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mtb bilmediklerimiz > Endoc/hemat > Flashcards

Endoc/hemat Flashcards

1
Q

Pituitary def

Decreased ACTH level test?

A

response to cosyntropin in the beginning(increased cortisol)
İn chronic cases: no response to the test, adrenal goes atrophy

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2
Q

Hypotyroidsim
Na?
k?
Ca?

A

Hyponatremia
K normal since aldesteron still exists in hipopituitarism
Ca npt related😁

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3
Q

Metyrapone test

A

İnhibit 11 beta hydroxylase
Decrease cortisol profuction
Should increase levels of ACTH RİSE

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4
Q

İnsulin stimulation

A

When blood glucose decreases, GH should rise

For pituitary insuff

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5
Q

Diseases causing nephrogenic DI

A 
Chronic pyelonephritis
Myeloma
Amyloidosis
Sickle cell disease
Hypercalcemia
Hypokalemia
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6
Q

Central DI tx

A

Desmopressin

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7
Q

Nephrogenic DI tx

A

Hydroclorothiazide
Amiloride
NSAIDs

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8
Q

Acromegaly part of which disease/syndrome?

A

Pituitary-MEN 1
Lymphoma
Bronchial carcinoid

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9
Q

Menly problem in Acromegaly men

A

Erectile dysfunct due to co- secreted prolactin with GH

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10
Q

Acromegaly diagnosis
Best initial
Most accuraye test

A

IGF-1 level: best initial
Glucose supression: most accurate
Do mrı after lab results

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11
Q

Acromegaly tx

A

Surgery: transsphenoidal
Medical: cabergoline, octreotide, pegvisomant
RT: if not respond either tx

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12
Q

Pegvisomant: ?

A

GH antagonist, inhibit IGF release from liver

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13
Q

One drug raising prolactin levels other than psychotic ones

A

Verapamil🎉🎉

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14
Q

Drugs causing increased levels of prolactin

A 
Antipsikotik
Methyldopa
Metoclopromide
Opioid
TCA
Verapamil
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15
Q

After prolactin is found to be high:

4 tests you should do?

A
  1. pregnancy
  2. TRH level
  3. BUN/cr
  4. LFT( cirrhosis)
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16
Q

Mrı done in high prolactin only after:

A
  1. Blood test
  2. Sec causes (pregnancy))
  3. Medications
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17
Q

Hyperprolactinoma:

Tx?

A

Fırst cabergoline ( better tolerated than bromocriptine)

Transsphenoidal surgery then

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18
Q

HypotyroidismAll body slows down except:

A

Menstrual flow

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19
Q

When TSH is double the upper limit and T4 is normal

Managmnt?

A

Give tyrpxine

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20
Q

When TSH high but not double

What to do?

A

Look antityroid peroxidase and tyroglobulin ab
İf positive
Give tyroxine

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21
Q

Which drugs causes folate def?

A

Sulfa
Metotraxate (RA)
Phenytoin

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22
Q

B12 and folate tx side effect?

A

Hypokalemia: sudden increase of production of cells

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23
Q

Only microcytic anemia with increased reticulocytes??

A

3 alpha gene deleted thalasemia

HbH

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24
Q

Sickle cell hastaisnda aniden dusen htc??

A

Parvo-B 19infection
Sudden drop in reticulocyte level seen 💕💕❤️
Tx : ivig

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25
Q

Autoimm hemolysis warm causes

A

CLL
lymphoma
SLE
penicillin methyldopa, rifampin, phenytoin, allopurinol

26
Q

Cold agglutinin dx

A

Infectious mono
Mycoplasma
Waldenstrom hmacroglobulinemia

27
Q

In warm agg

Vs

Cold agglutinin
Cryoglobunemia tx differenxe?

A

In warm: steroid
In later: NO STEROID
NO SPLENECTOMY

28
Q

Cold agg disease tx

A 
Stay warm
Rituximab, sometimes plasmapheresis
Mostly in liver: cyclophosphamide, cyclosporine
NO STEROID
NO SPLENECTOMY
29
Q

Cryoglobulins

A 
IgM
Not responding steroid
Seen in:
1. Joint pain
2. GN
3. Hep C ( hep c var kelimelerde)🙄💃🏻💃🏻
30
Q

TTP seen in?

A

T: ticlopidine, clopidigrel
T: t cell, cyclosporine, AIDS
P: pancytopenia: SLE

31
Q

Ttp tx

A

Plasmapheresis

If will be late, infuse FFP

32
Q

Autoimmune hemolysis
Vs
Ttp/hus

A

AI: extracellular hemolysis no schistocyte in smear
Vs
Trp/hus: ++smear of fragmented red cells

33
Q

Pnh most common cause of death?

A 
Stem cell defect
Pig-a defective
Daf( cd55-59 def)
Mc cause of death: THROMBOSIS
Mostly in mesenteric or hepatic veins
34
Q

PNH tx?

A

Prednisone for acute hemolysis
Allogenic bone marrow tx only cure
Eculizumab: inactivate C5, comp inhibitor
Give folic acid and iron with transfusion as needed

35
Q

Aplastic anemia causes

A 
Phenytoin
Carbamazepine
Sulfa
Chloramphenicol
Tyroid drugs
Viruses
Alcohol
NSAID
PNH
SLE
Toluene, DDT, benzene
36
Q

PV

Can convert to ??

A

> %60 htc,
JAK2 mutation:most accurate test
B12 high, iron levels low
O2 levels normal( exclude hypoxia)

Can convert to AML!

37
Q

PV tx?

A 
Phelebotomy
Asprin for thrombosis
Hydroxyurea to decrease cell count
Allopurinol rasburicase
Antihistamines
38
Q

ET

Tx?

A

Above 1 million, thrombosis+bleeding
Jak2 mut
If pt1.5 million: begin hydroxyurea
Use anagrelide when there is supresiion of red cells

39
Q

Erytromelalgia
Seen where?
Tx?

A

Painful red hands
ET
asprin

40
Q

Myelofibrosis

A

Old patient
Spleen and liver production: megaly
Tx: thalidomide, lenalidomide (TNF inh to increase bone marrow production)
Under age 50,55:allogenic BMT

41
Q

TdT

CALLA positive

A

ALL

42
Q

Myeloperoxidase

Esterase

A

AML

43
Q

M4-M5 AML?
Ehich type?
Most commonly present with?

A

Acute monocytic leukemia

CNS INVOLVEMENT

44
Q

ALL AML tx?

A

Induction of remission with CT first
Then:
If prog poor: go BMT directly
If prog good: give more CT

45
Q

Ondicator of prognosis in all aml?

A

Cytogenetics:
Good cytogenetics: more chemo YOU HAVE CHANCE 🎉
Bad cytogenetics: BMT

46
Q

ALL specific tx?

A

Intracranial methotraxate to prevent brain metastasis( superior to RT)

47
Q

Greatest likelihood to convert AML?

A

CML

If untreated , %20 of patients every year

48
Q

Myelodysplasia

A

5q deletion: characteristic, good prognosis
Preleukemic
Pancytopenia despite hypercellular marrow
Can go to AML but mostly pat dies from infection and bleeding before it
Old pt >60 y

49
Q

Myelodysplasia lab values

MCV

A

MCV increased, nucleated red cell
Pelger Huet cells: distinct finding bilobed neutrophil
Ringed sideroblast
Folate, b12 azalir

50
Q

Give lenalidomide to M

A

Mm
Myelofibrosis
Myelodysplasia (5q deletion)

51
Q

Ringed sideroblast
Mcv increased
Pelger huet cells
??which disease

A

MDS

Severity based on blasts

52
Q

Richter phenomenon

A

CLL can transform to high grade lypmhoma in 5% of patients

53
Q

CLL tx

A 
Stage0 and 1 (Lap): no tx
stage 2 hsm, 3 anemia, 4 thrombocytopenia:
Fludarabine+rituximab ( for sympt also)
Cyclophosphamide: recurrent
Mild: chlorambucil
Infection: ivig
Autoimm anemia thrombocytopenia
Give prednisone
54
Q

Hairy cell leukemia:

A

Pancytopenia
Massive splenomegaly
Monocytopenia dry tap despte hypercellular marrow
Initial test: smear, best accurate flow cytomet cd 11c
Tx: cladribine, pentostatin

55
Q

Reason of hypercalcemia in MM?

A

Osteoclast activating factor (OAF): causes lytic lesions in bone
Made by plasma cells, do not seen in bone scan

56
Q

Mm

What shows severity of dx?

A

Beta2 mocroglobulin corresponds to severity of dx

57
Q

Nuclear bone scan in Mm

A

Normal since it shows osteoblast activty

58
Q

Most accurate test for multip myleoma

A

Bone marrow biopsy

>10 percent plasma cells

59
Q

MM tx

A

Dexamethasone
Lenalidomide
Bortezomib ( recurrent cases or combinations drug)
Melphalan old fragile patinets cannot tolerate other drugs

60
Q

Gh deficiency which test?

A

Arginine stimulation test

No response to GHRH infusion

mtb bilmediklerimiz (2 decks)

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