HY Review #1 Part 2 Flashcards
Blunt flank or kidney trauma, NBSIM?
1st obtain a(n) _____
if (+) _____
if (–) _____
1st → UA
If (+) blood → CT A/P with contrast
If (no) blood → send home
Pain, redness, and swelling behind the L ear.
dx/NBSIM/tx?
Acute Mastoiditis
• CT head/temporal bone
CTX (or Levofloxacin)
─
infection from middle ear to mastoid air cells
Recurrent episodes of acute otitis media.
PE reveals non-specific debris behind the tympanic membrane.
(+) chronic, foul smelling discharge from the affected ear.
Dx:
NBSIM:
Tx:
Cx?
Cholesteatoma (keratin ball)
CT Head
Surgery
─
bc it damages ossicles → conductive hearing loss
35 M with hx of NF2 presents with a 3 month hx of of progressively worsening morning headaches.
Head CT shows a calcified mass with an enhancing linear projection connected to the dura.
Dx?
FYI: NF2 → (vestibular schwannoma + early onset cataracts)
Meningioma
(dural tail described in vignette)
(+ Psammoma bodies → concentric, intracellular calcium swirls)
Neuro sxs based on structures compressed
32F smoker with chest pain worse at night.
Coronary angiography done for past for ST elevations showed <30% occlusion of coronary vessels.
Dx/Tx?
Variant Angina (Prinzemetal)
Smoking cessation+ Any CCB
Pt presents after having a TIA
on NBME, what treatment is indicated if,
◆ Pt has h/o A-Fib or a recent MI?
◆ Pt has Atherosclerotic risk factors (3)?
Cardioembolic → Warfarin (anti-Coagulant)
Atherosclerotic → Aspirin (anti-Platelet)
Pt with mechanical or bioprosthetic valves in place presents with TIA or Stroke.
Aside from NC-CT Head what other diagnostic work-up is appropriate?
Echocardiography (TEE)
To evaluate for Prosthetic valve thrombosis (PVT)
Down syndrome associated oncologic malignancy
ALL
(children)
WBC of 400 in a 23F on antithyroid therapy.
Most likely cause?
Agranulocytosis
s/t PTU/MMZ
Management of post op hyperglycemia.
Basal Bolus insulin regimen
──
◆Basal → long acting (Glargine or Detemir)
◆Bolus w/ meals → rapid-acting (Lispro, Aspart, or Glulycine)
BRF for Multifocal Atrial Tachycardia
Smoking
Tx for post MI pericarditis?
Aspirin only
Loud diastolic heart sound (after S2, before S1)
Neck veins distend more on inspiration (Kussmaul Sign)
Prominent JVP waves on inspiration
Dx/Tx?
Kussmaul Sign = Constrictive Pericarditis (END OF STORY)
Pericardiectomy
Calcified pericardium
12F with Migratory Joint pain and
painless nodules under the skin
↑ ESR/CRP
URI 12 months ago.
Dx/Tx?
Rheumatic Fever
NSAIDs + Penicillin
─
Group A Strept infection
(URI + Migratory joint pain = rheumatic fever)
DOC in chronic SLE mgt (+ preventive screening).
Hydroxychloroquine
Annual Eye exams bc retinal damage from the med
Arthritis, fever, and pleuritic chest pain after starting hydralazine/isoniazid
Dx?
Drug-Induced Lupus (anti-Histone antibodies)
Drug-Induced Lupus
(anti-Histone antibodies)
commonly involved drugs (4)
Hydralazine
Isoniazid
Procainamide
TMP-SMX
(other causes: sulfonamides, Etanercept, Isoniazid, Phenytoin)
young person having trouble swallowing solids and liquids
Dx/ NBSIM (3 steps)/ Definitive tx?
Achalasia
NBSIM: Barium Swallow (BME)
THEN
Manometry → EGD + Biopsy (to r/o cancer)
Definitive tx: Myotomy
Acute onset of severe first MTP tenderness (toe), redness, and warmth in a patient being treated for CML
Dx:
Drug triggers:
Antihypertensive of choice:
Acute tx (3 step up tx)
Acute tx with a Cr of 2.5:
Chronic tx:
Gout (s/t Tumor Lysis Syndrome)
─
Drug triggers: loops & thiazides
─
Anti- HTN: Losartan (ARB)
─
Acute tx: NSAID → Steroid → Colchicine
Naproxen, Indomethacin, ibuprofen
PO Prednisone
Colchicine c/i if gastric ulcers
─
Acute tx with a Cr of 2.5: Steroid
─
Chronic tx: Allopurinol or Febuxostat or Rasburicase
30F Always tired, hurts everywhere, multiple points of tenderness around the body. Normal ESR & CK.
dx/tx?
Fibromyalgia
Pre-gabalin, Gabapentin
Duloxetine/Milnacipram (SNRIs)
TCAs
23M presents in the summer with a 1 year history of hematuria that is more pronounced when he wakes up in the morning.
He occasionally has severe penile and ear pain that responds poorly to naproxen.
Flow cytometry reveals red cells that are negative for GPI anchored proteins.
CBC: ↓↓ Hgb, ↓ PLTs, ↓ WBCs
↑↑↑ Reticulocytosis
─
In addition to Eculizumab therapy, what is the
NBSIM?
Diagnosis? Mutation? Complications?
PNH (paroxysymal Nocturnal Hemoglobinuria)
Vaccination against Neisseria Meningitidis.
Cx: Recurrent infections with Neisseria
─ ─ ─
s/t sporadic mutation in PIG-A gene (anogram for GPI-Anchor).
Lack GPI anchors (CD59, GP1) so MAC kills RBCs
Person with UNILATERAL HA + IPSILATERAL eye-findings
dx/Acute & Chronic tx?
Cluster Headache
Acute TX: O2 therapy
Chronic Tx: VERAPAMIL or DILTIAZEM (for ppx)
How is severe ophthalmopathy s/t hyperthyroidism treated?
Steroids
─
Fibroblast have TSH receptors creating glycosaminoglycans in the eyes/body
Hashimotos (Hypothyroidism)
anti-__& anti-__
antibodies
Anti-TPO
Anti-Tgb
(thyroglobulin)
immunocompromised pt with malaise + dyspnea
CXR shows diffuse, ground glass , interstitial infiltrates.
PaO2 is 57 (hypoxic)
Dx/Tx?
Pneumocystis Jirovecii (Interstitial PNA)
TMP-SMX + STEROIDS
(bc PaO2 is less than 70 they NEED a steroid for inflammation)
In an immunocompromised individual
(HIV, TNF inhibitor, immunosuppression, etc)
when are steroids indicated for respiratory distress?
when PaO2 is less than 70
they NEED a steroid for inflammation
Female about to beginning valproic acid therapy, what is the next best step in the management of this patient?
Get Urine pregnancy test
Valproate is a Teratogen
Dyspnea after surgery + normal PCWP + High CVP
Diagnosis?
ARDS (Increased permeability of pulmonary vasculature)
PCWP is wnl (so it’s non-cariogenic)
CVP: 3–6 mm Hg
PCWP: 4-15 mm Hg
Pleural effusions caused by anything that increases hydrostatic pressure or causes loss of protein in urine
(CHF, Cirrhosis, Nephrotic syndrome)
Transudative effusion
(Easier to remember than Light’s criteria)
Lights criteria is 3 rules you only need to satisfy 2 to answer NBME Qs.
Pleural protein/Serum Protein < __
&
Pleural LDH/serum LDH <__
─ ─ ─
If both rules are satisfied it is a _____ effusion
If one rule is not met it is _____ effusion
• Protein < 0.5
• LDH < 0.6
Both rules met → transudative effusion
One rule broken → not transudative (exudative)
FYI: Pleural LDH < 187 (aka < 2/3 upper limit of normal for serum LDH which is ~280) is the 3rd rule
Cloudy or straw-colored pleural fluid suggests ___ effusion
exudative effusion
(protein rich)
Pleural Glucose that is 60 or more mg/dL suggests ___ effusion
transudative effusion
55M with trouble climbing stairs & shampooing his hair.
Has fallen multiple times & has trouble playing the piano.
PE: Asymmetric weakness Hands, UE, & LE
Creatine kinase is 7x the upper limit of normal.
Dx?
Inclusion body myositis
Proximal & Distal muscle weakness myopathy
3 mo with Fever + periumbilical cellulitis
Umbilical stump was surgically removed 7 days prior b/c of delayed umbilical cord separation.
WBCs >30k
Dx/Cx?
Defect?
Leukocyte adhesion deficiency
Recurrent Dental Infections
─
Integrin defect:
• Siadyl Lewis X
•CD18
• LFA-1
MAC1
2 NBME diseases associated with recurrent dental infections: (HY)
Leukocyte Adhesion Deficiency
Chediak-Higashi
Recurrent infections, Albino (silvery hair/ fair skin and frequently has sunburns), GIANT granules in WBC,
(all you need to know) Diagnosis?
MCC Infection:
Chediak-Higashi
Staph. A
Lysosomal transport defect
(Chediaki Highway defect)
Severe abdominal pain and lip edema after initiating antihypertensive therapy in a 25F.
She has had similar episodes in the past. Father died of respiratory failure & had similar sxs.
Dx/Contraindications?
Deficiency?
Hereditary angioedema
Avoid: ACE-I
s/t C1 esterase inhibitor deficiency (AD)
Makes too much Bradykinin (adverse drug rxn)
Pt has recurrent episodes of meningococcal meningitis/ Strept PNA infections.
Dx:?
C5-C9 terminal complement defect
FYI (Drug): Eculizumab (inhibits C5 protein) can mimic this disorder
7 mo boy has no thymic shadow on a newborn CXR, his initial postpartum period was complicated by multiple seizures and runs of VTach that required Ca repletion.
Dx/Tx?
CATCH 22 →
Digeorge (Chrm 22q11 disorder)
Tx: IVIg & BM transplant + ABs ppx
CATCH 22 → Cardiac problems, Abnormal face, Thymic aplasia, Cleft palate, Hypocalcemia, Chrm 22.
─ ─
3rd & 4th pharyngeal pouches do not form
→ No parathyroid glands = ↓ PTH & ↓ Ca = Hypocalcemic seizures & V-tach
→ No thymus = recurrent infections
1 mo with Failure to Thrive + Recurrent viral/fungal (Oral Thrush) & bacterial infections since birth
CXR: absent thymic shadow
Dx:
Temporary & Definitive Tx:
Deficiency:
SCID
Temp tx: IvIg
Definitive tx: Bone Marrow Transplant
Adenosine deaminase deficiency (AR)
6 mo boy with recurrent bacterial infections (pneumonia, otitis media)
and tonsillar hypoplasia
All immunoglobulins are decreased
Dx/Tx?
Brutons Agammaglobinemia (XLR)
Tx: IvIg
Brutons Agammaglobinemia (XLR)
Presents at 3-6m when ____ levels fall.
Mutation?
maternal IgG
BTK (B-cell Tyrosine Kinase) defect
Hypoplastic Tonsils
22 yo Caucasian F presents to the ED with a 3 day h/o productive cough, SOB, and high fevers.
Hx of recurrent infections (bacterial PNAs) & Celiac’s
Reduced levels of IgG, IgA, IgM levels
Dx/Tx?
Most important complications of this disorder (2)?
CVID (recurrent infections in young adult/teens)
Tx: IvIg
Cx: Auto-immune diseases > Lymphoma
Recurrent P. Jirovecii infections in a 7 mo boy with
reduced levels of all immunoglobulins
Except IgM
Dx/Tx? Deficiency?
Hyper IgM syndrome (XLR)
Tx: IvIg
CD40-Ligand deficiency
Neonate with low IgG, IgA, IgM levels →
Infant (3m+) with low IgG, IgA, IgM levels →
Young adult with low IgG, IgA, IgM levels →
Infant with low IgG, IgA, but not IgM →
SCID
Brutons Agammaglobinemia (XLR)
CVID
Hyper IgM Syndrome (XLR)
Child with Recurrent infections with encapsulated organisms (otitis media)
Purpura/Petechiae/ ↓ PLTs
Eczema (skin rash)
Dx/Tx?
Wiskott-Aldrich syndrome (XLR)
IvIg
Recurrent pyogenic infections +Peripheral neuropathy + Albinism
Peripheral smear shows giant cytoplasmic granules in granulocytes
dx/tx?
Chediak-Higashi syndrome
Bone Marrow Transplant
microtubule polymerization dysfunction
Child with Recurrent, severe infections with catalase-positive organisms
(S. aureus, Nocardia spp., E. coli, Candida, Klebsiella, Pseudomonas, Aspergillus, Serratia)
Lymphadenopathy
Granulomas/Abscesses of the skin
High levels of Immunoglobulins
dx/tx?
Chronic granulomatous disease (XLR)
IFN-γ therapy
─
Life-long ppx: TMP-SMX
BM Transplant
Infant/Child with Recurrent nonsuppurative bacterial infections (skin and mucosal infections)
Delayed separation of the umbilical cord (> 30 days postpartum)
Marked Leukocytosis
Dx?
Leukocyte adhesion deficiency type 1 (LAD1)
R knee pain that is worse with passive extension of the knee.
The knee is swollen and warm with overlying erythema.
Dx:
Dx testing:
Tx:
Septic Arthritis
Arthrocentisis
Vancomycin (MRSA is mcc)
Sexually active young F with skin petechiae + R knee pain (swollen and red) Negative gram stain of fluid.
Dx?
Nisseria Gonnorrhea
Electromyography (EMG) diagnosis associated with
low amplitude, short duration, polyphasic motor unit potentials:
Myopathy
EMG diagnosis with fibrillation potentials
ALS
Proximal shoulder/hip weakness + nl/slightly ↑ CK
EMG is usually normal.
In a 22F on chronic therapy for severe, persistent asthma.
Steroid Myopathy
s/t muscle breakdown from Prednisone
(can also be s/t hypercortisolism)
45 yo M with a history of ulcerative colitis presents with a 6 month history of pruritus and worsening jaundice.
dx/tx
Primary Sclerosing Cholangitis
(assoc with IBD/Auto-immune dz)
Liver Transplant
Primary Sclerosing Cholangitis
ANA association
U/S findings (HY)
P-ANCA
INTRA & EXTRA HEPATIC ducts are both affected
45F with a 6 month history of intense pruritus. CMP is notable for conjugated hyperbilirubinemia.
dx/tx?
Primary Biliary Colangitis
Ursodiol (Ursodeoxycholic Acid) → transplant liver
Primary Biliary Colangitis
ANA association
U/S findings (HY)
anti-mitochondrial antibodies
Only the INTRA HEPATIC bile ducts are affected
5 yo F presents with a 6 week history of weight loss and fever. CBC is notable for pancytopenia.
Cytologic studies reveal TDT (+)ve cells.
PE is notable for diffuse cervical lymphadenopathy
Dx?
Child + Lymphoma = ALL
ALL → Down Syndrome
ALL & CLL → Lymphadenopathy
CML & CLL → Lekocytosis
AML → ____ (No lymphadenopathy, No leukocytosis, No splenomegaly)
DIC
55 yo M is on chemotherapy for a hematologic malignancy. Plt count is 40K Low, D-dimers are elevated, he is bleeding from every IV Site
dx/tx?
AML = middle age + lymphoma + DIC
All Trans Retinoic Acid
AML translocation
Finding on blood smear?
15:17 Translocation → Auer Rod on smear triggers coagulation cascade
CML translocation
9:22 Philadelphia Chromosome → BCR-ABL (Imatinib/Disatinib)
On USMLE:
_____: Marked leukocytosis OR normal WBC count + (↓ Hgb & ↓ PLTs)
_____: Normal CBC + B-sxs + Lympadenopathy
Leukemia
Lymphoma
65M with pancytopenia. A peripheral smear reveals teardrop shaped RBCs
dx?
primary myelofibrosis
(Dacrocyte = tear drop) → s/t collagenous bone marrow (Dry Tap)
45 yo Caucasian F presenting with worsening epigastric pain and vomiting. She was diagnosed with H.Pylori gastritis 3 mo ago and completed triple therapy.
EGD with this admission is notable for persistent gastric ulcers and a large posterior antral ulcer with raised edges.
dx/Dxt/tx?
Dx: Maltoma aka MALT-Lymphoma
(gastric tumor s/t H. Pylori infection)
Dxt: EGD + Biopsy (Germinal Centers)
Tx: H. Pylori eradication therapy
Test of cure: Urea Breath test
Eosinophilia + wrist or foot drop
dx/tx?
─
± Heart problems, Asthma
Churge Strauss (Eosinophilic GPA)
Steroids + Cyclophosphamide
P-Anca + MPO Abs
dx?
Churge Strauss (Eosinophilic GPA)
Steroids + Cyclophosphamide
C-Anca + against Proteinase 3 (anti PR3)
dx/tx?
Wegener’s (GPA)
tx: Steroids + Cyclophosphamide
Upper respiratory problems (Nose/throat/eye)
Lung problems
Eye problems (Conjuctivitis)
and Kidney dz RPGN (nephritis)
dx/tx?
Wegener’s (GPA)
Steroids + Cyclophosphamide
Middle age woman + Abdominal pain + Neuropathy (burning/ tingling of extremity) → segmental aneurysm of arteries (String of beads) on Angiography
dx/tx?
HY association?
Polyarteritis Nodosum (PAN)
Antivirals (if s/t HBV) or Steroids
HY association → HBV infection
Asian F + absent pulses =
dx/dxt/tx(2)?
Takayasu arteritis
MR Angiography
High dose Glucocorticoid
+ MTX
Palpable Crepitus of skin lesion
Dx/Bug?
Nec. Fasciitis
C. Perfringes
(Gas Gangrene)
65F with Fever + L thigh is swollen and exquisitely tender muscle.
Exam notable for red and purple splotches on the L thigh.
Disproportionate level of pain ± CK high
Dx/Tx?
Bug pattern:
Necrotizing Fasciitis (aka myonecrosis)
(Old + Fever + Muscle pain + Purple/Red lesions)
───
Debride (surgery) + IV Antibiotics (Clindamycin)
───
Polymicrobial (Areobes/ Anaerobes)
Skin complication associated with SGLT-2 Inhibitors?
Forneir’s gangrene
→ Nec fasciitis in ass/groin
It ↑ urinary glucose excretion hence making the perineum a warm, sugary place bacteria will thrive in.
66 F presents with Right shoulder pain for the past 1 week.
+Pain over L shin.
PE is notable for a palpable “step-off” on the left shoulder.
Vitals wnl. Labs show
↓ Hb, Hct, PLTs
↑ Creatinine, Calcium
Dx/NBSIM/Tx?
Multiple Myeloma
Spep/Upep
Bortezomib
───
> 60 OLD + ↑ Calcium High + Renal problems + Anemia + Bone pain = CRAB symptoms = MM)
SPEP → Raloux formation (RBCs stacked)
Tx: proteasome inhibitor
65M
40 year smoking hx
CXR: spiculated cavitary lesion in the L upper lung lobe. Bronchoscopy + biopsy: Dysplastic, undifferentiated, (+) keratin cells
CT A/P & Head + PET imaging is negative
Dx/NBSIM?
Squamous cell lung cancer → Resection
get Preoperative PFTs
FEV1> 1L before surgical lung resection
───
NBME Tip: Before cutting out a piece of their shitty lungs make sure FEV1 >1L
Obese patient + snoring + Fatigue + HTN
Dx/NBSIM/Tx?
OSA
Polysomnography
C-PAP
In OSA (HTN + Obese+ Snorer)
───
Chronic ___ retainers s/t poor ____
Chronic metabolic derangement?
Compensation?
───
OSA causes Hypoxia which constricts pulmonary vessels.
__ EPO
__ CVP & __ PCWP
Chronic CO2 retainers s/t poor Ventilation
Chronic respiratory acidosis + compensated metabolic alkalosis
────
↑ EPO
↑ CVP
Normal PCWP
Name the diagnosis:
* Atypical T cells on a blood smear.
* B Cells with Reed Sternberg morphologies.
* Hypersegmented neutrophils
* CD5+ B lymphocytes with weakened cell membranes.
* Epithelial cells with intranuclear inclusions
- EBV/Mono → young person dz
- Hodgkin’s → teens or middle age dz
- B12 folate deficiency
- CLL → smudge cells + OLD ppl dz
- CMV
Middle age woman + Abdominal pain
+ Neuropathy (burning/ tingling of extremity)
Segmental aneurysm (String of beads) on Angiography
Dx/Dxt(2)?
Spared organ:
Polyarteritis Nodosum (PAN)
─
Angiography & Biopsy
─
Lungs spared
25 y.o. AA female with 6 mo hx of dyspnea and dry cough.
+ Pertinent Labs: ↑ LDH, Calcium, Vit D & ACE
Dx/Tx (if symptomatic)
Sarcoidosis
if SYMPTOMATIC give oral steroids
──
Non-caseating granulomas +
Macrophages expressing excess 1 alpha hydroxylate
making excess Vit D and reabsorbing too much enteric calcium
↑ Na+
↑ serum Osm
↓ urine Osm
Dx/Tx?
Diabetes Insipidus (Excessively peeing out Free water)
First give NS
Central → Desmopressin
Nephrogenic→ Thiazide Diuretic
Sarcoidosis + violet colored cheek, nose, ear, lesions:
Lupus Pernio
Bad Prognosis
(Malar rash)
Female in her 30s with neuron deficits that come and go
+ sudden eye pain w/ movement and vision loss
dx/dxt/tx for eye sxs?
Optic Neuritis (s/t MS)
MRI Brain
IV Steroids
Optho emergency → permanent blindness
Female in her 30s with neuron deficits that come and go
with R eye nystagmus when looking Right + Left eye is not adducting towards Right side
dx/lesion?
Intra-nuclear Ophthalmoplegia (s/t MS)
lesion → Left MLF
Lesion is ipsilateral to the eye that is not adducting
(can be bilateral too tho)
Female in her 30s with neuron deficits that come and go
dx/dxt (2)/chronic tx (2) & exacerbation tx?
Multiple Sclerosis
MRI brain + spine → periventricular plaques
CSF analysis → Oligoclonal bands
Ch tx: Interferon Beta (IFN- ꞵ) or Glatiramer
Exacerbation tx: IV Steroids
Vitamin Supplementation needed in Multiple Sclerosis?
Vitamin D
Which illness is treated with
IFN ꞵ
IFN 𝛼
IFN ɣ
IFN ꞵ → Multiple Sclerosis
IFN 𝛼 → Hep C
IFN ɣ → Chronic Granulomatous Dz (immune d/o)
Budd Chiari Syndrome (aka Hepatic vein thrombosis)
can be caused by (2)
Manifestations → Tender hepatomegaly, Ascites, Abd distention ± Jaundice
Polycythemia Vera (s/t thrombosis of Hepatic Vein)
PNH
22 M in a MVA 2 hrs ago. Now in the ER with
mild SOB, ↓ PaO2 and b/l pulmonary interstitial infiltrates.
pulmonary contusion
s/t blunt force trauma to chest/lungs
(Recent Impact trauma + infiltrates on CXR = pulm contusion)
22 M in a MVA 2 hrs ago. Now in the ER with
mild SOB, Chest pain, normal lungs/heart on CXR
dx/Mgt?
Myocardial contusion
s/t blunt force cardiac injury
Place on Telemetry/Cardiac Monitoring
Monitor EKG + Troponin
Pt admitted for Myocardial contusion & placed on telemetry/continuous cardiac monitoring
EKG &/or Troponin are worsening a few hours later
NBSIM?
Cardiac Surgery
Pt becomes comatose and has blown pupils.
They recently received continuous insulin therapy for A glucose of 907.
Dx/Pathophys?
Cerebral edema
s/t fast correction of hyperglycemia
Mcc of death in pts presenting with DKA or HHS
Cerebral edema
s/t fast correction of glucose
DKA vs HHNS bicarb differences
DKA ↓ Bicarb (<20)
HHS ↑/nl Bicarb (>20)
Diagnosis & Treatment for the following disease permutations?
Serum Osmolality & Urine Osmolality
* ↓ & ↓
* ↓ & ↑
* ↑ & ↓
Serum Osmolality & Urine Osmolality
* ↓ & ↓ Psychogenic Polydipsia → Fluid Restriction
* ↓ & ↑ SIADH (↓Na)→ Fluid Restriction
* ↑ & ↓ Diabetes Insipidus (↑Na) → Central or Nephro
CDI → Desmopressin (ADH analog)
NDI → Thiazide diuretic
Sarcoidosis + tender, erythematous nodules on the shins
Erythema Nodosum
21F presents with 2 weeks of fatigue and malaise
+ painful cervical Lymphadenopathy
+ Splenomegaly
LN biopsy → paracortical zone hyperplasia.
dx/potential cx?
EBV
Burkitts lymphoma (8:14)
Nasopharyngeal carcinoma (south china)
A leukemia 9:22 translocation.
A lymphoma 15:17 translocation.
A leukemia 12:21 translocation.
A lymphoma 8:14 translocation.
A leukemia 2:14 translocation.
9:22 → CML
15:17 → AML
12:21 → ALL
8:14 → Burkitt’s
2:14 → CLL
Per the NBME, what kind of drug is used for
breast cancer chemoprophylaxis in women
< 50 yo
vs
> 50 yo
Less than 50 → Tamoxifen (E2 antagonist in breast)
Older than 50 → Anastrozole, Letrozole (aromatase inhibitor)
Tamoxifen vs Raloxifen
MOA?
Tamoxifen → E2 antagonist in breast & E2 agonist in uterus → ↑ risk of endometrial cancer → Used for breast cancer ppx
Raloxifene → E2 antagonist in breast/uterus & E2 agonist in bone → ↑ risk of hypercoagulation cx → post-menopause osteoporosis therapy
How are HER2+ breast malignancies treated?
How is this drug toxicity compared to daunorubicin/doxorubicin?
Trastuzumab (HER2+) → Reversible Dilated Cardiomyopathy
──
Daunorubicin/Doxorubicin → Irreversible Dilated cardiomyopathy which can be prevent with Dexerazoxane
How is BPH treated
acutely?
long term?
Prazosin, Tamsulosin (alpha blocker)
──
Finasteride, Dutasteride (5-𝛼 reductase Inhibitor)
to ↓ DHT
──
if all fails surgery (Trans Urethral Prostate Resection)
53F
+ firm, non tender mass in the anterolateral neck
+ low grade fevers, 6 months
+ unintended weight loss.
Tissue biopsy → CD15/30+ B cells
Dx/ ↑survival factor?
Hodgkins Lymphoma (CD15/30+)
Increased survival in patients with:
* Large numbers of lymphoid cells w/in tumor stroma
* Lymphocyte predominant lymphoma
65F is complaining of tingling in her upper and lower extremities but has now progressed to having multiple “blackout” episodes over the last few hours.
EKG → Flat T waves + U waves in multiple leads.
CBC → Hypocalcemia & Hypokalemia
Aggressive efforts are made to replete these electrolytes with no improvement in symptoms. Why?
Low magnesium
kidney transporter that reabsorb Ca2+ & K+ do not work w/o Mg
3 causes of Nephrogenic Diabetes Insipidus
Hypercalcemia
Lithium
Demeclocycline
44M rarely goes to doctor
presents with HTN, hematuria, and mildly ↑ AST/ALT
(Kidney & Liver problems)
(+) FMH sudden death of father at 49yo s/t neuro cause.
Dx?/List 2 possible cc for this pt.
ADPKD
+Cyst in the liver and kidneys → Flank pain & hematuria
+ Aneurysm in circle of willis → SAH (worst HA ever)
+ Mitral Valve Prolapse
Nephrotic syndrome cause ___ loss leading to a hypercoagulable state.
Antithrombin 3
15M w/ leg swelling & cloudy urine
dx/tx/EM findings?
Minimal Change Dz
tx: Steroids
EM: Podocyte effacement
