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Step studying 10 Flashcards

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1
Q

What causes elevated AFP in pregnancy

A

NTD, ventral wall deficits, multiple gestations

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2
Q

What causes low AFP in pregnancy

A

Aneuploidies

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3
Q

What will you see in the following in Down Syndrome

  • AFP
  • bHCG
  • Estriol
  • Inhibin A
A 
	Decreased alpha-fetoprotein
	Increased b-hCG
	Decreased estriol
	Increased Inhibin A
•	THINK: low boy (alpha) and girl (estriol)
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4
Q

What will you see in the following in Edwards syndrome (Trisomy 18)

  • AFP
  • bHCG
  • Estriol
  • Inhibin A
A

 Decreased alpha-fetoprotein
 Decreased b-hCG
 Decreased estriol
 Normal Inhibin A

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5
Q

What part of the brain is affected in Parkinson’s

A

Basal ganglia (this is where dopamine works)

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6
Q

What type of anemia will you see in liver disease

A

Macrocytic (non-megaloblastic) anemia

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7
Q

Causes of B12 deficiency

A
  • Strict vegan
  • Pernicious anemia
  • Crohn’s disease
  • Gastric bypass
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8
Q

How can you distinguish between B12 deficiency caused by nutritional deficiency vs impaired absorption

A

Schilling’s Test
o Give pt IM injection of B12 to saturate liver
o Then give pt oral B12 and check urine
o Because body is saturated, all oral B12 will be absorbed and then excreted in the urine, so pt will have positive B12 in urine IF they were able to absorb it
♣ = deficiency due to poor nutrition
o If urine is negative for B12, that means there was poor absorption
♣ = deficiency due to malabsorption

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9
Q

How should you think about total iron binding capacity (TIBC) in determining anemia cause

A

Think: opposite of Ferritin

• High TIBC (Total iron-binding capacity = # of transferrin molecules in the blood – will be elevated because the liver is pumping out more in a state of low iron in order to replenish iron

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10
Q

Does sickle cell have micro or normocytic anemia

A

Normocytic

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11
Q

What lab value can you use to distinguish leukemoid reaction from leukemia

A

♣ Leukocyte alkaline phosphatase (LAP) will be elevated

♣ Will have more mature neutrophils (metamyelocytes > myelocytes)

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12
Q

What will you see in AML (histology, chromosomes, tx, tumor marker)

A

o When you think AML, think “All My Life” = musicals
o Auer sounds like Fuer (Hitler) – Sound of music - Auer rods
o I am 16 going on 17 (15;17)
o Poke Hitler in the eye with a carrot – treat with retinoic acid

Myleoperoxidase (MPO) +

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13
Q

Which leukemia is primarily a disease of children

A

ALL

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14
Q

What positive tumor marker is in ALL

A

TdT+

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15
Q

Tx of ALL

A

Chemotherapy with CNS prophylaxis (ALL tends to infect the CNS)

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16
Q

Treatment of CML

A

Imatinib (bcr-abl tyrosine kinase inhibitor)

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17
Q

Which chronic leukemia has risk for blast crisis (transforming into acute leukemia)

A

CML

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18
Q

Tx of CLL

A

Usually occurs in older people

  • If old and asymptomatic = no tx
  • If old and symptomatic = chemo
  • If young = stem cell transplant
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19
Q

What lymphoma do you see Reed Sternberg cells

A

Hodgkin

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20
Q

What are alcohol lymph nodes

A

Nontender lymph nodes of Hodgkns lymphoma turns painful with consumptions of alcohol

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21
Q

What type of lymphoma is Burkitt’s

A

Non-hodgkins

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22
Q

What population does lichen sclerosis occur in

A

Prepubertal girls and perimenopausal/postmenopausal women

o These are all hypoestrogenic populations

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23
Q

Tx of multiple myeloma

A
  • <70 y/o with donor = stem cell transplant

* >70 or without donor = chemo

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24
Q

Diagnosis of multiple myeloma

A
  • +Serum protein electrophoresis (SPEP)
  • +Urine protein electrophoresis
  • Skeletal bone survery shows lytic lesions
  • Bone marrow biopsy >10% plasma cells
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25
Diagnosis of monoclonal gammopathy of undetermined significance
* +Serum protein electrophoresis * (-)Urine protein electrophoresis * (-) Skeletal survery * Bone marrow biopsy <10% plasma cells
26
Diagnosis of Waldenstrom
* +Serum protein electrophoresis * (-) Urine protein electrophoresis * (-) skeletal bone * Bone marrow biopsy >10% lymphoma
27
Tx of Waldenstrom
* Rituximab (treat it like a lymphoma) | * Plasmapharesis for hyperviscosity
28
Cause of TTP
``` o Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation ♣ No vWF degradation = abnormal platelet adhesion = microthrombi ```
29
Clinical presentation of TTP
``` o Findings (Pentad) – THINK: FAT RN ♣ F = Fever ♣ A = anemia (Microangiopathic hemolytic anemia = RBCs sheared by microthrombi) ♣ T = thrombocytopenia (platelets being used up) ♣ R = renal insufficiency (thrombi involve vessels of kidney) ♣ N = neurological symptoms – confusion, HA, seizures, coma (thrombi involve vessels of CNS) ```
30
Tx of TTP
Plasma exchange transfusion
31
Describe following lab findings in TTP: - Platelets - PT/PTT - Fibrinogen - D-dimer
* Low platelets * PT/PTT = normal * Fibrinogen = normal * D-dimer = normal
32
Describe following lab findings in DIC - Platelets - PT/PTT - Fibrinogen - D-dimer
♣ Increased bleeding time – low platelets ♣ Increased PT and PTT ♣ Low fibrinogen – being used up ♣ High D-dimer (fibrin split products)
33
Describe cause of immune thrombocytopenic purpura (ITP)
o IgG autoantibodies to GP2b3a (which allow platelets to connect to each other) o Antibodies produced by plasma cells of spleen and antibody-bound platelets consumed by macrophages of spleen o Often associated with HIV
34
Tx of ITP
♣ Steroids and IVIG (autoimmune treatment) | ♣ Splenectomy
35
Tx of leprosy
Dapsone + Rifampin Add Clofazimine if severe
36
What is laryngomalacia
♣ Caused by “floppy” supraglottic structures that collapse during inspiration ♣ Inspiratory stridor worsens when supine ♣ Peaks at age 4-8 months
37
Diagnosis of laryngomalacia
♣ Usually clinical | ♣ Confirmation by flexible laryngoscopy for moderate/severe cases
38
Tx of laryngomalacia
♣ Reassurance for most cases | ♣ Supraglottoplasty for severe symptoms
39
Empiric tx for community acquired pneumonia
- Moxifloxacin - CTX + Azithro - Azithro
40
Empiric tx for hospital acquired pneumonia
Want to include coverage of MRSA and Pseudomonas | - Vanc + Pip/Tazo
41
Empiric tx for meningitis
CTX + Vancomycin +/- steroids +/- Ampicillin (if immunocompromised)
42
Tx for UTI in pregnancy
Amoxicillin
43
Empiric tx for UTI
- Nitrofurantoin (if woman) | - TMP-SMX aka Bactrim (do not use with renal failure)
44
Empiric tx for pyelo | inpatient vs outpatient
``` Inpatient = CTX Outpatient = Cipro ```
45
Empiric tx of cellulitis
♣ Vancomycin ♣ Clindamycin ♣ Bactrim
46
What test is used to diagnose anti-retroviral syndrome
This is the acute flu-like illness that occurs with initial onset of disease Too early to have antibodies so ELISA will be negative Need to get PCR (viral load) for diagnosis
47
Diagnosis of chronic HIV
ELISA first, and if positive must confirm with Western Blot Then check viral load and CD4 count to see where you start and to follow how medications work
48
What's the bug you are worried about at CD4 <200
PCP Toxo is <100 MAC is <50
49
What do you do if pt had a positive PPD skin test
Get a CXR
50
What do you do if pt has +PPD and -CXR
This is latent TB - treat with Isoniazid + B6
51
What do you do if pt has +PPD and +CXR
Get an AFB smear (3 separate) to determine if they are infectious
52
What do you do if pt has +PPD, +CXR, and -AFB
This is latent TB - treat with Isonizid + B6
53
What do you do if pt has +PPD, +CXR, and +AFB
This is active TB - RIPE therapy
54
What are the contraindications to LP
FAILS - FND - AMS - Immunosuppression - Lesion over site where LP would happen - Seizures
55
Tx of asymptomatic Bartholin duct cyst
Observation Can I&D if it is symptomatic or infected (abscess)
56
Describe imaging in meconium ileus
• Contrast enema will show a narrow, undeveloped colon
57
Describe imaging in Hirschprung
o Level of obstruction usually at the rectosigmoid junction, with proximal dilated colon
58
Describe the MOA behind cyanide poisoning
Cyanide poisoning occurs because cyanide binds to Fe3+, inhibiting its reduction to Fe2+ and blocking production of ATP from oxidative phosphorylation
59
Describe MOA of methemoglobinemia
Caused by nitrates/nitrites, antimalarial drugs, dapsone, sulfonamides It causes an oxidation of hemoglobin to methemoglobin (Fe2+ to Fe3+) - oxidized form has reduced affinity for O2 and thus reduced O2 delivery to tissues
60
Tx of cyanide toxicity
o You can induce methemoglobinemia with nitrites (will oxidize Fe2+ to Fe3+) in order to treat cyanide poisoning Cyanide will get bound up by Fe3+
61
Tx of methemoglobinemia
* Methylene blue | * Vitamin C
62
Tx of elevated homocysteine
Folate + B6 | - Can also add B12 if it is deficient
63
Next step in management of solitary pulmonary nodule
- Check old imaging (if stable for 2-3 years, can just observe) - CT scan to look for malignant features - Biopsy or surgical excision if malignant features
64
What is the pathophys of Fanconi Anemia
♣ Inherited DNA repair defect | ♣ Bone marrow failure
65
Clinical findings of Fanconi anemia
``` ♣ Short stature ♣ Hypo/hyperpigmented macules ♣ Abnormal thumbs ♣ Genitourinary malformations + Pancytopenia ```
66
Tx of Fanconi anemia
Stem cell transplant
67
Tx of hospital acquired pneumonia
♣ Vanc + Pip/Tazo Want to cover for MRSA and pseudomonas
68
How do you diagnose syphilis
``` Primary disease (chancre) o Darkfield microscopy ``` ``` Secondary disease (fever and rash) o RPR antibody ``` Tertiary (tabes dorsalis and Argyll Robertson pupil) o Get an LP and check RPR of the CSF
69
Tx of native valve endocarditis
Vancomycin
70
Causes of Cushing syndrome (x4)
♣ Exogenous corticosteroids (most common cause) ♣ ACTH-secreting pituitary adenoma (Cushing disease) ♣ Paraneoplastic ACTH secretion (e.g. small cell lung cancer) ♣ Primary adrenal adenoma
71
First step in suspected Cushings
♣ First give low-dose dexamethasone (synthetic glucocorticoid) + 24 hour urine cortisol or late night salivary cortisol • If there is a failure to suppress cortisol, this is cushing syndrome
72
Next step if low dose dex test is positive
♣ Measure ACTH:
73
What does +low dose dex test + low ACTH mean
Adrenal tumor or exogenous glucocorticoids
74
What dose +low dose dex test + high ACTH mean Also what is next step
• If high, suspect Cushing disease (ACTH-pituitary adenoma) or ectopic ACTH secreting tumor o Give high dose Dexamethasone:
75
What dose +low dose dex + high ACTH + lack of suppression with high dose dex mean
Ectopic tumor (e.g. small cell lung)
76
What does +low dose dex + high ACTH + suppression with high dose dex man
Cushing disease (pituitary adenoma)

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