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step II > amboss 6/26 > Flashcards

amboss 6/26 Flashcards

1
Q

what is the presentation of zika syndrome

A

microcephaly and spasticity; endemic travel during the first trimester.

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2
Q

how to prevent zika transmission

A

barrier contraception and mosquito netting

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3
Q

what is the most definitive way of diagnosing lymphoma

A

excisional biopsy of the lymph node

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4
Q

what is the presentation of lymphoma

A

weight loss, swollen lymph nodes, chronic enlargement of lymph nodes, relapsing remitting fevers.

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5
Q

Waldenstrom macroglobulinemia is

A

an indolent type of non-Hodgkin lymphoma that is caused by abnormal production of IgM antibodies by monoclonal plasma cells. It usually presents in old age with impaired platelet function (nosebleeds), anemia (Hb < 13.5 g/dL), and mild thrombocytopenia, progressive neuropathy (history of pain and numbness in the feet), and hyperviscosity syndrome (vision and hearing loss). Lymph node enlargement is possible. Additionally, increased ESR, LDH, and ALP can be seen. Serum protein electrophoresis demonstrating a dense, monoclonal IgM band is essential for diagnosis.

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6
Q

Bone marrow biopsy for waldenstroms

A

often shows characteristic Dutcher bodies.

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7
Q

what is the difference between waldenstroms and multiple myeloma

A

waldenstroms is IgM; myeloma is IgG and/or IgA

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8
Q

what does JAK2 positive suggest

A

myelodysplasia/polycythemia vera

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9
Q

what is the treatment for JAK2 positive myelodysplasia

A

ruxolitinib

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10
Q

what is a common consequence of multiple myeloma

A

patients will be more susceptible to infections

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11
Q

what type of infections are commonly seen in people with multiple myeloma

A

UTIs and pneumonia

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12
Q

what is the next best test for diagnosing multiple myeloma after a blood protein electrophoresis and why

A

Whole body CT to assess for bone lesions. This could be M spike of unknown significance. Need lytic bone lesions to tell the difference and CT is the most sensitive

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13
Q

what is the underlying pathophysiology of multiple myeloma

A

expansion of plasma cells

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14
Q

what is the most likely presentation of multiple myeloma

A

decreased kidney function (elevated creatinine) from myeloma kidney, bone pain, very high calcium, anemia due to suppression of hematopoiesis

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15
Q

what is the cause of thrombotic thrombocytopenic purpura

A

deficiency of ADAMTS13. this cleaves von willebrand factor and without it leads to accumulation on endothelial cells which causes fragmentation of RBCs into schistocytes

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16
Q

what type of patient is at particularly high risk for developing TTP

A

immunocompromised (steroids or HIV) or patients with SLE

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17
Q

what is the cause of TTP in someone with lupus

A

antibody against ADAMTS13

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18
Q

what is the treatment for TTP

A

prompt plasma exchange and steroids

19
Q

who most often gets HUS and what usually precedes it

A

children and a diarrheal illness

20
Q

what is a common complaint in TTP

A

bleeding gums, occult bleeding stool, petechiae

21
Q

what is a common presentation of polycythemia vera

A

hepatic vein thrombosis –tender hepatomegaly, jaundice, ascites, dyspnea, HIGH RBC count

22
Q

what is the presentation of migratory thrombophlebitis and what does this indicate

A

migratory cord like structures that are recurrent and causes erythema of the surrounding skin. They are highly associated with occult malignancy –most likely pancreatic

23
Q

what is the presentation of septic shock

A

fever, tachycardia, tachypnea, hypotension, general poor condition

24
Q

what is factor V Leiden

A

hyper coagulability disease, does not allow factor C/S to inihibit the coagulation cascade. most common of hypercoagulable diseases

25
Q

what does activated protein C and S do

A

inhibits the cascade thus they are anticoagulants

26
Q

how do protein C and S work

A

when C is activated it complexes with S and inhibits the cascade halting coagulation

27
Q

what is a serious side effect of methimazole

A

agranulocytosis

28
Q

if someone has agranulocytosis while taking methimazole can you switch to PTU

A

NO. same class, high cross-reactivity. will likely cause the same thing

29
Q

what is the most common non-hodgkins lymphoma

A

diffuse large B cell lymphoma

30
Q

what are the characteristics of diffuse large B cell lymphoma

A

agressive, spontaneous, stain positive for CD20

accounts for 25% of all cases in adults

31
Q

what is the cause of chronic venous stasis/dermatitis

A

this is venous valvular insufficiency. leads to varicose veins and leaking into the interstitial of inflammatory molecules. this leads to dermatitis and edema

32
Q

why do premature infants have anemia

A

reduced EPO production

33
Q

what is the bleeding time in hemophilia

A

normal. platelets are normal

34
Q

what parameter would be elevated in hemophilia

A

PTT

35
Q

how does von willebrands present

A

usually with prolonged bleeding. PT and PTT are generally normal, but PTT can be prolonged if it is severe enough .

36
Q

what is the cause of warm agglutination disease

A

cephalosporins can cause that.. typically this causes autoimmune hemolytic anemia afterward.

37
Q

what is the treatment for warm agglutination and secondary hemolytic anemia

A

oral prednisone

38
Q

what is the most common causal organism for osteomyelitis in a SCD patient

A

salmonella enterica

39
Q

what vaccine should bee given to SCD patients

A

encapsulated bacteria such as the PPSV23 to cover strep pneumonae

40
Q

what initial test should be given for people with ITP

A

hepatitis C antibody testing

41
Q

what can liver disease cause for the coagulation cascade

A

decreased vitamin K production which can lead to bleeding f

42
Q

what is the best treatment for warfarin reversal

A

phytonadione and prothrombin complex concentrate

43
Q

what is second line treatment for warfarin reversal

A

fresh frozen plasma

step II (22 decks)

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