Medicine Clerkship Flashcards
Doxazosin
Alpha-1 selective blocker used to tx hypertension and BPH
Doxazosin and sildenaphil
Give at least 4 hours apart to reduce the risk of hypotension.
MEN 2
Both: medullary carcinoma of the thyroid and pheo.
2A: hyperparathyroidism
2B: mucosal neuromas and marfanoid habitus
MEN 1
3 P’s: pitutary adenoma, pancreatic islet cell tumor, hyperparathyroidism
Choriocarcinoma in males (associated hormone)
beta-hCG
Hormone elevation in teratoma
Increase in AFP or beta-cCG
Hormone elevation in seminomas
Serum tumor markers are usually normal (beta-hCG may be elevated)
Hormone elevation in Yolk sac tumor
AFP
What happens to LH and FSH in Leydig cell tumor?
Leydig cell tumors cause increased estrogen production –> inhibition of LH and FSH
B12 and Folic acid supplementation in strict vegetarians
Suspect B12 deficiency if there are neurological complications and anemia. Folic acid will correct the anemia but NOT THE NEUROLOGIC COMPLICATIONS!
Characteristics of Hairy cell leukemia
Lymphocytes have fine, hair-like, irregular projections. Stains with tartrate-resistant acid phosphatase (TRAP).
Treatment for hairy cell leukemia
Cladribine
What happens to the bone marrow in hair cell leukemia
It becomes fibrotic, leading to dry taps
“Soap bubble appearnace” on x-ray
GIANT CELL TUMOR OF BONE
Treatment of CML
Imatinib –> binds the ATP binding site of the BCR-ABL protein (prohibiting the conformation change to its active form)
What is the mutation of CML?
reciprocal translocation of chromosome 9 & 22 containing the BCR/ABL fusion gene
What is used to treat HER2+ breast cancer?
Trastuzamab
Major side effect of trastuzumab
cardiac toxicity (get an ECHO before beginning treatment)
Differential for microcytic/hypochromic anemia
- Iron deficiency
- Defective utilization of storage iron (anemia of chronic disease)
- Reduced globin (thalassemias)
- Reduced heme synthesis (pb poisoning, sideroblastic anemia)
Iron studies in iron-deficiency anemia
Depressed serum iron, increased TIBC, decreased serum ferritin
Iron studies in thalassemias
Normal to high serum iron and ferritin levels
Iron studies in Anemia of chronic disease
Below normal TIBC; normal or increased serum ferritin level
Iron studies in sideroblastic anemia
Normal to high serum iron and ferritin values
How can the level of HER2 expression be determined in breast cancer?
Immunohistochemical staining of FISH
–positvely predicts a positive response to trastuzumab and anthracycline chemo
Pagophagia
Pica for ice (quite specific for iron deficiency anemia)
Why are post-splenectomy patients at risk for sepsis?
They are at increased risk for sepsis from encapsulated organisms due to impaired antibody-mediated opsonization in phagocytosis
What does tamoxifen increase the risk of?
Endometrial cancer and venous thrombosis
Shat drugs can cause folic acid deficiency?
- -Antiepileptic drugs (phenytoin, primidone, phenobarbital)
- trimethoprim
- methotrexate
How can blood transfusions cause paresthesias?
Packed cells contain citrate, which can chelate serum calcuium
Does hypocalcemia or hypercalcemia cause paresthesias?
Hypocalcemia
What is the drug of choice for mild to moderate hypercalcemia due to malignancy?
Bisphophonates (IV fluids and furosemid are used in the treatment of hypercalcemic crisis)
Waht is the cause of senile purpura (bruising on extensor surfaces of old people)?
Perivascular connective tissue atrophy
What is seen on peripheral smear with lead poisoning?
Basophilic stippling
Treatment for lead poisoning?
Lead chelator (EDTA or succimer)
TTP
Consumptive thrombocytopenia caused by widespread platelet thrombi that form in the microcirculation.
- Thrombocytopenia
- Microangiopathic hemolytic anemia
- Fever
- Neurological signs
HUS
Similar to TTP:
- Thrombocytopenia
- Microangiopathic hemolytic anemia
- Fever
- Renal failure (NOT neurological signs)
What type of breast cancer is associated with Paget’s disease of the breast?
Adenocarcinoma
What type of cancer is the vast majority of head and neck cancer?
Squamous Cell Carcinoma
What does heparin induced thrombocytopenia increase your risk for?
Arterial and venous clots (this is paradoxical)
S/sx of obstructive sleep apnea?
excessive daytime sleepiness, snoring, morning headaches, impotence, arterial hypertension. OSA –> short term hypoxemia, which is sensed by the kidneys –> increased EPO!!
What is the cause of acquired sideroblastic anemia?
Defective heme synthesis
What vitamin must be administered with INH?
Pyridoxine
Diagnosis in a patient with new-onset diabetes, arthropathy, and hepatomegaly?
hemochromatosis
What is the role of G6PD in RBCs?
G6PD is the enzyme involved in creating NADPH (a cofactor for glutathione, which prevents the oxidation of hemoglobin)
What are the characteristics of paroxysmal nocturnal hemoglobinuria?
Combination of:
- hemolytic anemia
- venous thrombosis
- diminished hematopoiesis (anemia)
What is the treatment of MALT without any METS?
Eradicate H. Pylori (omperazole, clarithromycin, amoxicillin)
Trousseau’s syndrome
Migratory thrombophlebitis (pain, itching, red streaks, cord like veins). It is typically in the chest and arms. Suggestive of underlying malignancy (esp adenocarcinoma)
Treatment of FAP?
Procto-colectomy at the time of diagnosis (100% go to colon cancer)
What does protein electrophoresis reveal for Waldenstrom’s Macroglobulinemia?
IgM Spike
Differential diagnosis for a mediastinal mass?
4 T’s: Thymoma, teratoma, thyroid neoplasm, and terrible lymphoma
What bone cancer has Codman’s Triangle (periosteum lifted)
Osteosarcoma
Radiographic findings for osteosarcoma
- Codman’s Triangle
2. Sunburst Appearance
Waht is the characteristic radiographic findings in Ewing Sarcoma?
Onion Skinning
What is the characteristic radiographic finding for Giant Cell Tumor?
Soap Bubble Appearance
Soap Bubble Appearance
Giant Cell Tumor of Bone
Onion skinning on radiography
Ewing Sarcoma
Smudge Cells
Characteristic for CLL
What is the classic triad of glucagonoma?
Hyperglycemia, necrotizing dermatitis, and weight loss
Necrolytic Migratory Erythema
Erythematous, scaly plaques on the face and buttocks associated with glucagonoma.
Leukocyte Alkaline Phosphatase
Typically elevated in leukemoid reactions and low in CML
What is seen on bone marrow examination in multiple myeloma?
Overproliferation of plasma cells
What is the treatment for stroke secondary to sickle cell crisis?
Exchange transfusion
What is the first line treatment for a patient with severe symptomatic hypercalcemia?
Vigorous hydration with IV Normal Saline
What is the effect of aldosterone on sodium and potassium?
Aldosterone Saves Sodium and loses potassium
How does diabetes insipidus present?
Polyuria, polydipsia, and excretion of dilute urine in the presence of elevated serum osmolality
How does primary polydipsia present?
From excessive water drinking: both plasma and urine are diluted
How does SIADH present?
Hyponatremia, low serum osmolality, and inappropriately high urine osmolality.
What beta blockers can be used to treat pheo?
Labetolol- because it has both alpha- and beta-blocking activity