Endoc/hemat Flashcards
Pituitary def
Decreased ACTH level test?
response to cosyntropin in the beginning(increased cortisol)
İn chronic cases: no response to the test, adrenal goes atrophy
Hypotyroidsim
Na?
k?
Ca?
Hyponatremia
K normal since aldesteron still exists in hipopituitarism
Ca npt related😁
Metyrapone test
İnhibit 11 beta hydroxylase
Decrease cortisol profuction
Should increase levels of ACTH RİSE
İnsulin stimulation
When blood glucose decreases, GH should rise
For pituitary insuff
Diseases causing nephrogenic DI
Chronic pyelonephritis Myeloma Amyloidosis Sickle cell disease Hypercalcemia Hypokalemia
Central DI tx
Desmopressin
Nephrogenic DI tx
Hydroclorothiazide
Amiloride
NSAIDs
Acromegaly part of which disease/syndrome?
Pituitary-MEN 1
Lymphoma
Bronchial carcinoid
Menly problem in Acromegaly men
Erectile dysfunct due to co- secreted prolactin with GH
Acromegaly diagnosis
Best initial
Most accuraye test
IGF-1 level: best initial
Glucose supression: most accurate
Do mrı after lab results
Acromegaly tx
Surgery: transsphenoidal
Medical: cabergoline, octreotide, pegvisomant
RT: if not respond either tx
Pegvisomant: ?
GH antagonist, inhibit IGF release from liver
One drug raising prolactin levels other than psychotic ones
Verapamil🎉🎉
Drugs causing increased levels of prolactin
Antipsikotik Methyldopa Metoclopromide Opioid TCA Verapamil
After prolactin is found to be high:
4 tests you should do?
- pregnancy
- TRH level
- BUN/cr
- LFT( cirrhosis)
Mrı done in high prolactin only after:
- Blood test
- Sec causes (pregnancy))
- Medications
Hyperprolactinoma:
Tx?
Fırst cabergoline ( better tolerated than bromocriptine)
Transsphenoidal surgery then
HypotyroidismAll body slows down except:
Menstrual flow
When TSH is double the upper limit and T4 is normal
Managmnt?
Give tyrpxine
When TSH high but not double
What to do?
Look antityroid peroxidase and tyroglobulin ab
İf positive
Give tyroxine
Which drugs causes folate def?
Sulfa
Metotraxate (RA)
Phenytoin
B12 and folate tx side effect?
Hypokalemia: sudden increase of production of cells
Only microcytic anemia with increased reticulocytes??
3 alpha gene deleted thalasemia
HbH
Sickle cell hastaisnda aniden dusen htc??
Parvo-B 19infection
Sudden drop in reticulocyte level seen 💕💕❤️
Tx : ivig
Autoimm hemolysis warm causes
CLL
lymphoma
SLE
penicillin methyldopa, rifampin, phenytoin, allopurinol
Cold agglutinin dx
Infectious mono
Mycoplasma
Waldenstrom hmacroglobulinemia
In warm agg
Vs
Cold agglutinin
Cryoglobunemia tx differenxe?
In warm: steroid
In later: NO STEROID
NO SPLENECTOMY
Cold agg disease tx
Stay warm Rituximab, sometimes plasmapheresis Mostly in liver: cyclophosphamide, cyclosporine NO STEROID NO SPLENECTOMY
Cryoglobulins
IgM Not responding steroid Seen in: 1. Joint pain 2. GN 3. Hep C ( hep c var kelimelerde)🙄💃🏻💃🏻
TTP seen in?
T: ticlopidine, clopidigrel
T: t cell, cyclosporine, AIDS
P: pancytopenia: SLE
Ttp tx
Plasmapheresis
If will be late, infuse FFP
Autoimmune hemolysis
Vs
Ttp/hus
AI: extracellular hemolysis no schistocyte in smear
Vs
Trp/hus: ++smear of fragmented red cells
Pnh most common cause of death?
Stem cell defect Pig-a defective Daf( cd55-59 def) Mc cause of death: THROMBOSIS Mostly in mesenteric or hepatic veins
PNH tx?
Prednisone for acute hemolysis
Allogenic bone marrow tx only cure
Eculizumab: inactivate C5, comp inhibitor
Give folic acid and iron with transfusion as needed
Aplastic anemia causes
Phenytoin Carbamazepine Sulfa Chloramphenicol Tyroid drugs Viruses Alcohol NSAID PNH SLE Toluene, DDT, benzene
PV
Can convert to ??
> %60 htc,
JAK2 mutation:most accurate test
B12 high, iron levels low
O2 levels normal( exclude hypoxia)
Can convert to AML!
PV tx?
Phelebotomy Asprin for thrombosis Hydroxyurea to decrease cell count Allopurinol rasburicase Antihistamines
ET
Tx?
Above 1 million, thrombosis+bleeding
Jak2 mut
If pt1.5 million: begin hydroxyurea
Use anagrelide when there is supresiion of red cells
Erytromelalgia
Seen where?
Tx?
Painful red hands
ET
asprin
Myelofibrosis
Old patient
Spleen and liver production: megaly
Tx: thalidomide, lenalidomide (TNF inh to increase bone marrow production)
Under age 50,55:allogenic BMT
TdT
CALLA positive
ALL
Myeloperoxidase
Esterase
AML
M4-M5 AML?
Ehich type?
Most commonly present with?
Acute monocytic leukemia
CNS INVOLVEMENT
ALL AML tx?
Induction of remission with CT first
Then:
If prog poor: go BMT directly
If prog good: give more CT
Ondicator of prognosis in all aml?
Cytogenetics:
Good cytogenetics: more chemo YOU HAVE CHANCE 🎉
Bad cytogenetics: BMT
ALL specific tx?
Intracranial methotraxate to prevent brain metastasis( superior to RT)
Greatest likelihood to convert AML?
CML
If untreated , %20 of patients every year
Myelodysplasia
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
Myelodysplasia lab values
MCV
MCV increased, nucleated red cell
Pelger Huet cells: distinct finding bilobed neutrophil
Ringed sideroblast
Folate, b12 azalir
Give lenalidomide to M
Mm
Myelofibrosis
Myelodysplasia (5q deletion)
Ringed sideroblast
Mcv increased
Pelger huet cells
??which disease
MDS
Severity based on blasts
Richter phenomenon
CLL can transform to high grade lypmhoma in 5% of patients
CLL tx
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
Hairy cell leukemia:
Pancytopenia
Massive splenomegaly
Monocytopenia dry tap despte hypercellular marrow
Initial test: smear, best accurate flow cytomet cd 11c
Tx: cladribine, pentostatin
Reason of hypercalcemia in MM?
Osteoclast activating factor (OAF): causes lytic lesions in bone
Made by plasma cells, do not seen in bone scan
Mm
What shows severity of dx?
Beta2 mocroglobulin corresponds to severity of dx
Nuclear bone scan in Mm
Normal since it shows osteoblast activty
Most accurate test for multip myleoma
Bone marrow biopsy
>10 percent plasma cells
MM tx
Dexamethasone
Lenalidomide
Bortezomib ( recurrent cases or combinations drug)
Melphalan old fragile patinets cannot tolerate other drugs
Gh deficiency which test?
Arginine stimulation test
No response to GHRH infusion
