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Internal Medicine > JH IM Board Review - SOS V > Flashcards

JH IM Board Review - SOS V Flashcards

1
Q

The ristocetin test is abnormal in which patients:

A
  1. VWD.

2. B-S syndrome.

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2
Q

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

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

4 inherited platelet disorders:

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

Gray platelet syndrome — Defect:

A

Deficiency of alpha granules.

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5
Q

Storage pool disease — Defect:

A

Deficiency of dense granules.

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6
Q

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

A

MILD bleeding manifestations.

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7
Q

Infections that may lead to thrombocytopenia:

A
  1. HIV.
  2. CMV.
  3. EBV.
  4. HANTAVIRUS.
  5. Viral hep.
  6. Mycoplasma.
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8
Q

Clinical presentation of ACQUIRED platelet disorders typically results in bleeding.

Mention the 2 exceptions:

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

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

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9
Q

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

A

NO clinical bleeding disorder.

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10
Q

HIT type 1:

A

NON immune-mediated.

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

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11
Q

HIT type 2:

A

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

Begins 5-10 days after initiation of heparin.

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12
Q

Heparin must be DISCONTINUED immediately in which HIT?

A

2

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13
Q

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

A

DIRECT THROMBIN INHIBITOR.

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14
Q

HIT 2 or HIT 1 is a/w thromboses?

A

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

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15
Q

HIV and HCV cause thrombocytopenia directly or indirectly?

A

DIRECTLY.

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16
Q

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

Which 2 factors are the best predictors?

A
  1. Advanced age.

2. Previous thrombosis.

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17
Q

Palpable vs non palpable purpura?

A

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

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

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18
Q

Protein S levels are reduced by E…

A

ESTROGENS.

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19
Q

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

A

FASTING.

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20
Q

Lab monitoring of LMWH is usually NOT necessary.

If monitoring is warranted, use the L…

A

LMW (anti-Xa) assay.

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21
Q

LMWH are or aren’t reversible with protamine?

A

60-80% they are partially reversible.

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22
Q

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

A

Renal insufficiency. (GFR <30)

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23
Q

INR limits:

A

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.

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24
Q

5 syndromes that increase AML risk:

A
  1. Down.
  2. Bloom.
  3. Fanconi.
  4. ATM.
  5. Klinefelter (!).
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25
Q

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

A

Elevated WBC count or M4/M5 morphology.

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26
Q

S… is uncommon in AML.

A

Splenomegaly.

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27
Q

Low WBC in AML raises suspicion of which subtype?

A

M3/APL.

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28
Q

Clinical features a/w poor prognosis in AML include:

A
  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).
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29
Q

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

A

35-40%.

10%.

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30
Q

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

A

50%.

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31
Q

Evaluation of ALL always includes analysis of C…

A

CSF for CNS involvement.

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32
Q

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

A

NOT be dealing w/ CHRONIC-phase CML.

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33
Q

Tx-related or chemo-related MDS — Topoisomerase II inhibitors (eg anthracyclines, etoposide):

A/w which cytogenetic abnormality?

A

11q23.

Typical onset between 1 and 3 years after chemotherapy.

34
Q

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

A

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)

35
Q

In MDS, the cytogenetic abnormality predicts the o…

36
Q

Early MDS:

A

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

37
Q

Later MDS:

A

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

38
Q

MDS — Order of cells affected?

A

RBCs ==> WBCs ==> PLTs.

39
Q

Target cells — DDx:

A
  1. Hemoglobin C.
  2. Liver disease.
  3. Thalassemia.
40
Q

Basophilic stippling — DDx:

A
  1. Hemolysis.
  2. Lead.
  3. Thal.
41
Q

Burr cells — DDx:

A

Renal disease.

42
Q

Acanthocytes — DDx:

A
  1. Liver disease.

2. Abetalipoproteinemia.

43
Q

Leukopenia w/ HYPOsegmented PMNs — DDx:

A
  1. MDS.
  2. Stress.
  3. Infection.
  4. Pelger-Huet anomaly.
44
Q

Indications for a BM biopsy and aspirate:

A
  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.
45
Q

CI to BM biopsy and aspirate:

A
  1. Coagulation defects — should be corrected before procedure.

Eg hemophilia, DIC, heparin, warfarin, direct thrombin inhibitors.

  1. Local infections at the site.

*** Thrombocytopenia (regardless of number) is NOT a CI for BM biopsy.

46
Q

Lynch — Extracolonic cancer w/ highest incidence?

A

Endometrial.

47
Q

CRC w/ pelvic pain usually indicates L…

A

Late-stage disease — extension into pelvic nerves.

48
Q

Adjuvant chemo in colorectal cancer has been shown to s…

A

Significantly improve survival in pts w/ STAGE III disease.

49
Q

The 5 polyposis syndromes:

A
  1. FAP.
  2. Gardner.
  3. Turcot.
  4. Peutz-Jeghers.
  5. Juvenile polyposis.
50
Q

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

A

Colonoscopy + CT scans (pelvis, abdo, chest) should be performed.

If negative ==> REPEAT every 3mo.

If positive ==> Salvage therapy.

51
Q

Mention 3 unfavorable prognostic factors of CRC:

A
  1. Long duration of symptoms.
  2. Bowel obstruction or perforation.
  3. Elevated PRE-op CEA.
52
Q

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

53
Q

DCIS — Tamoxifen role?

A

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

54
Q

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

A

Equivalent.

55
Q

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

56
Q

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

57
Q

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

A

Hematospermia.

58
Q

PSA may be elevated from:

A
  1. BPH.
  2. Acute prostatitis.
  3. Transrectal needle biopsy.
  4. Acute urinary retention.
  5. Prostate surgery.
  6. Ejaculation.
59
Q

Side effects of androgen ablation:

A
  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.
60
Q

What is Balkan nephropathy?

A

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.

61
Q

What is Stauffer syndrome?

A

Hepatic dysfunction NOT a/w metastases in RCC pts.

62
Q

In RCC, does renal vein involvement affect survival?

63
Q

Sunitinib may cause …

A

Decreased cardiac EF.

64
Q

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

A

Hypogonadism and the use of marijuana.

65
Q

Functional incontinence occurs when …

A

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

66
Q

Functional incontinence is a/w …

A
  1. Dementia/depression.
  2. Physical impairments that impede motility (eg degenerative arthritis, stroke, PD).
  3. Physical restraints or inaccessible toilets.
67
Q

Mention the 4 stages of pressure ulcers:

A

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.

68
Q

Pressure ulcers and infections:

A

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.

69
Q

Falls — Where do they happen?

A

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

70
Q

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

A
  1. Sedatives.
  2. Antidepressants.
  3. Neuroleptics.
71
Q

Cataract — Morphological types:

A
  1. Nuclear sclerosis.
  2. Posterior subcapsular.
  3. Cortical.
72
Q

Most cataracts are age-related.

Mention some causes of cataract:

A
  1. Steroids.
  2. Trauma.
  3. DM.
  4. FHx.
  5. Uveitis.
  6. Radiation.
  7. Wilson — SUNFLOWER cataract.
  8. Prior ocular surgery — especially pars plana vitrectomy.
73
Q

Does cataract have pain/redness?

A

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

74
Q

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

A
  1. HTN.

2. Smoking.

75
Q

Clinical presentation of age-related macular degeneration:

A
  1. Distortion of STRAIGHT LINES may be an early sign.
  2. No pain/no redness.
  3. Peripheral vision remains INTACT.
76
Q

Prevention of age-related macular degeneration:

A
  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.
77
Q

Primary open-angle glaucoma screening in asx pts:

A
  1. Recommended every 2-4y for 40-64yo pts.
  2. Every 1-2y for >65y.
  3. Begin before 40y in African Americans.
78
Q

Aminoglycosides may lead to what eye problem?

A

Toxic or allergic keratoconjunctivitis.

79
Q

What should be strictly avoided in HSV keratitis?

80
Q

MC ocular manifestation of HIV:

A

Background HIV retinopathy (non infectious).

81
Q

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

A

Syndrome of uveitis + vitreitis + macular edema + epiretinal membrane formation.

RFs for IRU unclear.

Internal Medicine (107 decks)

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