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Level 2 Boards > Hematology/Oncology & Infectious Disease > Flashcards

Hematology/Oncology & Infectious Disease Flashcards

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1
Q

Heparin

MOA
Lab

A

Activated antithrombin

Then inactivates factor Xa, Thrombin (IIa)

Increases PTT

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2
Q

Warfarin

MOA
Lab

A

Inhibits synthesis of Vit K- dependent coagulation factors (II, VII, IX, X and to a lesser extent proteins C and S) by blocking vitamin K epoxide reductase

Increases PT

Rapid reversal give FFP (or Vit K)

Teratogenic

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3
Q

Tissue plasminogen activators (tPAs)

  • name
  • MOA
  • Lab (3)
A

Alteplase
Reteplase
Tenecteplase

Aid conversion of plasminogen to plasmin which breaks down fibrin

Increase PT
Increase PTT
No change in platelet count

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4
Q

Factor Xa inhibitors

  • Name
  • MOA
  • Lab
  • Reversal agent
A

ApiXAban
RivaroXAban

Directly inhibit factor Xa

New/noval oral anticoagulant (NOAC)

PT/PTT not monitored

Reversal agent: Andexanet alfa

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5
Q

LMWH

  • Name
  • MOA
  • Administered
A

Enoxaparin
Dalteparin

Mainly inhibits factor Xa

Can be administered SQ

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6
Q

Direct thrombin inhibitors

  • Name
  • MOA
  • Antidote
A

Dabigatran
Argatroban

Directly inhibit factor II (thrombin)
NOAC

Antidote: idarucizumab

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7
Q

Glycoprotein IIb/IIa inhibitors

  • Name
  • MOA
A

Abciximab
Eptifibatide
Tirofiban

Reversibly binds to the glycoprotein receptor IIb/IIIa on activated platelet, preventing aggregation

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8
Q

Hemophilia A

Hemophilia B

Hemophilia C

A

Hemophilia A
- Factor VIII

Hemophilia B
- Factor IX

Hemophilia C

  • Factor XI
  • Ashkenazi Jews
  • AR

X linked recessive for males

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9
Q

Hemophilia Lab

Tx

A

PTT prolonged

PT and bleeding time normal

Tx: Transfuse missing factor
- If unavailable: Cryoprecipitate

If bleeding not severe: Desmopressin

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10
Q

Cryoprecipitate

A

Consists of factor VIII and fibrinogen with smaller concentrations of factor XIII, vWF, and fibronectin

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11
Q

Von Willebrand disease

  • Inheritence
  • MOA
A

Autosomal dominant

Deficiency in vWF with decreased levels of factor VIII

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12
Q

Epistaxis
Gum and gingival bleeding
Menorrhagia

Dx
Lab
Tx

A

Von Willebrand

Dx: Ristocetin cofactor assay (decreased agglutination )

Lab:
Increased bleeding time
Increased PTT

Normal PT and platelet

Tx: Desmopressin

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13
Q

Activated protein C (APC) resistance/ Factor V Leiden

A

Inherited thrombophilia

Single point mutation in factor V, rendering it resistant to inactivation/ breakdown by activated protein C

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14
Q

Heparin-induced thrombocytopenia (HIT)

  • Caused by
  • MOA
  • Timeline
  • Also seen
  • NOT seen
  • Tx
A

More common w/ Heparin
Can happen w/ Heparin or enoxaparin

Immunologic reaction to heparin which creates platelet activating antibodies which leads to blood clots and rapid drop in platelet count

5-10 days after starting heparin

Skin necrosis at injection site

[No bleeding]

Tx: Stop heparin immediately
Start a direct thrombin inhibitor (fondaparinux, argatroban, bivalirudin)

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15
Q

Antiphospholipid syndrome (APS)

  • Associated with
  • Antibodies
  • Two features
  • Lab
  • Tx
A

Associated with SLE and rheumatoid arthritis

APS antibodies

  • Lupus anticoagulatn
  • Anticardiolipin

Spontaneous abortion
Arterial and venous thrombi formation

Prolonged PTT

Tx: Heparin and warfarin

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16
Q

Recurrent miscarriages and stroke

PE

A

Antiphospholipid syndrome

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17
Q

Disseminated Intravascular Coagulation

A

Acquired coagulopathy caused by deposition of fibrin in small blood vessels leading to thrombosis and end-organ damage

Depletion of clotting factors and platelets leading to bleeding diathesis

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18
Q

Bleeding for venipuncture sites

Lab
Tx

A

Disseminated intravascular coagulation (DIC)

Increased PT and PTT
Decreased platelets
Increased D-dimer and fibrin
Decreased fibrinogen

Factor VIII depressed

Tx: Transfuse RBC, platelets and FFP

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19
Q

Thrombotic Thrombocytopenic purpura

  • what is it
  • MOA
  • Addition result
  • Features (5)
  • Lab
  • Tx
A

TTP is a deficiency of the vWF-cleaving enzyme (ADAMTS-13) resulting in abnormally large vWF multimers that aggregate platelets and create platelet microthrombi

Block small blood vessels —> end organ damage

RBC are fragmented by contact w/ microthrombi —> hemolysis

Microangiopathic hemolytic anemia

TTP = adults
HUS= children associated with E.coli
Low platelet count
Neurologic changes (delirium, seizure, stroke, decreased vision) 
Pyrexia (fever) 
Schistocytes
Acute kidney injury

Decreased platelets
Decreased hemoglobin
Increased creatinine
Normal clotting cascade

Tx: Plasma exchange

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20
Q

Hemolytic uremic syndrome

  • Causes
  • Features (6)
  • Lab (4)
  • Tx
A

Children more often

Similar to TTP but no neurologic features

Ecoli diarrhea preceedes
Shiga toxin (atypical HUS) 
Renal failure
Microangiopathic hemolytic anemia
Low platelets
Abdominal pain
Bloody diarrhea
Schistocytes

Decreased platelets
Decreased hemoglobin
Increased creatinine
Normal clotting cascade

Tx: Dialysis for AKI
Plasma exchange

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21
Q

Idiopathic thrombocytopenic purpura

  • MOA (3)
  • Lab
  • Affects who
  • Feature (5)
  • Antibody
  • Tx
A

IgG antibodies (antiplatelet antibodies) are formed against the patients platelets

Platelet antibodies complexes are destroyed in the spleen

Bone marrow production of platelets is increased

Increased Megakaryocytes

Women of child bearing age

Mucocutaneous bleeding
Easy bruising
Petechiae
Hematuria
Melena

If Acute: following viral infection, children 2-6, self limiting purpura

Antiplatelet Ab

Tx: if platelet <30,000 then Corticosteriods and IVIG

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22
Q

Basophilic stippling

A 
Lead poisoning (low iron) 
Sideroblastic anemia (high iron)
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23
Q

B12 deficiency

Folate deficiency

A

B12 deficiency

  • Increased MMA (methylmalonic acid)
  • Increased homocysteine

Folate deficiency

  • Normal MMA
  • Increased homocysteine
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24
Q

African american male

Fatigue
Dark urine
SOB
Jaundice

Taking TMP-SMX for cold

  • Inheritence?
A

G6PD deficiency

X linked

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25
Heinz bodies Bite cells Hemolytic anemia
G6PD deficiency
26
Spleen removed at risk for
Pneumococcal Meningococcal Haemophillus Spleen Makes Human Prey
27
Tx Paroxysmal nocturnal hemoglobinuria
Prednisone
28
Sickle cell Acute chest syndrome causes
Fat embolism from bone marrow | Infxn from Mycoplasma, Chlamydia or viruses
29
Autoimmune hemolytic anemia vs hereditary spherocytosis
Both have spheroctyes and positive osmotic fragility tests AIHA has + direct Coombs test
30
``` Fatigue Pallor Weakness Frequent infections Petechiae Bruising Bleeding ``` Pancytopenic
Aplastic anemia
31
Polycythemia vera - MOA - Elevated - Low - Tx (2)
Clonal proliferation of pluripotent marrow stem cells caused by mutation in JAK2 protein which regulate marrow production Excess proliferation of WBC, RBC and platelets Low Erythropoietin Tx: Phlebotomy - Hydroxyurea
32
Febrile nonhemolytic reaction
Cytokine formation during storage of blood Host antibodies against the donor HLA antigens Type II hypersensitivity 1-6 hrs after Fever, HA, chills, flushing, rigors Prevention: using leukoreduced blood products
33
Hemolytic transfusion reaction
Preformed (acute) or formed (delayed) recipient antibodies against donor erythrocytes Type II hypersensitivity Fever, hypotension, chills, nausea, flushing, burning at IV site, tachycardia, flank pain Bloody urine During or shortly after transfusion
34
Smudge cells Lab
CLL Increase NK, T or B cells
35
Auer rods
AML
36
Tx APL chemo
All trans retinoic acid
37
Tx CLL
FLudarabine | Chlorambucil
38
9;22 Lab Tx
CML Lab: granulocytosis (increased granulocytes: neutrophils, eosinophils, or basophils) Tx: Tyrosine kinase inhibitors (imatinib)
39
Tx Hairy cell Leukemia
Cladribine
40
Single group of localized nodules Reed sternberg cells EBV
Hodgkin lymphoma
41
Many peripheral nodes involved Noncontiguous spread Mainly B cells 65-75 years old HIV
Non-Hodgkin lymphoma
42
8; 14
Starry sky Burkitt lymphoma Jaw lesion EBV
43
Eczema like lesions Pruritus Biopsy: cerebriform lymphoid cells
Mycosis fungoides/ Sezary syndrome T cell lymphoma of skin Sezary syndrome: T cell leukemia
44
Staging of Lymphoma
Stage I: single site Stage II: two or more sites on same side of diaphragm Stage III: Multiple sites on both sides of diaphragm STage IV; diffuse disease
45
Lymphoma Tx
R-CHOP ``` Rituximab Cyclophosphamide Doxorubicin Vincristine Prednisone ``` Little Police Cam DVR
46
Tx High grade NHL can lead to
Tumor lysis syndrome Rapid cell death —> release intracellualr contents and leads to Hyperkalemia Hyperphosphatemia Hyperuricemia Hypocalemia
47
Given for nausea with chemo
Ondansetron | - serotonin 5-HT3 receptor antagonist
48
Tx Hodgkin lymphoma
ABVD Adriamycin (doxorubicin) Bleomycin Vinblastine Dacarbazine
49
Transplant rejections 1) Within minutes 2) 5 days to 3 months 3) Months to years
1) Within minutes - Hyperacute - Preformed antibodies - Check ABO compatibility - Tx: Cytotoxic agents 2) 5 days to 3 months - Acute transplant rejection - T cell mediated - Increased GGT, alk phos, LDH, BUN, creatinine - Tx: Corticosteroids, tacrolimus, Mycophenolate mofetil (MMF) 3) Months to years - Chronic transplant rejection - Chronic immune reaction causing fibrosis - Gradual loss of organ function - No tx
50
Tuberous sclerosis malignancies
Astrocytoma | Cardiac rhabdomyoma
51
Pruritus worsened by water Facial plethora Elevated Hematocrit Risk of?
Polycythemia vera Risk of thrombus
52
Pruritus worsened by water Facial pletora Elevated Hematocrit Abdominal discomfort Ascites Hepatosplenomegaly Elevated liver enzymes Elevated bilirubin Elevated Alk phos - Name - Test to get - Mutation
Budd Chiari Get Abdominal doppler U/S JAK2 mutation
53
``` Constipation Back pain Anemia Renal insufficency Hypercalcemia ```
Multiple myeloma Constipation due to hypercalcemia
54
RBC w/o central pallor - Name - Lab (2) - If, then
Hereditary spherocytosis High mean corpuscular hemoglobin concentration High reticulocytes [If Coombs positive= Autoimmune hemolytic anemia]
55
Absence of CD55 in RBC membranes
Paroxysmal nocturnal hemoglobinuria Red urine Normal RBC on blood smear
56
Elevated Hemoglobin A2 Elevated hemoglobin F
Elevated Hemoglobin A2= beta thalassemia Elevated hemoglobin F= sickle cell anemia, beta thalassemia
57
Acute hemolytic transfusion reaction
ABO incompatibilty Within 1 hr Fever Chills Hypotension Flank pain DIC ** Acute renal failure Positive Coombs Tx: IV normal saline
58
Hypercalcemia in setting of breast cancer Tx
Metastatic to bone Tx: Bisphosphonates
59
Periorbital bruising Abdominal mass
Neuroblastoma
60
Worsening back pain Bladder incontinece Hyperreflexia What to do first
IV glucocorticoids Epidural spinal cord compression Then MRI
61
Headaches Confusion Low hemoglobin Low platelets Low Leukocytes Elevated BUN Elevated Cr Fragmented cells and normal PTT Tx
Thrombotic thrombocytopenic purpura Plasma exchange
62
Eczema Low platelets Recurrent infections - Name - Genetics - MOA - Feature - Tx
Wiskott aldrich syndrome X linked recessive defect in WAS gene Impaired cytoskeleton changes in leukocytes and platelets Small platelets (microthrombocytopenia) Tx: Stem cell transplant
63
Had otitis media Splenomegaly Jaundice Low Hemoglobin Normal MCV Normal MCHC High reticulocytes
Drug induced immune-mediated hemolytic anemia Normocytic anemia Reticulocytosis Splenomegaly
64
Transfusion Develop SOB Fever Pale Clear breath sounds Pain at IV site No rashes Dark urine
Acute hemolytic transfusion reaction ABO incompatibility
65
PE PT & PTT normal
Hereditary thrombophilias Factor V Leiden -Activated protein C resistance
66
Thrombocytopenia Clumps of platelets on smear (blue dots)
Pseudothromobocytopenia Laboratory error
67
Fever Nonproductive cough right lower lobe infiltrate Lymphadenopathy Hepatomegaly Thrombocytopenia Anemia - Name - Lab - Diagnosed by
CLL Dramatic leukocytosis w/ lymphocytes CLL diagnosed by flow cytometry (showing a clonality of mature B cells)
68
3 y.o Fatigue Pallor Had abdominal pain and diarrhea 1 week ago Scleral icterus Ecchymoses on upper and lower extremities Pitting edema Low hemoglobin Normal MCV Low platelets High Leukocytes Normal PT Normal PTT Schistocytes
Hemolytic uremic syndrome
69
DVT w/ end stage renal disease tx
Unfractionated heparin followed by warfarin
70
Epistasis Celiac disease Elevated PT time
Vitamin K deficiency
71
Bleeding wont stop Painful heavy menses Ecchymoses Low platelets
Immune thrombocytopenia Isolated thormbocytopenia - IgG autoantibodies
72
Bleeding from IV Prolonged PT and PTT Normal platelet
Vit K deficiency
73
Iron deficiency vs Thalassemia
Iron deficiency - Low iron - Low MCV - Low Ferritin - Low Transferrin sat - HIgh TIBC Thalassemia - High iron - High Ferritin - High transferrin - Low TIBC - Very low MCV
74
Headache Dizzineess Blurry vision Total protein 10.5 Albumin 3.7 Dilated segmented tortuous retinal veins
Waldenstrom macroglobulinemia Monoclonal IgM antibody production Hyperviscosity syndrome Screening: serum protein electrophoresis
75
Erectile dysfunction HTN Elevated hematocrit
Obstructive sleep apnea
76
Sickle cell Severe anemia Low reticulocyte count
aplastic crisis Parvovirus B19 cause [Aplastic anemia= pancytopenia]
77
Vitamin B12 deficiency at risk for
Most common cause B12 deficiency is pernicious anemia which is antibody mediated destruction of intrinsic factor Antibodies also target gastric parietal cells —> atrophy of acid/ pepsin producing parts of stomach Risk of gastric cancer
78
Stem cell transplant Develop profuse watery diarrhea and rash
Acute graft vs host disease Cytotoxic T cells Within 100 days
79
Cerevical paraspinal mass Horner syndrome
Neuroblastoma
80
Overexpression of BCL-2
Follicular lymphoma 14;18
81
Elevated metamyelocytes Elevated band cells High Leukocyte alkaline phosphatase (LAP) Leukocytes 48,000
Leukemoid reaction Leukocytosis > 50,000
82
Pneumonia hospitalization
CURB-65 ``` Confusion Uremia (BUN > 19) Resp rate ( > 30 breaths/min) BP (<90 or < 60) Age > 65 ```
83
Pneumonia tx 1) Community acquired, < 65 2) >65 or comorbidity (COPD, HF, RF, DM, liver dis, ETOH use) 3) Community acquired but requires hospitilzation 4) Community acquired requiring ICU 5) Hospital acquired; ventilator associated 6) MRSA pneumonia
1) Macrolide or doxycycline 2) Fluoroquinolone or beta-lactam + macrolide 3) Fluoroquinolone or antipneumococcal beta lactam _ macrolide 4) Antipneumococcal beta lactam + Fluoroquinolone (or azithromycin) 5) Extended spectrum cephalosporin or carbapenem with antipseudonomal activity - add aminoglycoside or fluroquinolone for coverage of pseudomonas 6) Add vancomycin or linezolid Beta lactam - Ceftriaxone, cefotaxime, Ampicillin/ Sulbactam Antipneumococcal Beta-lactam - Cefepime, Imipenem, Meropenem, Piperacillin/ Tazobactam, Doripenem (Carbapenems)
84
TB Treatment
INH Pyrazinamide Rifampin Ethambutol INH - Peripheral neuropathy - Drug induced hepatitis [Give B6 pyroxidine w/ INH to prevent neuropathy] Rifampin - orange fluids Ethambutol - optic neuritis
85
Silver strain shows branched septate hyphae
Aspergillosis
86
Serum galactomannan assay
Aspergillosis
87
Aspergilloma vs Aspergillosis
Aspergilloma - preexisting lung disease - Solid mass within preexisting cavity - Itraconazole Aspergillosis - Rapidly progressive infection in immunocompromised - Voriconazole or caspofungin
88
Postviral pneumonia
S. aureus Risk in elderly
89
Early antibiotic treatment of streptococcal pharyngitis can prevent
Pencillin Rheumatic fever But not glomerulonephritis
90
Acute pharyngitis Centor criteria
``` Fever +1 Tonsillar exudate +1 Tender anterior cervical lymphadenopathy +1 Lack of cough +1 3-14 y.o +1 15-45 +0 >45 -1 ``` If 4-5 tx empirically w/ antibiotics (get culture first) If 2-3 pts, perform rapid antigen test
91
Complications of sinusitis
Meningitis Frontal bone osteomyelitis Cavernous sinus thrombosis Abscess formation
92
Antigenic drift Antigenic shift
Drift - influenza changes each year - change in surface protein Shift - pandemic - genetic reassortment
93
Influenza tx
Oseltamivir | Zanamivir
94
``` Fever Proptosis Decreased extraocular movements Ocular pain Decreased visual acuity ``` DM Palatal and nasal mucosal ulceration w/ maxillary sinusitis Tx
Orbital cellulitis by Mucormycosis or Rhizopus [Normally: Strep or staph) Amphotericin B and surgical debridement
95
Gonorrhoeae conjunctivitis tx
IM or IV ceftriaxone
96
C trachomatis conjunctivitis tx
Neonatal: azithromycin, tetracycline or erythromycin
97
Reoccuring eye pain Blurred eye pain Tearing Redness Corneal vesicles Dendritic ulcers Scraping= multinucleated giant cells
Herpes simplex keratitis
98
Tx Otitis externa
Ofloxacin or ciprofloxacin and steroid drops
99
CSF Low Glucose Increased Protein Increased opening pressure
Bacterial meningitis
100
CSF Normal glucose Normal or increased protein Normal or increased pressure
VIral meningitis
101
Tx Bacterial meningitis
< 1 month - GBS, E.coli, Listeria - Ampicillin + cefotaxime or gentamicin 1-3 months - S. pneu, N. meningitis, H. influenza - Vancomycin IV + ceftriaxone or cefotaxime 3 mn - adult - N. meningitidis, S. pneu - Vancomycin IV + Ceftriaxone or cefotaxime >60/ alcoholism - s. pneu, listeria, n. mening - Ampicillin + vancomycin + ceftriaxone or cefotaxime
102
RBC in CSF w/o trauma
HSV encephalitis
103
HSV encephalitis Tx
Coronal Flair IV acyclovir Foscarnet if resistant
104
CMV encephalitis tx
IV ganciclovir +- foscarnet
105
HIV pregnant lady not on ART give what at delivery
Zidovudine Infant receives ZDV at 6 weeks after birth
106
Painless fluffy granular hemorrhages in eye
CMV retinitis
107
Tx Brain abscess
IV metronidazole + cephalosporin + vacomycin 6-8 weeks
108
Tests for HIV
ELISA test - high sensitivity - moderate specificity - take up to 6 months Western blot - low sensitivity - high specificity - confirmatory
109
Live vaccines okay to give to HIV patients
> 200 CD4 MMR and varicella [Do not give polio]
110
CD4 < 200 at risk for
Pneumocytosis Toxoplasmosis (< 100) Cryptococcosis Coccidioidomycosis Crytosporidiosis
111
CD4 < 50 at risk for
Disseminated MAC infection Histoplasmosis CMV retinitis CNS lymphoma
112
TX 1) P jirovecii pneumonia 2) MAC 3) Toxoplasma gondii
1) P jirovecii pneumonia - High dose IV TMP-SMX + steriods 2) MAC - Weekly azithromycin 3) Toxoplasma gondii - Double strength TMP-SMX
113
Pseudohyphae and budding yeast
Candida
114
45 angle branching septate hyphae
Aspergillus
115
Wide capsular halo Narrow-based unequal budding India ink stain - Tx
Crytococcus Tx: IV amphotericin B + Flucytosine for 2 weeks, then fluconzole for 8 weeks
116
Nonseptate hyphae, wide angle branching
Mucor
117
Spelunking Ohio / mississippi - CXR (2) - stain - description of cell - Tx (2)
Histoplasmosis Nodular densities Hilar lymphadenopathy Giemsas stain Cell contain many smaller cells Itraconazole If disseminated: fever, malaise, WL, pancytopenia, hepatomegaly= amphotericin B followed by itraconazole
118
Branching filaments on acid fast stain - Name - Found - Tx
Nocardia found in soil TMP-SMX
119
Respiratory infection Southwest USA
Coccidioidomycosis PO fluconazole or itraconazole
120
Mississippi and ohio river valleys Broad budding yeast Tx?
Blastomycosis Itraconazole
121
Diffuse bilateral interstitial infiltrates with ground glass appearance - Name - Tx
Pneumocystis pneumonia TMP-SMX 21 days w/ corticosteriods
122
Hx Tb Fatigue Low hemoglobin Low MCV High Iron Low TIBC Hypochromic and normochromic cells Tx
Acquired sideroblastic anemia Isoniazid can cause this Give pyridoxine (Vit B6)
123
African american Poorly localized abd pain Hx Hematuria no vaccines Elevated reticulocytes
Sickle cell
124
Pregnant goes into labor Vesicular rash on face that spreads to chest and abdomen Pruritic Given baby
Varicella Zoster infection Varicella zoster immune globulin
125
Negative Rapid streptococcal antigen test Then get
Throat culture
126
Slow growing painless mass in right submandibular region Had right molar extracted for tooth decay Thick yellow drainage Small yellow granules Gram positive rod with rudimentary branching Tx
Actinomyces Penicillin
127
Diarrhea in AIDs patient
CD4 < 180= cryptosporidium - severe watery diarrhea CD4 < 100= Microsporidium/ Isosporidium - Fever rare - Crampy abd pain - watery diarrhea CD4 < 50= MAC - Watery diarrhea - High fever CD4 < 50= CMV - Small volume diarrhea - Hematochezia - Abd pain
128
TB in HIV patient
Positive if >= 5
129
Painful genital ulcers
Herpes simplex virus - small vesicles or ulcers on erythematous base Haemophilus ducrey - larger deep ulcers with gray/ yellow exudate - severe lymphadenopathy
130
Painless genital ulcer
Treponema pallidum (syphilis) - single ulcer (chancre) - regular borders and hard base Chlamydia - small shallow ulcers - can progress to buboes
131
Salvage
Tx given after initial tx failed
132
Consolidation therapy
Reduce tumor size
133
End stage renal disease Severe HTN HA Retinal hemorrhages Anemia EPO tx
Hypertensive crisis Due to erythropoietin therapy
134
Prolonged bloody diarrhea Organism? Tx
Entamoeba histolytica | - Metronidazole
135
Periventricular calcifications on infant
CMV Spread by saliva
136
Hydrocephalus Diffuse parenchymal calcifications in brain of infant
Toxoplasmosis Cat feces Uncooked meat
137
Fever Drowsiness Nuchal rigidity Septic Large petechial Hypotensive Hypothermic
Meningococcemia —> Waterhouse Friderichsen syndrome Sudden vasomotor collapse and skin rash due to adrenal hemorrhage
138
Acute meningitis (over night)
Neisseria meningitidis
139
Left upper quadrant pain Leukocytosis Fever
Splenic abscess from infective endocarditis
140
Elevated LDH
High tumor burden
141
Acute lymphadenitis organism
Staph aureus
142
Pneumonia secondary to influenza infxn organism
Staph aureus
143
1) Bacterial invasion of the intestinal muscosa 2) Ingestion of preformed enterotoxin in the food 3) Intestinal bacterial colonization and toxin production 4) Protozoal attachment and alteration of microvilli
1) Campylobacter, Salmonella Listeria ``` 2) Staph aureus Bacillus cereus (reheated rice) ``` 3) C. difficile C. perfringens ETEC E.coli 4) Giardia
144
Vit B 12 deficiency causes
Impaired DNA synthesis
145
Cough with posttussive emesis - Name - Dx - Tx
Bordetella pertussis PCR dx Macrolides (azithromycin, clarithromycin)
146
Epistaxis Ruby colored papules that blanch with pressure Increased hematocrit - Name - Inheritence - MOA - Causes
Hereditary hemorrhagic telangiectasis (Osler-Weber-Rendu syndrome) AD Widespread arteriovenous malformations AVM in lung shunt blood from right to left causing chronic hypoxemia, digital clubbing and reactive polycythemia
147
Anemia Hypoalbuminemia Increased Alk phos Foamy macrophages with acid fast bacilli - Name - Tx
MAC Tx: Clarithromycin + ethambutol
148
Give what prophylaxis to CD4 < 50
Weekly azithromycin
149
Tx Toxoplasmosis
High dose PO pyrimethanime + sulfadiazine and leucovorin 4-8 weeks
150
Prophylaxis CD4 < 100
TMP-SMX or pyrimethamine + dapsone
151
Shallow ulcer, painless Now painiful swelling inguinal lymph nodes
Lymphogranuloma verereum [Chlamydia]
152
Tx Chlamydia
Doxycycline for 7 days Or azithromycin once Use azithromycin on pregnant patients
153
Tx Gonorrhea
Ceftriaxone IM and azithromycin PO
154
Jarisch-Herxheimer rxn
Tx of syphilis can result in acute flu like illness (HA, fever, chills, myalgisa) which result from the release of endotoxins by the killed organism
155
False positive VDRL (4)
Mono HSV HIV Hepatitis
156
Papule becomes beefy-red ulcer with rolled edge of granulation tissue Painless Dx Tx
Klebsiella granulomatis Donovan bodies (deep purple rod shaped in cytoplasm of phagocytes) Tx: Doxycycline or azithromycin
157
Tx UTI
PO TMP-SMX or fluoroquinolone 3 days or nitrofurantoin 5 days
158
Tx Pyelonephritis
Fluoroquinolones
159
``` Fever Chills Altered mental status Tachycardia Tachypnea ``` - Name - Also see (2) - Lab (3)
Sepsis Also hypotension in septic shock Also Leukocytosis/ leukopenia WBC < 4000 WBC > 12000 with increased bands > 10%
160
``` Fever 105 Chills Myalgias HA Diaphoresis ``` Anemia Normocytic Normochromic - Name - Tx
Malaria Chloroquine (resistance) Mefloquine
161
Primquine
For malaria Must test for G6PD first
162
Fever Neutrophil < 500
Neutropenic fever Common in chemotherapy Piperacillin- tazobactam Chemo can lead to disruption of skin and mucosal barrier in mouth resulting in pseudomonas infection
163
Tx Lyme disease
Early: doxycycline Children/ pregnant: amoxicillin Advanced: ceftriaxone
164
Ring shaped Flu Intravascular hemolysis Anemia Jaundice - Name - Tx
Babesioses Azithromycin and Atovaquone
165
Borrelia burgdorferi
Lyme disease
166
Rickettsia rickettsii
Rocky mountain spotted fever
167
HA Fever Malaise Rash Rash macular at wrist and ankles but spreads centrally - Name - Tx
RMSF Doxycycline
168
Endocarditis organism 1) Dental procedure 2) Prosthetic valve 3) Most common
Dental procedure= Viridans streptococci Prosthetic valve= Coagulase negative staphylococcus (epidermidis, haemolyticus) Most common= staph aureus
169
Endocarditis from IV drug users
Tricuspid valve
170
Tx Endocarditis
Vancomycin + gentamicin
171
Tx anthrax
Ciprofloxacin or doxycycline for inhaled disease
172
Chronic osteomyelitis with draining sinus can eventually lead to
SCC (Marjolin ulcer)
173
Tick ``` Fever Fatigue Myalgia Anemia Dark urine ``` Drenching sweats
Babesiosis
174
Off-white discharge fishy odor - Name - Features (2) - Tx
Bacterial vaginosis Gardnerella vaginalis pH> 4.5 Clue cells Metronidazole
175
Yellow green malodorous, frothy discharge pH> 4.5 - Name - Tx
Trichomoniasis Tx: Metronidazole
176
Unilateral lymphadenitis tx
Clindamycin
177
Solid organ transplant prophylaxis
TMP-SMX for opportunistic infections (pneumocystis pneumonia)
178
Lymphangitis tx
Cephalexin cutaneous wound —> red streaks
179
Fell and got abrasion on leg Severe pain Swelling Spread Hypotension
Necrotizing fasciitis
180
Viral meningitis organisms
Enteroviruses such as Group B coxsackievirus
181
Chemotherapy Get gangrenous ulcers - Name - Organism
Ecthyma gangrenosum Pseudomonas
182
Pelvic pain Bleeding
Consider PID
183
Fever Pain in multiple joints Uses heroin Sex worker Pustules on chest and extensor surfaces of forearms Blood cultures negative - Name - Diagnosis
Disseminated gonococcal infection Dx: Nucleic acid amplification testing
184
UTI pH > 8
Urease producing bacterium Proteus mirabilis or Klebsiella Risk of struviate stones (magnesium ammonium phosphate)
185
Tx Hepatitis C in pregnancy
Ribavirin is teratogenic Hep A & B vaccination
186
``` Sandpaper rash on trunk Armpits and groin Fever Sore throat Cervical lymphadenopathy ``` Two kids in class also sick - Name - Organism - Tx - Feature (1)
Scarlet fever Streptococcus pyogenes Penicillin Strawberry tongue
187
Erythema infectiosum
Parvovirus B19 Slapped cheek
188
Hand foot and mouth disease
Coxsackievirus infection
189
High fever few days This rash
Roseola
190
IV drug user Murmur Arm cellulitis - Murmur - Due to - Organism - Tx
Tricuspid regurgitation Right sided infection endocarditis Staphylococcus aureus Vancomycin
191
Rocky mountain spotted fever Features (4) Tx
Petechial rash on wrist/ ankles Decreased platelets Decreased sodium Increase AST/ALT Doxycycline
192
9 y.o Writhing of arms Grimacing of face 1 month ago: sore throat and fever that resolved Lived in Honduras Pericardial friction rub Elevated ESR Prolonged PR interval and diffuse ST elevations - What organism - Disorder - Tx
Streptococcus pyogenes Acute rheumatic fever Penicillin
193
Skin lesion Painful nerves iwth loss of sensory - Name - Diagnosis - Tx (2)
Leprosy Biopsy of lesion Dapsone + rifampin
194
Large blue cells with extra space around capsule
CMV
195
Tx Asymptomatic bacteriuria w/ Ecoli
Amoxicillin clavulanate Cephalexin NItrofurantoin
196
High grade fever for 6 days Rash face —> extremities No immunizations Diffuse maculopapular rash that spares palms and soles - Name - What helps reduce morbidity - Cause it does what
Measles (rubeola) Vit A Promotion of antibody producing cells and regeneration of epithelial cells
197
Organism of acute bacterial rhinosinusitis Facial pain Symptoms > 10 Worsening symptoms - Name - Tx
Nontypeable Haemophilius influenzae Amoxicillin +- clavulanate [Next streptococcus pneumoniae, and then Moraxella catarrhalis]
198
Rash that started on face Localized lymphadenopathy Arthralgias spares palms and soles 100.8 F No vaccines
Rubella German measles
199
Measles vs Rubella
Measles - High fever (104) - Koplick spots Rubella - Cephalocudal spread but coalesces and appears hemorrhagic - ARTHRITIS - Tender lymphadenopathy
200
Infective endocarditis from mitral valve prolapse
Streptococcus sanguinis Part of viridans
201
Gray vesicles that progress to fibrin coated ulcers Soft palate and uvela
Herpangina Coxsackie virus Late summer Early fall
202
Anus pruritus
Enterobius vermicularis (pin worm) Tx: Pyrantel pamoate or albendazole
203
Rash that went away Diarrhea Nausea Cramps Fever WL Night sweats Lymphadenopathy
HIV
204
Liver transplant Immunosuppressive therapy ``` Dry cough fever LDH elevated Tachypnea Hypoxia ``` - Name - Diagnosis
Pneumocystis pneumonia Bronchoalveolar lavage
205
HIV Non enhancing asymmetric white matter lesion Hypodense w/ no edema
Progressive multifocal leukoencephalopathy JC virus
206
HIV associated dementia
Diffuse brain atrophy, ventricular enlargement
207
Tx Vibrio vulnificus
IV ceftriaxone + doxycycline
208
Sensorineural hearing loss No red reflex Loud harsh murmur over left second intercostal Hepatosplenomegaly
Rubella (German measles) Cataracts Deafness PDA
209
Opportunistic infections
Pneumocystis pneumonia CMV - pulmonary symptoms - GI symptoms
210
Tx Acute otitis media
Amoxicillin clavulanate
211
Syphillis tx if pencillin allergy
Doxycycline
212
Tick Flu like illness No rash Neurlogic symptoms - Name - Organism - Tx
Human monocytic ehrlichiosis E chaffeensis/ E ewingii Doxycycline
213
Liver cyst Cyst within Cyst
Echinococcus granulosus Dog tapeworm Hydatid cyst
214
Thin malodorous discharge Postcoital bleeding Motile, ovoid shaped organisms - Name - Tx - Feature
Trichomoniasis Metronidazole pH> 4.5
215
Small reddish/ purple papules that enlarge to large nodules HIV Bleed easily
Bartonella species Bacillary angiomatosis
216
Multiple large shallow erosions or ulcers on colonscopy Immunosuppressed
CMV colitis
217
Droplet precautions
N/ mneingitidis H. influenza Mycoplasma pneumonias
218
HIV HA Fatigue Bilateral papilledema Fever MRI normal
Cryptococcal meningoencephalitis
219
Bacterial meningitis empiric tx
Vancomycin Ampicillin 3rd generation cephalosporin (cefepime)
220
Sore throat Elevated fever Difficulty swallowing Given azithromycin for pharyngitis Swell of neck along SCM Internal jugular vein thrombosis Peripheral lung nodules w/ cavitation - Organism - Syndrome - Tx (2)
Fusobacterium necrophorum Lemierre syndrome Airway management IV antibiotics/ drainage if none responsive *Thrombophlebitis of Jugular vein
221
Urethral discharge Culture negative
Chlamydia
222
Low hemoglobin MCV Low Reticulocytes High Elevated Total bilirubin Jaundice - Name - Feature (4)
Hereditary spherocytosis Hemolytic anemia Jaundice Splenomegaly Negative coombs test
223
Tx Sickle cell crisis SE
Hydroxyurea SE Myelosuppression
224
Hepatosplenomegaly 5% Hemoglobin A 95% hemoglobin F - Name - Tx
Beta thalassemia Chelation therapy
225
Bruising Lymphadenopathy Hepatosplenomegaly Petechiae Mucosal bleeding - Name - Deficiency
ALL Deficiency of platelet production
226
Target cells
Alpha thalassemia minor -no therapy needed ``` HALT said hunter to his target HbC disease Asplenia Liver disease Thalassemia ```
227
Osteolytic lesions Fractures - Name - MOA - Appearance - Seen on microscope
Multiple myeloma Impaired effective antibody production Fried egg Roulex formation (RBC stacked)
228
SLE cause of thrombocytopenia
Peripheral destruction Antiplatelet antibodies
229
Asplenic prophylaxis if develops fever - organisms (3) - Tx
Encapsulated bacteria - Streptococcus pneumoniae - Hemophilus influenzae - Neisseria meningitidis Develop fever - Amoxicillin- clavulanate
230
Mass in right lobe of liver Central scar Well circumscribed
Focal nodular hyperplasia
231
Diagnostic test for hereditary spherocytosis
Osmotic fragility test
232
Anemia associated with absent radii and thumbs Diffuse hyperpigmentation Cafe au lait spots Microcephaly Pancytopenia
Fanconi anemia
233
How to distinguish polycythemia vera form secondary polycythemia
Both have increased hematocrit and RBC mass But polycythemia vera should have normal O2 saturation and low erythropoietin levels
234
TTP pentad
LMNOP ``` Low platelet Microangiopathic hemolytic anemia Neurologic changes Obsolete renal function Pyrexia ```
235
Anemia Thrombocytopenia Acute renal failure
HUS
236
Which of the following are increased in DIC ``` Fibrin split products D-dimer fibrinogen Platelets Hematocrit ```
Fibrin split products and d-dimer are increases Platelets, fibrinogen and hematocrit are decreased
237
Microcytic anemia with decreased iron, decreased TIBC and normal or increased ferritin
Anemia of chronic disease
238
Microcytic anemia with decreased iron, decreased ferritin and increased TIBC
Iron deficiency anemia
239
CML features (4)
50 y.o with early satiety, splenomegaly and bleeding t (9;22)
240
At what CD4 count should pneumocystis jiroveci pneumonia prophylaxis be initiated in a HIV + patient? Mycobacterium avium complex prophylaxis?
< 200 cells/mm3 - Give TMP-SMX <= 50-100 cells/mm for MAC - Give clarithromycin/ azithromycin
241
Causes of meningitis in neonates Tx
GBS Ecoli Listeria Ampicillin + cefotaxime or gentamicin
242
Causes of meningitis in infants Tx
S pneu N meningitidis H influlenza type b Vancomycin + cefotaxime
243
Patient presents with pruritic papules with regional lymphadenopathy. Evlves into a black eschar after 7-10 days Tx
Cutaneous anthrax Ciprofloxacian or doxycycline
244
Branching rods in oral infection
Actinomyces israelii
245
Weakly gram + | Partially acid fast in lung infection
Nocardia
246
Gardener
Sporothrix schenckii
247
Raw pork | Skeletal muscle cysts
Trichinella spiralis
248
Sheep herders with liver cysts
Echinococcus granulosus
249
Perianal itching
Enterobius vermicularis
250
Meningoencephalitis in AIDS patient
Cryptococcus neoformans
251
Patient from california or arizona presents with fever, malaise, cough and night sweats Tx
Coccidiodidomycosis Amphotericin B
252
Endocarditis 3 wks after receiving prosthetic heart valve
S aureus S epidermidis
253
Patient develops endocarditis in a native valve after having dental cleaning
S viridans
254
Asthma Nasal polyps Eosinophila
Eosinophilic granulomatosis iwth polyangiitis Churg struass syndrome
255
Elevated indirect bilirubin Hx HIV & Hep C Low platelets High reticulocytes Anemia Jaundice What test to go
Thrombotic thrombocytopenic purpura Life threatening Small vessel thrombi Autoantibody to ADAMTS13 *Get peripheral blood smear (schistocytes, helmet cells, triangle cells) Plasma exchange
256
Von Willebrand disease MOA PTT PT
Impaired platelet endothelial binding Prolong PTT PT is normal
257
Abnormal activation of coagulation and fibrinolysis PT PTT Platelets
Disseminated intravascular coagulation (DIC) Thrombocytopenia Prolonged PT Prolonged PTT
258
Decreased factor VIII production Inheritence
Hemophilia A X linked recessive
259
Autoimmune mediated platelet destruction Symptoms PT/PTT Platelets - Name - Physical exam (4) - Lab
Immune thrombocytopenia Easy bleeding Petechiae Purpura Epistaxis Thrombocytopenia Normal PT/PTT
260
Microcytic anemia Normal Iron studies - Name - Inheritence - Dx
Hemoglobinopathy Alpha or beta thalassemia AR Get Hemoglobin electorphoresis
261
Seen with Lead toxicity
Microcytic anemia Iron and TIBC are low
262
CLL leukocytosis
>100,000 cells Lymphadenopathy
263
HTN AKI Anemia Thrombocytopenia Elevated total bilirubin Elevated Cr Difficulty opening mouth Skin tightening over face, forearms, chest and legs
Scleroderma renal crisis Schistocytes
264
Develops hemolytic anemia (low hemoglobin, reticulocytosis, icterus) Started taking dapsone Fatigue Dark urine Rash on scalp and elbows
G6PD deficiency Unable to generate sufficient NADPH to counter oxidativeinjury Dapsone TMP-SMX Primaquin Fava beans Hyperbilirubinemia hemoglobinuria
265
Complement activation
HUS Hematuria Proteinuria
266
Immune complex deposition
Membranous glomerulonephritis
267
Interstitial leukocyte infiltration
Acute interstitial nephritis Associated with taking TMP-SMX Erythrocytes Leukocytes White cell casts Rash Fever Peripheral eosinophila
268
1 year ago multiple gun shot wounds to abdomen ``` Now: Fever confusion Hypotension Tachycardia ``` Dullness to percussion and crackles in lower chest Gram positive cocci Due to?
Impaired antibody facilitate phagocytosis No spleen Gram + cocci (Strep pneumoniae)
269
Impaired chemotaxis
Leukocyte adhesion deficiency Recurrent bacterial infections of skin and mucosa
270
Impaired oxidative burst
Chronic granulomatous disease Recurrent bacterial and fungal infections Catalase producing organisms - Aspergillus - Staph aureus
271
DVT in setting of increased homocysteine levels
Give Pyridoxine Homocysteine is a highly reactive amino acid. increased level leads to venous thrombosis and atherosclerosis Homocysteine to cysteine is catalyzed by cystathionine beta synthase using cofactor pyridoxine (B6)
272
Vit E
Antioxidant Acts to protect cell membranes from free radical damage
273
Warfarin induced skin necrosis caused by
Decreases in protein C Protein C drop by 50% in first day II, IX, X decline more slowly
274
Abdominal pain Dark urine RUQ tenderness Anemia Normal platelets Elevated bilirubin Low Haptoglobin Hepatic vein thrombosis - Name - MOA - Defect - Absent
Paroxysmal nocturnal hemoglobinuria Intravascular and extravascular hemolysis Defect in proteins CD55 and CD59 (lack anchor) Absent allows complement membrane attack complex to form and result in hemollysis
275
DVT Right leg swelling Myalgias Joint pain Facial rash by sun exposure Miscarriages HTN Lab finding
Prolonged PTT Antiphospholipid antibody syndrome
276
Jak 2 mutation
Polycythemia vera Increased risk fo thromboembolism Older individuals
277
Increased central venous pressure
Heart failure
278
Anemia of chronic disease MOA
Increased inflammatory cytokines (hepcidin) Inhibition of ferroportin on enterocytes and macrophages Decreased iron absorption and increased iron sequestration Reduced circulating iron Impaired erythropoiesis
279
Stacking of cells like coins - Name - Symptoms (3) - Features (4)
Rouleaux formation Multiple myeloma WL Fatigue Bone pain Hypercalcemia noromocytic anemia Protein gap > 4 (protein/ albumin) M spike
280
Hypocellular fibrotic bone marrow
Myelofibrotic disorder Fatigue Anemia Hepatosplenomegaly
281
Hypoplastic fat filled marrow
Aplastic anemia Pancytopenia (not anemia)
282
Megaloblastic erythroid hyperplasia
Megaloblastic anemia Vit B12 Folate
283
Ring sideroblasts
Sideroblastic anemias Microcytic anemia < 7
284
Cancer related anorexia/ cachexia tx
Progesterone analogues - Megestrol acetate - corticosteroids
285
Morning joint stiffness Hemoglobin low Low Serum iron Low Total iron binding capacity High ferritin Tx
Anemia of chronic disease
286
Thalassemia iron studies ``` MCV IRON TIBC Ferritin Transferrin saturation ```
``` MCV low Iron High TIBC Low Ferritin High Transferrin High ```
287
Back pain Renal insufficiency Granular casts
MM
288
On Enoxaparin and develops low platelet count At risk for
Hepatrin induced thrombocytopenia IgG autoantibody Risk Thrombus (arterial and venous)
289
Chest CT angiography vs Compression ultrasound
CT angiography: PE Compression US: DVT
290
65 y.o Fatigue Extending bleeding Bruising Elevated Lactate dehydrogenase Anemia Low platelets Low Leukocytes Elevated PT/PTT Low Fibrinogen
Acute myeloid leukemia Pancytopenia DIC Atypical promyelocytes
291
HIV prophylaxis toxoplasma CMV
Toxoplasma only if CD4 < 100 Never for CMV
292
Chronic Hep C infection can result in
Porphyria cutanea tarda Photosensitive skin with vesicles and bullae on dorsa of hands
293
Grey mucosal patch Widespread rash
Secondary syphilis
294
From mississippi Cough Hilar adenopathy Erythema nodosum noncaseating granulomas Dx with sarcoidosis but deteriorates with high-dose corticosteriod therapy
Histoplasmosis Caseating granulomas most common but non-caseating can be found Histoplasma urinary antigen testing
295
Mexico two weeks ago 4 days fever, double vision, and painful swelling of eyes. Muscle pain in neck and jaw muscles One week ago had abdominal pain, n/V, diarrhea Subungual spinter hemorrhages, periorbital edema, chemosis Elevated leukocytosis Elevated creatine kinase ``` A. Ascariasis B. Dengue fever C. Giardiasis D. Infective endocarditis E. Trichinellosis F. Typhoid fever ```
E. Trichinellosis (round worm) Undercooked meat (pork) Gastric acid releases larvae (1 wk) Female worms release larvae (up to 4 weeks later) muscle pain Eosinophilia Self limiting Severe: Mebendazole/ albendazole with corticosteriods
296
Travels' diarrhea
Cryptosporidium parvum Cyclospora Giardia Prolonged profuse watery diarrhea
297
Foul smelling sputum Recent endoscopy Right upper lobe infiltrate not getting better with azithromycin what to add ``` A. Ampicillin and gentamicin B. Ciprofloxacin C. Clindamycin D. Doxycycline E. TMP-SMX ```
C. Clindamycin Aspiration pneumonia Anaerobic organisms
298
Ciprofloxacin coverage
Gram negative coverage
299
Painful swallowing Not improving with fluconazole Endoscopy reveals multiple large, linear ulcers in distal esophagus Abnormal mucosa shows tissue destruction and presence of intranuclear and intracytoplasmic inclusions ``` A. Acyclovir B. Ganciclovir C. Pentamidine D. Prednisone E. Voriconazole ```
B. Ganciclovir CMV esophagitis
300
Watery diarrhea in HIV patient < 180/ mm3 < 100 < 50 High fever < 50 Frequent small volume diarrhea, abd pain
< 180 severe watery diarrhea, W, low grade fever= Cryptosporidium < 100 watery diarrhea, abdominal pain= Microsporidium <50 High fever, watery diarrhea= MAC < 50 Frequent small volume diarrhea, abdominal pain= Cytomegalovirus
301
Immunocompromised Lung nodules Brain abscess Gram + partially acid fast filamentous branching rods - Name - Tx
Nocardia TMP-SMX
302
Seen with Mono (7)
Fever Tonsillitis Posterior or diffuse cervical lymphadenopathy * Hepatosplenomegaly * Anemia * Elevated bilirubin * Elevated LFTS
303
Tremor Nephrotoxicity ``` A. Antithymocyte globulin B. Azathioprine C. Mycophenolate D. Prednisone E. Tacrolimus ```
E. Tacrolimus Calcineurin inhibitors - Tacrolimus - Cyclosporine
304
Azathioprine SE
Hepatotoxicity Bone marrow suppression
305
Mycophenolate SE
GI disturbances Bone marrow suppression
306
CD4 = 45 What treatment
TMP-SMX [ MAC for azithromycin not given anymore] [Fluconazole not given prophylaxis due to cost and resistance] [Acyclovir/ valaclovir prophylaxis for HSV not for primary prophylaxis]
307
Low grade fever Night sweats Cough WL Wisconsin Lytic bone lesions in ribs Left upper lobe consolidation ``` A. Disseminated TB B. Sarcoidosis C. Metastatic osteosarcoma D. Blastomycosis E. Coccidioidomycosis ```
D. Blastomycosis
308
31 y.o Most common cause of right sided testicular pain Testicular swelling and fever
Chlamydia trachomatis > 35 then E.coli < 35 Chlaymydai If HIV then Ureaplasma urealyticum
309
67 y.o several swollen LN in axilla, non painful, mobile and in cervical No fever, chills or WL 156/92 Spleen tip palpable Low Hemoglobin Low MCV 90,000 platelets 56,000 leukocytes Benefit from what therapy? ``` A. BCR-ABL tyrosine kinase B. CD20 cell surface antigen C. Epidermal growth factor receptor D. Interleukin 1 receptor E. Tumor necrosis factor alpha ```
B. CD20 cell surface antigen CLL Rituximab (monoclonal ab against CD20)
310
BCR-ABL tyrosine kinase
Imatinib inhibits this Tx CML
311
Sickle cell patient with decreased appetite and sleepiness Scattered petechiae on legs Fever Pathogen?
Streptococcus pneumoniae [Staph and pseudomonas only in osteomyelitis]
312
Fatigue WL Normocytic anemia Elevated BUN Elevated Creatinine Elevated Calcium Common seen with this disease
Multiple myeloma Renal insufficiency Monoclonal light chains clog the renal tubules, causing intratubular cast formation and toxicity
313
30 month old with sore throat and decreased appetite. Cries when swallowing Several small vesicles on the uvela, soft palate and tonsillar pillars. Erytehmatous tonsils no exudates No rashes
Herpangina Infection caused by Coxsackie A virus Tx Reassurance and supportive care
314
66 y.o with progressive fatigue and decreased exercise tolerance. SOB doing house hold chores. Hx GERD and BPH. Chest pain a year ago with negative stress test. Conjunctiva are pale. Low Hemoglobin High MCV Low Platelets Low Leukocytes Ovalomacrocytosis and neutrophils with reduced segmentation. Normal B12, electrolytes and renal function ``` A. Anti-intrinsic factor antibody B. Blood lead level C. Bone marrow biopsy D. Erythropoietin level E. Methylmalonic acid level F. Serum protein electrophoresis ```
C. Bone marrow biopsy Myelodysplastic syndrome Cytopenias - Anemia - Leukopenia - Thrombocytopenia Dysplastic red and white blood cells
315
24 y.o routine check up Spleen tip palpated Blood smear shows RBC without white center ``` At risk for A. Acute leukemia B. Atrophic gastritis C. Gallstones D. OSteoporotic fractures E. Renal insufficiency F. Venous thromboembolism ```
C. Gallstones [From hemolytic anemia, pigmented] Spherocytes Hereditary spherocytosis
316
How to tell hemolytic anemia
Schistocytes ``` Increased LDH (Lactate dehydrogenase) - Means tissue damage ```
317
Palms and soles rash
CARS Coxsackie A virus Rocky mountain spotted fever Syphilis

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