Heme/Onc, MSK (54)

Question 1

2yo with Sickle cell = ___vaccine

65yo w/ splenectomy w/o vaccination hx

Answer 1

pneumococcal polysaccharide (PPSV-23)

Hib - if uncertain or never received
Meningococcal polysaccharide - >55 Meningococcal conjugate (MCV4) - 55 and younger
Pneumococcal - PCV13 if immunization status unknown, otherwise polysaccharide

Question 2

Name three encapsulated organisms

Answer 2

strep pneumo
N. meningitidis
H. influenza

Question 3

reactive arthritis pathogen

Answer 3

chlamydia trachomatis

Question 4

Pt started an anticoagulant and develops an area of edematous, erythematous flush with developing petechiae that progress to hemorrhagic bullae and quickly to a necrotic eschar.

Answer 4

warfarin skin necrosis

Question 5

Beta-blockers:

use

A through M - MOA

N through Z - MOA

Answer 5

use - control HR in sinus tachy and afib

A through M = beta-1 selective

N through Z = nonselective antagonists

Question 6

first line tx for OA

Answer 6

acetaminophen

then NSAIDs, then injection, then surgery

Question 7

define vWD

Answer 7

MC inherited bleeding disorder

impaired platelet function and hemostasis

defect in F8-related ag. both clot formation and coagulation cascade impaired

Question 8

define F5Leiden

Answer 8

MC inherited thrombophilia in Caucasians.

presents as venous thormboembolism

Question 9

Best way to reduce dental caries

Answer 9

fuoridation

Question 10

MC cancer of oral cavity and associated risk factor

Answer 10

SCCa

risk factor: smoking hx

Question 11

test name and what it tests: performed by flexing knee and placing hand over joint line (inferior to patella) medially. Hold heel w/ other hand and rotate tibia externally while placing valgus stress on it.

Positive if pop, click, pain

Answer 11

McMurray test

Medial meniscus tear

Question 12

adolescent athlete with dill, aching knee pain and point tenderness at the tibial tuberosity.

Answer 12

Osgood-Schlatter disease

Question 13

a) well appearing preschool aged child with signs of mucocutaneous bleeding and isolated thrombocytopenia (platelet reduction). usually resolves in 3-6mo.

OR

b) chronic in women 20-40yo

Answer 13

Immune thrombocytopenia (idiopathic thormbocytopenic purpura)

Question 14

Kid

Answer 14

HUS

Question 15

FAT RN: Fever, Anemia (HA), Thrombocytopenia, Renal failure, Neuro change.

Schistocytes, abnormal RFTs, thrombocytopenia

Answer 15

TTP - thrombotic thrombocytopenic purpura

Question 16

cobalamin deficiency causes…

Answer 16

macrocytic anemia and neuro (vit B12)

Question 17

crescent sign - sunchondral crescent shaped radiolucent area representing area of necrotic bone. wt bearing groin pain.

risk factors: chronic CS use and smoking

Answer 17

avascular necrosis (osteonecrosis)

Question 18

neoplastic clonal proliferation of plasma cells on marrow. produces IgG or IgA. Median age is 65y. Anemia, leukoplakia, thrombocytopenia. Monoclonal spike on protein electrophoresis.

CRAB

Answer 18

MM

hyperCalcemia
Renal failure (bence jones proteins - IgG light chains in urine)
Anemia
Bone lesions

Question 19

other than MM, what also has bence jones proteins, but malignant proliferation of IgM. no lytic bone lesions. hyperviscosity of blood

Answer 19

waldenstrom’s macroglobulinemia

Question 20

conservative initial management of carpal tunnel syndrome

Answer 20

neutral wrist splinting

Question 21

what is a reticulocyte and what pathology is it increased

Answer 21

an immature cell line of erythrocyte lineage.

sickle cell.

Question 22

pt with RA wol dmost likely have what type of anemia if they had one?

Answer 22

microcytic dt anemia of chronic disease

Question 23

Anemia of chronic disease has what expected lab findings:
MCV
Fe
Ferritin
TIBC

Answer 23

MCV - normo that COT to micro
Fe - low
Ferritin - high
TIBC - low/NORMAL

Question 24

Define:
MCV - micro
Fe - low
Ferritin - low
TIBC - high

Answer 24

iron deficiency anemia

low iron in the cells (low ferritin) and the cell wants more (high TIBC)

Question 25

anemia, leukocytosis, thrombocytopenia, basophilia, ch(9;22)t, B-sx and bleeding/petechiae/eccymosis/bone pain

Answer 25

CML

Question 26

why do diabetics get anemia?

Answer 26

bc kidneys responsible for 90% of EPO production. renal fxn decreases, reduced EPO = decr erythrocyte precursors.

Question 27

epitaxis, telangiectasia, visceral lesions, first degree releative w/ sam sx/dx

Answer 27

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

Question 28

Sickle cell anemia pt with acute drop in Hb and | -retic count

Answer 28

-retic count

Question 29

heinz bodies (oxidized Hb manifesting as small round unclusions w/in RBCs) or bite cells (semicircular chunks)

Answer 29

G6PD deficiency (think x-linked, antimalarials or sulfa or fava or bitter melon or DKA)

Question 30

When is radiograph of foot or ankle injury appropriate?

Answer 30

Ottowa foot and ankle rules: cannot walk 4 steps, tenderness of base of 5th metatarsal (Jones fracture), tenderness over navicular boen, tenderness over medial or lateral malleolus, tenderness along distal 6cm of tibia or fibula

Question 31

Most likely dx: pain between toes in interdigital space, numbness, paresthesias radiating to toes proximal to pain. Tight shoe wear, relief after shoe removal. possible painful click

Answer 31

morton's neuroma

Question 32

CMP PIP DIP localized pain. Rheumatologic dz in FHx. PMH of RF. worse w/ repetitive use. XR: joint space loss, sunchondral bony sclerosis and cyst formation PE: pain when rotating thumb and applying downward force toward wrist

Answer 32

Osteoarthritis

Question 33

PIP MCP affected. joint space erode w/ destruction of joints.

Answer 33

RA

Question 34

first step in evaluation of IDA

Answer 34

upper endoscopy and colonoscopy

Question 35

tx of hereditary spherocytosis tx of G6PD deficiency tx of Sickle cell disease repeat sequestration crisis

Answer 35

``` HS = splenectomy G6PD = avoid precipitants w/ oxidative potential SCD = splenectomy ```

Question 36

Falling on flexed wrist - - describe fx and name

Answer 36

Smith fracture of distal radius with ventral (palmar) displacement of distal protion

Question 37

FOOSH - describe fx and name

Answer 37

colles fracture fracture of distal radius with associated dorsal displacement

Question 38

anti-jo1-ab anti-mi2-ab

Answer 38

anti-jo1-ab = polymyositis anti-mi2-ab = dermatomyositis

Question 39

COL5A1 and COL5A2

Answer 39

ehlers danlos syndrome 1. skin hyperextensibility 2. joint laxity 3. widened, atrophic scars

Question 40

FBN1

Answer 40

marfan

Question 41

b/l proximal mm aches (hips and shoulders), morning stiffness ofor >1hr, basence of joint or other mm involvement. Giant cell arteritis associated with it.

Answer 41

Polymyalgia rheumatica

Question 42

tx of Polymyalgia rheumatica

Answer 42

CS

Question 43

HbA2 level elevation. target or tear drop cell on PBS, microcytic anemia

Answer 43

beta thalassemia

Question 44

basophilic stippling

Answer 44

lead poisoning

Question 45

ortolani and barlow test infant dysplasia of hip - next step?

Answer 45

refer to ortho

Question 46

MCC of osteomyelitis XR description

Answer 46

contiguous spread of infection from closely related soft tissues Staph aureus MCC XR: lytic bone lesion

Question 47

anemia with elevated reticulocyte count, positive direct antiglobulin (Coomb's) test, spherocytes on PBS

Answer 47

autoimmune HA (AIHA) - autoab attach to erythrocytes leading to premature destruction

Question 48

hallmark abnormal lab in Paget dz of bone

Answer 48

alk phos increased

Question 49

UMN (myelopathy) and LMN (radiculopathy) in UE and LE siggest widespread changes of spine

Answer 49

- cervical spondylosis. dx w/ MRI