MISCELLANEOUS Flashcards
MULTIPLE MYELOMA
PLASMA CELLS GONE WILD and attacking the bone.
Plasma cells are the B-Cells that produce Antibodies (immunoglobulins) thus in MM IGs are off the charts. It is a:
HypoImmunoGlobulinemia, or an immunoproliferative state
Characterized by:
- Punched out osseous lesions
- Osteoporosis
- Elevated Calcium
- Plasma Cell Infiltration of bone marrow
Urine Test Results in:
PreRenal vs IntraRenal vs PostRenal
Pre-Renal - Volume depletion. Urine will be
low in sodium as the RAAS works
overtime to increase BP
Intra-Renal Glomerulonephritis or Acute
Tubular Necrosis these will usually
show some kind of CAST in Urine
Post-Renal Often RBCs w/o CASTS
Stones scraping up ureters or the
bladder or a UTI
Murmur radiates to the carotids, bilaterally
Aortic Stenosis.
Also has click after S1 followed by crescendo-decrescendo
It’s an “Ejection” murmur meaning its systolic.
Describe pupils of US poisonous snakes
Eliptical Slit-Like except for the Coral Snake, which does have round pupils but is Red Yellow and Black with a BLACK HEAD.
Coral snakes don’t bite unless you pick them up, but if they DO bite you, in keeping with their quiet nature, there may be NO pain and NO reaction for many many hours. This is a problem especially with children who don’t report bites.
With a coral snake you have TIME to get anti venom, maybe even hours. Signs will be neurological:
Ptosis: eyelid, mouth
Tongue Mvments : cr 9 and 11 don’t work
Gait/legs (esp in pets)
Vaccines that “prevent” cancer
Hep A + B
Hepatitis A,B + C effectively cause liver cancer thus the vaccine essentially prevents it.
Fever and Petechial Rash in an infant, suspect?
MOST important tes?
Meningococcal Dz
Get Lumbar Puncture
Clearly CBC will be done, but even if its negative, get the lumbar puncture.
First sign of Fe++ Poisoning
Vomit and Bloody diarrhea
Fe++ causes constipation @ supplement levels but in overdose, the effect is quite the opposite.
Ringed Sideroblasts under prussian blue
Fe++ laden mitochondria encircle the nuclei of atypical still-nucleated immature RBCs
Signs of significant Lead Poisoning
Ataxia and Colicky Abdominal Pain
Blue Along The Gum
Confusion, seizure, coma death
Basophilic Stippling of RBCs
High Hb and Hct
Engorged retinal veins and
eventually splenomegaly
Suspect
Polycythemia Vera
Too many RBCs…
Pallor + Fatigue Pale Mucus Membanes (conjunctiva, oral) Spoon Shaped Nails - Koilonychia Cheillosis (cracking @ corners of mouth) ICE PICA
Iron Deficiency Anemia
Decreased Vibratory Sense, Vitamin?
B12 Deficiency
Also Stocking Glove Neuropathy
Red painful tongue - BEEFY Raw Glossitis
Dementia in elderly
Ataxia + hyperreflexia
Neural Tube Defect, Deficiency
Folate (in pregnancy)
Also slight jaundice
Splenomegaly
SMOOTH glossitis
Depression
Hodgkins vs Non
k
Alk Phos Up- Differentials?
Normal range
Growth- Kids are 3X Adult normal in growth
Bone Cancer
Back door indication of Cholecystitis
(extra-hepatic cholestasis, probably gallbladder but could be ductal) if present with abdominal pain
If elevated, retest. If still elevated get GGT. If Both GGT and ALP are up, this is pretty specific for hepatic Dz. Figure out which kind. If GGT is normal, look to the bones unless there is abdominal pain, then look to the gallbladder and ducts for blockage.
Common in Crones, not right on alimentary canal
Cholecystitis
Lab derangements in Bulemia
Hypo Chloremia and concomitant HypoKalemia
MMR
Measels (Rubiola)
Mumps
Rubella (German Measels)
Live Attenuated Vaccine (not during pregnancy)
12 mo + Pre-Kindergarten
There is a MMRV which includes varicella
Moth-eaten pattern of femur margin and onion skin periosteum
Ewings Sarcoma
Teens + young adults, More common in males
High Fever is not responsive to NSAIDS or Tylenol
and peeling fingertips/palms/Soles
Lips very red/Strawberry tongue and conjunctivitis (red sclera like viral)
Kawasaki Disease
Its a systemic vasculitis which can cause sudden death if it affects coronary arteries.
Peeling of palms/soles is preceded by swelling of hands + feet.
THIS is the one where you give IV ASPIRIN to CHILDREN - the only one, first you must ensure the child doesn’t have chicken pox or you risk REYE Syndrome.
Aspirin is magic in this one and the fever and vasculitis pass quickly once initiated
Thumb tucked into closed fist and ulnar flexed causes pain
Tenosynovitis
Game keepers thumb is when you break/overstretch the tendon and thumb bends backwards.
Small Cell vs Non-Small Cell
Small cell carcinoma is TOO SMALL TO SECTION. It’s very aggressive and is treated only with chemo
Non-Small Cell is responsive to surgery and chemo.
Squamous Cell-
Adenocarcinoma - in the periphery of the lung
Acute Gout Rx
NSAIDS: Naproxin or Indomethacin are first line
for acute
Colchecine causes diarrhea so it isn’t 1st line but used if NSAIDS are contraindicated. Not for advanced hepatic or renal disease.
Allopurinol is preventative and not for acute gout.
Steroids for those who cannot take NSAIDS or Colchecine (GI, Liver, Renal Comorbidities)
Hemochromatosis
Too Much Iron - genetic disorder
Causes Cirrhosis, Diabetes and Skin Bronzing
Kept at bay by regular blood letting aka
Recurrent Phlebotomy
On lithium, what gets tested regularly
TSH
Lithium causes goiter and hypothyroidism
Bug associated with Guillian Barre
Campyolbacter Jejuni
post anthrax prophylaxix
cipro
Uncontrollable epistaxis originating in the posterior oropharynx
ENT 911
Admit for Balloon Pack
Whipple Procedure
Tumor of the Pancreatic Head
Pancreatic Head, Gallbladder, common bile duct, pyloric Sphincter and Duodenum are removed. Jejunum is attached to distal stomach + Common Hepatic Duct and to remaining portion of the Pancreatic body
TIPPS procecure
Liver Bypass to lower portal hypertension in treatment of esophageal varices
Intends to shunt blood from Portal Vein into the Hepatic Vein which emerges from the superior liver an empties into the IVC
Budd Chiari Syndrome
Thrombosis if Hepatic Vein
Acute is fatal- this represents blockage of all blood coming from the digestive system thru the liver attempting to rejoin the IVC.
Sub-Acute causes portal backup, Ascites, Esophageal Varicies etc
as with DVT, is associated with estrogen hormone therapy.
Treponema Pallidum causes
Syphilis
Painless Ulcer - Stage 1 (heals 6 wks)
Infectious and symptomatic
Non-Itchy Rash Trunk, Palms/Soles Stage 2
(heals 6 weeks) Infectious and symptomatic
NOW SYPHILIS GOES UNDERGROUND FOR UP TO 15 YEARS!!! This is called LATENT SYPHILIS
Early Latent: Up to 1 yr after Stage 2 rash resolves. Early latent can relapse in to Rash. Infectious and potentially symptomatic.
Late Latent: Over 1 year since stage 2. Late Latent is wholly Asymptomatic but VERY INFECTIOUS!!!
STAGE 3/TERTIARY SYPHILIS:
Is Fatal.
Skin, Bone, Skull, Brain, Vessel lesions
-Ulcerating Gumma
-Vascularitis (Thoracic Aortic Dissection)
-Hard Palatte Fistula into nasal cavity
-DEMENTIA d/t brain lesions
-Blindness/Deafness
Oddly, Late Syphilis is NONINFECTIOUS
Sample a syphilis lesion by:
Pressing chancre against glass slide
Test is the RPR: Rapid Plasma Reagin
Unreliable below 6 weeks so
either wait to test or retest
after 6 weeks
Once you’ve had Syphilis, you’ll always test (=) for it even after you’re cured - as the test is for the Antibody.
Syphilis Rx
Pen G
Stage 1 + 2: 2.4 M Units IM Single Dose
Stage 3: 2.4 M Units IM weekly X 3 Weeks
For Neuro/CNS syphilis, add Probenecid (gout med) to the Pen G.
ALL STAGES are treatable. Damage isn’t reversible but progression of the spirochete is stopped.
Benzo overdose:
Pump stomach
Charcoal gastric lavage
Flumazenil
Not the worst thing to OD on
Don’t use Statins with which ABX class and why?
Macrolides
Prolong QT
Myopathy
Rhabdo
Pasturella/ Cat Bite Rx?
Augmentin
Is your baby too good? Rarely cries but is:
Jaundiced, Hypotonic, Sleeps most of the time, feeds poorly FTT and has an ENLARGED TONGUE?
Congenital Hypothyroidism
Either the gland is abnormal or he’s got low I2, either way, test his TSH, FT4 and FT3
Prolonged aPTT and Bleed time, normal platelets and PT. Also Swollen Joints, usually knees
Hemophelia A
Rx is Factor VIII usually in the form of
Cryoprecipitate
Depakote/Valproate Risks
Liver Damage - Monitor LFTs
Low Platelet count - CBC
Its a Teratogen, females on it need to be on serious birth control
Its a broad application anticonvulsant, still a Gold Std Drug for all kinds of adult AND pediatric seizures and It comes second after you get Lorazapam into a status epileptics
Histoplasmosis, Cause/Cure
Chicken/Bird Poo
Mainly liver and spleen but if inhaled there will be lung cavitations
Amphotericin B as this is a fungus
On Heparin and bleeding internally?
Stop Heparin IV/Sq
Give Protamine
On Warfarin and bleeding internally?
Stop Warfarin
Give Fresh Frozen Plasma
No Time for Vitamin K - FFP works fastest
INR range
The lower the number 2 vs 3 the clottier the blood
Unknown Tetanus Status with a contaminated wound?
Tetanus Vaccine with Tetanus IgG
Td (or TdaP, what the heck, hit him with the whole deal and ensure he doesn’t give his infant son whooping cough…)
TIG (Tetanus Imunnoglobulin G)
Small Cell Carcinoma
Clusters near the Carina
VERY AGGRESSIVE, no surgery as it is likely already out into the blood
Chemo
Not good 6-18 weeks
Squamous Cell
Along the periphery
Amenable to surgery
Survivable if caught early
Metastasizes to Liver Bones Adrenals Brain
