JH IM Board Review - SOS V

Question 1

The ristocetin test is abnormal in which patients:

Answer 1

1. VWD.

2. B-S syndrome.

Question 2

Which specific lab tests are important to be ordered since they may all manifest as thrombocytopenia?

Answer 2

1. Liver disease.
2. HCV.
3. HIV.
4. Pregnancy.

Question 3

4 inherited platelet disorders:

Answer 3

1. Glanzmann.
2. B-S.
3. Gray platelet syndrome.
4. Storage pool disease.

Question 4

Gray platelet syndrome — Defect:

Answer 4

Deficiency of alpha granules.

Question 5

Storage pool disease — Defect:

Answer 5

Deficiency of dense granules.

Question 6

Pts w/ gray platelet syndrome or storage pool disease often have only …

Answer 6

MILD bleeding manifestations.

Question 7

Infections that may lead to thrombocytopenia:

Answer 7

1. HIV.
2. CMV.
3. EBV.
4. HANTAVIRUS.
5. Viral hep.
6. Mycoplasma.

Question 8

Clinical presentation of ACQUIRED platelet disorders typically results in bleeding.

Mention the 2 exceptions:

Answer 8

1. HIT type 2 ==> a/w thrombosis.

2. Myeloproliferative disorders ==> May have bleeding or thrombosis.

Question 9

Medical disease-related platelet disorders (specifically LIVER disease) may result in apparent thrombocytopenia caused by sequestration but …

Answer 9

NO clinical bleeding disorder.

Question 10

HIT type 1:

Answer 10

NON immune-mediated.

Begins a few days after initiation of heparin + will spontaneously resolve if heparin is CONTINUED.

Question 11

HIT type 2:

Answer 11

Immune-mediated development of abs against heparin/PAF-4 complex.

Begins 5-10 days after initiation of heparin.

Question 12

Heparin must be DISCONTINUED immediately in which HIT?

Answer 12

2

Question 13

What should be administered in HIT 2 after the discontinuation of the heparin?

Answer 13

DIRECT THROMBIN INHIBITOR.

Question 14

HIT 2 or HIT 1 is a/w thromboses?

Answer 14

HIT 2 ==> Can present 40 days (!) post-heparin exposure.

Question 15

HIV and HCV cause thrombocytopenia directly or indirectly?

Answer 15

DIRECTLY.

Question 16

Thrombosis in pts w/ thrombocytosis is NOT predicted by the platelet count.

Which 2 factors are the best predictors?

Answer 16

1. Advanced age.

2. Previous thrombosis.

Question 17

Palpable vs non palpable purpura?

Answer 17

Palpable ==> Vessel wall inflammation (eg vasculitis).

Non-palpable ==> Vessel wall disorders or connective tissue disorders.

Question 18

Protein S levels are reduced by E…

Answer 18

ESTROGENS.

Question 19

If homocysteine testing is performed, blood samples should be drawn after f…

Answer 19

FASTING.

Question 20

Lab monitoring of LMWH is usually NOT necessary.

If monitoring is warranted, use the L…

Answer 20

LMW (anti-Xa) assay.

Question 21

LMWH are or aren’t reversible with protamine?

Answer 21

60-80% they are partially reversible.

Question 22

LMWH should be used w/ caution in pts w/ R…

Answer 22

Renal insufficiency. (GFR <30)

Question 23

INR limits:

Answer 23

2-3 ==> VTE — Aortic bileaflet mechanical heart valves — A-fib.

2.5-3.5 ==> Mitral bileaflet mechanical heart valves — Recurrent VTE — APS w/ recurrent thromboembolism.

Question 24

5 syndromes that increase AML risk:

Answer 24

1. Down.
2. Bloom.
3. Fanconi.
4. ATM.
5. Klinefelter (!).

Question 25

In AML, leptomeningeal involvement is more common with e... at diagnosis or M...

Answer 25

Elevated WBC count or M4/M5 morphology.

Question 26

S... is uncommon in AML.

Answer 26

Splenomegaly.

Question 27

Low WBC in AML raises suspicion of which subtype?

Answer 27

M3/APL.

Question 28

Clinical features a/w poor prognosis in AML include:

Answer 28

1. >60y. 2. Poor performance status. 3. Therapy-related AML (2o to chemo). 4. AML arising from another marrow disorder (MDS or myeloproliferative). 5. WBC >100K (hyperleukocytosis).

Question 29

AML prognosis — Expected ...-...% of pts >60y and

Answer 29

35-40%. 10%.

Question 30

Up to ...% of ALL pts will present w/ fever caused by either pyrogenic cytokine release or true concurrent infection.

Answer 30

50%.

Question 31

Evaluation of ALL always includes analysis of C...

Answer 31

CSF for CNS involvement.

Question 32

In CML — anemia, thrombocytopenia, and monocytosis are red flags that you may ...

Answer 32

NOT be dealing w/ CHRONIC-phase CML.

Question 33

Tx-related or chemo-related MDS — Topoisomerase II inhibitors (eg anthracyclines, etoposide): A/w which cytogenetic abnormality?

Answer 33

11q23. Typical onset between 1 and 3 years after chemotherapy.

Question 34

Tx-related or chemo-related MDS — Alkylating agents (eg cyclophosphamide):

Answer 34

A/w unbalanced cytogenetic changes including abnormalities of chromosome 5 or 7. Typical onset is 5-7y post-chemo. (Hah same chromosomes and same year)

Question 35

In MDS, the cytogenetic abnormality predicts the o...

Answer 35

Outcome.

Question 36

Early MDS:

Answer 36

Increased levels of apoptosis + increased proliferation ==> Hypercellular BM w/ peripheral cytopenias.

Question 37

Later MDS:

Answer 37

Apoptosis decreases and proliferation increases ==> More aggressive disease and possible transformation to AML.

Question 38

MDS — Order of cells affected?

Answer 38

RBCs ==> WBCs ==> PLTs.

Question 39

Target cells — DDx:

Answer 39

1. Hemoglobin C. 2. Liver disease. 3. Thalassemia.

Question 40

Basophilic stippling — DDx:

Answer 40

1. Hemolysis. 2. Lead. 3. Thal.

Question 41

Burr cells — DDx:

Answer 41

Renal disease.

Question 42

Acanthocytes — DDx:

Answer 42

1. Liver disease. | 2. Abetalipoproteinemia.

Question 43

Leukopenia w/ HYPOsegmented PMNs — DDx:

Answer 43

1. MDS. 2. Stress. 3. Infection. 4. Pelger-Huet anomaly.

Question 44

Indications for a BM biopsy and aspirate:

Answer 44

1. Unexplained cytopenias — Young pts w/ ITP and no other hematologic abnormalities or dysplasia may not need a BM evaluation. 2. Suspected hematologic malignancies (leukemia, MDS, lymphoma, plasma cell dyscrasia). 3. FUO. 4. Storage disease. 5. Splenomegaly. 6. Chromosomal abnl in neonates. 7. Donor selection process for SCT.

Question 45

CI to BM biopsy and aspirate:

Answer 45

1. Coagulation defects — should be corrected before procedure. Eg hemophilia, DIC, heparin, warfarin, direct thrombin inhibitors. 2. Local infections at the site. *** Thrombocytopenia (regardless of number) is NOT a CI for BM biopsy.

Question 46

Lynch — Extracolonic cancer w/ highest incidence?

Answer 46

Endometrial.

Question 47

CRC w/ pelvic pain usually indicates L...

Answer 47

Late-stage disease — extension into pelvic nerves.

Question 48

Adjuvant chemo in colorectal cancer has been shown to s...

Answer 48

Significantly improve survival in pts w/ STAGE III disease.

Question 49

The 5 polyposis syndromes:

Answer 49

1. FAP. 2. Gardner. 3. Turcot. 4. Peutz-Jeghers. 5. Juvenile polyposis.

Question 50

CRC recurrence evaluation — If elevated CEA is found, then c...

Answer 50

Colonoscopy + CT scans (pelvis, abdo, chest) should be performed. If negative ==> REPEAT every 3mo. If positive ==> Salvage therapy.

Question 51

Mention 3 unfavorable prognostic factors of CRC:

Answer 51

1. Long duration of symptoms. 2. Bowel obstruction or perforation. 3. Elevated PRE-op CEA.

Question 52

The BRCA genes are not X-linked, but are s... in most men.

Answer 52

SILENT.

Question 53

DCIS — Tamoxifen role?

Answer 53

Decreases the risk of a contralateral cancer and decreases IN-BREAST recurrence after lumpectomy and RT, but it does NOT improve survival.

Question 54

Breast cancer — Choosing between lumpectomy + RT and mastectomy — Survival is e...

Answer 54

Equivalent.

Question 55

...% of pts w/ advanced ovarian cancer have an elevated CA-125, but

Answer 55

82%. 50%.

Question 56

Autopsy studies suggest that nearly ...% of men will have prostate cancer by age 80.

Answer 56

60%.

Question 57

Prostate cancer extension to seminal vesicles may manifest w/ h...

Answer 57

Hematospermia.

Question 58

PSA may be elevated from:

Answer 58

1. BPH. 2. Acute prostatitis. 3. Transrectal needle biopsy. 4. Acute urinary retention. 5. Prostate surgery. 6. Ejaculation.

Question 59

Side effects of androgen ablation:

Answer 59

1. Hot flashes. 2. Sexual dysfunction (loss of libido, erectile dysfunction, microgenitalia). 3. Decreased bone and muscle mass. 4. Gynecomastia. 5. Fatigue — Anemia. 6. Metabolic syndrome. 7. Neurocognitive effects.

Question 60

What is Balkan nephropathy?

Answer 60

A familial nephropathy of unknown cause that results in progressive inflammation of the renal parenchyma ==> Renal failure + Multifocal, superficial, low-grade cancers of the renal pelvis and ureters.

Question 61

What is Stauffer syndrome?

Answer 61

Hepatic dysfunction NOT a/w metastases in RCC pts.

Question 62

In RCC, does renal vein involvement affect survival?

Answer 62

No.

Question 63

Sunitinib may cause ...

Answer 63

Decreased cardiac EF.

Question 64

False(+) elevations can be seen with h... and the use of m... .

Answer 64

Hypogonadism and the use of marijuana.

Question 65

Functional incontinence occurs when ...

Answer 65

An individual is unable or unwilling to reach the toilet in time.

Question 66

Functional incontinence is a/w ...

Answer 66

1. Dementia/depression. 2. Physical impairments that impede motility (eg degenerative arthritis, stroke, PD). 3. Physical restraints or inaccessible toilets.

Question 67

Mention the 4 stages of pressure ulcers:

Answer 67

Stage 1 ==> Nonblanchable erythema. Stage 2 ==> Irregular shallow ulceration — Loss of epidermis, dermis, or both. Stage 3 ==> Deep ulceration with necrotic base. Stage 4 ==> Deep ulceration reaching underlying bone.

Question 68

Pressure ulcers and infections:

Answer 68

Colonization of the ulcer is common and does not represent infection. Swab cultures of the wound base have NO clinical utility. DO NOT use topical antibiotics.

Question 69

Falls — Where do they happen?

Answer 69

70% ==> At home. 10% ==> On the stairs. 50% ==> Environmental hazards (Eg wet surface, throw rugs).

Question 70

Which meds are a/w the greatest risk for falling?

Answer 70

1. Sedatives. 2. Antidepressants. 3. Neuroleptics.

Question 71

Cataract — Morphological types:

Answer 71

1. Nuclear sclerosis. 2. Posterior subcapsular. 3. Cortical.

Question 72

Most cataracts are age-related. Mention some causes of cataract:

Answer 72

1. Steroids. 2. Trauma. 3. DM. 4. FHx. 5. Uveitis. 6. Radiation. 7. Wilson — SUNFLOWER cataract. 8. Prior ocular surgery — especially pars plana vitrectomy.

Question 73

Does cataract have pain/redness?

Answer 73

NO — EXCEPT in cases of lens-induced glaucoma or uveitis.

Question 74

Risk factors for progression of “wet”, neovascular age-related macular degeneration?

Answer 74

1. HTN. | 2. Smoking.

Question 75

Clinical presentation of age-related macular degeneration:

Answer 75

1. Distortion of STRAIGHT LINES may be an early sign. 2. No pain/no redness. 3. Peripheral vision remains INTACT.

Question 76

Prevention of age-related macular degeneration:

Answer 76

1. Sunglasses or hats to block UV light. 2. Control of BP to reduce risk of wet AMD may also be helpful. 3. Cessation of smoking strongly encouraged.

Question 77

Primary open-angle glaucoma screening in asx pts:

Answer 77

1. Recommended every 2-4y for 40-64yo pts. 2. Every 1-2y for >65y. 3. Begin before 40y in African Americans.

Question 78

Aminoglycosides may lead to what eye problem?

Answer 78

Toxic or allergic keratoconjunctivitis.

Question 79

What should be strictly avoided in HSV keratitis?

Answer 79

CS

Question 80

MC ocular manifestation of HIV:

Answer 80

Background HIV retinopathy (non infectious).

Question 81

Immune recovery uveitis (IRU) occurs in minority of eyes w/ CMV retinitis in pts responsive to HAART:

Answer 81

Syndrome of uveitis + vitreitis + macular edema + epiretinal membrane formation. RFs for IRU unclear.