day 6 - heme, GI, endocrine Flashcards
1
Q
Heparin Induced Thrombocytonpenia treat w/?
A
1) Stop heparin
2) Direct Thrombin Inhibitors
- Argatroban
- Fondaparinux
- Lepirudin
need something good for BOTH arterial and venous thrombi
2
Q
Pt started on heparin –> plt count goes low, but still hypercoaguable –> arterial and venous thrombi = think?
A
Heparin Induced Thrombocytonpenia
3
Q
big rugae folds in stomach = think?
A
Menetrier’s Disease
4
Q
Anemia + loss of sensory = think?
A
Pernicious Anemia –> B12 deficiency
5
Q
Pernicious Anemia find what levels of gastrin?
A
High serum gastrin levels
Ab against Intrinsic factor –> destruction of parietal cells –> dec feedback to stop gastrin (bc dec H+ being made)
6
Q
Abnormal secretin stimulation test = think?
A
Zollinger Ellison syndrome
7
Q
Zollinger Ellison syndrome is?
A
Zollinger-Ellison syndrome (ZES) is gastric acid hypersecretion by duodenal or pancreatic neuroendocrine tumors (gastrinomas).
8
Q
Pernicious Anemia is?
A
Ab against Intrinsic factor –> malabsorption of B12 –> B12 deficiency –> Macrocytic Anemia
9
Q
Benzene –> what?
A
Aplastic Anemia
10
Q
Diff dx of aplastic anemia (5)?
A
- Fanconi Syndrome
- Parvo B19
- Arsenic
- Chloramphenicol (abx)
- Benzene
11
Q
Tear drop cells = think?
A
Myelofibrosis (Bone marrow fibrosis)
12
Q
Tear drop cells + splenomegaly - think?
A
Myelofibrosis (Bone marrow fibrosis)
13
Q
Aplastic anemia finding w/in bone marrow stroma?
A
Predominance of fat in the stroma of bones
14
Q
Schilling test for?
A
test for intrinsic factor to test for B12 def
15
Q
Haptoglobin assay for?
A
haptoglobin binds to hemolyzed hemoglobin –> low free haptoglobin = hemolytic anemia
16
Q
Glanzmann’s Thrombasthenia
A
Genetic Platelet aGGregation Issue
17
Q
Bernard-Soulier syndrome
A
Genetic Platelet ADhesion Issue
BernArD
18
Q
Bernard-Soulier syndrome has platelet of what size?
A
BIG!
“Bernard Soulier has Big Suckers”
19
Q
Chediak Higashi
A
Issues w/ microtubules –> infections and albinism
20
Q
How do you tell the difference b/t Glanzmann’s Thrombasthenia and Bernard-Soulier Syndrome?
A
Bernard Soulier – LOW platelet count, large platelets
Glanzmann’s Thrombasthenia - nL platelet count, nL sized platelets, (NO clumping)
21
Q
Neutropenia is considered if?
A
22
Q
afebrile neutropenia vs febrile neutropenia treat?
A
- afebrile: observation
- febrile: IV cefepime
23
Q
Treatment for afebrile neutropenia?
A
Observation
24
Q
Febrile neutropenia treatment?
A
1stline: IV cefepime
IF hasn’t worked in a few days can add vanc –> still not afebrile can add amphotericin B
25
schistocytes + dec platelet count = diff dx (5)
- Disseminated Intravascular Hemolysis (DIC)
- Hemolytic Uremic Syndrome (HUS)
- Thrombotic Thrombocytopenic Purpura (TTP)
- HELLP syndrome (must be pregnant)
- trauma
26
schistocytes + dec platelet count + abnormal PT/PTT = think?
DIC
27
schistocytes + dec platelet count + history of diarrhea = think?
HUS
28
schistocytes + dec platelet count + pregnant = think?
HELLP syndrome
29
What is Thrombotic Thrombocytonpenic Purpura?
TTP is a thrombotic microangiopathy caused by severely reduced activity of the von Willebrand factor-cleaving protease ADAMTS13. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia, and sometimes organ damage. TTP is a medical emergency.
30
MCHC == ?
how much hemoglobin in RBCs
31
MCHC mentioned and high, think = diff dx (2)?
DISEASES w/ SPHEROCYTES!
- Hereditary spherocytosis (neg Coombs test)
- Autoimmune hemolytic anemia (pos Coombs test)
32
Treat hereditary spherocytosis how (mild/severe)?
- mild: folate
| - severe: splenectomy
33
HELLP Syndrome is?
Hemolysis,
Elevated Liver enzymes,
Low Platelets
34
peripheral smear reveals small than normal erythrocytes = think?
Microcytic
35
Monoclonal gammopathy of undetermined significance (MGUS) is?
a condition in which monoclonal protein is elevated your blood. The protein is produced in a type of white blood cell (plasma cells) in your bone marrow.
- precursor to multiple myeloma
- Usually IgG spike on electrophoresis
36
Differentiate b/t myoclonal and MGUS?
- Ca high in Multi Myeloma
| - Clinical symptoms (lytic bone lesions, weight loss etc)
37
Treat MGUS?
Monitor --> follow Ig levels every 6mo for at least 2 years
38
Paroxsysmal Nocturnal Hematuria can be confirmed by testing for what?
Flow cytometry showing deficiency of CD59 on RBCs
39
Heinz bodies -= think?
G6PD deficiency
40
Deficiency of CD59 = think?
Paroxsysmal Nocturnal Hematuria
41
Osmotic fragility = think?
Spherocytosis
42
IgM spike = think?
Waldenstrom
43
IgG spike = think (2)?
- Multiple Myeloma
| - MGUS
44
hemarthrosis = think?
Hemophilia
45
Mixing study is?
Test for types of hemophilia
- give factor 8
- -> if normalizes PTT --> pt has absence of VIII
- --> if doesn't normalize --> pt likely has Ab to VIII
46
Hemophilia 2 types?
1) Congenital absence of factor VIII
| 2) Antibodies to factor VIII
47
Hemophilia 2 types differentiate how?
differentiate through mixing study
48
High WBC + Leukocyte alkaline phosphatase (LAP) high = think?
leukomoid rxn
49
High WBC + Leukocyte alkaline phosphatase (LAP) low = think?
Chronic Myeloid Leukemia (CML)
50
Smudge cells - think?
Chronic Lymphocytic Leukemia (CLL)
51
Treatment of CLL in asymptomatic older patients?
No therapy
52
Treatment of CLL for symptomatic pt (bld in stool, hepatosplenomegaly, systemic symp etc)?
Fludarabine
53
Cyclophosphamide causes?
Hemorrhagic cystitis
54
What drug associated w/ hemorrhagic cystitis?
cyclophosphamide
55
macrocytosis + hypersegmented neutrophils = think?
- B12 (sensory issues)
| - Folate (no sensory issues)
56
Crohn's disease in terminal ileum can --> ?
B12 deficiency b/c that is where it is absorbed
57
Marked rouleau formation = think?
Multiple Myeloma
58
Hyper IgM immunodeficiency is? lab findings?
IgM is high bc can't class switch --> other Ig's are low --> immune-deficient
59
Differentiate b/t B12 and folate deficiency (clinical finding and lab value)?
clinically: B12 - sensory loss/numbness/tingling
folate - NO sensory/nerve stuff
Lab: methylmalonate CoA level
B12 - high
Folate - normal
60
bite cells = think?
G6PD deficiency
61
rod shaped structure in the cytosol = think?
Acute myelogenous leukemia (AML)
Auer Rods
62
Terminal deoxynucleotidyl transferase (TdT) positive or in high amt = think?
(ALL) Acute L Leukemia
63
teardrop cells = think?
Myelofibrosis
64
HIV + fragmented RBCs + purpura = think?
Thrombotic thrombocytopenic purpura
65
Thrombotic Thrombocytopenic purpura what lab findings?
- normal PT and aPTT
- high bilirubin (bc hemolysis)
- high retic count
66
Tumor lysis syndrome is?
large solid tumors (ie lymphoma, etc) --> rupture --> release of bad stuff (ie uric acid, etc)
67
What drug to prevent major issue of tumor lysis syndrome?
allopurinol
| --> prevents uric acid damaging kidneys
68
Vit K deficiency --> what PT or PTT abnormalities?
PT prolongation, PTT normal
69
Na low, K high --> think?
too little adrenal
70
diffentiate b/t primary, secondary, and tertiary adrenal insufficiency?
primary - ACTH high, hyperpigmentation of skin
secondary
tertiary
71
Na low, K high, ACTH high = think?
primary adrenal insufficiency
72
cosyntropin stim test?
Synthetic ACTH to see if cortisol can be stimulated
- -> stays low, doesn't have adrenal glands to stim (ie primary adrenal insufficiency)
- -> goes up, does have adrenal glands to stim
73
symptomatic + high Ca treat?
Initial: IV saline
| then bisphosphonates
74
high Ca but asymptomatic what is initial treatment?
bisphosphonate
75
Weight loss + constipation - think what electrolyte abnormality?
High Ca
| - potentially multiple myeloma
76
Diabetic w/ elevated morning glucose - 2 main reasons ?
1) Dawn Phenomenon - not giving enough insulin at night --> should inc night dose
2) Somogyi Effect - giving too much insulin before bed --> dec night dose
77
Diabetic w/ elevated morning glucose, next step in dx?
measure glucose at 3am
| - to differentiate b/t dawn phenomenon (not enough night insulin) and Somogyi Effect (giving too much night insulin)
78
cortisol causes what kind of fat depositing?
- puts fat centrally
- thins peripherally
- fat deposit on back --> buffalo hump
79
blood tinged sputum cough + smoker + high ACTH --> think?
Small-cell carcinoma
80
Amiodarone can cause what endocrine issue?
Hypothyroidism
81
24 urine catecholamine vs plasma catecholamine test for pheo?
BEST: 24 urine catecholamine -- bc most likely to find abnl
Plasma only elevates during attacks, so may miss dx
82
Treatment for prolactinoma steps?
1) Dopamine agonist (ie bromocriptine, cabergoline)
| 2) transsphenoidal surgical resection if medical tx doesn't work
83
cushing disease/high cortisol effect on heme?
Hypercoaguable
84
diarrhea causes what metabolic derangement?
metabolic acidosis
85
licorice ingestion --> ?
acts like aldosterone --> high Na, and low K
86
vomiting causes what metabolic derangement?
metabolic alkalosis w/ low Na and low K
87
Bartter syndrome lab findings?
High renin and high aldosterone
88
testicular mass + small crystalline cytoplasmic inclusions = think?
Leydig cell tumor
89
CA w/ high hCG? mneumonic?
```
hCG SET high
h- hydaditiform mold
C- choriocarcinoma
G- gestational trophoblastic
S- seminoma
E- embryonal carcinoma
T - Teratoma
```
90
CA w/ high alpha fetal protein? mneumonic?
```
Fetus YET Lives
fetus = alpha fetal protein
Y - yolk sac tumor
E - Embryonal carcinoma
T - Teratoma
Lives - Liver CA (HCC)
```
91
high alpha fetal protein and hCG, think (2)?
Endodermal sinus tumor
| Teratoma
92
carcinoid tumor test?
24 hour urine 5-hydroxyindoleacetic acid (5-HIAA)
93
definitive treatment of Graves disease?
Radioactive iodine ablation
94
Graves disease findings?
- Hyperthyroidism symptoms
- Low TSH
- Diffuse inc radioiodine uptake
95
Na and K finding in Addison's disease?
Low Na and high K
96
Addisonian crisis treat?
Prednisone plus fludrocortisone
97
Addisonian crisis is?
An Addisonian crisis is a serious medical emergency caused by extremely low levels of cortisol.
98
Addison's diease in 1 word?
hypo-steroidism (dec aldosterone and cortisol)
99
Aldosterone to renin ratio high --> means? treatment?
Too much aldosterone. Treat w/ sprinolactone
100
Euthyroid sick syndrome is?
Is a state of adaptation or dysregulation of thyrotropic feedback control[1] where the levels of T3 and/or T4 are at unusual levels, but the thyroid gland does not appear to be dysfunctional (ie TSH levels are normal.
101
No symptoms of thyroid disease + TSH normal + low T4 and T3 = think?
Euthyroid sick syndrome
102
Treatment of euthyroid sick syndrome?
Treat underlying illness.
103
workup of palpable thyroid nodule?
1) Measure TSH
- TSH low --> think toxic adenoma - non-CA --> 2) Radionuclide thyroid scan
- TSH nL/high --> could be CA --> 2) FNA of thyroid mass
104
main reason DM has poor ulcer healing?
hypoxia
105
Mycobacterium avium-intracellulare (MAC) can cause what endocrine issue?
Adrenal insufficiency (low Na and high K)
106
Waterhouse friedrich syndrome can be caused by 2 main organisms?
- Neisseria meningitidis (immune competent)
| - Mycobacterium avium-intracellulare in HIV pts w/ CD4
107
thyrotoxic storm treatment?
Beta-adrenergic blockade
108
Pheochromocytoma treatment (2 initial steps)?
1) Alpha blockers (MUST DO FIRST)
| 2) Beta blockers
109
Asymptomatic hypErCacalcemia most common?
Primary hyperparathyroidism
110
Symptomatic hypErCacalcemia most common?
Cancer
| - squamous cell lung, multiple myeloma, etc.
111
pseudohypoparathyroidism vs hypoparathyroidism?
Pseudo - PTH high (receptor problem)
| Hypo - PTH low
112
pseudohypoarathyoidism issue is?
Issue w/ PTH receptor --> high PTH bc trying to get message across but can't (so low Ca and high Phos)
113
Workup of cushing disease (4)?
1) Low-dose dexamethasone suppression test or measure urine cortisol
2) High dose dexamethasone suppression test
3) Check ACTH
4) CT chest and abdomen
114
low dose dexamethasone test, what is? tells?
give low dose at night --> measure cortisol in morning
- nL response would be to have low levels in morning b/c gave exogenous cortisol so body didn't make
- Cushing syndrome --> no suppression --> high cortisol in morning
Tells whether normal response
115
high dose dexamethasone suppression test, what is?
give high dose --> should effect pituitary ACTH response
- pituitary and nL will be suppressed --> low cortisol in morning
- ectopic ACTH producing lung CA, adrenal CA -- will not be suppressed --> high cortisol in morning
Helps to differentiate where ACTH production is happening (ie brain vs peripheral)
116
Anti-thyrotropin receptor Ab = think?
Graves Disease
117
Exopthalmos = think
Graves Disease
118
Pretibial myxedema = think?
Graves Disease
| Hashimoto's Disease
119
Macrocytic anemia + neurological issues = think?
Vit B12 deficiency
120
Toxic megacolon treatment?
Colectomy!
121
Signs of fulminant liver failure (3)?
- Prolonged PT (coagulation factors down)
- Encephalopathy
- Low glucose (failed gluconeogenesis)
122
Acute Hepatitis best serological marker?
IgM Anti-HBc (acute and window period)
or
surface antigen
123
To delay progression of primary biliary cirrhosis, give?
Ursodeoxycholic acid
124
Antimitochondiral Ab = think?
Primary biliary cirrhosis
125
Really itchy liver disease --> think
primary biliary cirrhosis
126
bronze skin + liver disease = think
Hemochromatosis
127
What organs effected by Wilson's disease?
- Liver
- Brain
- Eyes (gold flecks)
128
PAS stained macrophages - think?
Whipple's Disease
129
Enteroinvasive E.coli vs Enterotoxigenic E.coli?
Is the diarrhea bloody?
- Invasive --> bloody diarrhea
- Toxigenic --> watery diarrhea
130
Young women using OCP liver lesion?
Hepatic Adenoma
131
Man w/ hepatic adenoma, what is likely cause?
Steroids
132
Never what to hepatic adenoma?
Biopsy, bc it will cause hemorrhage
133
Hepatic adenomas appear how on sulfur colloid scan?
Cold on a sulfur colloid scan
134
Cholangitis treatment?
1) Fluids
2) Abx -- ceftriaxone and metronidazole
3) Elective sphincterotomy when stable
135
Most common bug for cholangitis?
E.coli
136
What meds for cholangitis?
Ceftriaxone (E.coli coverage)
| Metronidazole (to cover for bacteroides/anaerobes)
137
dehydrated cirrhotic --> hepatic encephalopathy, what drug is likely to have caused?
Furosemide
138
Management of esophageal variceal bleed?
1) ABCs
2) Octreotide, Vasopressin (ADH)
3) Esophageal Variceal Ligation
continued bleeding--> balloon tamponade --> TIPS vs surgery
139
2 most common causes for ascites in USA for women?
1) cirrhosis - alcoholic most commonly
| 2) ovarian CA
140
Gastrinoma (Zollinger Ellison syndrome) workup? (3)
1) Serum gastrin level
2) Secretin stimulation test
3) Image somehow to find gastrinoma
141
Angiodysplasia treatment?
ablation
142
Melanosis coli = think
chronic laxative use
"pigmentation of colon"
143
Pigmentation of colon on colonoscopy = think?
melanosis coli due to CHRONIC LAXATIVE USE
144
W/ UC should get what additional health care maintenance?
Regular colonoscopies w/ biopsies
145
Check lipids at what ages for health care maintenance?
Men - 35
| Women - 45
146
irritable bowel syndrome would have what type of mucosa?
Normal!
147
cobblestone mucosa = think?
Crohn's
148
intermittent diarrhea and constipation + crampy abdominal pain + no blood in stool = think?
Irritable Bowel sydnrome
149
What GI issue can be in differential dx for wheezing (esp at night)?
GERD
150
what clinical finding with compression of superior vena cava?
Facial edema
151
Target cells = think?
Thalassemia
152
Treatment of hepatic encephalopathy?
Initial: Lactulose +/- low protein diet +/- rifaximin
153
erythema nodosa = think?
Ulcerative colitis
154
tender, erythematous nodule on lower extremities
erythema nodosa --> think UC
155
Palpable purpuric papules on lower extremities
HSP
156
Intenpruirtic
Dermatitis Herpetiformis
157
Edema medial malioli
Dermatitis stasis
158
Anti-Intrinsic Factor Antibodies = think?
Pernicious Anemia (specific)
159
Anti-Parietal Cell Antibodies = think?
Pernicious Anemia (sensitive)
160
Peripheral smear w/ low platelet count, what do look at next?
Size of platelets!
161
Mucocutaneous bleeding --> low platelet count --> Big platelets, diff dx (3)?
- Bernard Soulier
- ITP
- others (type 2B von willebrand deficiency)
162
Mucocutaneous bleeding --> low platelet count --> Normal platelets, diff dx (3)?
- Aplastic Anemia
- Amegakaryocytic Thrombocytonpenia
- Leukemia
163
Mucocutaneous bleeding --> Normal platelet count --> no clumping, diff dx (3)?
- Platelet function disorders (ie Glanzmann's)
- VonWillebrand disease
- Vascular disease
164
Mucocutaneous bleeding --> low platelet count --> CLUMPING, diff dx (2)?
- type 2B vonWillebrand Disease
| - Pseudo vonWillebrand disease
165
Peripheral smear w/ normal platelet count, what do look at next?
Clumping or not
166
Thrombotic Thrombocytonpenic Purpura associated w/ what defect?
defect w/ ADAMTS13 (cleaves vonWillebrand factor --> vW sticks around too long --> ultralarge VWF multimers accumulate on the endothelial surface --> platelets attach and accumulate --> microangiopathic thrombi)
167
M spike = is?
M spike ("myeloma" or "monoclonal" spike) is an abnormal immunoglobulin fragment or immunoglobulin light chain that is produced in excess by an abnormal clonal proliferation of plasma cells.
168
M spike = think?
Think: Monoclonal gammopathy
- MGUS
- Multiple myeloma (monoclonal proliferation of plasma cells)
169
Addison disease is?
Autoimmune destruction of adrenal gland (insidious) --> chronic adrenal insufficiency
--> dec aldosterone and cortisol
170
Skin finding in Addison disease?
Hyperpigmentation esp skin creases and gum lines
inc ACTH b/c no feed back --> inc melanin (bc precursor) --> hyperpigmentation
171
anisocytosis (cells of varying sizes) = think?
Iron deficiency anemia
172
microcytic anemia w/ high RDW means and think?
Cells of varying size
| Think Iron deficiency Anemia
173
RDW low/nL = means?
Cells are the same size (helps differentiate Thalassemia from Iron Deficiency Anemia)
