Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
174 Cards in this Set
- Front
- Back
next step in mgmt:
25 y/o man dx'd with a solitary testicular mas by US |
orchiectomy
|
|
classic findings of HSP
|
palpable purpura
GI sx's (e.g. abd'l pain, vomiting, guaiac+, intussusception) renal disease transient arthritis/arthralgias |
|
What variables shift the Hb-O2 dissociation curve to the right
|
"CADET-face RT"
C: incr'd A: incr'd altitiude/acid (i.e. decr' pH) D: incr'd DPG3 E: exercise T: incr'd temp |
|
what effect does a right shift on Hb-O2 curve have
|
Incr'd delivery of O2 to peripheral tissues
|
|
what is cause of anemia that develops after taking a sulfa drug
|
G6PD deficiency
|
|
what lab markers suggest anemia due to hemolysis
|
decr'd H&H with incr'd retics
normal MCV decr'd haptoglobin incr'd indirect bilirubin incr'd LDH |
|
in hemolytic anemia, why is serum haptoglobin level der'd & serum LDH increased
|
Haptoglobin binds free Hb in blood
LDH spills out of hemolyzed RBC's |
|
characteristic findings in hereditary spherocytosis
|
jaundice & gallstones (2nd/2 elevated bilirubin)
splenomegaly anemia with incr'd retics & MCHC spherocytes on peripheral smear positive osmotic fragility test |
|
spherocytosis is a/w higher incidence of what lab abnormality
|
pseudohyperkalemia
(2nd/2 K+ spilling into blood when RBC's lyse after blood draw) |
|
tx of hereditary spherocytosis
|
folic acid 1mg qD
splenectomy (moderate to severe cases) RBC transfusion (extreme cases) |
|
Rx for diarrhea 2nd/2 E. histolytica
|
metronidazole (+ hydration)
|
|
Rx for diarrhea 2nd/2 G. Lamblia
|
metronidazole (+ hydration)
|
|
Rx for diarrhea 2nd/2 salmonella
|
quinolones or TMP-SMX (+ hydration)
|
|
Rx for diarrhea 2nd/2 shigella
|
quinolones or TMP-SMX (+ hydration)
|
|
Rx for diarrhea 2nd/2 campylobacter
|
erythromycin (+ hydration)
|
|
Rx for mild persistent asthma
|
ACUTE TX:
short-acting B2-agonist (i.e. albuterol) IV corticosteroids (for persistent sx's) LONG-TERM CONTROL: albuterol, prn inhaled glucocorticoid +/- leukotriene inhibitor (e.g. cromolyn) |
|
what is charcots triad indicative of & what are the components
|
Dx: cholangitis
TRIAD: jaundice RUQ pain Fever |
|
what is reynold's pentad indicative of & what are the components
|
Dx: cholangitis
PENTAD: jaundice RUQ pain Fever hypotension AMS |
|
Iron Def Anemia:
serum iron ferritin transferrin Fe/TIBC |
serum iron: decr'd
ferritin: decr'd transferrin: incr'd Fe/TIBC: < 12% |
|
Anemia of chronic disease:
serum iron ferritin transferrin Fe/TIBC |
serum iron: decr'd
ferritin: incr'd transferrin: decr'd Fe/TIBC: > 18% |
|
what is seen on blood smear of a patient with lead poisoning
|
microcytic
hypochromic basophilic stippling |
|
RBC disorder a/w:
schistocyte (fragmented RBC) |
hemolytic anemia
DIC TTP HUS |
|
RBC disorder a/w:
acanthocyte (spur cell) |
abetalipoproteinemia
|
|
RBC disorder a/w:
bite cell |
G6PD def
|
|
RBC disorder a/w:
basophilic stippling |
lead poisoning
B-thalassemia alcohol |
|
RBC disorder a/w:
peripheral neuropathy and ringed sideroblastic in BM |
lead poisoning
|
|
RBC disorder a/w:
hypersegmented neutrophils |
folate/B12 def
|
|
RBC disorder a/w:
heinz bodies (denatured Hgb in RBC) |
G6PD def
|
|
RBC disorder a/w:
burr cells |
uremia
|
|
MCV & anemia a/w:
mental status changes, neuropathy, constipation |
microcytic
lead poisoning |
|
MCV & anemia a/w:
heavy menses, strict vegetarians, ice pica |
microcystic
iron def |
|
MCV & anemia a/w:
dark urine, jaundice, hepatosplenomegaly |
normocytic
hemolytic anemia |
|
MCV & anemia a/w:
alcoholic, malnourished |
macrocytic
folate/B12 def |
|
what virus can cause aplastic anemia as well as erythema infectiosum disease (i.e. "fifth disease")
|
Parvovirus B19
|
|
what test is used to rule out urethral injury
|
retrograde cystourethrogram
|
|
lipid-lowering agent:
SE = facial flushing |
niacin
|
|
lipid-lowering agent:
SE = elevated LFT's, myositis |
statins
fibrates |
|
lipid-lowering agent:
SE = GI discomfort, bad taste |
bile acid sequestrants
(e.g. cholestyramine) |
|
lipid-lowering agent:
best effect on HDL |
niacin
|
|
lipid-lowering agent:
best effect on TG's |
fibrates
|
|
lipid-lowering agent:
best effect on LDL/cholesterol |
statins
|
|
lipid-lowering agent:
binds C. Diff toxin |
cholestyramine
|
|
which types of thalassemias are most commonly a/w pts of Mediterranean & AA/Asian descent
|
MEDITERRANEAN: B-Thal
AA/ASIAN: a-Thal |
|
What complication occurs in 10% of pts with sideroblastic anemia
|
myelodysplastic syndrome (aka "refractory anemia)
--> acute leukemia |
|
Besides Staph Aureus, which organism may be responsible for osteomyelitis in a sickle cell pt
|
salmonella
|
|
Which vaccines are particularly important in children with sickle cell disease
|
HiB
Pneumoccal Meningococcal Influenza Hep B |
|
What medication is used in the long-term management of sickle cell anemia
|
Hydroxyurea
|
|
drugs a/w elevated prolactin levels
|
METHYLDOPA
PSYCHIATRIC DRUGS phenothiazines haloperidol risperidone |
|
what substances cause hemolysis in px with G6PD def
|
primaquin
dapsone sulfonamides fava beans isoniazid nitrofurantoin high-dose ASA |
|
when would you expect eosinophillic casts in urine
|
acute interstitial nephritis, AIN
(i.e. allergic interstitial nephritis) |
|
differential dx for eosinophilia
|
"DNAAACP"
D = drugs (e.g. NSAIDS, PCN's/Ceph's) N = neoplasms A = allergies/asthma (churg-strauss), allergic bronchopulmonary aspergillosis A = adrenal insufficiency (Addison's) A = AIN (allergy-induced) C = CVD's (e.g. PAN, dermatomyositis) P = parasites (e.g. strongyloides, Ascaris --> Loeffler's eosinophilic pneumonitis) |
|
what is the management in a px with febrile neutropenia due to chemo
|
admit
culture start broad-spectrum antibiotics (e.g. cefepime/ceftazidine) |
|
what type of infection causes eosiniphilia
|
parasitic
|
|
immunoglobulin a/w eosinophilia
|
IgE
|
|
what type of hypersensitivity is good pasture
|
type II HSN
|
|
what is the treatment for type II hypersensitivity
|
anti-inflammatories
immunosuppressives (e.g. corticosteroids) possibly plasmaphoresis |
|
most important medication for anaphylaxis
|
epinephrine
|
|
Tx for anaphylaxis
|
ABC's
stop offending agent epinephrine IM or IV (for AW obstruction) H1/H2 blockers (for cutaneous sx's) bronchodilators steroids IVF's (for hypotension) |
|
Dx
45 yo with acute flank pain and hematuria |
nephrolithiasis
|
|
MCC of aortic stenosis in 50 y/o
|
congenital bicuspid aortic valve
|
|
MOA:
streptokinase |
activates tissue plasminogen --> cleaves fibrin clots
|
|
MOA:
aspirin |
Cox-2 inhibitor --> blocks plt aggregation
|
|
MOA:
clopidogrel |
inhibits ADP receptor
|
|
MOA:
abciximab |
Gp2b3a Inhibitor
|
|
MOA:
tirofiban |
Gp2b3a Inhibitor
|
|
MOA:
ticlopidine |
inhibits ADP receptor
|
|
MOA:
enoxaparin |
LMWH --> inhibits CF Xa
|
|
MOA:
eptifibatide |
Gp2b3a Inhibitor
|
|
classic triad of HUS
|
hemolytic anemia
uremia thrombocytopenia |
|
what is the pentad of TTP
|
hemolytic anemia
uremia thrombocytopenia neurologic sequelea fever |
|
lab test to monitor:
warfarin |
PT/INR
|
|
lab test to monitor:
heparin |
PTT
|
|
lab test to monitor:
LMWH |
doesn't need monitoring
(h/w it can be monitored with anti-CF Xa) |
|
drugs known to cause thrombocytopenia
|
heparin (HIT)
abciximab (GP2b3a inhibitor) carbamazepine, phenytoin, valproate cimetidine acyclovir, rifampin sulfonamides (e.g. sulfasalazine, TMP-SMX) procainamide, quinidine quinine, gold compounds |
|
1st line Rx for vWD
|
desmopressin, DDAVP (increases vWF secretion)
|
|
Rx for vWD that is severe or refractory
|
cryoprecipitate or Factor VIII
|
|
Rx for vWD with menorrhagia
|
OCP
|
|
MCC's of DIC
|
"STOP Making Thrombi"
S = sepsis T = trauma O = OB complications P = pancreatitis M = malignancy T = transfusions |
|
PLT's, BT, PT, PTT:
HUS/TTP |
PLT's: decr'd
BT: incr'd PT: normal PTT: normal |
|
PLT's, BT, PT, PTT:
hemophilia A or B |
PLT's: normal
BT: normal PT: normal PTT: incr'd |
|
PLT's, BT, PT, PTT:
vWD |
PLT's: normal
BT: incr'd PT: normal PTT: incr'd |
|
PLT's, BT, PT, PTT:
DIC |
PLT's: decr'd
BT: incr'd PT: incr'd PTT: incr'd |
|
PLT's, BT, PT, PTT:
warfarin use |
PLT's: normal
BT: normal PT: incr'd PTT: incr'd |
|
PLT's, BT, PT, PTT:
aspirin |
PLT's: normal
BT: incr'd PT: normal PTT: normal |
|
PLT's, BT, PT, PTT:
end stage liver disease |
PLT's: normal/decr'd
BT: normal/incr'd PT: incr'd PTT: incr'd |
|
what is the MC mutation that predisposes white pt's to venous thrombosis
|
Factor V Leiden mutation
|
|
Dx & Tx:
post-op pt with poor urine output, BUN 85, Cr 3 & clear lungs |
Dx: Prerenal azotemia (2nd/2 dehydration)
Tx: IVF's |
|
what infection causes aplastic crisis in sickle cell pt's
|
Parvovirus B19
|
|
Dx:
pt presents with glomerulonephritis plus b/l sensorineural deafness |
Alport's Syndrome
|
|
Tx of shock
|
IVF's & pressors
blood, urine, & sputum cultures (BEFORE starting antibiotics) CXR empiric antibiotics insulin drip continuous cardiac monitoring & central venous pressure measurments |
|
man returns from African safari c/o periodic fevers, chills, diaphoresis, muscle aches, & fatigue; how could he have avoided illness
|
prophylactic anti-malarials
|
|
Tx for infectious mononucleosis
|
rest & plenty of fluids
NSAIDS or Tylenol (for fever, sore throat, & malaise) gradual return to sports (incr'd risk of splenic rupture): NONCONTACT: 3 wks after sx onset CONTACT: 4 wks after sx onset |
|
what is the spectrum of conditions related to blood infections
|
bacteremia
SIRS sepsis severe sepsis septic shock multiple organ dysfxn syndrome |
|
definition:
bacteremia |
bacteria of any amount in the blood that does not meet criteria for SIRS
|
|
definition:
SIRS |
Systemic Inflammatory Response Syndrome (SIRS) WITHOUT an identified source of infection
(NOTE: criteria may be met due to other causes independent of infection or source may never be found) |
|
what are the 4 categories for SIRS criteria
|
temperature
tachycardia tachypnea WBC's |
|
how many of the SIRS categories must be present to meet the SIRS criteria
|
2 or more
|
|
What is the SIRS "temperature" criteria
|
> 38.3C or < 36.0C
|
|
What is the SIRS "tachycardia" criteria
|
HR > 90 bpm
|
|
What is the SIRS "tachypnea" criteria
|
RR > 20 bpm or PaCO2 < 32
|
|
What is the SIRS "WBC's" criteria
|
ANY 1 OF THE FOLLOWING:
> 12,000 > 10% bands < 4,000 |
|
Criteria:
SIRS |
CRITERIA: 2 or more of the following:
TEMPERATURE: > 38.3C < 36.0C TACHYCARDIA: HR > 90 TACHYPNEA: RR > 20 bpm PaCO2 < 32 WBC'S: > 12,000 > 10% bands < 4,000 |
|
definition:
sepsis |
SIRS WITH an identified source of infection;
(FYI: if SIRS criteria met & there is no obvious source of infection, w/u should include urine, blood, & sputum cultures) |
|
definition:
severe sepsis |
SEPSIS + 1 OF THE FOLLOWING:
organ dysfxn hypotension hypoperfusion |
|
what signs are evidence of organ dysfxn, hypotension &/or hypoperfusion seen in severe sepsis
|
lactic acidosis
SBP < 90 mmHg SBP drop > 40 mmHg |
|
definition:
septic shock |
SEVERE SEPSIS + hypotension , despite adequate fluid resuscitation
|
|
definition:
multiple organ dysfxn syndrome |
SEPTIC SHOCK + evidence of 2 or more organs failing
|
|
SUMMARIZE the spectrum of conditions related to blood infections with definition of each
|
BACTEREMIA: bacteria in the blood that does not meet criteria for SIRS
SIRS: 2+ criteria met WITHOUT source of infection identified SEPSIS: SIRS + source of infection identified SEVERE SEPSIS: sepsis + organ dysfxn, hypotension, or hypoperfusion SEPTIC SHOCK: severe sepsis + hypotension, despite adequate fluid resuscitation MULTIPLE ORGAN DYSFUNCTION SYNDROME: septic shock + evidence of 2+ organs failing |
|
classic EKG finding in PE
|
"S1Q3T3"
wide S in Lead I large Q in lead III inverted T wave in lead III |
|
Dx:
post op px with pain presents with hyponatremia and normal volume status |
SIADH (2nd/2 stress)
|
|
Rx for mild unconjugated hyperbilirubinemia
|
phototherapy
|
|
Rx for severe unconjugated hyperbilirubinemia
|
exchange transfusion
|
|
what is the initial HAART regimen
|
2 NRTI's + EITHER:
1 protease inhibitor 1 NNRTI may be add ritonavir |
|
antiretroviral a/w:
SE of lactic acidosis |
NRTI'S
|
|
antiretroviral a/w:
SE of GI intolerance |
protease inhibitors
|
|
antiretroviral a/w:
SE pancreatitis |
zalcitibine
didanosine stavudine ritonavir |
|
antiretroviral a/w:
SE of peripheral neuropathy |
zalcitibine
didanosine stavudine |
|
antiretroviral a/w:
SE of megaloblastic anemia |
zidovudine
|
|
antiretroviral a/w:
SE of rash |
NNRTI's
|
|
antiretroviral a/w:
SE of hyperglycemia, DM, lipid abnormalities |
protease inhibitors
(e.g. indinavir, sequinavir, amprinavir) |
|
antiretroviral a/w:
SE of BM suppression |
zidovudine
|
|
antiretroviral a/w:
given to pregnant woman with HIV |
HAART regimen with zidovudine
|
|
antiretroviral a/w:
regimen for occupational HIV exposure |
LOW-RISK: zidovudine + lamivudine
HIGH-RISK: 3-drug HAART regimen |
|
what bugs are tx prophylactically in AIDS pt's with CD4+ < 200 and what is rx is given
|
PCP: TMP-SMX
TOXOPLASMOSIS: TMP-SMX MAC: Macrolide (e.g. clarithromycin or azithromycin) |
|
Tx for acute toxoplasmosis in AIDS pt
|
pyrimethamine or sulfadiazine
|
|
HIV prophylaxis for TB
|
INH
|
|
AIDS criteria
|
ANY OF THE FOLLOWING:
HIV+ with CD4+ < 200 HIV+ with CD4+ < 15% of total lymphocytes HIV+ with "AIDS-defining illness" |
|
what are some examples of "AIDS-defining illness"
|
THERE ARE MANY (refer to SU p.144-145):
esophageal candidiasis PCP toxoplasmosis MAC |
|
tumor marker:
hepatocellular carcinoma |
AFP
|
|
tumor marker:
colon cancer |
CEA
|
|
tumor marker:
gastric cancer |
CEA
|
|
tumor marker:
pancreatic cancer |
CA 19-9
CEA |
|
tumor marker:
ovarian cancer |
CA-125
|
|
dx:
young black man with painless hematuria |
sickle cell trait
|
|
MCC of aortic stenosis in a 70 y/o
|
senile (i.e. degenerative) calcifications
|
|
labs in DIC
|
ELEVATED:
fibrin-split products D-dimers DECREASED: fibrinogen platelets hematocrit |
|
which type of RTA is a/w abnormal H+ secretion & nephrolithiasis
|
RTA I
|
|
what is the classic presentation of polycythemia vera
|
thrombosis
erythromelalgia (i.e. burning pain in hands & feet) pruritis (esp after warm bath/shower) facial plethora hepatosplenomegaly visual disturbances abnormal labs |
|
what visual distrubances are seen with polycythemia vera
|
blurred vision
amaurosis fugax scintillating scotoma ophthalmic migraine |
|
what lab abnormalities are seen with polycythemia vera
|
elevated H&H
elevated red cell mass basophilia leukocytosis thrombocytosis |
|
what is the Rx for polycythemia vera
|
phlebotomy
(FYI: induces a desirable iron def anemia --> DO NOT supplement with iron) |
|
what is used in px with polycythemia vera with high risk of thrombosis; which pts are considered "at risk"
|
hydroxyurea
"AT RISK": h/o thrombosis plts > 1,500,000 CV RF+ > 70 y/o |
|
what is used in px with polycythemia vera with refractory pruritis or refractory erythrocytosis
|
IFN-a
|
|
what tests will help in dx of MM
|
SPEP: monoclonal AB spike
UPEP: bence-jones proteins BM BX: incr'd plasma cells |
|
Dx
px with weight loss, pruritis, night sweats, hepatosplenomegaly, nontender cervical lymphadenopathy |
Hodgkin's lymphoma
|
|
Dx:
3 y/o girl presents with abd'l mass, hematuria, & HTN |
Wilm's tumor
|
|
Dx & Tx:
recent Cuban immigrant with sx's of malabsorption is found to also have megaloblastic anemia |
Dx: Tropical sprue
Tx: folate & antibiotics (e.g. tetracycline or sulfa) |
|
cell pathology a/w:
EBV |
Burkitt's lymphoma
|
|
cell pathology a/w:
reed sternberg cell, cervical lymphadenopathy, night sweats |
Hodgkin's lymphoma
|
|
cell pathology a/w:
bence jones proteins, osteolytic lesions, high Ca2+ |
MM
|
|
cell pathology a/w:
translocation 14:18 |
follicular lymphoma
|
|
cell pathology a/w:
MC lymphoma in US |
diffuse large B cell lymphoma
|
|
cell pathology a/w:
translocation 8:14 |
burkitt's lymphoma
|
|
cell pathology a/w:
translocations 9:22 |
philadelphia (CML or ALL)
|
|
cell pathology a/w:
MC hodgkin lymphoma |
nodular sclerosing
|
|
cell pathology a/w:
starry sky pattern due to phagocytosis of apoptotic tumor cells |
burkitt's lymphoma
|
|
cell pathology a/w:
high H&H, pruritis (esp after hot bath or shower), burning pain in hands or feet |
polycythemia vera
|
|
cell pathology a/w:
white cells with hair-like projections & splenomegaly |
hairy-cell leukemia
|
|
cell pathology a/w:
macrocytosis, hypogranular granulocytes with bilobed nuclei |
myelodysplastic syndrome
|
|
Rx for CML
|
imatinib
|
|
leukemia a/w:
MC in children (peak age 3-4 y/o) |
ALL
|
|
leukemia a/w:
MC in adults (avg age of onset 50 y/o) |
CLL
|
|
leukemia a/w:
philadelphia Chromosome is always present |
CML
|
|
leukemia a/w:
smudge cells |
CLL
|
|
leukemia a/w:
peripheral blasts are PAS+ and TdT+ |
ALL
|
|
leukemia a/w:
peripheral blasts are PAS-, MPO+ and have Auer rods |
AML
|
|
leukemia a/w:
pancytopenia in a down syndrome px |
ALL
|
|
lung cancer a/w:
elevated ACTH --> glucocorticoid excess --> Cushing's |
small cell lung cancer
|
|
lung cancer a/w:
elevated PTH related peptide --> hypercalcemia |
squamous cell lung cancer
|
|
lung cancer a/w:
elevated ADH --> SIADH --> hyponatremia |
small cell lung cancer
|
|
lung cancer a/w:
antibodies to presynaptic Ca2+ channels --> Lambert-Eaton syndrome |
small cell lung cancer
|
|
disease that causes glomerulonephritis with deafness
|
Alport's syndrome
|
|
MC adrenal tumor in children; lab study used to dx
|
MC = neuroblastoma
Dx'c = 24-hr urine --> incr'd VMA & HVA |
|
Dx:
4 y/o girl with URI & dangling thumbs, short stature, & hypopigmentation of some skin areas; labs reveal pancytopenia |
fanconi's anemia
|