Grab Bag Flashcards
What is the most common acute leukemia in adults and hwo to dx?
AML
dx w/ bone marrow biopsy and cytogenietic studies (15:17 translocation)
How to tx AML?
ara-C and daunorubicin
How to dx Chronic lymphocytic leukemia?
bone marrow biopsy with flow cytometry showing CD5 and CD20 +.
What are s/sx of multiple myeloma and how to dx?
bone pain (lytic lesions) and fractures, infections, anemia
dx: protein electrophoresis with M protein spike, bone marrow biopsy with >10% plasma cells in marrow
How do you dx Hodgkins lymphoma?
CXR shows mediastinal lymphadenopathy
lymph node biopsy showing reed-sternberg cells
What are the negative effects of radiation?
thyroid dz, lung and breast cancer
What are the negative effects of vincristine?
preipheral neuropathy
What are the negative effects of bleomycin?
pulmonary fibrosis
What are the negative effects of doxorubicin?
Cardiomyopathy
Who should get tamoxifen?
pts with BRCA positive genetic mutation - lowers risk by 50%
How do you work up high calcium?
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)
How to treat hyperthyroidism?
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
How to dx cushing’s syndrome?
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
What is the goal HgA1c?
< 6.5%
How to treat prolactinomas?
dopamine agonists (bromocriptine or cabergoline)
How to dx and tx adrenal insufficeincy?
ACTH stim test (cosyntropin test)
give hydrocortisone
(if aldosterone is missing - give fludrocortisone as well)
What are the criteria to dx rheumatoid arthritis?
(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
How to tx rheumatoid arthritis?
NSAIDS and cortisocsteroids until methotrexate takes affect
methotrexate - follow LFTs and CBC
How to work up acute pain, welling, tenderness in one joint?
joint aspiration and xrays
How to treat gout?
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
How to dx gout?
joint aspiration showing neg-birefringement crystals (needle shaped)
How to treat symptomatic lupus?
prednisone
What antibodies are specific for lupus?
dsDNA and anti-smith
How do you treat a lupus pt who is pregnant?
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
antibody associated with CREST syndrome (scleroderma)
anti-centromere antibody
antibody associated with systemic scleroderma
anti-topoisomerase (scl-70)
How to tx scleroderma?
CCB (nifedipine) and avoid cold exposure for raynauds
Ace inihibitor if kidney invovlment and HTN
methotrexate
What are hallmarks of osteoarthritis?
morning stiffness < 20-30 mins
worse with movement, better with rest
spares MCP joints
no systemic manifestations
How to treat osteoporosis?
calcium and vit D supplements
alendronate
smoking cessation, exercise, reduce caffeine,
What is the work up for dermatomyositis/polymyositis?
muslce biopsy
Anti-jo antibodies (dermatomyositis)
ANA
EMG
How to tx dermatomyositis?
steroids and follow CPK
*if not resovling, methotrexate or azathioprine
check for cancer! CT chest, abd, pelvis, UA, colonoscopy, PSA, pap smear, CA-125
