5/20/13

Question 1

Unexplained hemolytic anemia, thrombocytopenia, and acute renal failure in a normally healthy pt should raise suspicion for what?

Answer 1

TTP-HUS

Question 2

What is the pathogenetic cause of TTP-HUS?

Answer 2

deficiency of or Ab against ADAMTS-13, an enzyme that cleaves vWF

Question 3

What happens when there is a deficiency of ADAMTS-13?

Answer 3

vWF and plt clumps exhaust plt stores and cause microangiopathic hemolysis

Question 4

What is the tx for TTP-HUS?

Answer 4

plasmapheresis

Question 5

What is the most common cause of orbital cellulitis?

Answer 5

bacterial sinusitis

Question 6

Bursts of atrial tachycardia followed by bradycardia on EKG is probably indicatve of what?

Answer 6

sick sinus syndrome (impaired AV node automaticity)

Question 7

In a pt w/ CHF, at what Hb is a blood transfusion required?

Answer 7

<10 g/L

Question 8

In a previously healthy pt, at what hemoglobin is a blood transfusion required?

Answer 8

<7 or 8 g/L

Question 9

Why is plt transfusion contraindicated in TTP-HUS?

Answer 9

it can worsen nephro and neuro Sx

Question 10

Why does TTP-HUS cause confusion?

Answer 10

microthrombi

Question 11

How does plasmapheresis treat TTP-HUS?

Answer 11

removes Abs and replenishes ADAMTS-13

Question 12

What is the most specific test for acromegaly?

Answer 12

oral glucose tolerance test

Question 13

What is the result of an oral glucose tolerance test if the pt has acromegaly?

Answer 13

failurew to suppress growth hormone

Question 14

What is the first-line of treatment for a GH secreting macroadenoma?

Answer 14

transsphenoidal surgery

Question 15

What are the medical treatments for acromegaly?

Answer 15

somatostatin analogs (octreotide) or dopamine agonists ( cabergoline, bromocriptine)

Question 16

What is the size limit for a pituitary microadenoma?

Answer 16

1 cm

Question 17

Microcytic anemia w/ normal RBC count and distribution width (RDW) strongly suggests what Dx?

Answer 17

Thalassemia!

Question 18

How is thalassemia confirmed?

Answer 18

Hb electrophoresis

Question 19

What are the results of iron studies in thalassemia?

Answer 19

normal

Question 20

Which type of bilirubin, conjugated or unconjugated, can be found in the urine?

Answer 20

conjugated

Question 21

Which 2 syndromes resulting from hepatic enzyme deficiencies cause conjugated hyperbilirubinemia?

Answer 21

Rotor’s and Dubin-Johnson

Question 22

How can Rotor’s syndrome be differentiated from Dubin-Johnson?

Answer 22

Rotor’s causes elevated coproporphyrin

Question 23

What 2 syndromes resulting from hepatic enzyme deficiencies cause UNconjugated hyperbilirubinemia?

Answer 23

Gilbert’s and Crigler-Najjar