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52 Cards in this Set
- Front
- Back
most common cause of inherited thrombophilias?
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- factor V leiden 40-50%
- other causes: prothrombin gene mutation, hyperhomocysterinemia, protein C, protein S, antithrombin III deficiency, antiphospholipid |
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epidural spinal cord compression
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- common complication of cancer
- cancers that tend to met to spinal cord: prostate, breast, lung, non-Hodgkins, RCC - sx: thoracic radicular pain that wraps around the abdomen, lower exremity weakness and sensory changes - TREAT IMMEDIATELY b/c cord compression: high dose corticosteroids followed by MRI to confirm dx, followed by radiation therapy vs surgery |
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best prognostic sign for CNS lymphoma?
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- increase in CD4 count
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first step in treatment of sickle cell crisis?
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- IV fluids
- presence of sickling in bood smear is not useful |
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splenic sequestration crisis
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- high risk in young children with SCC
- check CBC - large fall in hemoglobin secondary to vaso-occlusion in spleen and splenic pooling - spleen can enlarge rapidly --> hypovolemic shock --> immediate blood transfusion |
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greatest correlation w/ dvlp colon cancer? what protects?
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- alcohol possibly due to decreased alcohol intake
- protects: NSAIDS, HRT, high fiber, exercise |
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risk of multiple blood transfusions?
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- development of alloantibodies --> difficulty in finding compatibility
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autoantibodies vs alloantibodies in finding match for blood transfusion?
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- alloantibodies develop in patient with long hx of transfusions
- autoantibodies usually become an issue in pts with AI anemia and taking certain drugs (methyldopa and procainamide) |
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HLA allosensitization
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- increases risk of graft rejection in pts awaiting organ or bone marrow transplantation
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patient with isolated thrombocytopenia- everything else is normal including PT, PTT, plasma fibrinogen, etc?
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- idiopathic thrombocytopenic purpura
- platelet destruction secondary to specific autoantibodies - don't give plt transfusion because they will just be destroyed anyway by antibodies - no need to treat if plt btw 30-50 - if severe, tx with corticosteroids esp in adults or IVIG if CS fails |
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tx of HUS and TTP?
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- plasmapheresis
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side effects of metoclopromide
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- D2 receptor blocker
- causes EPS when used in high doses - being replaced by odansetron 5HT3 receptor blocker |
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tx of platelet dsfx in pt who is acutely bleeding?
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- desmopressin, dialysis, estrogen tx, cryoprecipitate infusion
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clotting tests
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- PT: aka factor II, produced by liver, requires vit K, prolonged in liver disease
- PTT: detects deficiencies in all clotting factors except VII, XIII, used to monitor heparin therapy - bleeding time: prolonged in thrombocytopenic purpura, plt abnormalities, vascular abnormalitiy, leukemia, severe liver disease, DIC, factor deficiency, hemophilia |
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Heparin induced thrombocytopenia
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- Type I: w/in 2 days of heparin therapy, not as large drop (to 100), plt count return to normal once d/c heparin
- type II: 4-10 days after heparin, Ab driven, associated with venous and arterial thrombosis, so major manifestations: DVT, PE, venous limb gangrene, cerebral sinus thrombosis, stroke, MI - prevent by using LMWH over unfractionated and using heparin < 5 days to decrease risk of Ab formation |
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tx of HIT?
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- d/c heparin and warfarin if pt is on it (don't restart warfarin until plt count > 100) --> start lepirudin (don't use in renal insufficiency) or argatroban (dose adjust in hepatic dysfunction)
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what blood smear is consistent with iron deficiency anemia?
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- microcytic/hypochromic anemia with anisocytosis
- most common source is GI bleed in males --> fecal occult test |
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microcytic vs macrocytic anemia?
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- microcytic: iron deficiency
- macrocytic: check b12, folate |
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febrile transfusion reaction
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- 10 minutes after transfusion, pt gets chills and spikes a fever
- pathophys: pt's ab reacts to donor's leukocytes - prevent by cell washing, using frozen deglycerolized red cells, other leukocyte depletion techniques |
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dx acute hemolytic transfusion reactions
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- classic triad that you rarely see: fever, back pain, red or pink colored urine
- to r/o stop transfusion and get tests: direct antiglobulin/Coombs test and measurement of plasma-free hemoglobin level, UA to see hemoglobin |
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what calcium abnormality occurs with transfusions?
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- hypocalcemia --> calcium gluconate infusion
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tx of DVT secondary to reversible cause vs idiopathic?
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- treat w/ warfarin for 3-6 months
- idiopathic: at least 6 months, reassess on whether to continue |
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1 unit of platelet should raise the plts by how much? when to recheck plts after transfusion?
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- 5,000
- 10-60min after copmletion |
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platelet refractoriness
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- absolute platelet increment of less than 2,000 per unit
- most common cause is alloimmuniation |
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plt count rises appropriately after transfusion but then falls w/in 24 hours
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- DIC, sepsis, active bleeding, drugs that reduce plt survival
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superior vena cava syndrome
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- dyspnea, cough, facial fullness, neck pain --> hoarseness, dysphagia, chest pain, syncope
- Pex: dilated veins in arms and neck - best dx test is CT w/ contrast - 80% bronchogenic carcinoma |
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use and risk of tamoxifen? testing?
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- use in estrogen receptor positive breast cancer for 5 years
- risk of uterine cancer - only do further testing if pt is post menopausal w/ abnormal sx e.g. bleeding or vaginal sx --> U/S or biopsy |
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tx for non-operable head and neck cancer?
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- both chemo and radiation
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ABO incompatibility
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- fever and hypotension
- stop transfusion and HYDRATE with normal saline (not LR) - also consider dopamine infusion and osmotic diuresis |
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tx of metastatic prostate cancer?
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- e.g. met to spine
- palliative rather than curative - androgen depletion: LHRH (leutinizing hormone releasing hormone) eg. leuprolide but causes initial T surge followed by decrease so also give antiandrogen e.g. flutamide for that first week T surge |
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pt with lobular carcinoma in situ on core needle biopsy, next step?
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- nonmalignant lesion but increased risk of lobular or ductal carcinoma
- do excisional biopsy because may actually be DCIS or invasive cancer - follow up yearly surveillance or consider SERMS: tamoxifen, raloxifene or prophylactic bilateral mastectomy |
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pt with elevated PSA and shoulder pain
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- get radioiostope bone scan
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elderly pts with bone pain?
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- always suspect multiple myeloma
- will see hyperCa2+ and renal dysfx -to dx get: SPEP, UPEP, skeletal survey, bone marrow biopsy |
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pt with multiple myeloma- what test to assess for bone lesions?
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- whole body xray b/c looking or lytic lesions (not radionucleotide bone scan that look for blastic lesions)
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hyperviscosity syndrome
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- increased serum vicosity due to high protein content
- seen in multiple myeloma, Waldestrom's macroglobulinemia - sx: HA, dizziness, vertigo, nystagmus, hearing loss, visual impairment, mucosal hemorrhage from impaired plt function - ddx ARF: not as acute - hypercalcemia: no mucosal bleeding or blurry vision ** HY |
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patient presents with elevated Hg/Hct... next step?
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- get EPO
- if pt has hx of lung disease then secondary to hypoxia and pt with high EPO - if low EPO then think myeloproliferative d/o |
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side effect of methotrexate?
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- macrocytic anemia
- methotrexate inhibits folate conversion --> folate deficiency |
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what drugs cause macrocytic anemia?
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- trimethoprim, methotrexate, phenytoin --> interferes with folate
- give folinic acid (leucovorin) |
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common primary sites of origin of brain metastasis
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- order of frequency: lung, breast, unknown, melanoma, colon cancer
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pernicious anemia
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- autoimmune destruction of parietal cells
- dx by measurement of autoantibodies against intrinsic factor (which is produced by parietal cells and is needed to bind to B12 for body to absorb) - schilling test is second line - see atrophy in fundus and body, not antrum **high yield |
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bcr/abl translocation?
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- CML
- tx with tyrosine kinase inhibitor to control disease; then if stable and w/ donor tx with bone marrow transplant |
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pt treated with EPO for anemia secondary to renal disease --> inadequate response in 4-6 wks... next step?
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- look if pt has other causes of anemia as well ---> measure ferritin and transferrin saturation
- avoid blood transfusion in ESRD because can sensitize pt for allograft rejection |
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treatment of multiple brain metastasis
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- whole brain radiation to improve survival by a couple of months
- chemotherapy has poor penetration |
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pt with pancoast's tumor: what finding requires immediate therapy?
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- asymmetric chest movement and lower DTR --> phrenic nerve involvement or invasion of intervertebral foramina --> risk of spinal cord compression
- Horner's is bad prognostically but not an emergency |
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anemia of chronic disease
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- seen in pts with cancer or chronic inflammation (e.g. RA) --> suppress RBC in bone marrow
- see low iron, high ferritin, normal transferritin - bone marrow biopsy: decreased sideroblast, increased iron storage in macrophages - tx underlying disease, give EPO or blood transfusions - EPO ineffective if pt's EPO is already >500 |
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neutropenic fever
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- isolate fever >101 and lasts more than an hour
- don't get many other symptoms - emergency |
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pt with anemia, normal MCV
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- get retic count to ddx disease of RBC production vs destruction
- ESR may be useful because anemia of chronic disease will look similar; ESR would be elevated |
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palliative pain tx for pt with spine metastasis?
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- radiation therapy
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patient with squamous cell carcinoma refuses excision... next step?
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- do radiation therapy
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work up of lung cancer
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get CT
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HER2/neu overexpression
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- worse prognosis
- bad response to treatment - tx with monoclonal ab to Her2/neu e.g. herceptin (trastuzumab) |
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note: IM/IV EPO is not more effective then oral EPO, so don't choose if oral EPO is ineffective
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ok
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