Heme/Onc, MSK (54) Flashcards
2yo with Sickle cell = ___vaccine
65yo w/ splenectomy w/o vaccination hx
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
Name three encapsulated organisms
strep pneumo
N. meningitidis
H. influenza
reactive arthritis pathogen
chlamydia trachomatis
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.
warfarin skin necrosis
Beta-blockers:
use
A through M - MOA
N through Z - MOA
use - control HR in sinus tachy and afib
A through M = beta-1 selective
N through Z = nonselective antagonists
first line tx for OA
acetaminophen
then NSAIDs, then injection, then surgery
define vWD
MC inherited bleeding disorder
impaired platelet function and hemostasis
defect in F8-related ag. both clot formation and coagulation cascade impaired
define F5Leiden
MC inherited thrombophilia in Caucasians.
presents as venous thormboembolism
Best way to reduce dental caries
fuoridation
MC cancer of oral cavity and associated risk factor
SCCa
risk factor: smoking hx
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
McMurray test
Medial meniscus tear
adolescent athlete with dill, aching knee pain and point tenderness at the tibial tuberosity.
Osgood-Schlatter disease
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
Immune thrombocytopenia (idiopathic thormbocytopenic purpura)
Kid
HUS
FAT RN: Fever, Anemia (HA), Thrombocytopenia, Renal failure, Neuro change.
Schistocytes, abnormal RFTs, thrombocytopenia
TTP - thrombotic thrombocytopenic purpura
cobalamin deficiency causes…
macrocytic anemia and neuro (vit B12)
crescent sign - sunchondral crescent shaped radiolucent area representing area of necrotic bone. wt bearing groin pain.
risk factors: chronic CS use and smoking
avascular necrosis (osteonecrosis)
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
MM
hyperCalcemia
Renal failure (bence jones proteins - IgG light chains in urine)
Anemia
Bone lesions
other than MM, what also has bence jones proteins, but malignant proliferation of IgM. no lytic bone lesions. hyperviscosity of blood
waldenstrom’s macroglobulinemia
conservative initial management of carpal tunnel syndrome
neutral wrist splinting
what is a reticulocyte and what pathology is it increased
an immature cell line of erythrocyte lineage.
sickle cell.
pt with RA wol dmost likely have what type of anemia if they had one?
microcytic dt anemia of chronic disease
Anemia of chronic disease has what expected lab findings: MCV Fe Ferritin TIBC
MCV - normo that COT to micro
Fe - low
Ferritin - high
TIBC - low/NORMAL
Define: MCV - micro Fe - low Ferritin - low TIBC - high
iron deficiency anemia
low iron in the cells (low ferritin) and the cell wants more (high TIBC)
anemia, leukocytosis, thrombocytopenia, basophilia, ch(9;22)t, B-sx and bleeding/petechiae/eccymosis/bone pain
CML
why do diabetics get anemia?
bc kidneys responsible for 90% of EPO production. renal fxn decreases, reduced EPO = decr erythrocyte precursors.
epitaxis, telangiectasia, visceral lesions, first degree releative w/ sam sx/dx
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
Sickle cell anemia pt with acute drop in Hb and
-retic count
-retic count
heinz bodies (oxidized Hb manifesting as small round unclusions w/in RBCs) or bite cells (semicircular chunks)
G6PD deficiency (think x-linked, antimalarials or sulfa or fava or bitter melon or DKA)
When is radiograph of foot or ankle injury appropriate?
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
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
morton’s neuroma
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
Osteoarthritis
PIP MCP affected. joint space erode w/ destruction of joints.
RA
first step in evaluation of IDA
upper endoscopy and colonoscopy
tx of hereditary spherocytosis
tx of G6PD deficiency
tx of Sickle cell disease repeat sequestration crisis
HS = splenectomy G6PD = avoid precipitants w/ oxidative potential SCD = splenectomy
Falling on flexed wrist - - describe fx and name
Smith
fracture of distal radius with ventral (palmar) displacement of distal protion
FOOSH - describe fx and name
colles fracture
fracture of distal radius with associated dorsal displacement
anti-jo1-ab
anti-mi2-ab
anti-jo1-ab = polymyositis
anti-mi2-ab = dermatomyositis
COL5A1 and COL5A2
ehlers danlos syndrome
- skin hyperextensibility
- joint laxity
- widened, atrophic scars
FBN1
marfan
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.
Polymyalgia rheumatica
tx of Polymyalgia rheumatica
CS
HbA2 level elevation. target or tear drop cell on PBS, microcytic anemia
beta thalassemia
basophilic stippling
lead poisoning
ortolani and barlow test
infant dysplasia of hip - next step?
refer to ortho
MCC of osteomyelitis
XR description
contiguous spread of infection from closely related soft tissues
Staph aureus MCC
XR: lytic bone lesion
anemia with elevated reticulocyte count, positive direct antiglobulin (Coomb’s) test, spherocytes on PBS
autoimmune HA (AIHA) - autoab attach to erythrocytes leading to premature destruction
hallmark abnormal lab in Paget dz of bone
alk phos increased
UMN (myelopathy) and LMN (radiculopathy) in UE and LE siggest widespread changes of spine
- cervical spondylosis.
dx w/ MRI
