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usmle step 2 > Hemato oncologie > Flashcards

Hemato oncologie Flashcards

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USMLE® Step 1 flashcards
1
Q

Hyperglycemia and skin findings(2)

A

glucagonoma

hemochromatosis

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2
Q

Skin findings in glucagonoma

A

NME necrolytic migratory erythema

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3
Q

Zone bastion de NME(3)

A

Face
extremities
perineum

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4
Q

Neurologic Manif of glucagonoma(3)

A

Demencia
ataxia
Proximal mx weakness

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5
Q

Confirmatory test of glucagonoma

A

Glucagon > 500pg/ml

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6
Q

Why anemia in glucagonoma(2)

A

Anemia of chronic disease

Glucagon directly affects erythropoiesis

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7
Q

Malt Lymphoma management(3)

A

Omeprazole
clarythro
Amox

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8
Q

Failure of antibio in Malt Lymphoma what to do?

A

CHOP + bleomycine

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9
Q

Quid for CHOP(4)

A

Cyclophosphamide
adryamycine
vincristine
Prednisone

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10
Q

classification of hyper ca++

A

Mild 10-12
Moderate 12-14
severe >14

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11
Q

Management of asymptomatic Mild Hyperca++

A

No rx needed

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12
Q

What to avoid in Mild hypercalcemia(4)

A

Hctz
Lithium
prolonged bed rest
volume depletion

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13
Q

rx of severe hyperca++(2)

A

Normal saline plus calcitonin

Biphosphonate

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14
Q

what’s the long term rx for hyper ca++

A

Biphosphonate

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15
Q

When to rx moderate hypercalcemia(2)

A

if symptomatic

rx similar to severe hyper ca++

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16
Q

Quid of Hairy celle leukemia

A

B cell tumor

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17
Q

Marker for Hairy cell leukemia

A

TRAP(Tartrate resistant acid phosphatase)

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18
Q

Rx of hairy cell leukemia

A

cladribine

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19
Q

What’s cladribine

A

Purine analog

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20
Q

clue for waldenstrom macroglobulinemia(3)

A

invasion of reticuloendothelial system
Sensory deficit
visual problems

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21
Q

quid for Waldenstrom

A

plasma cell proliferation

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22
Q

What’s the only blood cells to be normal or elevated in Waldenstrom

A

WBC

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23
Q

What explains the sensory deficit in Waldenstrom

A

demyelinating sensorimotor neuropathy

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24
Q

Physiopatho of Hyperviscosity in waldenstrom

A

excess of production of IGM

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25
Q

Disease causing gamma gap (4)

A

Amyloidosis
Multiple Myeloma
MGUS
waldenstrom

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26
Q

next step in in presence of isolated trombocytopenia

A

Test for HIV

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27
Q

What are the 2 main causes ot low platelet

A

Decrease production

Peripheral destruction

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28
Q

What virus could decrease platelet production(3)

A

HIV
epstein Barr
Hep C

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29
Q

What chemicals could cause decrease platelet production?(2)

A

Chemotherapy

Alcohol use

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30
Q

Congenital disease causing decreased platelet production

A

Fanconi syndrome

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31
Q

What carence could cause decreased platelet production(2)

A

B12

folate

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32
Q

What other disease can cause decreased platelet production

A

Myelodysplasia

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33
Q

Disease causing increased platelet destruction

A 
Lupus
antiphospholipid syndrome
Idiopathic thrombocytopenic purpura
TTP-HUS
DIC
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34
Q

Drugs causing increased platelet destruction

A

Heparin

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35
Q

Non tender nodes in neck in older patient and smoker?

A

Squamous cell carcinoma of Head matastasis

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36
Q

Management of antiphospholipid syndrome in pregnant women

A

Low molecular weight Heparin

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37
Q

workup of antiphospholipid syndrome

A

prolonged PTT
thrombocytopenia
VDRL false positive

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38
Q

causes of anemia

A

RBC destruction
decrease red blood cell production
blood loss

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39
Q

cause of anemia in lymphoproliferative disorder

A

invasion of moelle osseuse

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40
Q

Cause of decreased red blood cell production(2)

A

Carence

Moelle osseuse problem

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41
Q

Physio patho of senile purpura

A

perivascular connective tissue atrophy

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42
Q

findings in senile purpura

A

dark ecchimosis in elderly

in area of trauma

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43
Q

People at risk for B12 anemia

A

Vegetarians

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44
Q

Symptoms of B12 anemia(2)

A

Memory loss

Balance problem

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45
Q

Megaloblastic anemia in alcoholic

A

B9 deficiency

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46
Q

if you give b9 to correct the megalobalstic anemia in a Veg what will happen?(2)

A

No more anemia

persistence of neurologic symtoms

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47
Q

Quid of polycythemia vera

A

erythropietin independent red blood cells overproduction

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48
Q

Hmg in polycythemia vera

A

Everything is high

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49
Q

why pruritus after bath in polycyhemia vera(2)

A

release of Histamine

and Prostaglandine

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50
Q

What causes release of histamine in Polycythemia vera

A

Mast cell degranulation

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51
Q

what cause release of prostaglandine

A

stimuli comming from red blood cells

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52
Q

How to explain the HTA

A

because of increase blood volume

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53
Q

How to explain face plethora in polycythemia vera

A

because of vasodilation(Histamine and prostaglandine)

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54
Q

Confirmatory test of polycythemia vera(2)

A

Low erythropoietin

JAK2V617F Mutation

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55
Q

Digestive problem in Polycthemia vera

A

Peptic ulceration

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56
Q

How to explain peptic ulceration in Polycythemia vera

A

Massive release of histamine

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57
Q

why abortion in antiphospholipid syndrome

A

because of thrombosis

arterial and veinous

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58
Q

why anemia in paroxystic nocturnal hemoglobinuria

A

hemolysis

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59
Q

what will be low in intra vxar hemolytic anemia(2)

A

Hb

Haptoglobin

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60
Q

What will be high in intra vxar hemolytic anemia

A

Bilirubin

LDH

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61
Q

why hemolytic anmemia in PNH

A

Absence of CD55 CD59 on RBC

Attack by complement

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62
Q

clue for PNH

A

Hepatic vein thrombosis

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63
Q

confirmatory DX for PNH(2)

A

Flow cytometry

Absence CD55 CD59

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64
Q

What explain absence of CD55 and 59 in PNH

A

GP1 abnormality

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65
Q

role of GP1

A

Help CD55 and CD59 to bind to RBC surface

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66
Q

Confirmatory test of Myastenia Gravis MG(2)

A

antibody to acethylcholine receptor

Electromyogram

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67
Q

If you confirm MG what will be the next step

A

Ct scan of chest for Thymoma

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68
Q

lung cancer in non smoker and smoker

A

adenocarcinoma

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69
Q

lung cancer with central localisation(2)S

A

Scc small cell carcinoma

SCC squamous cell carcinoma

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70
Q

Lung cancer with peripheral localisation(2)

A

adenocarcinoma

Large cell carcinoma

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71
Q

Paraneoplastic syndrome in Small cell carcinoma(3)

A

SiADH
Cushing syndrome
Lambert eaton syndrome

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72
Q

Paraneoplastic syndrome in squamous cell carcinoma

A

hypercalcemia

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73
Q

Paraneoplastic syndrome in Large cell carcinoma(2)

A

galactorrhea

gynecomastia

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74
Q

Paraneoplastic syndrome in adenocarcinoma(2)

A

clubbing

hypertrophic osteoarthropathy

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75
Q

Antibody produced in waldenstrom

A

IGM

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76
Q

Antibody mostly produced in MM

A

IGG

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77
Q

What cells are incriminated in MM

A

Plasma cells

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78
Q

Why reccurrent infection in MM

A

Inability to produce effective antibody

leukopenia

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79
Q

Clue for MM(CRAB)

A

High Calcium
ranal impairement
anemia
bone pain

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80
Q

What gamma gap

A

Protein total-albumin>3 a 4

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81
Q

Why renal impairement

A

IGG or paraprotein produced by myeloma cells collect in glomeruli and cause renal impairement

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82
Q

Why leukopenia and anemia in MM

A

Malignant cells invade moelles osseuse

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83
Q

Bone pain in MM

A

bone invasion and Lysis

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84
Q

Hypercalcemia in MM why?

A

Because of bone invasion

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85
Q

management of prostate cancer with metastasis

A

orchiectomy

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86
Q

Despite of orchiectomy pain persist in prostate cancer what ‘s the next step?

A

radiation

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87
Q

why orchiectomy in advanced prostatic cancer?

A

because androgen plays a key role prostactic cancer

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88
Q

workup for Hemachromatosis(3)

A

serum iron
HFE gene marker
Liver biopsy

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89
Q

What are the six organs targeted by hemochromatosis

A 
Liver
Pancreas
Heart
Pituitary gland
skin
Musculoskeletic system
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90
Q

quid of cardiac problem(3) in hemochromatosis

A

restrictive cardiomyopathy
dilated cardio
trouble de conduction

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91
Q

Quid of pancreas problem in hemochromatosis

A

Diabetes

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92
Q

Skin problem in hemochromatosis

A

Hyperpigmentation of skin

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93
Q

Pituitary problem in Hemochromatosis

A

Hypoptuitarism

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94
Q

quid Hypopituitarism(2)

A

sexual organ problem (amenorrhee femme,impotence sexuelle pour homme)
Hypothyroidism

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95
Q

quid of articular pain in hemochromatosis

A

Pseudo gout

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96
Q

cause of pseudogout

A

deposit of calcium pyrophosphate dihydrate in articulation

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97
Q

radiologic hallmark of pseudogout

A

chondrocalcinosis

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98
Q

cause of chondrocalcinosis(3)

A

Hypomagnesemie
Hyperparathyroidism
Hemochromatosis

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99
Q

confirmatory test for hemochromatosis(2)

A

HFE gene

liver biopsy

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100
Q

rx of hemochromatosis

A

phlebotomy

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101
Q

clue for TTP HUS(4)

A

Hemolytic anemia
low platelet
renal impairement
neurologic symptoms

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102
Q

rx of TTPHUS

A

Plasma exchange(plasmapheresis)

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103
Q

why plasma pherseis works

A

Because the disease in caused by antibody

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104
Q

what antibdy cause TTP-HUS

A

ADAMTS-13,antibody against von willebrand cleaving protease factor

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105
Q

explain low platelet in TTP-HUS(2)

A

accumulation ao von willebrand factor

and aggregation of platelets

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106
Q

Peripheral smear of TTP-HUS

A

fragmented cells

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107
Q

What’s the hallmark of fragmented cells

A

Microangiopathic hemolytic anemia

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108
Q

What’s trastuzumab

A

Monoclonal antibody

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109
Q

indication of trastuzumab

A

breast cancer with HER2 receptor

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110
Q

What to before beginning tratuzumab

A

echocardiographie

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111
Q

Breast cancer with progesterone and oestrogene receptor,rx?

A

chemotherapy

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112
Q

Thrombosis and low platelets days after initiating Heparin DX

A

thrombocytopenia induced by heparin

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113
Q

How to explain thrombosis in HIT

A

because the complexe Heparin -PF4-IGG activates platelets

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114
Q

sideroblastic anemia

A

inability to produce heme

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115
Q

What anemia can develop patients on anti TB drugs

A

sideroblastic anemia

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116
Q

why patient on anti TB can develop sideroblatic anemia

A

because of lack of B6

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117
Q

what ‘s the role of pyridoxine in erytropoiesis

A

protoporphyrin synthesis

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118
Q

cause of b6 deficiency(2)

A

alcohol

isoniazid

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119
Q

what’s salvage therapy

A

failure of standards rx

begin a second to eliminate the metastasis

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120
Q

adjuvant therapy

A

rx given in addition to the standard therapy

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121
Q

Neoadjuvant therapy

A

rx given before the standard therapy

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122
Q

cancer of esophagus associated with reflux disease

A

adenocarcinoma

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123
Q

ca of esophagus associated with cigarettes and alcohol

A

squamous cell carcinoma

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124
Q

workup of esophageal cancer(2)

A

baryum swallow

endoscopy and biopsy

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125
Q

work up for sqamous cell carcinoma of the skin

A

Punch biopsy

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126
Q

staging for esophageal cancer

A

Pet scan

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127
Q

most common cause of matastasis in brain

A

lung cancer

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128
Q

Multiple brain metastasis(2)

A

Lung

Malignant melanoma

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129
Q

solitary brain metastasis(3)

A

breast cancer
colon cancer
renal cancer

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130
Q

MEN 1 syndromes(3)

A

Pancreatic tumor
Pituatary adenoma
parathyroid hyperplasia

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131
Q

pancreatic tumor in MEN 1(4)

A

gastrinoma
vipoma
glucagonoma
insulinoma

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132
Q

quid zollinger ellisson syndrome

A

Multiple peptique ulcer rebelious to rx

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133
Q

management of sickle cell disease complicated by stroke

A

exchange transfusion

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134
Q

Long term treatment of sickle cell disease

A

hydroxyurea

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135
Q

action of hydroxyurea

A

Increase of HB F

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136
Q

Rx anorexia induced by cancer(2)

A

progesterone analog

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137
Q

Quid of progesterone analog(2)

A

Medroxy progesterone or

megestrol acetate

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138
Q

quid for amsterdam criteria

A

useful for lynch syndrome diagnosis

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139
Q

Criteria for Lynch syndrome(4)

A

at least 3 relatives with colon cancer ,one of them is first degree relative with the two others
two or more generation involved
at least one dx before 50
FAP has been excluded

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140
Q

quid of lynch

A

Hereditary non polyposis colorectal cancer

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141
Q

Quid of lynch 1

A

only colon is involved

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142
Q

quid of Lynch 2

A

colon plus extra colon involvement

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143
Q

The most common extra colon site for lynch 2

A

endometrial carcinoma

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144
Q

Ovarian cancer screening

A

BRCA 1

BRCA 2

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145
Q

Si BRCA genes positive what’s the next step in case of ovarian cancer workup(2)

A

CA-125

Pelvis ultrasound

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146
Q

Complication of EPO

A

iron deficiency anemia

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147
Q

why anemia in administration of EPO

A

rapid depletion of body’s iron store

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148
Q

Treatment of iron deficiency anemia in dyalisis patient

A

iron dextran

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149
Q

Population involved in G6PD deficiency

A

Afro american(black)

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150
Q

Peripheral smear of G6PD(2)

A

Heinz bodies

Bite cells

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151
Q

Physiopatho of Heinz bodies

A

oxydation of hB

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152
Q

Why Hb is easily oxydized in G6PD deficiency

A

because of lack of glutathione

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153
Q

role of G6PD

A

formation of NADPH

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154
Q

role of NADPH

A

cofactor in formation of gluthatione

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155
Q

what can cause hemolysis in G6PD deficiency(4)

A

fava beans
sulfa drugs
antimalaric drugs
nitrofurantoin

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156
Q

Next step iron deficinecy anemia in Men >40 ans

A

fecal occult blood

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157
Q

Next step iron deficiency anemia in menopause woman

A

fecal occult blood

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158
Q

what’s the most common cause of iron deficiency anemia in male or post menopausal women

A

chronic gastrointestinal blood loss

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159
Q

Best confirmatory test for HIT

A

serotonin release assay

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160
Q

Rx of HIT(2)

A

stop heparin
Direct thrombin inhibitor or
Fondaparinux

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161
Q

after how many day can begin HIT

A

after 5 days or more after the beginning of heparin treatment

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162
Q

Microcytic anemia non responsive to iron therapy

A

Thalassemie

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163
Q

epidemio of thalassemia

A

Europe descendant

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164
Q

Physiopatho of thalassemia(2)

A

Hemoglobinopathy

globin problem synthesis

165
Q

Marker for mononucleosis

A

Heterophile antibody

166
Q

Vit K deficiency cause(3)

A

Dietary
Malabsorbtion
storage problem in liver

167
Q

Lab in Vit K deficiency(3)

A

Pt prolonged
Ptt prolonged
but PT>PTT

168
Q

role of Vit k

A

play key role 2, 7 ,9, 10 synthesis

169
Q

molecular action of vit K

A

cofactor in carboxylation of glutamic residues

170
Q

in case of acute bleeding with vit k deficiency what to do

A

fresh frozen plasma

171
Q

PICA quid

A

appetite for other things than food

172
Q

quid of Pagophagia

A

craving for ice

173
Q

Cause of PICA

A

iron deficiency anemia

174
Q

key problem in hereditary spherocytosis

A

Spectrin problem

175
Q

role of spectrin

A

scallfolding protein of RBC

if absent RBC is not deformable anymore

176
Q

clue for spherocytosis(2)

A

Hemolysis

pigmented gallstones

177
Q

epidemio of hereditary spherocytosis

A

Mediteraneen

178
Q

work up of herediatary spherocytosis(2)

A

osmotic fragility test

Eosin 5maleinide binding test

179
Q

rx of spherocytosis(2)

A

acid folic

splenectomy

180
Q

hemogram of hereditary spherocytosis(2)

A

High mean cell hb concentration

high red blood cell distribution width

181
Q

transmission of herediatary spherocytosis

A

autosomal dominant

182
Q

peripheral smear of spherocytosis

A

spherocytes

183
Q

knee pain ,lytic lesion in distal femur with soap bubble appearance

A

giant cell tumor

184
Q

rx of giant cell tumor

A

curettage

185
Q

what’s trousseau syndrome

A

superficial thrombophlebitis

186
Q

Physical exam in superficial thrombophlebitis

A

cord like veins on chest and arm

187
Q

ca associated with trousseau(6)

A 
pancreas
Lung
prostate 
colon
stomach
acute leukemias
188
Q

first thing to do devant un trousseau syndrome

A

ct scan of abdomen to rule out pancreatic ca

189
Q

Physio patho of thrombophlitis in trousseau syndrome

A

Mucin production

causes aggregation of platelet

190
Q

complication of hyperhmocysteinemia

A

Venous thrombosis

atheroclerosis

191
Q

cause of hyperhomocysteinemia

A

B6

B12/foalte deficiency

192
Q

role of folate and b12 in homocysteine metabolism

A

cofactors in tansformation of homocysteine in methionine

193
Q

role of B6 in homocysteine metabolism

A

cofactor in transformation of homocysteine in cysteine

194
Q

risk in HIT(2)

A

arterial clot

vein clot

195
Q

rx of Polycythemia vera

A

phlebotomy to keep hmt <45

196
Q

triad of pernicious anemia(3)

A

Macrocytic anemia
glossitis
neurologic changes

197
Q

Physio patho of b12 deficiency in pernicious anemia(2)

A

antibody against intrinsic factor

atrophic gastritis,low parietal cells ,no intrinsic factor

198
Q

Long term complication of pernicious anemia

A

gastric cancer

199
Q

Patient eating only preccoked food whay substance will be deficient

A

folate

200
Q

patient eating precooked food what substance will be high

A

Homocysteine

201
Q

Wquid of megalobaste/dx(2)

A

Hypersegmented neutrophiles

MEGALOBALSTIC anemia

202
Q

Cause of megalobalstic anemia

A

Folate

B12 deficiency

203
Q

How to differentiate B9 and B12 deficiency

A

high methyl malonic acid —->B12 deficiency

204
Q

role of B12

A

transforms methylmalonyl co A en succinyl co A

205
Q

what marker is important in the future management of breast adenocarcinoma(ductal carcinoma)

A

HER2

206
Q

Why Her 2 so important(2)

A

because it’s determinant for
Prognosis
treatment of breast adenocarcinoma

207
Q

How to determine the presence of HER2(2)

A 
FISH or (fluorescent in situ hybridization)
IHC (immuno histo chemical staining)
208
Q

If Her2 is positive what will be the next step(2)

A

trastuzumab or

antracycline

209
Q

cause of pancytopenia in lupus

A

autoimmune peripheral destruction of the 3 types of blood cells

210
Q

cause of anemia in lupus(4)

A

auto immune hemolytic anemia
gastrointestinal blood loss
renal insufficiency
anemia of chronic disease

211
Q

breast ca associated with paget disease

A

adenocarcinoma

212
Q

prurit in nipple in paget why?

A

migration of cancer cells

213
Q

Mechanical valve and hemolysis

A

microangipathic hemolytic anemia

214
Q

peripheral smear in microangiopathic hemolytic anemia

A

schistocytes

215
Q

ulcerative colitis when to begin surveillance

A

after 8 years with the disease

216
Q

surveillance of ulcerative colitis

A

colonoscopy q1 -2 year

217
Q

Patient with adenopathy cerciv]cale ,biopsy shows metastasis od squamous celle carcinoma what to do?

A

Panendoscopy

  • laryngoscopy
  • esophagoscopy
  • brochoscopy
218
Q

HIT management(2)

A

stop heparin

start argatroban

219
Q

Management of fibrocystic disease

A

aspiration

follow during 4-6 weeks

220
Q

work up of MM

A

serum electrophoresis

M spike

221
Q

urine of MM

A

bence jones protein

222
Q

cause of cell damage in G6PD

A

oxidative stress

223
Q

prussian blue stain of urine,role?

A

detecting hemosiderrin(hemolysis)

224
Q

cause of microcytic anemia

A

iron deficiency
lead poisonning
thalassemia
chronic disease

225
Q

what are the 4 indicaors used to work up microcytic anemia

A

serum iron
ferritin
TIBC
% saturation

226
Q

how will be the 4 indicators in iron deficiency anemia

A

everything is low except TIBC(high)

227
Q

how will be the 4 indicators in thalassemia

A

everything is high except TIBC(low)

228
Q

how will be the indicators in anemia of chronic disease (2)

A

everything is low except ferritin (normal or High)

could also be normal MCV,saturation

229
Q

Normal MCV,Normal % saturation, normal ferritin but low fer and TIBC

A

anemia of chronic disease

230
Q

characteristic of immune thrombocytopenic purpura(2)

A

isolated low platelet

<100 000

231
Q

other name of ITP

A

idiopathic thrombocytopenic purpura

232
Q

cause thromcytopenia in ITP

A

auto antibody IGG directed aaginst platelet membrane glycoprotein

233
Q

What the first step in front of isolated thrombocytopenia(2)

A

test for HIV

Hep C

234
Q

what ‘s the clue for rx of isolated thrombocytopenia

A

platelet level

30000

235
Q

ITP with platelet >30000 no bleeding

A

observe

236
Q

ITP platelet<30000

A

Rx

237
Q

First line regimen for ITP <30000 or bleeding

A

corticosteroids

238
Q

second line regimen for ITP <30000 or bleeding

A

rituximab

239
Q

bad prognosis for CLL

A

low platelet

240
Q

stage 0 CLL

A

Lymphocytosis

241
Q

stage 1 CLL

A

Lymphocytosis and adenopathy

242
Q

stage 2 CLL

A

splenomegaly

243
Q

stage 3 CLL

A

anemia

244
Q

stage 4 CLL

A

Low platelet

245
Q

stage 1 and 2 CLL prognosis

A

fair

246
Q

stage 3 CLL prognosis

A

intermediate

247
Q

smudges cells Quid

A

partial breakdown of leucocytes during preparation because fragility

248
Q

disease with smudge cells

A

CLL

249
Q

cause of hypotension during transfusion(4)

A

anaphylactic reaction
transfusion related acute lung injury
primary hypotension reaction
sepsis

250
Q

cause of anaphylactic reaction during transfusion

A

caused by recipient anti IGA antibodies

251
Q

when anaphylactic reaction can occur during transfusion

A

seconds to minutes after the transfusion

252
Q

cause of transfusion related acute lung injury

A

donor anti leucocytes antibody

253
Q

when does the reaction start(acute lung injury)

A

whitin 6 hours of transfusion

254
Q

Symptoms of tranfusion related acute pulmonary injury

A

pulmonary edema

255
Q

primary hypotension cause?

A

bradikinin in blood products

256
Q

people at risk for Primary hypotension and why

A

People receiving ACE inhibitor

bradikinin is normally degraded by ACE

257
Q

when does primary hypotension develops(2)

A

Minutes after the transfusion

transient

258
Q

when patient will develop sepsis after transfusion

A

minutes to hours after transfusion

259
Q

people at risk of anaphylactic reaction and why(2)

A

people with IGA deficiency

presence of anti IGA antibody

260
Q

whats the rx for anaphylactic reaction induced by transfusion

A

intra mxar epinephrine

261
Q

how to prevent anaphylactic transfusion reaction

A

washed red cells products

262
Q

Testicular mass management

A

remove without bilan d’extension

263
Q

the only cured even with metastasis

A

testicular cancer

264
Q

Immunologic blood transfusion reaction (6)

A 
Febrile non hemolytic
acute hemolytic
delayed hemolytic
anaphylactic
allergic
acute lung injury
265
Q

cause of febrile non hemolytic reaction

A

cytokine accumualation in blood products

266
Q

time for development of febrile non hemolytic reaction

A

1-6 hres

267
Q

cause of acute hemolytic reaction

A

ABO mismatching

268
Q

time for development of acute hemolytic rx

A

within one hour

269
Q

symptoms of acute hemolytic reaction(3)

A

flank pain
fever
hemolysis

270
Q

Delayed hemolytic reaction cause

A

anmnestic antibody response

271
Q

time for development of delayed hemolytic reaction

A

2-10 jours

272
Q

cause of allergic reaction during blood transfusion(2)

A

IGE

mast cells activation

273
Q

time for development allergic reaction

A

within 2-3 hours

274
Q

what’s the five ways to diferentiate B12 deficiency caused by pernicious anemia from folate deficiency

A 
High LDH
achlrydria
schilling test +
Methylmalonyl co A in urine
neurological symptoms
all favor B12 deficiency
275
Q

cause of macrotic anemia en dehros de B12 and folate deficiency(3)

A

hypothyroidism
severe liver disease
anti metabolites

276
Q

traffic controller with polycythemia dx?

A

secondary polycythemia induced by co poisonning

277
Q

why co poisonning causes secondary polycythemia(2)

A

co has high affinity for HB

compensatory mechanism —>increase of RBC

278
Q

how will be PTT in lupus anti coagulant and why

A

prolonged

IGG or IGM is responsible for that

279
Q

rouleux appearance of RBC

A

MM

280
Q

management of solitary brain metastasis(2)

A

surgery

whole brain radiation

281
Q

Management of multiple brain metastasis

A

radiation

282
Q

Most common brain tumor

A

Metastatic brain tumor

283
Q

lung cancer involved mostly in solitary brain metastasis

A

Non small cell lung carcinoma

284
Q

whay t is impaired in splenectomised patient?

A

phagocytosis

285
Q

why splenectomised patients are prone to infection

A

because they can opsonised encapsulated bugs

286
Q

infection in patient with splenectomy(3)

A

S pneumonia
hi flu
Neisseria

287
Q

disease with spherocytes with central pallor(2)

A

hereditary spherocytosis

autoimmune hemolytic anemia

288
Q

disease causing extra vascular hemolysis

A

hereditary spherocytosis

autoimmune hemolytic anemia (warm agglutinin)

289
Q

2 types of autoimmune hemolytic anemia

A

warm agglutinin

cold agglutinin

290
Q

cause of warm agglutunin

A

autoimmune disease

291
Q

rx of warm agglutinin(3)

A

corticosteroids
rituximab
splenectomy

292
Q

Lieu of hemolysis in warm agglutinin

A

extra vascular

293
Q

cause of cold agglutinin(2)

A

infection or

auto immune disease

294
Q

Lieu of hemolysis in cold agglutinin

A

intra vascular

295
Q

rx of cold agglutinin

A

supportive care

red blood cell transfusion

296
Q

Hb extra vasculaire

A

destruction exageree des globules rouges dans le system reticuloendothelial(foie rate moelle osseuse)

297
Q

clue for autoimmune hemolytic anemia

A

direct test coombs positif

298
Q

athlete with polycythemia why?

A

steroid s use

299
Q

side effect of steroids on athlete(4)

A

infertility/decrease libido/gynecomastia
psychiatric problem
left ventricular hypertrophy
Increase LDL and decrease HDL

300
Q

hypocalcemie induced by tumor lysis syndrome why

A

cells explode

phosphate binds to ca++

301
Q

workup for tumor lysis syndrome(4)

A

K+ high
ca++ low
phosphate low
aci uric high

302
Q

mechanism of macrocytosis in B12 deficiency

A

B12 is cofactor for demethylation Methyl THF

303
Q

role of THF

A

Purine synthesis

304
Q

role purine

A

gives DNA

305
Q

quid rituximab

A

CD 20 antibody

306
Q

Ca in tamoxifen(2)

A

endometrial carcinoma

uterine sarcoma

307
Q

other risk with tamoxifen

A

DVT

308
Q

quid of MGUS

A

high serum monoclonal protein without any symptom

309
Q

work up for MGUS(2)

A

-serum monoclonal protein< 10 % plasma cells

310
Q

MM work up(3)

A

serum monoclonal protein> 3 g
>10 % plasma cells
elevated B2 microglobulin

311
Q

management of all patients with MGUS

A

skletal bone survey to rule out MM

312
Q

Is there a risk for MGUS to become MM

A

1% per year

313
Q

anterior mediastinal mass with high AFP and BHCG

A

Mixed germ cell tumor(non seminomatous teratoma)

314
Q

anterior mediastinal mass(4)

A

teratoma
thyroid mass
terrible lymphoma
thymoma

315
Q

ant mediastinal mass producing BHCG

A

seminoma

316
Q

confirmatory diagnostic of CLL

A

flow ctometry showing clonalityof cells.

317
Q

disease with low leukocyte alkaline phosphatase(3)

A

CML
PNH
Hypophosphatemia

318
Q

High WBC and high leukocyte alkaline phosphatase dx?(2)

A

leukemoid reaction

infection

319
Q

clue for CML

A

philadelphia chromosome

320
Q

cardiovascular risk for traumatic hemolytic anemia(2)

A

calcified aorta

artificial cardiac valves

321
Q

peripheral smear in traumatic hemolytic anemia

A

Helmet cells or fragmented cells

322
Q

TTP-HUS peripheral smear finding and why(2)

A

fragmented RB cells or schistocytes

microangiopathic hemlolytic anemia

323
Q

calcified aorta or mechanical heart valve par psmear finding and why?(2)

A

Fragmented RBC or Helmet cells

Macroangiopathic hemolytic anemia

324
Q

hallmark of TTP-HUS

A

Schistocytes(Microangiopathic hemolytic anemia)

325
Q

rx of anemia chronic disease

A

rx the chronic disease

326
Q

what’s the target in treating CML

A

Non-receptor tyrosine kinase

327
Q

Quid philadelphia chromosome

A

translocation 9,22

328
Q

consequence of translocation 9,22(2)

A

abnormal BCR-Abl

Abnormal tyrosine kinase

329
Q

action of gleevec(imatinib)

A

tyrosine kinase inhibitor

inhibition of abnormal BCR-ABL gene

330
Q

prognosis factor inbreast cancer

A

TNM stage

331
Q

Marker for future management of breast cancer

A

HER2

332
Q

Patient with breast cancer ,HER2 positive with EFs the next step

A

can’t use trastuzumab

333
Q

Principle of pain management in ca(2)

A

begin with non narcotics

failure,short acting narcotics

334
Q

Patient with axillary adenopathy develops anemia normochromic with high reticulocytes and will WBC Dx

A

(WARM)autoimmune hemolytic anemia caused by non hogkin Lymphoma or CLL

335
Q

rx of warm hemolytic anemia(2)

A

Prednisone

if failure splenectomy

336
Q

what are the factors involved in Hemophilia(2)

A

8-hemophilia A

9-hemophilia B

337
Q

first site of bleeding in hemophilia

A

Joint

338
Q

weils criteria for DVT 1ant

A

previous DVT

339
Q

weils criteria 3 causes

A

Bedridden > 3 days
immobilization
cancer

340
Q

weils criteria 5 sign symptoms

A 
localised tenderness over vein distribution
swollen leg
pitting edema
collateral superficialnon varicoses vein
calf swelling >3 cm
341
Q

weils criteria exclusion

A

other dx possible _2 pts

342
Q

interpretation of weils criteria

A

/ 2 DVT Likely

343
Q

if DVT unlikely what will be the next step

A

D-dimer

344
Q

DVT likely

A

Compressive US

345
Q

weils criteria for DVT pointage

A

1 pt per criterion

346
Q

why arterio veinous shunting can cause secondary polycythemia

A

because of chronic hypoxemia

347
Q

quid of hereditary telengiectasia

A

osler weber rendu syndrome

348
Q

clue for osler weber rendu syndrome(2)

A

Nosebleeding

oral lesions

349
Q

cause of secondary polycythemia(3)

A

arterioveinous shunt
steroids
co poisonning
sleep apnea

350
Q

Why macrocytic anemia in Sickle cell disease

A

Folate deficiency

hydroxyurea use

351
Q

why folate deficiency in SCD

A

increase RBC turn over

increase consumption of folate in bone marrow

352
Q

cause macrocytic anemia MCV>100(8)

A 
folate deficiency
B12 deficiency
Myelodysplastic syndrome
AML
drugs induced
liver disease
alcohol abuse
hypothyroidism
353
Q

Drugs causing macrocytic anemia(5)

A 
Zidovudine
hydroxyurea
chemo agents
TMS
Phenytoin
354
Q

what’s the two type of HIT(2)

A

Non immune mediated

immune mediated

355
Q

criteria to differentiate the two types(2)

A

time of occuring

Platelet count

356
Q

Type 1(non immune mediated) HIT(2)

A

1-4 days after initiation of heparin

Platelet count more than 100000

357
Q

Quid type 2HIT(2)

A

5-10 jours after initiation of heparin

platelet count less than 100 000

358
Q

what’s the clinical outcome for type 1 HIT

A

none

359
Q

what’s the management of type 1 HIT(2)

A

Continue heparin

observation

360
Q

What’s the clinical outcome for type 2 HIT(3)

A

risk of thrombosis
Necrolytic skin lesions at heparin injections site
acute systemic reaction

361
Q

Management of type 2 HIT(2)

A

stop heparin

use alternative anticoagulant to prevent thrombosis(direct thrombin inhibitor , argatroban)

362
Q

Physiopatho of TMS induced macrocytosis

A

Inhibition of dihydro folate reductase

363
Q

Risk with high dose TMS

A

Pancytopenia

364
Q

Physiopatho of metrotrexate induced Macrocytosis

A

Inhibition of dihydrofolate reductase

365
Q

rx macrocytic anemia induced by by metrotrexate

A

folinic acid(Leucovorin)

366
Q

the most common threat in splenectomy

A

s Pneumo sepsis

367
Q

How long last the threat for S Pneumo sepsis

A

More than 30 years after the splenectomy

368
Q

Management before splenectomy(3)

A

3 vaccines
Anti pneumoccocal
Hi flu
Meningoccoque

369
Q

Management after splenectomy

A

PNC for 2 to 5 years

370
Q

drug causing a false positive result for protin S deficiency

A

warfarin

371
Q

Why microcytic anemia in lead poisonning and sideroblastic anemia

A

reduced heme synthesis

372
Q

cause of reduced heme synthesis

A 
Lead poisonning
sideroblastic anemia(B6 deficiency)
373
Q

how are Iron and ferritin in sideroblastic anemia

A

Normal

374
Q

physio patho of sleep apnea induced secondary polycythemia

A

Increase production of erythropoietine

375
Q

first line regimen of chemotherapy induced vomiting

A

ondansetron

376
Q

what’s ondansetron(2)

A

5HT3 receptor blocker

serotonin antagonist

377
Q

why sulfa drugs and primaquine cause hemolysis in G6PD deficiency?

A

because they have high redox potential

378
Q

two forms of G6PD deficiency

A

G6PD A

Mediterranean G6PD

379
Q

Quid G6PD A

A

Moderate form

380
Q

Quid of Mediteranean G6PD

A

The severe form

381
Q

clue for hairy cell leukemia(3)

A

dry tap during bone marrow biosy
TRAP +
cd 11 c marker

382
Q

quid of TRAP

A

strong phosphatase reaction not inhibited by acid tartaric

383
Q

during hemolysis how is G6PD level

A

normal

384
Q

approach of pulmonary nodule in less than 40 years non smoker(2)

A

ask for an old xray

obtain chest xray q 3 months for 12 months

385
Q

pulmonry nodule in smoker

A

CT
FNA
for peripheral lesion

386
Q

why brochoscopy is not good for peripheral lesion workup

A

because you wont reach the lesion with brochoscopy

387
Q

what category of patient is at risk of warfarin induced skin necrosis

A

patient with protein C deficiency

388
Q

why during the first days of warfarin initiation procoagulant activity is increased

A

because warfarin does not block all the factors at the same time,in the beginning only protein C and S are blocked

389
Q

management of back pain in patinet with malignancy first step

A

determine if Myelopathy by physical exam

390
Q

If no Myelopathy what to do in case of back pain in Malignancy

A

Xray lumbar

391
Q

no myelopathy in back pain xray - next step

A

bone scan

392
Q

No myelopathy in back pain induce d by malignancy xray +,next step

A

MRI of the spine within 24 hours

393
Q

severe myelopathy in patient having back pain caused by malignancy(2)

A

urgent MRI

IV glucocorticoids

394
Q

If myelopathy is not severe next step

A

MRI within 24 hours

395
Q

back pain in malignancy plus myelopathy Dx?

A

epidural spinal cord compression

396
Q

paresthesia after blood transfusion

A

hypocalcemia

397
Q

why blood transfusion can cause hypocalcemia?

A

because of chelation calcium by citrate

NB citrate can also chelate Mg

398
Q

BCC of ear management

A

excision 1-2 mm of clear margins whre microscopic

shaving can be done

399
Q

BCC in perioral region management

A

excision 1-2 mm of clear margins

400
Q

BCC in nose or lips,management

A

excision 1-2mm of clear margins

401
Q

the most common skin cancer in the US

A

BCC

402
Q

BCC characteristics

A

sore that bleeds oozes and remain open for more than 3 weeks

403
Q

clue for febrile non hemolytic reaction(2)

A

fever gone away with acetaminopen and stopping transfusion

no sigh of hemolysis

404
Q

prevention of non hemolytic febrile reaction

A

Leukoreduction

405
Q

Timeline of transfusion reactions(4)

A

sec to min-ananphylaxis
min to 1 hour-acutehemolysis
1 hour to 6 hour-non hemolytic febrile reaction/TRALI
2 days-10 days delayed hemolytic reaction

406
Q

anti infectious effect of leukoreduction(2)

A

prevent CMV infection

because this virus is living inside of white cells

407
Q

dx differentiel of High glucagon level(4)<500 Pg/ml

A

hypoglycemia
cushing
pancreatitis
sepsis

408
Q

glucagon level more than 500 pg /ml

A

glucagonoma

409
Q

peripheral smear in thalassemia

A

target cells

usmle step 2 (22 decks)

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