amboss 6/26 Flashcards
what is the presentation of zika syndrome
microcephaly and spasticity; endemic travel during the first trimester.
how to prevent zika transmission
barrier contraception and mosquito netting
what is the most definitive way of diagnosing lymphoma
excisional biopsy of the lymph node
what is the presentation of lymphoma
weight loss, swollen lymph nodes, chronic enlargement of lymph nodes, relapsing remitting fevers.
Waldenstrom macroglobulinemia is
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.
Bone marrow biopsy for waldenstroms
often shows characteristic Dutcher bodies.
what is the difference between waldenstroms and multiple myeloma
waldenstroms is IgM; myeloma is IgG and/or IgA
what does JAK2 positive suggest
myelodysplasia/polycythemia vera
what is the treatment for JAK2 positive myelodysplasia
ruxolitinib
what is a common consequence of multiple myeloma
patients will be more susceptible to infections
what type of infections are commonly seen in people with multiple myeloma
UTIs and pneumonia
what is the next best test for diagnosing multiple myeloma after a blood protein electrophoresis and why
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
what is the underlying pathophysiology of multiple myeloma
expansion of plasma cells
what is the most likely presentation of multiple myeloma
decreased kidney function (elevated creatinine) from myeloma kidney, bone pain, very high calcium, anemia due to suppression of hematopoiesis
what is the cause of thrombotic thrombocytopenic purpura
deficiency of ADAMTS13. this cleaves von willebrand factor and without it leads to accumulation on endothelial cells which causes fragmentation of RBCs into schistocytes
what type of patient is at particularly high risk for developing TTP
immunocompromised (steroids or HIV) or patients with SLE
what is the cause of TTP in someone with lupus
antibody against ADAMTS13
what is the treatment for TTP
prompt plasma exchange and steroids
who most often gets HUS and what usually precedes it
children and a diarrheal illness
what is a common complaint in TTP
bleeding gums, occult bleeding stool, petechiae
what is a common presentation of polycythemia vera
hepatic vein thrombosis –tender hepatomegaly, jaundice, ascites, dyspnea, HIGH RBC count
what is the presentation of migratory thrombophlebitis and what does this indicate
migratory cord like structures that are recurrent and causes erythema of the surrounding skin. They are highly associated with occult malignancy –most likely pancreatic
what is the presentation of septic shock
fever, tachycardia, tachypnea, hypotension, general poor condition
what is factor V Leiden
hyper coagulability disease, does not allow factor C/S to inihibit the coagulation cascade. most common of hypercoagulable diseases
what does activated protein C and S do
inhibits the cascade thus they are anticoagulants
how do protein C and S work
when C is activated it complexes with S and inhibits the cascade halting coagulation
what is a serious side effect of methimazole
agranulocytosis
if someone has agranulocytosis while taking methimazole can you switch to PTU
NO. same class, high cross-reactivity. will likely cause the same thing
what is the most common non-hodgkins lymphoma
diffuse large B cell lymphoma
what are the characteristics of diffuse large B cell lymphoma
agressive, spontaneous, stain positive for CD20
accounts for 25% of all cases in adults
what is the cause of chronic venous stasis/dermatitis
this is venous valvular insufficiency. leads to varicose veins and leaking into the interstitial of inflammatory molecules. this leads to dermatitis and edema
why do premature infants have anemia
reduced EPO production
what is the bleeding time in hemophilia
normal. platelets are normal
what parameter would be elevated in hemophilia
PTT
how does von willebrands present
usually with prolonged bleeding. PT and PTT are generally normal, but PTT can be prolonged if it is severe enough .
what is the cause of warm agglutination disease
cephalosporins can cause that.. typically this causes autoimmune hemolytic anemia afterward.
what is the treatment for warm agglutination and secondary hemolytic anemia
oral prednisone
what is the most common causal organism for osteomyelitis in a SCD patient
salmonella enterica
what vaccine should bee given to SCD patients
encapsulated bacteria such as the PPSV23 to cover strep pneumonae
what initial test should be given for people with ITP
hepatitis C antibody testing
what can liver disease cause for the coagulation cascade
decreased vitamin K production which can lead to bleeding f
what is the best treatment for warfarin reversal
phytonadione and prothrombin complex concentrate
what is second line treatment for warfarin reversal
fresh frozen plasma
