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Step 3 > Grab Bag > Flashcards

Grab Bag Flashcards

1
Q

What is the most common acute leukemia in adults and hwo to dx?

A

AML

dx w/ bone marrow biopsy and cytogenietic studies (15:17 translocation)

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2
Q

How to tx AML?

A

ara-C and daunorubicin

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3
Q

How to dx Chronic lymphocytic leukemia?

A

bone marrow biopsy with flow cytometry showing CD5 and CD20 +.

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4
Q

What are s/sx of multiple myeloma and how to dx?

A

bone pain (lytic lesions) and fractures, infections, anemia

dx: protein electrophoresis with M protein spike, bone marrow biopsy with >10% plasma cells in marrow

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5
Q

How do you dx Hodgkins lymphoma?

A

CXR shows mediastinal lymphadenopathy

lymph node biopsy showing reed-sternberg cells

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6
Q

What are the negative effects of radiation?

A

thyroid dz, lung and breast cancer

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7
Q

What are the negative effects of vincristine?

A

preipheral neuropathy

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8
Q

What are the negative effects of bleomycin?

A

pulmonary fibrosis

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9
Q

What are the negative effects of doxorubicin?

A

Cardiomyopathy

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10
Q

Who should get tamoxifen?

A

pts with BRCA positive genetic mutation - lowers risk by 50%

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11
Q

How do you work up high calcium?

A

get a serum parathyroid hormone level, if elevated, consider thyroidectomy in a young pt if symptomatic (kidney stones) or worried about long term effects (bone loss, fracture risk)

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12
Q

How to treat hyperthyroidism?

A

give beta blocker (if tachy) and antithyroid drug (propylthiouracil or methimazole) to get to euthryoid

then radioactive iodine ablation

*may need to do surgery if pregnant orrefuse radioactive iodine

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13
Q

How to dx cushing’s syndrome?

A

cushing’s is a state of increased cortisol!

24 hour urine free cortisol

midnight salivary cortisol measurement

overnight low dose dexamethazone suppression test

*if one +, confirm with a second

get an ATCH level to tell if it is coming from the pituitary or adrenal gland

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14
Q

What is the goal HgA1c?

A

< 6.5%

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15
Q

How to treat prolactinomas?

A

dopamine agonists (bromocriptine or cabergoline)

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16
Q

How to dx and tx adrenal insufficeincy?

A

ACTH stim test (cosyntropin test)

give hydrocortisone

(if aldosterone is missing - give fludrocortisone as well)

17
Q

What are the criteria to dx rheumatoid arthritis?

A

(need 4 of the following)

morning stiffness > 1 hr

3 joints affected simultaneously

proximal interphalangeal joint, metacarpophalangeal joint, or wrist involved

joints affected on both sides

RF or anti-cyclic citrullinated peptide positive

elevated CRP/ESR

18
Q

How to tx rheumatoid arthritis?

A

NSAIDS and cortisocsteroids until methotrexate takes affect

methotrexate - follow LFTs and CBC

19
Q

How to work up acute pain, welling, tenderness in one joint?

A

joint aspiration and xrays

20
Q

How to treat gout?

A

NSAIDs or cochicine in acute period

allopurinol outside of the acute period if >1 episode per year or tophaceous gout

*if pt already on allopurinol during attack - continue it and add NSAIDs/colchicine

21
Q

How to dx gout?

A

joint aspiration showing neg-birefringement crystals (needle shaped)

22
Q

How to treat symptomatic lupus?

A

prednisone

23
Q

What antibodies are specific for lupus?

A

dsDNA and anti-smith

24
Q

How do you treat a lupus pt who is pregnant?

A

LMWH to prevent clots/spontaneous abortions

screen for anti-ro and anti-la (can cross placenta and cause neonatal lupus/heart block)

a flare can be tx with steroids safely

25
Q

antibody associated with CREST syndrome (scleroderma)

A

anti-centromere antibody

26
Q

antibody associated with systemic scleroderma

A

anti-topoisomerase (scl-70)

27
Q

How to tx scleroderma?

A

CCB (nifedipine) and avoid cold exposure for raynauds

Ace inihibitor if kidney invovlment and HTN

methotrexate

28
Q

What are hallmarks of osteoarthritis?

A

morning stiffness < 20-30 mins

worse with movement, better with rest

spares MCP joints

no systemic manifestations

29
Q

How to treat osteoporosis?

A

calcium and vit D supplements

alendronate

smoking cessation, exercise, reduce caffeine,

30
Q

What is the work up for dermatomyositis/polymyositis?

A

muslce biopsy

Anti-jo antibodies (dermatomyositis)

ANA

EMG

31
Q

How to tx dermatomyositis?

A

steroids and follow CPK

*if not resovling, methotrexate or azathioprine

check for cancer! CT chest, abd, pelvis, UA, colonoscopy, PSA, pap smear, CA-125

Step 3 (15 decks)

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