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Level 2 Boards > Hematology/Oncology & Infectious Disease > Flashcards

Hematology/Oncology & Infectious Disease Flashcards

1
Q

Heparin

MOA
Lab

A

Activated antithrombin

Then inactivates factor Xa, Thrombin (IIa)

Increases PTT

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2
Q

Warfarin

MOA
Lab

A

Inhibits synthesis of Vit K- dependent coagulation factors (II, VII, IX, X and to a lesser extent proteins C and S) by blocking vitamin K epoxide reductase

Increases PT

Rapid reversal give FFP (or Vit K)

Teratogenic

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3
Q

Tissue plasminogen activators (tPAs)

  • name
  • MOA
  • Lab (3)
A

Alteplase
Reteplase
Tenecteplase

Aid conversion of plasminogen to plasmin which breaks down fibrin

Increase PT
Increase PTT
No change in platelet count

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4
Q

Factor Xa inhibitors

  • Name
  • MOA
  • Lab
  • Reversal agent
A

ApiXAban
RivaroXAban

Directly inhibit factor Xa

New/noval oral anticoagulant (NOAC)

PT/PTT not monitored

Reversal agent: Andexanet alfa

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5
Q

LMWH

  • Name
  • MOA
  • Administered
A

Enoxaparin
Dalteparin

Mainly inhibits factor Xa

Can be administered SQ

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6
Q

Direct thrombin inhibitors

  • Name
  • MOA
  • Antidote
A

Dabigatran
Argatroban

Directly inhibit factor II (thrombin)
NOAC

Antidote: idarucizumab

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7
Q

Glycoprotein IIb/IIa inhibitors

  • Name
  • MOA
A

Abciximab
Eptifibatide
Tirofiban

Reversibly binds to the glycoprotein receptor IIb/IIIa on activated platelet, preventing aggregation

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8
Q

Hemophilia A

Hemophilia B

Hemophilia C

A

Hemophilia A
- Factor VIII

Hemophilia B
- Factor IX

Hemophilia C

  • Factor XI
  • Ashkenazi Jews
  • AR

X linked recessive for males

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9
Q

Hemophilia Lab

Tx

A

PTT prolonged

PT and bleeding time normal

Tx: Transfuse missing factor
- If unavailable: Cryoprecipitate

If bleeding not severe: Desmopressin

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10
Q

Cryoprecipitate

A

Consists of factor VIII and fibrinogen with smaller concentrations of factor XIII, vWF, and fibronectin

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11
Q

Von Willebrand disease

  • Inheritence
  • MOA
A

Autosomal dominant

Deficiency in vWF with decreased levels of factor VIII

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12
Q

Epistaxis
Gum and gingival bleeding
Menorrhagia

Dx
Lab
Tx

A

Von Willebrand

Dx: Ristocetin cofactor assay (decreased agglutination )

Lab:
Increased bleeding time
Increased PTT

Normal PT and platelet

Tx: Desmopressin

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13
Q

Activated protein C (APC) resistance/ Factor V Leiden

A

Inherited thrombophilia

Single point mutation in factor V, rendering it resistant to inactivation/ breakdown by activated protein C

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14
Q

Heparin-induced thrombocytopenia (HIT)

  • Caused by
  • MOA
  • Timeline
  • Also seen
  • NOT seen
  • Tx
A

More common w/ Heparin
Can happen w/ Heparin or enoxaparin

Immunologic reaction to heparin which creates platelet activating antibodies which leads to blood clots and rapid drop in platelet count

5-10 days after starting heparin

Skin necrosis at injection site

[No bleeding]

Tx: Stop heparin immediately
Start a direct thrombin inhibitor (fondaparinux, argatroban, bivalirudin)

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15
Q

Antiphospholipid syndrome (APS)

  • Associated with
  • Antibodies
  • Two features
  • Lab
  • Tx
A

Associated with SLE and rheumatoid arthritis

APS antibodies

  • Lupus anticoagulatn
  • Anticardiolipin

Spontaneous abortion
Arterial and venous thrombi formation

Prolonged PTT

Tx: Heparin and warfarin

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16
Q

Recurrent miscarriages and stroke

PE

A

Antiphospholipid syndrome

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17
Q

Disseminated Intravascular Coagulation

A

Acquired coagulopathy caused by deposition of fibrin in small blood vessels leading to thrombosis and end-organ damage

Depletion of clotting factors and platelets leading to bleeding diathesis

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18
Q

Bleeding for venipuncture sites

Lab
Tx

A

Disseminated intravascular coagulation (DIC)

Increased PT and PTT
Decreased platelets
Increased D-dimer and fibrin
Decreased fibrinogen

Factor VIII depressed

Tx: Transfuse RBC, platelets and FFP

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19
Q

Thrombotic Thrombocytopenic purpura

  • what is it
  • MOA
  • Addition result
  • Features (5)
  • Lab
  • Tx
A

TTP is a deficiency of the vWF-cleaving enzyme (ADAMTS-13) resulting in abnormally large vWF multimers that aggregate platelets and create platelet microthrombi

Block small blood vessels —> end organ damage

RBC are fragmented by contact w/ microthrombi —> hemolysis

Microangiopathic hemolytic anemia

TTP = adults
HUS= children associated with E.coli
Low platelet count
Neurologic changes (delirium, seizure, stroke, decreased vision) 
Pyrexia (fever) 
Schistocytes
Acute kidney injury

Decreased platelets
Decreased hemoglobin
Increased creatinine
Normal clotting cascade

Tx: Plasma exchange

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20
Q

Hemolytic uremic syndrome

  • Causes
  • Features (6)
  • Lab (4)
  • Tx
A

Children more often

Similar to TTP but no neurologic features

Ecoli diarrhea preceedes
Shiga toxin (atypical HUS) 
Renal failure
Microangiopathic hemolytic anemia
Low platelets
Abdominal pain
Bloody diarrhea
Schistocytes

Decreased platelets
Decreased hemoglobin
Increased creatinine
Normal clotting cascade

Tx: Dialysis for AKI
Plasma exchange

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21
Q

Idiopathic thrombocytopenic purpura

  • MOA (3)
  • Lab
  • Affects who
  • Feature (5)
  • Antibody
  • Tx
A

IgG antibodies (antiplatelet antibodies) are formed against the patients platelets

Platelet antibodies complexes are destroyed in the spleen

Bone marrow production of platelets is increased

Increased Megakaryocytes

Women of child bearing age

Mucocutaneous bleeding
Easy bruising
Petechiae
Hematuria
Melena

If Acute: following viral infection, children 2-6, self limiting purpura

Antiplatelet Ab

Tx: if platelet <30,000 then Corticosteriods and IVIG

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22
Q

Basophilic stippling

A 
Lead poisoning (low iron) 
Sideroblastic anemia (high iron)
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23
Q

B12 deficiency

Folate deficiency

A

B12 deficiency

  • Increased MMA (methylmalonic acid)
  • Increased homocysteine

Folate deficiency

  • Normal MMA
  • Increased homocysteine
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24
Q

African american male

Fatigue
Dark urine
SOB
Jaundice

Taking TMP-SMX for cold

  • Inheritence?
A

G6PD deficiency

X linked

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25
Q

Heinz bodies
Bite cells

Hemolytic anemia

A

G6PD deficiency

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26
Q

Spleen removed at risk for

A

Pneumococcal
Meningococcal
Haemophillus

Spleen Makes Human Prey

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27
Q

Tx Paroxysmal nocturnal hemoglobinuria

A

Prednisone

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28
Q

Sickle cell

Acute chest syndrome causes

A

Fat embolism from bone marrow

Infxn from Mycoplasma, Chlamydia or viruses

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29
Q

Autoimmune hemolytic anemia vs hereditary spherocytosis

A

Both have spheroctyes and positive osmotic fragility tests

AIHA has + direct Coombs test

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30
Q 
Fatigue
Pallor
Weakness
Frequent infections
Petechiae
Bruising 
Bleeding

Pancytopenic

A

Aplastic anemia

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31
Q

Polycythemia vera

  • MOA
  • Elevated
  • Low
  • Tx (2)
A

Clonal proliferation of pluripotent marrow stem cells caused by mutation in JAK2 protein which regulate marrow production

Excess proliferation of WBC, RBC and platelets

Low Erythropoietin

Tx: Phlebotomy
- Hydroxyurea

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32
Q

Febrile nonhemolytic reaction

A

Cytokine formation during storage of blood

Host antibodies against the donor HLA antigens

Type II hypersensitivity

1-6 hrs after

Fever, HA, chills, flushing, rigors

Prevention: using leukoreduced blood products

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33
Q

Hemolytic transfusion reaction

A

Preformed (acute) or formed (delayed) recipient antibodies against donor erythrocytes

Type II hypersensitivity

Fever, hypotension, chills, nausea, flushing, burning at IV site, tachycardia, flank pain

Bloody urine

During or shortly after transfusion

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34
Q

Smudge cells

Lab

A

CLL

Increase NK, T or B cells

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35
Q

Auer rods

A

AML

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36
Q

Tx APL chemo

A

All trans retinoic acid

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37
Q

Tx CLL

A

FLudarabine

Chlorambucil

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38
Q

9;22

Lab

Tx

A

CML

Lab: granulocytosis (increased granulocytes: neutrophils, eosinophils, or basophils)

Tx: Tyrosine kinase inhibitors (imatinib)

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39
Q

Tx Hairy cell Leukemia

A

Cladribine

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40
Q

Single group of localized nodules

Reed sternberg cells

EBV

A

Hodgkin lymphoma

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41
Q

Many peripheral nodes involved
Noncontiguous spread

Mainly B cells

65-75 years old

HIV

A

Non-Hodgkin lymphoma

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42
Q

8; 14

A

Starry sky

Burkitt lymphoma

Jaw lesion
EBV

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43
Q

Eczema like lesions
Pruritus

Biopsy: cerebriform lymphoid cells

A

Mycosis fungoides/ Sezary syndrome

T cell lymphoma of skin

Sezary syndrome: T cell leukemia

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44
Q

Staging of Lymphoma

A

Stage I: single site

Stage II: two or more sites on same side of diaphragm

Stage III: Multiple sites on both sides of diaphragm

STage IV; diffuse disease

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45
Q

Lymphoma Tx

A

R-CHOP

Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone

Little Police Cam DVR

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46
Q

Tx High grade NHL can lead to

A

Tumor lysis syndrome

Rapid cell death —> release intracellualr contents and leads to

Hyperkalemia
Hyperphosphatemia
Hyperuricemia
Hypocalemia

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47
Q

Given for nausea with chemo

A

Ondansetron

- serotonin 5-HT3 receptor antagonist

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48
Q

Tx Hodgkin lymphoma

A

ABVD

Adriamycin (doxorubicin)
Bleomycin
Vinblastine
Dacarbazine

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49
Q

Transplant rejections

1) Within minutes
2) 5 days to 3 months
3) Months to years

A

1) Within minutes
- Hyperacute
- Preformed antibodies
- Check ABO compatibility
- Tx: Cytotoxic agents

2) 5 days to 3 months
- Acute transplant rejection
- T cell mediated
- Increased GGT, alk phos, LDH, BUN, creatinine
- Tx: Corticosteroids, tacrolimus, Mycophenolate mofetil (MMF)

3) Months to years
- Chronic transplant rejection
- Chronic immune reaction causing fibrosis
- Gradual loss of organ function
- No tx

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50
Q

Tuberous sclerosis malignancies

A

Astrocytoma

Cardiac rhabdomyoma

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51
Q

Pruritus worsened by water
Facial plethora

Elevated Hematocrit

Risk of?

A

Polycythemia vera

Risk of thrombus

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52
Q

Pruritus worsened by water
Facial pletora

Elevated Hematocrit

Abdominal discomfort
Ascites
Hepatosplenomegaly

Elevated liver enzymes
Elevated bilirubin
Elevated Alk phos

  • Name
  • Test to get
  • Mutation
A

Budd Chiari

Get Abdominal doppler U/S

JAK2 mutation

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53
Q 
Constipation
Back pain
Anemia
Renal insufficency
Hypercalcemia
A

Multiple myeloma

Constipation due to hypercalcemia

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54
Q

RBC w/o central pallor

  • Name
  • Lab (2)
  • If, then
A

Hereditary spherocytosis

High mean corpuscular hemoglobin concentration

High reticulocytes

[If Coombs positive= Autoimmune hemolytic anemia]

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55
Q

Absence of CD55 in RBC membranes

A

Paroxysmal nocturnal hemoglobinuria

Red urine
Normal RBC on blood smear

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56
Q

Elevated Hemoglobin A2

Elevated hemoglobin F

A

Elevated Hemoglobin A2= beta thalassemia

Elevated hemoglobin F= sickle cell anemia, beta thalassemia

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57
Q

Acute hemolytic transfusion reaction

A

ABO incompatibilty

Within 1 hr

Fever
Chills
Hypotension

Flank pain

DIC **
Acute renal failure

Positive Coombs

Tx: IV normal saline

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58
Q

Hypercalcemia in setting of breast cancer

Tx

A

Metastatic to bone

Tx: Bisphosphonates

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59
Q

Periorbital bruising

Abdominal mass

A

Neuroblastoma

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60
Q

Worsening back pain

Bladder incontinece
Hyperreflexia

What to do first

A

IV glucocorticoids

Epidural spinal cord compression

Then MRI

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61
Q

Headaches
Confusion

Low hemoglobin
Low platelets
Low Leukocytes

Elevated BUN
Elevated Cr

Fragmented cells and normal PTT

Tx

A

Thrombotic thrombocytopenic purpura

Plasma exchange

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62
Q

Eczema
Low platelets
Recurrent infections

  • Name
  • Genetics
  • MOA
  • Feature
  • Tx
A

Wiskott aldrich syndrome

X linked recessive defect in WAS gene

Impaired cytoskeleton changes in leukocytes and platelets

Small platelets (microthrombocytopenia)

Tx: Stem cell transplant

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63
Q

Had otitis media

Splenomegaly
Jaundice

Low Hemoglobin
Normal MCV
Normal MCHC

High reticulocytes

A

Drug induced immune-mediated hemolytic anemia

Normocytic anemia
Reticulocytosis
Splenomegaly

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64
Q

Transfusion

Develop SOB
Fever
Pale

Clear breath sounds

Pain at IV site
No rashes

Dark urine

A

Acute hemolytic transfusion reaction

ABO incompatibility

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65
Q

PE

PT & PTT normal

A

Hereditary thrombophilias

Factor V Leiden
-Activated protein C resistance

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66
Q

Thrombocytopenia

Clumps of platelets on smear (blue dots)

A

Pseudothromobocytopenia

Laboratory error

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67
Q

Fever
Nonproductive cough
right lower lobe infiltrate

Lymphadenopathy
Hepatomegaly
Thrombocytopenia
Anemia

  • Name
  • Lab
  • Diagnosed by
A

CLL

Dramatic leukocytosis w/ lymphocytes

CLL diagnosed by flow cytometry (showing a clonality of mature B cells)

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68
Q

3 y.o
Fatigue
Pallor

Had abdominal pain and diarrhea 1 week ago

Scleral icterus
Ecchymoses on upper and lower extremities

Pitting edema

Low hemoglobin
Normal MCV
Low platelets
High Leukocytes

Normal PT
Normal PTT

Schistocytes

A

Hemolytic uremic syndrome

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69
Q

DVT w/ end stage renal disease tx

A

Unfractionated heparin followed by warfarin

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70
Q

Epistasis

Celiac disease

Elevated PT time

A

Vitamin K deficiency

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71
Q

Bleeding wont stop

Painful heavy menses

Ecchymoses

Low platelets

A

Immune thrombocytopenia

Isolated thormbocytopenia
- IgG autoantibodies

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72
Q

Bleeding from IV

Prolonged PT and PTT

Normal platelet

A

Vit K deficiency

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73
Q

Iron deficiency vs Thalassemia

A

Iron deficiency

  • Low iron
  • Low MCV
  • Low Ferritin
  • Low Transferrin sat
  • HIgh TIBC

Thalassemia

  • High iron
  • High Ferritin
  • High transferrin
  • Low TIBC
  • Very low MCV
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74
Q

Headache
Dizzineess
Blurry vision

Total protein 10.5
Albumin 3.7

Dilated segmented tortuous retinal veins

A

Waldenstrom macroglobulinemia

Monoclonal IgM antibody production

Hyperviscosity syndrome

Screening: serum protein electrophoresis

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75
Q

Erectile dysfunction
HTN
Elevated hematocrit

A

Obstructive sleep apnea

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76
Q

Sickle cell

Severe anemia
Low reticulocyte count

A

aplastic crisis

Parvovirus B19 cause

[Aplastic anemia= pancytopenia]

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77
Q

Vitamin B12 deficiency at risk for

A

Most common cause B12 deficiency is pernicious anemia

which is antibody mediated destruction of intrinsic factor

Antibodies also target gastric parietal cells —> atrophy of acid/ pepsin producing parts of stomach

Risk of gastric cancer

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78
Q

Stem cell transplant

Develop profuse watery diarrhea and rash

A

Acute graft vs host disease

Cytotoxic T cells

Within 100 days

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79
Q

Cerevical paraspinal mass

Horner syndrome

A

Neuroblastoma

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80
Q

Overexpression of BCL-2

A

Follicular lymphoma

14;18

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81
Q

Elevated metamyelocytes
Elevated band cells

High Leukocyte alkaline phosphatase (LAP)

Leukocytes 48,000

A

Leukemoid reaction

Leukocytosis > 50,000

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82
Q

Pneumonia hospitalization

A

CURB-65

Confusion
Uremia (BUN > 19)
Resp rate ( > 30 breaths/min)
BP (<90 or  < 60)
Age > 65
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83
Q

Pneumonia tx

1) Community acquired, < 65
2) >65 or comorbidity (COPD, HF, RF, DM, liver dis, ETOH use)
3) Community acquired but requires hospitilzation
4) Community acquired requiring ICU
5) Hospital acquired; ventilator associated
6) MRSA pneumonia

A

1) Macrolide or doxycycline
2) Fluoroquinolone or beta-lactam + macrolide
3) Fluoroquinolone or antipneumococcal beta lactam _ macrolide
4) Antipneumococcal beta lactam + Fluoroquinolone (or azithromycin)

5) Extended spectrum cephalosporin or carbapenem with antipseudonomal activity
- add aminoglycoside or fluroquinolone for coverage of pseudomonas

6) Add vancomycin or linezolid

Beta lactam
- Ceftriaxone, cefotaxime, Ampicillin/ Sulbactam

Antipneumococcal Beta-lactam
- Cefepime, Imipenem, Meropenem, Piperacillin/ Tazobactam, Doripenem (Carbapenems)

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84
Q

TB Treatment

A

INH
Pyrazinamide
Rifampin
Ethambutol

INH
- Peripheral neuropathy
- Drug induced hepatitis
[Give B6 pyroxidine w/ INH to prevent neuropathy]

Rifampin
- orange fluids

Ethambutol
- optic neuritis

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85
Q

Silver strain shows branched septate hyphae

A

Aspergillosis

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86
Q

Serum galactomannan assay

A

Aspergillosis

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87
Q

Aspergilloma vs Aspergillosis

A

Aspergilloma

  • preexisting lung disease
  • Solid mass within preexisting cavity
  • Itraconazole

Aspergillosis

  • Rapidly progressive infection in immunocompromised
  • Voriconazole or caspofungin
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88
Q

Postviral pneumonia

A

S. aureus

Risk in elderly

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89
Q

Early antibiotic treatment of streptococcal pharyngitis can prevent

A

Pencillin

Rheumatic fever

But not glomerulonephritis

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90
Q

Acute pharyngitis Centor criteria

A 
Fever +1
Tonsillar exudate +1
Tender anterior cervical lymphadenopathy +1
Lack of cough +1
3-14 y.o +1
15-45 +0
>45 -1

If 4-5 tx empirically w/ antibiotics (get culture first)

If 2-3 pts, perform rapid antigen test

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91
Q

Complications of sinusitis

A

Meningitis
Frontal bone osteomyelitis
Cavernous sinus thrombosis
Abscess formation

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92
Q

Antigenic drift

Antigenic shift

A

Drift

  • influenza changes each year
  • change in surface protein

Shift

  • pandemic
  • genetic reassortment
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93
Q

Influenza tx

A

Oseltamivir

Zanamivir

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94
Q 
Fever
Proptosis
Decreased extraocular movements
Ocular pain
Decreased visual acuity

DM

Palatal and nasal mucosal ulceration w/ maxillary sinusitis

Tx

A

Orbital cellulitis by Mucormycosis or Rhizopus

[Normally: Strep or staph)

Amphotericin B and surgical debridement

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95
Q

Gonorrhoeae conjunctivitis tx

A

IM or IV ceftriaxone

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96
Q

C trachomatis conjunctivitis tx

A

Neonatal: azithromycin, tetracycline or erythromycin

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97
Q

Reoccuring eye pain
Blurred eye pain
Tearing
Redness

Corneal vesicles
Dendritic ulcers

Scraping= multinucleated giant cells

A

Herpes simplex keratitis

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98
Q

Tx Otitis externa

A

Ofloxacin or ciprofloxacin and steroid drops

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99
Q

CSF

Low Glucose
Increased Protein
Increased opening pressure

A

Bacterial meningitis

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100
Q

CSF

Normal glucose
Normal or increased protein
Normal or increased pressure

A

VIral meningitis

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101
Q

Tx Bacterial meningitis

A

< 1 month

  • GBS, E.coli, Listeria
  • Ampicillin + cefotaxime or gentamicin

1-3 months

  • S. pneu, N. meningitis, H. influenza
  • Vancomycin IV + ceftriaxone or cefotaxime

3 mn - adult

  • N. meningitidis, S. pneu
  • Vancomycin IV + Ceftriaxone or cefotaxime

> 60/ alcoholism

  • s. pneu, listeria, n. mening
  • Ampicillin + vancomycin + ceftriaxone or cefotaxime
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102
Q

RBC in CSF w/o trauma

A

HSV encephalitis

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103
Q

HSV encephalitis Tx

A

Coronal Flair

IV acyclovir

Foscarnet if resistant

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104
Q

CMV encephalitis tx

A

IV ganciclovir +- foscarnet

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105
Q

HIV pregnant lady not on ART give what at delivery

A

Zidovudine

Infant receives ZDV at 6 weeks after birth

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106
Q

Painless fluffy granular hemorrhages in eye

A

CMV retinitis

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107
Q

Tx Brain abscess

A

IV metronidazole + cephalosporin + vacomycin 6-8 weeks

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108
Q

Tests for HIV

A

ELISA test

  • high sensitivity
  • moderate specificity
  • take up to 6 months

Western blot

  • low sensitivity
  • high specificity
  • confirmatory
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109
Q

Live vaccines okay to give to HIV patients

A

> 200 CD4

MMR and varicella

[Do not give polio]

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110
Q

CD4 < 200 at risk for

A

Pneumocytosis

Toxoplasmosis (< 100)

Cryptococcosis

Coccidioidomycosis

Crytosporidiosis

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111
Q

CD4 < 50 at risk for

A

Disseminated MAC infection

Histoplasmosis

CMV retinitis

CNS lymphoma

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112
Q

TX

1) P jirovecii pneumonia
2) MAC
3) Toxoplasma gondii

A

1) P jirovecii pneumonia
- High dose IV TMP-SMX + steriods

2) MAC
- Weekly azithromycin

3) Toxoplasma gondii
- Double strength TMP-SMX

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113
Q

Pseudohyphae and budding yeast

A

Candida

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114
Q

45 angle branching septate hyphae

A

Aspergillus

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115
Q

Wide capsular halo

Narrow-based unequal budding

India ink stain

  • Tx
A

Crytococcus

Tx: IV amphotericin B + Flucytosine for 2 weeks, then fluconzole for 8 weeks

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116
Q

Nonseptate hyphae, wide angle branching

A

Mucor

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117
Q

Spelunking

Ohio / mississippi

  • CXR (2)
  • stain
  • description of cell
  • Tx (2)
A

Histoplasmosis

Nodular densities
Hilar lymphadenopathy

Giemsas stain

Cell contain many smaller cells

Itraconazole

If disseminated: fever, malaise, WL, pancytopenia, hepatomegaly= amphotericin B followed by itraconazole

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118
Q

Branching filaments on acid fast stain

  • Name
  • Found
  • Tx
A

Nocardia

found in soil

TMP-SMX

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119
Q

Respiratory infection

Southwest USA

A

Coccidioidomycosis

PO fluconazole or itraconazole

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120
Q

Mississippi and ohio river valleys

Broad budding yeast

Tx?

A

Blastomycosis

Itraconazole

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121
Q

Diffuse bilateral interstitial infiltrates with ground glass appearance

  • Name
  • Tx
A

Pneumocystis pneumonia

TMP-SMX 21 days

w/ corticosteriods

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122
Q

Hx Tb

Fatigue

Low hemoglobin
Low MCV
High Iron
Low TIBC

Hypochromic and normochromic cells

Tx

A

Acquired sideroblastic anemia

Isoniazid can cause this

Give pyridoxine (Vit B6)

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123
Q

African american

Poorly localized abd pain

Hx Hematuria

no vaccines

Elevated reticulocytes

A

Sickle cell

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124
Q

Pregnant goes into labor

Vesicular rash on face that spreads to chest and abdomen

Pruritic

Given baby

A

Varicella Zoster infection

Varicella zoster immune globulin

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125
Q

Negative Rapid streptococcal antigen test

Then get

A

Throat culture

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126
Q

Slow growing painless mass in right submandibular region

Had right molar extracted for tooth decay

Thick yellow drainage

Small yellow granules

Gram positive rod with rudimentary branching

Tx

A

Actinomyces

Penicillin

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127
Q

Diarrhea in AIDs patient

A

CD4 < 180= cryptosporidium
- severe watery diarrhea

CD4 < 100= Microsporidium/ Isosporidium

  • Fever rare
  • Crampy abd pain
  • watery diarrhea

CD4 < 50= MAC

  • Watery diarrhea
  • High fever

CD4 < 50= CMV

  • Small volume diarrhea
  • Hematochezia
  • Abd pain
128
Q

TB in HIV patient

A

Positive if >= 5

129
Q

Painful genital ulcers

A

Herpes simplex virus
- small vesicles or ulcers on erythematous base

Haemophilus ducrey

  • larger deep ulcers with gray/ yellow exudate
  • severe lymphadenopathy
130
Q

Painless genital ulcer

A

Treponema pallidum (syphilis)

  • single ulcer (chancre)
  • regular borders and hard base

Chlamydia

  • small shallow ulcers
  • can progress to buboes
131
Q

Salvage

A

Tx given after initial tx failed

132
Q

Consolidation therapy

A

Reduce tumor size

133
Q

End stage renal disease

Severe HTN
HA
Retinal hemorrhages

Anemia
EPO tx

A

Hypertensive crisis

Due to erythropoietin therapy

134
Q

Prolonged bloody diarrhea

Organism?

Tx

A

Entamoeba histolytica

- Metronidazole

135
Q

Periventricular calcifications on infant

A

CMV

Spread by saliva

136
Q

Hydrocephalus

Diffuse parenchymal calcifications in brain of infant

A

Toxoplasmosis

Cat feces
Uncooked meat

137
Q

Fever
Drowsiness
Nuchal rigidity

Septic
Large petechial
Hypotensive
Hypothermic

A

Meningococcemia —> Waterhouse Friderichsen syndrome

Sudden vasomotor collapse and skin rash due to adrenal hemorrhage

138
Q

Acute meningitis (over night)

A

Neisseria meningitidis

139
Q

Left upper quadrant pain

Leukocytosis

Fever

A

Splenic abscess

from infective endocarditis

140
Q

Elevated LDH

A

High tumor burden

141
Q

Acute lymphadenitis organism

A

Staph aureus

142
Q

Pneumonia secondary to influenza infxn organism

A

Staph aureus

143
Q

1) Bacterial invasion of the intestinal muscosa
2) Ingestion of preformed enterotoxin in the food
3) Intestinal bacterial colonization and toxin production
4) Protozoal attachment and alteration of microvilli

A

1) Campylobacter, Salmonella
Listeria

2) Staph aureus
Bacillus cereus (reheated rice)

3) C. difficile
C. perfringens
ETEC E.coli

4) Giardia

144
Q

Vit B 12 deficiency causes

A

Impaired DNA synthesis

145
Q

Cough with posttussive emesis

  • Name
  • Dx
  • Tx
A

Bordetella pertussis

PCR dx

Macrolides (azithromycin, clarithromycin)

146
Q

Epistaxis

Ruby colored papules that blanch with pressure

Increased hematocrit

  • Name
  • Inheritence
  • MOA
  • Causes
A

Hereditary hemorrhagic telangiectasis (Osler-Weber-Rendu syndrome)

AD

Widespread arteriovenous malformations

AVM in lung shunt blood from right to left causing chronic hypoxemia, digital clubbing and reactive polycythemia

147
Q

Anemia
Hypoalbuminemia
Increased Alk phos

Foamy macrophages with acid fast bacilli

  • Name
  • Tx
A

MAC

Tx: Clarithromycin + ethambutol

148
Q

Give what prophylaxis to CD4 < 50

A

Weekly azithromycin

149
Q

Tx Toxoplasmosis

A

High dose PO pyrimethanime + sulfadiazine and leucovorin 4-8 weeks

150
Q

Prophylaxis CD4 < 100

A

TMP-SMX or pyrimethamine + dapsone

151
Q

Shallow ulcer, painless

Now painiful swelling inguinal lymph nodes

A

Lymphogranuloma verereum

[Chlamydia]

152
Q

Tx Chlamydia

A

Doxycycline for 7 days

Or azithromycin once

Use azithromycin on pregnant patients

153
Q

Tx Gonorrhea

A

Ceftriaxone IM and azithromycin PO

154
Q

Jarisch-Herxheimer rxn

A

Tx of syphilis can result in acute flu like illness (HA, fever, chills, myalgisa) which result from the release of endotoxins by the killed organism

155
Q

False positive VDRL (4)

A

Mono
HSV
HIV
Hepatitis

156
Q

Papule becomes beefy-red ulcer with rolled edge of granulation tissue

Painless

Dx

Tx

A

Klebsiella granulomatis

Donovan bodies (deep purple rod shaped in cytoplasm of phagocytes)

Tx: Doxycycline or azithromycin

157
Q

Tx UTI

A

PO TMP-SMX or fluoroquinolone 3 days or nitrofurantoin 5 days

158
Q

Tx Pyelonephritis

A

Fluoroquinolones

159
Q 
Fever
Chills
Altered mental status
Tachycardia
Tachypnea
  • Name
  • Also see (2)
  • Lab (3)
A

Sepsis

Also hypotension in septic shock

Also Leukocytosis/ leukopenia

WBC < 4000
WBC > 12000
with increased bands > 10%

160
Q 
Fever 105
Chills 
Myalgias
HA
Diaphoresis

Anemia
Normocytic
Normochromic

  • Name
  • Tx
A

Malaria

Chloroquine (resistance)
Mefloquine

161
Q

Primquine

A

For malaria

Must test for G6PD first

162
Q

Fever

Neutrophil < 500

A

Neutropenic fever

Common in chemotherapy

Piperacillin- tazobactam

Chemo can lead to disruption of skin and mucosal barrier in mouth resulting in pseudomonas infection

163
Q

Tx Lyme disease

A

Early: doxycycline

Children/ pregnant: amoxicillin

Advanced: ceftriaxone

164
Q

Ring shaped

Flu

Intravascular hemolysis

Anemia

Jaundice

  • Name
  • Tx
A

Babesioses

Azithromycin and Atovaquone

165
Q

Borrelia burgdorferi

A

Lyme disease

166
Q

Rickettsia rickettsii

A

Rocky mountain spotted fever

167
Q

HA
Fever
Malaise
Rash

Rash macular at wrist and ankles but spreads centrally

  • Name
  • Tx
A

RMSF

Doxycycline

168
Q

Endocarditis organism

1) Dental procedure
2) Prosthetic valve
3) Most common

A

Dental procedure= Viridans streptococci

Prosthetic valve= Coagulase negative staphylococcus (epidermidis, haemolyticus)

Most common= staph aureus

169
Q

Endocarditis from IV drug users

A

Tricuspid valve

170
Q

Tx Endocarditis

A

Vancomycin + gentamicin

171
Q

Tx anthrax

A

Ciprofloxacin or doxycycline for inhaled disease

172
Q

Chronic osteomyelitis with draining sinus can eventually lead to

A

SCC (Marjolin ulcer)

173
Q

Tick

Fever
Fatigue
Myalgia
Anemia
Dark urine

Drenching sweats

A

Babesiosis

174
Q

Off-white discharge fishy odor

  • Name
  • Features (2)
  • Tx
A

Bacterial vaginosis

Gardnerella vaginalis

pH> 4.5
Clue cells

Metronidazole

175
Q

Yellow green malodorous, frothy discharge

pH> 4.5

  • Name
  • Tx
A

Trichomoniasis

Tx: Metronidazole

176
Q

Unilateral lymphadenitis tx

A

Clindamycin

177
Q

Solid organ transplant prophylaxis

A

TMP-SMX for opportunistic infections (pneumocystis pneumonia)

178
Q

Lymphangitis tx

A

Cephalexin

cutaneous wound —> red streaks

179
Q

Fell and got abrasion on leg

Severe pain
Swelling
Spread
Hypotension

A

Necrotizing fasciitis

180
Q

Viral meningitis organisms

A

Enteroviruses such as Group B coxsackievirus

181
Q

Chemotherapy

Get gangrenous ulcers

  • Name
  • Organism
A

Ecthyma gangrenosum

Pseudomonas

182
Q

Pelvic pain

Bleeding

A

Consider PID

183
Q

Fever
Pain in multiple joints
Uses heroin
Sex worker

Pustules on chest and extensor surfaces of forearms

Blood cultures negative

  • Name
  • Diagnosis
A

Disseminated gonococcal infection

Dx: Nucleic acid amplification testing

184
Q

UTI

pH > 8

A

Urease producing bacterium

Proteus mirabilis or Klebsiella

Risk of struviate stones (magnesium ammonium phosphate)

185
Q

Tx Hepatitis C in pregnancy

A

Ribavirin is teratogenic

Hep A & B vaccination

186
Q 
Sandpaper rash on trunk
Armpits and groin
Fever
Sore throat
Cervical lymphadenopathy

Two kids in class also sick

  • Name
  • Organism
  • Tx
  • Feature (1)
A

Scarlet fever

Streptococcus pyogenes

Penicillin

Strawberry tongue

187
Q

Erythema infectiosum

A

Parvovirus B19

Slapped cheek

188
Q

Hand foot and mouth disease

A

Coxsackievirus infection

189
Q

High fever few days

This rash

190
Q

IV drug user
Murmur

Arm cellulitis

  • Murmur
  • Due to
  • Organism
  • Tx
A

Tricuspid regurgitation

Right sided infection endocarditis

Staphylococcus aureus

Vancomycin

191
Q

Rocky mountain spotted fever

Features (4)
Tx

A

Petechial rash on wrist/ ankles

Decreased platelets

Decreased sodium

Increase AST/ALT

Doxycycline

192
Q

9 y.o

Writhing of arms
Grimacing of face

1 month ago: sore throat and fever that resolved

Lived in Honduras

Pericardial friction rub

Elevated ESR

Prolonged PR interval and diffuse ST elevations

  • What organism
  • Disorder
  • Tx
A

Streptococcus pyogenes

Acute rheumatic fever

Penicillin

193
Q

Skin lesion

Painful nerves iwth loss of sensory

  • Name
  • Diagnosis
  • Tx (2)
A

Leprosy

Biopsy of lesion

Dapsone + rifampin

194
Q

Large blue cells with extra space around capsule

195
Q

Tx Asymptomatic bacteriuria w/ Ecoli

A

Amoxicillin clavulanate

Cephalexin

NItrofurantoin

196
Q

High grade fever for 6 days

Rash face —> extremities

No immunizations

Diffuse maculopapular rash that spares palms and soles

  • Name
  • What helps reduce morbidity
  • Cause it does what
A

Measles (rubeola)

Vit A

Promotion of antibody producing cells and regeneration of epithelial cells

197
Q

Organism of acute bacterial rhinosinusitis

Facial pain
Symptoms > 10
Worsening symptoms

  • Name
  • Tx
A

Nontypeable Haemophilius influenzae

Amoxicillin +- clavulanate

[Next streptococcus pneumoniae, and then Moraxella catarrhalis]

198
Q

Rash that started on face
Localized lymphadenopathy
Arthralgias

spares palms and soles

100.8 F

No vaccines

A

Rubella

German measles

199
Q

Measles vs Rubella

A

Measles

  • High fever (104)
  • Koplick spots

Rubella

  • Cephalocudal spread but coalesces and appears hemorrhagic
  • ARTHRITIS
  • Tender lymphadenopathy
200
Q

Infective endocarditis from mitral valve prolapse

A

Streptococcus sanguinis

Part of viridans

201
Q

Gray vesicles that progress to fibrin coated ulcers

Soft palate and uvela

A

Herpangina

Coxsackie virus

Late summer
Early fall

202
Q

Anus pruritus

A

Enterobius vermicularis (pin worm)

Tx: Pyrantel pamoate or albendazole

203
Q

Rash that went away

Diarrhea
Nausea
Cramps

Fever
WL
Night sweats

Lymphadenopathy

204
Q

Liver transplant

Immunosuppressive therapy

Dry cough
fever
LDH elevated
Tachypnea 
Hypoxia
  • Name
  • Diagnosis
A

Pneumocystis pneumonia

Bronchoalveolar lavage

205
Q

HIV

Non enhancing asymmetric white matter lesion

Hypodense w/ no edema

A

Progressive multifocal leukoencephalopathy

JC virus

206
Q

HIV associated dementia

A

Diffuse brain atrophy, ventricular enlargement

207
Q

Tx Vibrio vulnificus

A

IV ceftriaxone + doxycycline

208
Q

Sensorineural hearing loss

No red reflex

Loud harsh murmur over left second intercostal

Hepatosplenomegaly

A

Rubella (German measles)

Cataracts
Deafness
PDA

209
Q

Opportunistic infections

A

Pneumocystis pneumonia

CMV

  • pulmonary symptoms
  • GI symptoms
210
Q

Tx Acute otitis media

A

Amoxicillin clavulanate

211
Q

Syphillis tx if pencillin allergy

A

Doxycycline

212
Q

Tick

Flu like illness

No rash

Neurlogic symptoms

  • Name
  • Organism
  • Tx
A

Human monocytic ehrlichiosis

E chaffeensis/ E ewingii

Doxycycline

213
Q

Liver cyst

Cyst within Cyst

A

Echinococcus granulosus

Dog tapeworm

Hydatid cyst

214
Q

Thin malodorous discharge

Postcoital bleeding

Motile, ovoid shaped organisms

  • Name
  • Tx
  • Feature
A

Trichomoniasis

Metronidazole

pH> 4.5

215
Q

Small reddish/ purple papules that enlarge to large nodules

HIV

Bleed easily

A

Bartonella species

Bacillary angiomatosis

216
Q

Multiple large shallow erosions or ulcers on colonscopy

Immunosuppressed

A

CMV colitis

217
Q

Droplet precautions

A

N/ mneingitidis
H. influenza
Mycoplasma pneumonias

218
Q

HIV

HA
Fatigue

Bilateral papilledema
Fever

MRI normal

A

Cryptococcal meningoencephalitis

219
Q

Bacterial meningitis empiric tx

A

Vancomycin
Ampicillin
3rd generation cephalosporin (cefepime)

220
Q

Sore throat
Elevated fever
Difficulty swallowing

Given azithromycin for pharyngitis

Swell of neck along SCM

Internal jugular vein thrombosis

Peripheral lung nodules w/ cavitation

  • Organism
  • Syndrome
  • Tx (2)
A

Fusobacterium necrophorum

Lemierre syndrome

Airway management

IV antibiotics/ drainage if none responsive

*Thrombophlebitis of Jugular vein

221
Q

Urethral discharge

Culture negative

222
Q

Low hemoglobin
MCV Low
Reticulocytes High
Elevated Total bilirubin

Jaundice

  • Name
  • Feature (4)
A

Hereditary spherocytosis

Hemolytic anemia
Jaundice
Splenomegaly

Negative coombs test

223
Q

Tx Sickle cell crisis

SE

A

Hydroxyurea

SE Myelosuppression

224
Q

Hepatosplenomegaly

5% Hemoglobin A
95% hemoglobin F

  • Name
  • Tx
A

Beta thalassemia

Chelation therapy

225
Q

Bruising
Lymphadenopathy
Hepatosplenomegaly

Petechiae
Mucosal bleeding

  • Name
  • Deficiency
A

ALL

Deficiency of platelet production

226
Q

Target cells

A

Alpha thalassemia minor
-no therapy needed

HALT said hunter to his target
HbC disease
Asplenia
Liver disease
Thalassemia
227
Q

Osteolytic lesions

Fractures

  • Name
  • MOA
  • Appearance
  • Seen on microscope
A

Multiple myeloma

Impaired effective antibody production

Fried egg

Roulex formation (RBC stacked)

228
Q

SLE cause of thrombocytopenia

A

Peripheral destruction

Antiplatelet antibodies

229
Q

Asplenic prophylaxis if develops fever

  • organisms (3)
  • Tx
A

Encapsulated bacteria

  • Streptococcus pneumoniae
  • Hemophilus influenzae
  • Neisseria meningitidis

Develop fever
- Amoxicillin- clavulanate

230
Q

Mass in right lobe of liver

Central scar
Well circumscribed

A

Focal nodular hyperplasia

231
Q

Diagnostic test for hereditary spherocytosis

A

Osmotic fragility test

232
Q

Anemia associated with absent radii and thumbs

Diffuse hyperpigmentation

Cafe au lait spots

Microcephaly

Pancytopenia

A

Fanconi anemia

233
Q

How to distinguish polycythemia vera form secondary polycythemia

A

Both have increased hematocrit and RBC mass

But polycythemia vera should have normal O2 saturation and low erythropoietin levels

234
Q

TTP pentad

A

LMNOP

Low platelet
Microangiopathic hemolytic anemia
Neurologic changes
Obsolete renal function
Pyrexia
235
Q

Anemia
Thrombocytopenia
Acute renal failure

236
Q

Which of the following are increased in DIC

Fibrin split products
D-dimer
fibrinogen
Platelets
Hematocrit
A

Fibrin split products and d-dimer are increases

Platelets, fibrinogen and hematocrit are decreased

237
Q

Microcytic anemia with decreased iron, decreased TIBC and normal or increased ferritin

A

Anemia of chronic disease

238
Q

Microcytic anemia with decreased iron, decreased ferritin and increased TIBC

A

Iron deficiency anemia

239
Q

CML features (4)

A

50 y.o with early satiety, splenomegaly and bleeding

t (9;22)

240
Q

At what CD4 count should pneumocystis jiroveci pneumonia prophylaxis be initiated in a HIV + patient?

Mycobacterium avium complex prophylaxis?

A

< 200 cells/mm3
- Give TMP-SMX

<= 50-100 cells/mm for MAC
- Give clarithromycin/ azithromycin

241
Q

Causes of meningitis in neonates

Tx

A

GBS
Ecoli
Listeria

Ampicillin + cefotaxime or gentamicin

242
Q

Causes of meningitis in infants

Tx

A

S pneu
N meningitidis
H influlenza type b

Vancomycin + cefotaxime

243
Q

Patient presents with pruritic papules with regional lymphadenopathy. Evlves into a black eschar after 7-10 days

Tx

A

Cutaneous anthrax

Ciprofloxacian or doxycycline

244
Q

Branching rods in oral infection

A

Actinomyces israelii

245
Q

Weakly gram +

Partially acid fast in lung infection

246
Q

Gardener

A

Sporothrix schenckii

247
Q

Raw pork

Skeletal muscle cysts

A

Trichinella spiralis

248
Q

Sheep herders with liver cysts

A

Echinococcus granulosus

249
Q

Perianal itching

A

Enterobius vermicularis

250
Q

Meningoencephalitis in AIDS patient

A

Cryptococcus neoformans

251
Q

Patient from california or arizona presents with fever, malaise, cough and night sweats

Tx

A

Coccidiodidomycosis

Amphotericin B

252
Q

Endocarditis 3 wks after receiving prosthetic heart valve

A

S aureus

S epidermidis

253
Q

Patient develops endocarditis in a native valve after having dental cleaning

A

S viridans

254
Q

Asthma
Nasal polyps
Eosinophila

A

Eosinophilic granulomatosis iwth polyangiitis

Churg struass syndrome

255
Q

Elevated indirect bilirubin

Hx HIV & Hep C

Low platelets
High reticulocytes
Anemia
Jaundice

What test to go

A

Thrombotic thrombocytopenic purpura

Life threatening

Small vessel thrombi

Autoantibody to ADAMTS13

*Get peripheral blood smear (schistocytes, helmet cells, triangle cells)

Plasma exchange

256
Q

Von Willebrand disease MOA

PTT
PT

A

Impaired platelet endothelial binding

Prolong PTT

PT is normal

257
Q

Abnormal activation of coagulation and fibrinolysis

PT
PTT
Platelets

A

Disseminated intravascular coagulation (DIC)

Thrombocytopenia
Prolonged PT
Prolonged PTT

258
Q

Decreased factor VIII production

Inheritence

A

Hemophilia A

X linked recessive

259
Q

Autoimmune mediated platelet destruction

Symptoms
PT/PTT
Platelets

  • Name
  • Physical exam (4)
  • Lab
A

Immune thrombocytopenia

Easy bleeding
Petechiae
Purpura
Epistaxis

Thrombocytopenia

Normal PT/PTT

260
Q

Microcytic anemia
Normal Iron studies

  • Name
  • Inheritence
  • Dx
A

Hemoglobinopathy

Alpha or beta thalassemia

AR

Get Hemoglobin electorphoresis

261
Q

Seen with Lead toxicity

A

Microcytic anemia

Iron and TIBC are low

262
Q

CLL leukocytosis

A

> 100,000 cells

Lymphadenopathy

263
Q

HTN
AKI

Anemia
Thrombocytopenia
Elevated total bilirubin
Elevated Cr

Difficulty opening mouth
Skin tightening over face, forearms, chest and legs

A

Scleroderma renal crisis

Schistocytes

264
Q

Develops hemolytic anemia (low hemoglobin, reticulocytosis, icterus)

Started taking dapsone

Fatigue
Dark urine

Rash on scalp and elbows

A

G6PD deficiency

Unable to generate sufficient NADPH to counter oxidativeinjury

Dapsone
TMP-SMX
Primaquin
Fava beans

Hyperbilirubinemia
hemoglobinuria

265
Q

Complement activation

A

HUS

Hematuria
Proteinuria

266
Q

Immune complex deposition

A

Membranous glomerulonephritis

267
Q

Interstitial leukocyte infiltration

A

Acute interstitial nephritis

Associated with taking TMP-SMX

Erythrocytes
Leukocytes
White cell casts

Rash
Fever
Peripheral eosinophila

268
Q

1 year ago multiple gun shot wounds to abdomen

Now: 
Fever
confusion
Hypotension
Tachycardia

Dullness to percussion and crackles in lower chest

Gram positive cocci

Due to?

A

Impaired antibody facilitate phagocytosis

No spleen

Gram + cocci
(Strep pneumoniae)

269
Q

Impaired chemotaxis

A

Leukocyte adhesion deficiency

Recurrent bacterial infections of skin and mucosa

270
Q

Impaired oxidative burst

A

Chronic granulomatous disease

Recurrent bacterial and fungal infections

Catalase producing organisms

  • Aspergillus
  • Staph aureus
271
Q

DVT in setting of increased homocysteine levels

A

Give Pyridoxine

Homocysteine is a highly reactive amino acid. increased level leads to venous thrombosis and atherosclerosis

Homocysteine to cysteine is catalyzed by cystathionine beta synthase using cofactor pyridoxine (B6)

272
Q

Vit E

A

Antioxidant

Acts to protect cell membranes from free radical damage

273
Q

Warfarin induced skin necrosis caused by

A

Decreases in protein C

Protein C drop by 50% in first day

II, IX, X decline more slowly

274
Q

Abdominal pain
Dark urine
RUQ tenderness

Anemia
Normal platelets
Elevated bilirubin
Low Haptoglobin

Hepatic vein thrombosis

  • Name
  • MOA
  • Defect
  • Absent
A

Paroxysmal nocturnal hemoglobinuria

Intravascular and extravascular hemolysis

Defect in proteins CD55 and CD59 (lack anchor)

Absent allows complement membrane attack complex to form and result in hemollysis

275
Q

DVT

Right leg swelling

Myalgias
Joint pain
Facial rash by sun exposure

Miscarriages
HTN

Lab finding

A

Prolonged PTT

Antiphospholipid antibody syndrome

276
Q

Jak 2 mutation

A

Polycythemia vera

Increased risk fo thromboembolism

Older individuals

277
Q

Increased central venous pressure

A

Heart failure

278
Q

Anemia of chronic disease MOA

A

Increased inflammatory cytokines (hepcidin)

Inhibition of ferroportin on enterocytes and macrophages

Decreased iron absorption and increased iron sequestration

Reduced circulating iron
Impaired erythropoiesis

279
Q

Stacking of cells like coins

  • Name
  • Symptoms (3)
  • Features (4)
A

Rouleaux formation

Multiple myeloma

WL
Fatigue
Bone pain

Hypercalcemia
noromocytic anemia
Protein gap > 4 (protein/ albumin)

M spike

280
Q

Hypocellular fibrotic bone marrow

A

Myelofibrotic disorder

Fatigue
Anemia
Hepatosplenomegaly

281
Q

Hypoplastic fat filled marrow

A

Aplastic anemia

Pancytopenia (not anemia)

282
Q

Megaloblastic erythroid hyperplasia

A

Megaloblastic anemia

Vit B12
Folate

283
Q

Ring sideroblasts

A

Sideroblastic anemias

Microcytic anemia < 7

284
Q

Cancer related anorexia/ cachexia tx

A

Progesterone analogues

  • Megestrol acetate
  • corticosteroids
285
Q

Morning joint stiffness

Hemoglobin low
Low Serum iron
Low Total iron binding capacity
High ferritin

Tx

A

Anemia of chronic disease

286
Q

Thalassemia iron studies

MCV
IRON
TIBC
Ferritin
Transferrin saturation
A 
MCV low
Iron High
TIBC Low
Ferritin High
Transferrin High
287
Q

Back pain
Renal insufficiency

Granular casts

288
Q

On Enoxaparin and develops low platelet count

At risk for

A

Hepatrin induced thrombocytopenia

IgG autoantibody

Risk Thrombus (arterial and venous)

289
Q

Chest CT angiography vs Compression ultrasound

A

CT angiography: PE

Compression US: DVT

290
Q

65 y.o

Fatigue
Extending bleeding
Bruising

Elevated Lactate dehydrogenase
Anemia
Low platelets
Low Leukocytes

Elevated PT/PTT
Low Fibrinogen

A

Acute myeloid leukemia

Pancytopenia
DIC

Atypical promyelocytes

291
Q

HIV prophylaxis

toxoplasma

CMV

A

Toxoplasma only if CD4 < 100

Never for CMV

292
Q

Chronic Hep C infection can result in

A

Porphyria cutanea tarda

Photosensitive skin with vesicles and bullae on dorsa of hands

293
Q

Grey mucosal patch

Widespread rash

A

Secondary syphilis

294
Q

From mississippi

Cough
Hilar adenopathy
Erythema nodosum

noncaseating granulomas

Dx with sarcoidosis but deteriorates with high-dose corticosteriod therapy

A

Histoplasmosis

Caseating granulomas most common but non-caseating can be found

Histoplasma urinary antigen testing

295
Q

Mexico two weeks ago

4 days fever, double vision, and painful swelling of eyes.

Muscle pain in neck and jaw muscles

One week ago had abdominal pain, n/V, diarrhea

Subungual spinter hemorrhages, periorbital edema, chemosis

Elevated leukocytosis
Elevated creatine kinase

A. Ascariasis
B. Dengue fever
C. Giardiasis
D. Infective endocarditis
E. Trichinellosis
F. Typhoid fever
A

E. Trichinellosis (round worm)

Undercooked meat (pork)

Gastric acid releases larvae (1 wk)

Female worms release larvae (up to 4 weeks later) muscle pain

Eosinophilia

Self limiting
Severe: Mebendazole/ albendazole with corticosteriods

296
Q

Travels’ diarrhea

A

Cryptosporidium parvum
Cyclospora
Giardia

Prolonged profuse watery diarrhea

297
Q

Foul smelling sputum

Recent endoscopy

Right upper lobe infiltrate not getting better with azithromycin what to add

A. Ampicillin and gentamicin
B. Ciprofloxacin
C. Clindamycin
D. Doxycycline
E. TMP-SMX
A

C. Clindamycin

Aspiration pneumonia

Anaerobic organisms

298
Q

Ciprofloxacin coverage

A

Gram negative coverage

299
Q

Painful swallowing

Not improving with fluconazole

Endoscopy reveals multiple large, linear ulcers in distal esophagus

Abnormal mucosa shows tissue destruction and presence of intranuclear and intracytoplasmic inclusions

A. Acyclovir
B. Ganciclovir
C. Pentamidine
D. Prednisone
E. Voriconazole
A

B. Ganciclovir

CMV esophagitis

300
Q

Watery diarrhea in HIV patient

< 180/ mm3
< 100
< 50 High fever
< 50 Frequent small volume diarrhea, abd pain

A

< 180 severe watery diarrhea, W, low grade fever= Cryptosporidium

< 100 watery diarrhea, abdominal pain= Microsporidium

<50 High fever, watery diarrhea= MAC

< 50 Frequent small volume diarrhea, abdominal pain= Cytomegalovirus

301
Q

Immunocompromised

Lung nodules
Brain abscess

Gram + partially acid fast filamentous branching rods

  • Name
  • Tx
A

Nocardia

TMP-SMX

302
Q

Seen with Mono (7)

A

Fever
Tonsillitis

Posterior or diffuse cervical lymphadenopathy

  • Hepatosplenomegaly
  • Anemia
  • Elevated bilirubin
  • Elevated LFTS
303
Q

Tremor Nephrotoxicity

A. Antithymocyte globulin
B. Azathioprine
C. Mycophenolate
D. Prednisone
E. Tacrolimus
A

E. Tacrolimus

Calcineurin inhibitors

  • Tacrolimus
  • Cyclosporine
304
Q

Azathioprine SE

A

Hepatotoxicity

Bone marrow suppression

305
Q

Mycophenolate SE

A

GI disturbances

Bone marrow suppression

306
Q

CD4 = 45

What treatment

A

TMP-SMX

[ MAC for azithromycin not given anymore]

[Fluconazole not given prophylaxis due to cost and resistance]

[Acyclovir/ valaclovir prophylaxis for HSV not for primary prophylaxis]

307
Q

Low grade fever
Night sweats
Cough
WL

Wisconsin

Lytic bone lesions in ribs

Left upper lobe consolidation

A. Disseminated TB
B. Sarcoidosis
C. Metastatic osteosarcoma
D. Blastomycosis
E. Coccidioidomycosis
A

D. Blastomycosis

308
Q

31 y.o Most common cause of right sided testicular pain

Testicular swelling and fever

A

Chlamydia trachomatis

> 35 then E.coli

< 35 Chlaymydai

If HIV then Ureaplasma urealyticum

309
Q

67 y.o several swollen LN in axilla, non painful, mobile and in cervical

No fever, chills or WL

156/92

Spleen tip palpable

Low Hemoglobin
Low MCV
90,000 platelets
56,000 leukocytes

Benefit from what therapy?

A. BCR-ABL tyrosine kinase
B. CD20 cell surface antigen
C. Epidermal growth factor receptor
D. Interleukin 1 receptor
E. Tumor necrosis factor alpha
A

B. CD20 cell surface antigen

CLL

Rituximab (monoclonal ab against CD20)

310
Q

BCR-ABL tyrosine kinase

A

Imatinib inhibits this

Tx CML

311
Q

Sickle cell patient with decreased appetite and sleepiness

Scattered petechiae on legs

Fever

Pathogen?

A

Streptococcus pneumoniae

[Staph and pseudomonas only in osteomyelitis]

312
Q

Fatigue
WL

Normocytic anemia
Elevated BUN
Elevated Creatinine
Elevated Calcium

Common seen with this disease

A

Multiple myeloma

Renal insufficiency

Monoclonal light chains clog the renal tubules, causing intratubular cast formation and toxicity

313
Q

30 month old with sore throat and decreased appetite.
Cries when swallowing

Several small vesicles on the uvela, soft palate and tonsillar pillars.

Erytehmatous tonsils no exudates

No rashes

A

Herpangina

Infection caused by Coxsackie A virus

Tx Reassurance and supportive care

314
Q

66 y.o with progressive fatigue and decreased exercise tolerance. SOB doing house hold chores. Hx GERD and BPH. Chest pain a year ago with negative stress test. Conjunctiva are pale.

Low Hemoglobin
High MCV
Low Platelets
Low Leukocytes

Ovalomacrocytosis and neutrophils with reduced segmentation.

Normal B12, electrolytes and renal function

A. Anti-intrinsic factor antibody
B. Blood lead level
C. Bone marrow biopsy
D. Erythropoietin level
E. Methylmalonic acid level
F. Serum protein electrophoresis
A

C. Bone marrow biopsy

Myelodysplastic syndrome

Cytopenias

  • Anemia
  • Leukopenia
  • Thrombocytopenia

Dysplastic red and white blood cells

315
Q

24 y.o routine check up

Spleen tip palpated

Blood smear shows RBC without white center

At risk for
A. Acute leukemia
B. Atrophic gastritis
C. Gallstones
D. OSteoporotic fractures
E. Renal insufficiency
F. Venous thromboembolism
A

C. Gallstones
[From hemolytic anemia, pigmented]

Spherocytes

Hereditary spherocytosis

316
Q

How to tell hemolytic anemia

A

Schistocytes

Increased LDH (Lactate dehydrogenase) 
- Means tissue damage
317
Q

Palms and soles rash

A

CARS

Coxsackie A virus
Rocky mountain spotted fever
Syphilis

Level 2 Boards (14 decks)

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