyte abnormalities.

29
Q

What is the presentation of ichthyosis?

A

Dry and rough skin with horny plates over extensor surfaces of limbs (lizard skin)

30
Q

What is the presentation and treatment for acute rheumatic fever?

A

Peak incidence age 5-15. JONES (Erythema marginatum). Late sequalae - mitral regurgitation/stenosis. Prevention with group A streptococcal pyogenes. Elevated ESR

31
Q

What are the two types of breath holding spells?

A

Cyanotic and pallid. Cyanotic - breath holding and LOC. Pallid - minor trauma followed by breath holding, pallor, diaphoresis, LOC. These are harmless.

32
Q

What are symptoms of alcohol withdrawal within firswt 24-48 hours? When does DT occur? Treatmetn?

A

Anxiety, insomnia, tremors, diaphoresis, hallucinations, seizures. DT - 48-96 hours after last drink involves HTN, hyperthermia, agitation, hallucinations. Treat with Benzodiazepines (chlorizepoxide)

33
Q

How long should antibiotics be given to provide adequate therapy?

A

4-6 weeks at a therapeutic dosage.

34
Q

What are the characteristics of severe AS?

A

diminished and delayed carotid pulse, mid to late peaking systolic murmur, presence of soft and single second heart sound. Early peaking systolic murmur is moderate AS.

35
Q

What is suspected in patient swith hypotension, tachycardia, distended neck veins and pulsus paradoxus in acute aortic dissection?

A

Cardiac tamponade

36
Q

What are risk factors, presenation and treatment for tinea corporis?

A

Athletes with skin-skin contact, humid environment, contact with infected animals. Scaly, erythematous, pruritic patch with centrifugal spread with subsequent central clearing with raised annular border. Topical antifungals (clotrimazole, terbianfine) or oral antifungals.

37
Q

What is the treatment for thrombotic thrombocytopenic purpura?

A

Plasma exchange to replenish ADAMTS13 and remove the autoantibodies.

38
Q

What is rationalization?

A

Excusing an unacceptable behavior in a logical way to avoid acknowledging the true reasons for the behavior and protect self esteem

39
Q

What are neuroimaging findings for autism?

A

Increased total brain volume

40
Q

What are neuroimaging findings for OCD?

A

Abnormalities in orbitofrontal cortex and striatum

41
Q

What are neuroimaging findings for panic disorder?

A

Decreased volume of amygdala

42
Q

What are neuroimaging findings for PTSD?

A

Decreased hippocampal volume

43
Q

What are neuroimaging findings for schizophrenia?

A

Enlargement of cerebral ventricles

44
Q

What are risk factors, presentation and treatment for tinea versicolor?

A

Malassezia globosa. Hypopigmented, hyperpigmented or mildly erythematous lesions (face in children and trunk/UE in adults), fine scale, pruritis. KOH shows spaghetti and meatballs pattern of hyphae and yeast cells. Topical ketoconazole, terbinafine or selenium sulfide

45
Q

What is the etiology, clinical feature and treatment for herpangina?

A

Coxsackie A virus. Fever, pharynigits, gray vesicles/ulcers on posterior oropharynx. Supportive management.

46
Q

What is the etiology, clinical feature and treatment for herpetic gingivostomatitis?

A

Herpes simplex virus type 1. Fever, pharyngitis, erythematous gingiva, clusters of small vesicles on anterior oropharynx. Oral acyclovir.

47
Q

What is the presentation of angiofibroma?

A

Epistaxis, localized mass, bony erosion on the back of the nose

48
Q

When do you give x-ray vs. MRI for low back pain?

A

X-ray for osteoprosis, suspected malignancy, ankylosing spondylitis
MRI - sensory/motor deficits, cauda equina syndrome, suspected epidural abscess/infection

49
Q

How is diagnosis of ankylosing spondylitis confirmed?

A

Xray showing sacroilitis

50
Q

What is the treatment for non symptomatic HIV patients who have positive PPD?

A

Isonazid and pyridoxine for 9 months.

51
Q

What cardiac problem can present when BUN > 60? Treatment?

A

Uremic pericarditis. Hemodialysis

52
Q

What renal complication is associated with Crohn disease and pathophysiology?

A

Nephrolithiasis 2/2 oxalatae absorption increase

53
Q

What is the treatment for benign essential tremors? What is its side effect?

A

Primidone. Can precipitate AIP which can be monitored with urine prophobilinogen

54
Q

What is the biopsy findings of squamous cell carcinoma?

A

Invasive cords of squamous cells with keratin pearls

55
Q

What is the biopsy findings of basal cell carcinoma?

A

Invasive clusters of spindle cells surrounded by palisaded basal cells

56
Q

What is the treatment for cryptococcal meningoencephalitis? CD4? WHich meds should be deferred?

A

Amphoterocin B plus flucytosine.

57
Q

What is an increased risk factor for intraventricular hemorrhage?

A

Prematurity and low birth weight

58
Q

What are contraindications for Buproprion?

A

Seizures, anorexia, bulimia nervosa

59
Q

What is a common cause of primary adrenal insufficiency in endemic areas? What is teh blood gas situation?

A

TB. Non anion gap, hyperkalemic, hyponatremic metabolic acidosis.

60
Q

What is the most cammon cause of secondary HTN in children? What are findings?

A

Fibromuscular dysplasia. Bruit or venous hum at CVA. Angiogram reveals string of beads.

61
Q

What are preferred treatments for Hepatitis B?

A

Entecavir and Tenofovir due to lower drug resisitance

62
Q

What is the treatment for Raynaud’sphenomena?

A

CCB (nifedipine and amlodipine)

63
Q

What should you suspect in young healthy patients who develop CHF?

A

Viral myocarditis 2/2 Coxsackie or viral cause

64
Q

What is the presentation of uncomplicated phsryngitis? Complications and treatment?

A

Muffled voice, deviation of uvula and unilateral lymphadenopathy. Peritonsillar abscess that requires IV antiobiotics and urgent drainage of abscess.

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