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PANCE PREP > MISCELLANEOUS > Flashcards

MISCELLANEOUS Flashcards

1
Q

MULTIPLE MYELOMA

A

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
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2
Q

Urine Test Results in:

PreRenal vs IntraRenal vs PostRenal

A

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

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3
Q

Murmur radiates to the carotids, bilaterally

A

Aortic Stenosis.

Also has click after S1 followed by crescendo-decrescendo

It’s an “Ejection” murmur meaning its systolic.

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4
Q

Describe pupils of US poisonous snakes

A

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)

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5
Q

Vaccines that “prevent” cancer

A

Hep A + B

Hepatitis A,B + C effectively cause liver cancer thus the vaccine essentially prevents it.

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6
Q

Fever and Petechial Rash in an infant, suspect?

MOST important tes?

A

Meningococcal Dz

Get Lumbar Puncture

Clearly CBC will be done, but even if its negative, get the lumbar puncture.

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7
Q

First sign of Fe++ Poisoning

A

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

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8
Q

Signs of significant Lead Poisoning

A

Ataxia and Colicky Abdominal Pain
Blue Along The Gum
Confusion, seizure, coma death

Basophilic Stippling of RBCs

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9
Q

High Hb and Hct
Engorged retinal veins and
eventually splenomegaly

Suspect

A

Polycythemia Vera

Too many RBCs…

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10
Q 
Pallor + Fatigue
Pale Mucus Membanes (conjunctiva, oral)
Spoon Shaped Nails - Koilonychia
Cheillosis (cracking @ corners of mouth)
ICE PICA
A

Iron Deficiency Anemia

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11
Q

Decreased Vibratory Sense, Vitamin?

A

B12 Deficiency

Also Stocking Glove Neuropathy
Red painful tongue - BEEFY Raw Glossitis
Dementia in elderly
Ataxia + hyperreflexia

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12
Q

Neural Tube Defect, Deficiency

A

Folate (in pregnancy)

Also slight jaundice
Splenomegaly
SMOOTH glossitis
Depression

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13
Q

Hodgkins vs Non

A

k

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14
Q

Alk Phos Up- Differentials?

Normal range

A

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.

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15
Q

Common in Crones, not right on alimentary canal

A

Cholecystitis

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16
Q

Lab derangements in Bulemia

A

Hypo Chloremia and concomitant HypoKalemia

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17
Q

MMR

A

Measels (Rubiola)
Mumps
Rubella (German Measels)

Live Attenuated Vaccine (not during pregnancy)

12 mo + Pre-Kindergarten

There is a MMRV which includes varicella

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18
Q

Moth-eaten pattern of femur margin and onion skin periosteum

A

Ewings Sarcoma

Teens + young adults, More common in males

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19
Q

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)

A

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

20
Q

Thumb tucked into closed fist and ulnar flexed causes pain

A

Tenosynovitis

Game keepers thumb is when you break/overstretch the tendon and thumb bends backwards.

21
Q

Small Cell vs Non-Small Cell

A

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

22
Q

Acute Gout Rx

A

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)

23
Q

Hemochromatosis

A

Too Much Iron - genetic disorder

Causes Cirrhosis, Diabetes and Skin Bronzing

Kept at bay by regular blood letting aka
Recurrent Phlebotomy

24
Q

On lithium, what gets tested regularly

A

TSH

Lithium causes goiter and hypothyroidism

25
Q

Bug associated with Guillian Barre

A

Campyolbacter Jejuni

26
Q

post anthrax prophylaxix

A

cipro

27
Q

Uncontrollable epistaxis originating in the posterior oropharynx

A

ENT 911

Admit for Balloon Pack

28
Q

Whipple Procedure

A

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

29
Q

TIPPS procecure

A

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

30
Q

Budd Chiari Syndrome

A

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.

31
Q

Treponema Pallidum causes

A

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
32
Q

Sample a syphilis lesion by:

A

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.

33
Q

Syphilis Rx

A

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.

34
Q

Benzo overdose:

A

Pump stomach

Charcoal gastric lavage

Flumazenil

Not the worst thing to OD on

35
Q

Don’t use Statins with which ABX class and why?

A

Macrolides

Prolong QT
Myopathy
Rhabdo

36
Q

Pasturella/ Cat Bite Rx?

A

Augmentin

37
Q

Is your baby too good? Rarely cries but is:

Jaundiced, Hypotonic, Sleeps most of the time, feeds poorly FTT and has an ENLARGED TONGUE?

A

Congenital Hypothyroidism

Either the gland is abnormal or he’s got low I2, either way, test his TSH, FT4 and FT3

38
Q

Prolonged aPTT and Bleed time, normal platelets and PT. Also Swollen Joints, usually knees

A

Hemophelia A

Rx is Factor VIII usually in the form of
Cryoprecipitate

39
Q

Depakote/Valproate Risks

A

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

40
Q

Histoplasmosis, Cause/Cure

A

Chicken/Bird Poo

Mainly liver and spleen but if inhaled there will be lung cavitations

Amphotericin B as this is a fungus

41
Q

On Heparin and bleeding internally?

A

Stop Heparin IV/Sq

Give Protamine

42
Q

On Warfarin and bleeding internally?

A

Stop Warfarin
Give Fresh Frozen Plasma

No Time for Vitamin K - FFP works fastest

43
Q

INR range

A

The lower the number 2 vs 3 the clottier the blood

44
Q

Unknown Tetanus Status with a contaminated wound?

A

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)

45
Q

Small Cell Carcinoma

A

Clusters near the Carina

VERY AGGRESSIVE, no surgery as it is likely already out into the blood

Chemo

Not good 6-18 weeks

46
Q

Squamous Cell

A

Along the periphery

Amenable to surgery

Survivable if caught early

Metastasizes to Liver Bones Adrenals Brain

PANCE PREP (12 decks)

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