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Clin Medicine > Newman And Tyler Hl > Flashcards

Newman And Tyler Hl Flashcards

1
Q

Anc

A

(%neutrophils+%bands)xWBC)/100

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2
Q

ANC<500

A

Risk of serious infection is high

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3
Q

Moderate neutropenia

A

500-1000

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4
Q

Mild neutropenia

A

1000-1500

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5
Q

Kostmann

A

Severe congenital neutropenia

Life threatening pyogenic infections, often in infancy

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6
Q

Why kostmann

A

Impaired myeloid differentiation caused by maturational arrest of neutrophil precursors

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7
Q

Inheritance kostmann

A

AR

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8
Q

Prob with kostmann

A

ANC<200, risk for AML

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9
Q

Cyclic neutropenia

A

Cyclic dever, oral ulcers, gingivitis, periodontal disease, recurrent bacterial infections

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10
Q

Defect cyclic neutropenia

A

Stem cell regulatory defect resulting in defective maturation

Sporadic or AD

Severe neutropenia <200 for 3-7 days fever every 3 weeks

CYCLIC

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11
Q

Malignancy from cyclic neutropenia

A

No

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12
Q

How is cyclic neutropenia missed

A

Bounce er ot er not same person

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13
Q

Schwachman diamond syndrome

A

Triad of neutropenia, exocrine pancreas, insuffiency and skeletal abnormalities

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14
Q

Defect schwachman diamond

A

Neutrophil mobility migration and chemotaxis in addition to neutropenia

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15
Q

What see with exocrine pancreas prob

A

Poor abrospion nutrients loose oily stool

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16
Q

Inheritance schwachman diamond

A

AR

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17
Q

Risk malignancy schwachman diamond

A

MDS or leukemia

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18
Q

Faconi

A

Bone marrow failure syndrome all cell lines effects

GU and skeletal abnormalities
Increased chromosome fragility

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19
Q

Inheritance faconi

A

AR present at 1-

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20
Q

Risk faconi

A

All cell lines effects

Pancytopenia bone marrow failure/aplastic

Risk AML brain tumor wilms tumor

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21
Q

Pancytopenia in kids

A

Faconi

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22
Q

Leukocyte adhesion defiency

A

Delayed separation of umbilical cord >3 weeks, recurrent and severe bacterial and fungal infections without pus accumulation

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23
Q

Cause of leukocyte adhesion defiency

A

Neutrophils have dismissed adhesion to surfaces

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24
Q

Inheritance leukocyte adhesion defiency

A

Very rare

AR

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25
Q

Jones syndrome hyper IgE

A

Severe eczema
Recurrent bacterial infections of skin
Recurrent pulmonary infections

IgE eosinophil up risk of HL

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26
Q

Chefiam higashi

A

Partial oculocutaneous albinism , peripheral and cranial neuropathies, neutropenia, recurrent pyogenic infections

Defects in granule morphogenetic, chemotaxis and degranulation, ineffective granulopoiesus

Rare AR

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27
Q

Chronic granulomatous disease

A

Recurrent purulent infections with fungal or bacterial catalase positive organisms, usually starting in infancy, chronic inflammatory granulomas

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28
Q

Defect chronic granulomatous disease

A

Defect in oxidative metabolism, absent generation of superoxide (which is toxic to microbe)

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29
Q

Inheritance chronic granulomatous disease

A

1/250000
Good prognosis

X linked recessive ar

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30
Q

Infection associated neutropenia

A

Many viruses cause neutropenia withint he first 2-3 days of illness lasting up to a week

Parvovirus B19 (5th slapped cheek appearance 1-1 weeks after injection with the virus)

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31
Q

Drug induced neutropenia

A

Cytotoxic agents for treatment of malignancies NOTORIOUS

When see neutropenia

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32
Q

Neutropenia from defiency

A

B12 vitamin

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33
Q

Symptoms vitamin b12 defiency

A

Glossitis cheliosis

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34
Q

Leukocytosis

A

Usually a reactive process to an infection which subsides with resolution of the acute event (viral or bacterial infection)

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35
Q

Chronic inflammation with leukocytosis

A

Auto immune disease

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36
Q

Oncológica leukocytosis

A

Yes!

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37
Q

Bad symptom of leukocytosis

A

Seizure

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38
Q

If someone has seizure and has high WBC

A

Not infection. Seizure causes demargination

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39
Q

Eosinophilia

A

Parasites

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40
Q

Leading cause of death by disease in kids BY DISEASE

A

Cancer

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41
Q

Most common cancer kids

A

Leukemia

15-19 lymphoma

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42
Q

Lymphoma

A

Most common cancer in adolescents

14-19

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43
Q

HL

A

Most common malignancy in the age 15-19

EBV

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44
Q

Pathogenesis HL

A

Reed sternberg cell
-pathognomic feature of HL
A large cell with multiple or multilobulated nuclei

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45
Q

Clincial HL

A

Unexplained fever 39
We loss>10% total body weight over 6 months
Drenching night sweated

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46
Q

Diagnose HL

A

Any patient with persisten unexplained LAD unassociated with an obvious underlying inflammatory or infectious process should undergo chest radiography to rule out a mediastinal mass before undergoing lymph node biopsy

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47
Q

Non hodgkin lymphoam

A

60% lymphoma in kid and adolescents

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48
Q

SCID

A

NHL secondary to SCID

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49
Q

Wish ot Aldrich syndrome x linked recessive NHL secondary to it

A

Recurrent sinopulmonary and ear infections
Severe atopic dermatitis
Bleeding

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50
Q

Burkitt lymphoma

A

Commonly manifests as abdominal (sporadic type) or head and neck disease (endemic type) with involvement of the bone marrow or CNS

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51
Q

Prognosis NHL

A

Patients with localized disease 90-1005 survival

Advanced 60-90% survival
-depends on pathological subtype, tumor burden of diagnosis as reflected in serum lactate DH LDH levels, presence or absence of CNS disease and specific sites of metastatic

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52
Q

Childhood leukemia

A

Most common under 15

And brain tumor

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53
Q

Leukemia pathogenesis

A

Malignant transformationa nd clincal expansion of HSC at an early stage of differentiation hat are then unable to undergo further maturation

Lymphoblastic leukemia

Myeloid

Acute Leukemias -97%

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54
Q

ALL AML genetics

A

Trisomy 21 both

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55
Q

Supraclavisular lymph node

A

Not common so be aware

Perk up ears

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56
Q

Most important work up LAD

A

H AND P

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57
Q

SMOOTH MOBILE

A

OK

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58
Q

Matted down ruff and in place not expect

A

Perk up

Are you warm fever systemically ill

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59
Q

PE node

A

> 2 cm enlarged

Location important supraclavicular not normal!

Tendernesss, erythema, swelling, distal lesions, spleen liver size

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60
Q

Unusual spot node

A

Supraclavicular

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61
Q

Age and node

A

Not palpable in babies
Maybe shorty with viral illness

Lymphoma rare under 10

Reactive cervical LAD very common prescrhool . Early school age

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62
Q

Reactive cervical LAD

A

Really common

Kid with conjunctivitis if have preauricular node increase chance bacterial

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63
Q

> 2 cm

A

May be significat but put in context with patient

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64
Q

Watchful waiting

A

If etiology obvious or if nodes not concerning

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65
Q

Antibiotic

A

Bacterial fever

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66
Q

Shotgun approach

A

NO

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67
Q

When biopsy node

A

No go away or gets bigger

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68
Q

Kawasaki

A

Unilateral cervical node fever 102 for 5 days

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69
Q

Cat scratch

A

Bartonella

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70
Q

Axilla nods six with low grade fever no other kids sick. Sore left hand healed .

A

Bartonella

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71
Q

Treat cat scratch disease

A

Azithromycin

Self limited but treat

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72
Q

Eye cat scratch disease

A

Neuroretinitis

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73
Q

Bartonella

A

Cat scratch disease isolated LAD often in axilla or in neck

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74
Q

14 year old boy lump chest apprehensive supraclavicular , and lump on privates, really tired , cough a lot, nose bleeds

A

CHEST X ray
See radioopaque mass in anterior cavity

Lymphoma to oncologist can metastasize to testicle

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75
Q

Testicular mass painless

A

Likely malignancy

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76
Q

Ill kid supraclavicular node coughing fatigue and

A

So more work up

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77
Q

Tumor like lesions

A

Heterotopic and hamartoma

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78
Q

Heterotopic

A

Microscopically normal cells in abnormal spots

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79
Q

Hamartoma

A

Overgrowth of native to organ ins high masses

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80
Q

Hemangioma

A

Most common tumor of infancy

Port wine-do CT scan

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81
Q

Hemangioma and thrombocytopenia

A

Huh

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82
Q

Lymphatic tumor

A

Lymphangioma

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83
Q

Fibrous tumros

A

Ok

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84
Q

Teratomas

A

Well differentiated cystic lesions

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85
Q

Most common solid tumor

A

Wilms

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86
Q

Neuroblastoma

A

Test when see blueberry muffin big mass

Less than 2 yo usual presentation is fever, large abdominal mass, blueberry muffin rash

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87
Q

Neuroblastoma test

A

VMA HVA

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88
Q

Wilms

A

1/10000
Most common primary renal tumor of childhood 204 yo

See big abdominal mass

Wilms tumor

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89
Q

Beckwith wiedemann

A 
Enlarge body organs 
Macroglossia
Hemihypertrophy******
Omphalophcele 
Abnormal large cells in adrenal

11p15.5 wt2

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90
Q

Wilms tumor

A

Large abdominal mass

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91
Q

Anemia

A

Reduced rbc volume or hbg content

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92
Q

Anemia shift

A

Right less affinity for oxygen

Easier to dump off

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93
Q

2,3 DPG increase in anemia

A

Increases within the RBC

Oxygen dissociation curve shift right

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94
Q

Work of anemic

A

H and p

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95
Q

Family history

A

Anemia, splenomegaly, jaundice, eagerly onset gallstones

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96
Q

Clincial features kids anemia

A

Pallor, sleepy, irritability, decreased exercise tolerance, flow murmur

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97
Q

Gall stones and jaundice

A

Hemolysis

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98
Q

2-3 have gallstones?

A

Not really

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99
Q

Flow murmur anemia

A

Increase CO to get oxygen to organs

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100
Q

Anytime increase CO

A

Get flow murmur doesn’t mean not right

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101
Q

Anemia severe symptoms

A

Weak, tachypnea, SOB, tachycardia, cardiac dilation/cardiomyopathy

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102
Q

Slower developing anemia

A

Slower dev better can compensate

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103
Q

Hemoglobin

A

Actual amount of hemoglobin in blood

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104
Q

Hematocrit

A

Volume percentage of rbc in blood

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105
Q

H/H

A

Hemoglobin/hematocrit

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106
Q

RDW up

A

Increase variation in side of rbc

In iron defiency anemia

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107
Q

MHCH

A

Mean corpuscular hemoglobin concentration

Grams of hbg per 100 ml

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108
Q

MCH

A

Mean corpuscular

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109
Q

Average content of HGB per RBC

Picograms per cell

A

RDW

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110
Q

Variability to sizes

A

RDW

Anisocytosis

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111
Q

Peripheral smear

A

Anisocytosis, poikilocytosis

Schistocytes is-fragments (hemolysis)

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112
Q

Decreased RBC production in bone marrow differential

A

Ineffective erythropoietin

Complete or relative failure of erythrocytosis

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113
Q

Increased destruction of RBC differential

A

Hemolysis

Intravascular extravascular

Anemia, hemoglobinuria, hemoglobinuria, hemosideria

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114
Q

Extravascular

A

Reticuloendothelial system which is everywhere

Espicially liver spleen phagocytosis rbc can be due to rbc membrane abnormalities or antibodies on them

See splenomegaly, anemia, jaundice

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115
Q

Bleeding anemia

A

Acute

  • hemorrhage
  • normochromic normocytic

Chronic
-hypochromic microcytic bc of iron defiency

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116
Q

Reticulocyte count

A

Low or low normal number of reticulocytes in a patient with anemia is indicative of an inadequate bone marrow response

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117
Q

Increased number of reticulocytes in a normal bone marrow response to anemia

A

It’s trying to keep up

Bone marrow respongin appropriately

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118
Q

Low normal reticulocyte count is an inadequate bone marrow response

A

In face of significant anemia

Not appropriate inadequate response

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119
Q

If think bone marrow failure

A

Bone marrow aspirate

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120
Q

Hematocrit hemoglobin relationship normally

A

Hemoglobin 12

Hematocrit 3x 36

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121
Q

Reticulocyte low

A

Bone marrow not enough building blocks

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122
Q

Up RDW and reticulocyte count up

A

RDW iron defiency

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123
Q

Anemic MCV normal reticulocyte count low rdw normal

A

Transient erythroblastopenia see pop up

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124
Q

Objectives know where they fall on graph

A

Ok

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125
Q

Diamond black fan

A

Pure rbc aplasia
Macrocytic
Decreased reticulocytes

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126
Q

Increase reticulocytes (bone marrow doing what do) what do

A

Do direct antibodies test for antibodies on rbc

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127
Q

newborn anemia peripheral smear then what

A

Blood loss

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128
Q

Peripheral smear abnormal new born anemia

A

Hemolysis!

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129
Q

Multiple cell lines affected

A

Think back ot bone marrow

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130
Q

At 2 months

A

Kids physiologic nater for hemoglobin nothing wrong but do h and H and hemoglobin 10 or 9 and everything else ok just physiologic nater

Kids born with a lot of rbc with short lifespan lot hemolize as bone marro pick up

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131
Q

Immune hemolytic anemia (positive coombs test, elevated indirect bilirubin, normocytic anemia, elevated reticulocyte count)

A

ABO and Rh incompatibility

132
Q

Parvovirus b18

A

If mom had

Slapped cheek apperance

Congenital anemia

Brand new baby with anemia

133
Q

Brand new baby

A

Infection or TORCH

Parvovirus

134
Q

Diamond black fan syndrome

A

Macrocytic anemia with low reticulocyte count

Congenital pure red cell aplasia

Resulting from icnreased apoptosis in erythroid precursors (30% have othe abnormalities, average age is 3 month)

135
Q

Faconi

A

Macrocytic anemia and reticulocytopenia, theombocytopenia and leukopenia

Most common aplastic anemia

PANCYTOPENIA progression

DNA sequencing can detect genetic mutations for faconi anemia

136
Q

Most common inherited aplastic anemia

137
Q

Iron defiency anemia

A

Microcytic hypochromic

Target cells

Kids , funky diets,

138
Q

Microcytic anemic low RBC distribution width

A

Thalassemia -low menetrier index, Hgb electrophoresis ,

139
Q

Mentzer index

A

MCV/RBC

> 13 iron deficient anemia
<13 beta thalassemia

140
Q

Lead poisoning

A

Basophils stippling

Microcytic hypochromic

HISTORY can do serum iron and ferritin

141
Q

Ferritin

A

Acute phase reactant like platelets so be careful

142
Q

Where kid get hemorrhage

A

Between periosteum and galeal aponeurosis

143
Q

Heinz bodies bite cells

144
Q

Howell jolly

A

Spherocytosis

145
Q

Mom trait dad trait what percent kids have sickle cell

146
Q

When TPO high

A

Platelets low

147
Q

Megakaryocytic where

A

In bone marrow and bud and platelets are liberated

148
Q

Normal platelet count

149
Q

Thrombocytopenia

150
Q

When worry about low platelets

A

When bleed to death!

<75 then primary hemostasis impaired but no spontaneous bleeding…maybe longer to bleed

<50 spontaneous bleeding possible when see oozing of gums

<20* 20000 this is it the line if going to treat TPO want to keep at or above 20000

<10000 life threatening hemorrhage but still rare spontaneous

151
Q

Causes of theombocytopenia

A

Decrease production, sequesteration, increased destruction, platelet loss or dilution

152
Q

Fetal new thrombocytopenia

A

Congenital infections

TORCH can cause thrombocytopenia baby with petechiae

Wiscott Aldrich thrombocytopenia boys

153
Q

Alloimmune thrombocytopenia

A

Antibodies from mom igg

154
Q

DIC thrombocytopenia

A

They’re being used

155
Q

Kasabach merit

A

Thrombocytopenia associated with big hemangiomas

Sequesteration and consumption of platelets
Av valve malformations

156
Q

Late onset neonatal thrombocytopenia

157
Q

Primary platelet consumption syndrome

A

Idiopathic thrombocytopenia purpura

158
Q

Immunologically thrombocytopenia

A

Hemolytic uremic syndrome

159
Q

Nonimmunologic thrombocytopenia

A

Thrombotic thrombocytopenic purpura

160
Q

Combined platelet and fibrinogen consumption syndrome

A

DIC

Kasabach Merritt

161
Q

Specific to the neonate thrombocytopenia

162
Q

Clincial platelet disorder

A

Petechiae purpura gingival bleeding epistaxis

163
Q

Kid 1-2 mm red purple macules (flat)

A

Petechiae
Low platelets
Suffocation if on face choking

164
Q

Lab test petechiae

A

CBC for platelets

165
Q

Platelets 25000 what do

A

Look to see if clumping

166
Q

Diagnosis kid

A

Immune acute thrombocytopenic purpura

167
Q

Diffuse petechiae rash

168
Q

Purpura

169
Q

Rash

170
Q

Well appearing kid moderate tos every thrombocytopenia

A

Ask meds drug dependent antibodies

171
Q

Just platelet no other cell lines

A

Acute immune

172
Q

Multiple cell lines thrombocytopenia

A

Bone marrow exam

173
Q

Acute idiopathic thrombocytopenic purpura

A

Most common cause isolated thrombocytopenia in otherwise well kids

Acute petechia and bruising

Can get some mucosal hemorrhage

Antiplatelet antibody binds platelet surface and enhance phagocytosis and destruction in liver and spleen

174
Q

Most AITP follow what

A

Virus
EBV
Cold

175
Q

Platelet count AITP

176
Q

Other cell lines A ITP

177
Q

PTT A ITP

178
Q

Platelet function normal in AITP

179
Q

Prognosis A ITP

A

Resolve in 6 months

180
Q

Treat a ITP

A

No asprin please
No sports
Reassure and educate child has rash and how know not going to bleed to death how keep safe is big part of it their anxiety and living level choose to treat or not

No evidence alters course of ITP doesnt help get rid of platelet antibody

181
Q

Treat aIT

182
Q

Splenectomy with a ITP

A

Where antibodies are made where platelets destroyed can result in remission in many with chronic ITP but consider if longer than a. Year and kid older have to weight risks and benefits

183
Q

What percent a ITP go to chronic

A

20%

Consider if a othe autoimmmune process going on

184
Q

Chronic ITP and H pylori infection

A

Remember this

185
Q

Drug induced plt destruction

186
Q

Non immune platelet destruction

A

Thrombotic microangiopathy, platelet and fibrin vascular injury in kidney and colon

187
Q

E. coli 105

A

Consume Pate let’s HUS

Non immune platelet destruction

188
Q

Kasabach

A

Thrombocytopenia and hypofibrinogenimia secondary to giant hemangiomas and associated intravascular coagulation

189
Q

Histo TTP

A

Big platelets and megakaryocytic

190
Q

HUS

A

Vascular injury in kidney and colon from e 157H7 causing consumption of platelets non immune platelet destruction

191
Q

Kasabach Merritt

A

Thrombocytopenia and hypofibrinogemia secondary to giant hemangioma and associated coagulation

192
Q

Von williebrand

A

Defect in vwf involved in function of platelets

193
Q

ITP histo

A

Large paltelets and increased megakaryocytes

194
Q

Immune mediated destructive thrombocytopenia

A

ITP

Drug induced

195
Q

Destructive platelet activationa Nd consumption

A

HUS
TTP
Kasabach

196
Q

Sequestration and trapping

A

2B or paltelet type von williebrand

197
Q

Decreased platelet production infection

A

EBV, CMV, parovirus

198
Q

Acquired bone marrow failure decreased platelet production

A

Leukemia

Lymphoma

199
Q

Genetic impaired thromvopoiesis

A

Wiskott aldrich
Faconi
Diamond syndrome
Thrombocytopenia with absent radii syndrome

200
Q

ITP

A

Only palstelts no other cell lines involved

201
Q

Peripheral blood smear

A

Important to look at with thrombocytopenia

202
Q

Acute vs chronic ITP

A

Acute is most common 2-6 follow viral

Chronic adolescents pediatric

203
Q

Hubbard leukemia and lymphoma

204
Q

Acute leukemia

A

Immature precursor cells blasts

205
Q

Chronic leukemia

A

Mature cells

206
Q

Leukemia epidemiology

A

30000 causes 18000 deaths

207
Q

Cause leukemia

A

Drugs toxins chemicals

208
Q

AML cause

A

Benzene

Alkylation treatment chemo from prior cancers

209
Q

Radiaiton

A

Cause all leukemia except CLL

210
Q

Virus mediated chromosomal alterations

A

All leukemia and T cell

211
Q

Myeloid

A

Preleukemia

212
Q

Old patient pancytopenia and macrocytosis

213
Q

What cause leukemia-it is also the cornerstone of diagnosis

A

Chromosomal damage

922 CML

1517 APL

214
Q

Presentation acute leukemia

A

ABRUPT pin down date it start

Rapid downhill course

3 month survival

Fast

Fever, easy bruising, fatigue, weight loss, anemia, SOB from anemia, bone pain!!!! Espicially ALLL

215
Q

Chronic leukemia

A

Slow onset and chronic course
Just walk in for yearly PE and find leukytosis still alive 6 years later and haven’t needed treatment

Maybe lymph node

216
Q

Sweets syndrome, acute febrile neutrophilic dermatitis

A

Cutaneous AML

If biopsy myeloblasts in dermis

Very characteristic AML

Treat by manage AML

217
Q

Auer rods

218
Q

Gingival hypertrophy

A

M4 and M5 AML -if has monoblastic component

219
Q

Smudge cells

A

CLL if multiple

220
Q

34 male fatigue bruising rapid onset, scleroicterus, sclera bleeding , palatial petechiae, tender spleen,

A

Acute hematologic also problem

221
Q

CBC WBC 4.5 38% seg 6% band 3% metamyelocytes 18% promyelocytes, Hb 7.1 BLT 22.5

What are those little rods

A

Auer rods

Cabot rods-Hb denatured look like infinity
Toxic granulation-ticked off leukocytes in inflammation
Gaucher cells-gaucher disease in bone marrow
Thumbprinting-

222
Q

CMP K 5.4 bilirubin 1.2 uric acid 12.9 BUN 37 PT 22.7 PTTT 70 what else his labs have

A

AML-auer rods , ALM m3 promyelocytic

DIC! Fibrinogen goes (50) down D dimer>.4

223
Q

When see schistocytes

224
Q

When see icnreased lysosomal levels

A

Monocytes Leukemias

-AML wont have this

225
Q

What does this have and how treat it

A

APL

All trans retinoids acid

226
Q

Treat hairy cell leukemia

A

2 chlorodeocyadenosine

227
Q

Decitabine

A

Myelodysplastic syndrome treat

228
Q

Apl translocation

229
Q

1221

230
Q

Trisomy 8

A

Myelodysplastic syndrome and some aml

231
Q

821

232
Q

5q-

A

Myelodysplasia

233
Q

18 yo female fatigue and blurred vision cervical and supraclavicular palpable non tender, spleen palpable, diplopia, 118K WBC 10% sets, 18% lymph’s, 8% blasts 2% monos ,hb 9.1 pt 11.8 PTT 22.3 uric acid 8.6 (if over 7 gout and kidney urate nephropathy)

A

ALL

Blurred vision-

234
Q

Hairy cell

A

Big spleen hairy cells

235
Q

Her neuro findings are most likely

A

Leptomeningial carcinomatosis

236
Q

What is her cytogenic

237
Q

7q-

A

Myelodysplastic

238
Q

Inv 16

A

Myelodysplasia and AML often in MPN1 gene

239
Q

4:11

240
Q

In addition whihc therapy for diplopia

A

Intrathecal methotrexate in csf need

241
Q

Omaha reservoir

A

Catheterisnerted by neurosurgeon into a lateral ventricle with a subcutaneous resevoir

For intrathecal therapies in palliative care for morphine dont have to do lumbar puncture

For intrathecal methotrexate

242
Q

77 man no complaints well small bl cervical nodes. WBC 22.5 hb14.1 plts 342K

A

Kikuchi disease-benign lymphoproliferative disorder diffuse LAD but biopsy and reactive no infectious get better on own

Lymphoproliferative disorder

243
Q

Best tes to evaluate the problem

244
Q

Lymph node in lymphoma

A

Non tender and rubbery
Pain after beer in HL

Back pain, leg edema is retroperitoneal lymph node enlargement

245
Q

Richter syndrome

A

CLL develop a diffuse large B cell lymphoma..represents colonial evolution with additional cytogenic abnormalities tough to kill

246
Q

B symptoms

A

Fever, drenching night sweats, 10% weight loss in 6 months, likely paraneoplastic and associated with worse prognosis

247
Q

Increase risk for primary CNS lymphoma

A

Immunosuppressed HIV organ transplant recipients

248
Q

Infectious agent and lymphoma

A

EBV HD , burkitt

H pylori gastric MALT

249
Q

Patient cervical adenopathy

250
Q

24 yo woman lST swelling posterior right cervical neck. Best plan for management . Firm rubbery node

A

Surgical excision !
Asymptomatic -out neck and pathologist can do it takes 30 min done outpatient and can have diagnosis

Observe-no seems neoplastic and not reactive
CT head neck-but not closer to diagnosis and paid a lot

251
Q

Biopsy shows HL next step

A

Staging evaluation

252
Q

Stage 1a. What next

A

One side one sight and a means no b symptoms asymptomatic

Stem cell transplant-all other modalities failed
Lymphadenectomy-no same reasonradiotherapy-yes bc localized to one area
ABVD -chemo for higher stage , and relapse

253
Q

68 yo painless swelling in groin 2 months. No complaints or symptoms. 2 cm soft rubbery non tender LN in left femoral. Neoplastic etiology suspected. What think

A

Burkitt -aggressive fastest doubling time

Hodgkin lymphoma-less likely late 60s less common than NHL usually adolescents and young adults

Indolent lymphoma-YES common presntation for older patient

254
Q

Biopsy see 14 18 what do next

A

Follicular lymphoma

Staging evaluation dont pull trigger

255
Q

Staging mild paraaortic without hepatosplenomegaly. Stage 2 a NHL follicular indolent . How treat

A

She wont need fo years. If not sick nothing give mark you better. Observation.

256
Q

27 male fatigue, weight loss night sweat 100.6 spleen big nontender one small rubbery node in right groin . LDH 347 up. Ct scan . And how treat

A

Lymphoma

RCHOP-b cell lymphoma
CT needle biopsy-closer to diagnosis
-yes

257
Q

18 yo fatigue mass in neck 7 cm mass emanating from Lt supraclavicular region and a spleen tip palpable on deep inspiration. Listless. CBC normal what ask her LDH 1140. Bili 2.1

A

HOW FAST IS MASS GROWING -helpful yes!

Have you lost weight-most appropriate for malignancy also good

Anyone else sick-nah

258
Q

Next step

A

Excision biopsy of the mass

Then stage if prove to be malignant

259
Q

Starry sky pattern

A

8 14 burkitt

260
Q

14 18

A

Follicular

261
Q

7q

262
Q

69

A

Acute leukemia

263
Q

922

264
Q

Staging both sides of diaphragm and 2 other sites

265
Q

IVA

A

3 or more extralymphatic and marrow involvement

266
Q

Treat burkitt

A

All style chemotherapy regimen

If nasty high grade burkitt lymphoma up game treat with all regimen-systemic chemo intrathecal chemo maintenance chemo for years best chance

267
Q

If relapse on that

268
Q

Myofascial swelling prominence jugular veins, chest veins distended spleenomegaly

A

Superior vena cava syndrome
From lymphoma

Medistinocospy to get biopsy

269
Q

Treat ALK positice BM exam positive

A

Anaplastic lymphoma kinase

T cell lymphoma CHOP with radiation radiotherapy for residual disease

270
Q

Leukocytosis cause

A

Benign more

271
Q

Drugs and leukocytosis

272
Q

84 women 102 T Alzheimer’s, HTN, osteoarthritis, WBC 42.3 74% seg 10% bands. Urine seen yellow cloudy looks like crisco

Increased bands
Plus in urine
10% bands is a left shift

273
Q

20 year old female anaphylactic allergies to nuts. Has some and self injects cbc wbc 22.6 wheezing

A

Epinephrine

This is demargination

274
Q

74 diffuse arthralgias and myalgia which began 3 days ago. One week on ciprofloxacin for uti. 20-30 wbc in urine wbc 9800 30% eosinophils . What is this

A

Eosinophilia myalgia syndrome relatable to meds-fluoroquinolones causes. Ciprofloxacin is one

See eosinophils in the urine-allergic interstitial nephritis-asthma in kidneys and eosinophils int here as evidence

275
Q

Infections cause neutropenia

276
Q

Neutropenia

A

Meds, nutritional, meds, sequesteration

277
Q

27 1 day mouth pain , had uti ten days ago and on ampicillin .

3% es. H and h normal

Candida in mouth thrush

36% segs
ANC 600 really low

A

Neutropenia from ampicillin

278
Q

80 yo fever, AMS and dehydration, dementia, c diff, depression, diverticulosis, appendectomy, hysterectomy, GERD , on a ton of medications . Ab pain in suprapubic region. Urine pus again. 10 bands plt 240K
BUN 95

A

Neutropenia from meds
-antibiotics,

Sepsis can do this as well (raise WBC older impaired release from marrow storage so granulocytes circulate and get UTI and granulocytes all go to bladder and cause it measured WBC decreased bc only pool can measure)

Pure white cell aplasia (ibuprofen with thymoma)

Nutritional (cachexia from dementia)

279
Q

What else may want

A

PS exam
Serial labs
Cultures

280
Q

How manage

A 
Admit
Hydrate 
Cultures
Antibiotics 
Change out foley- change foley
hospice evaluation appropriate
281
Q

Who has HIV most

282
Q

HIV 3 enzymes for replication

A

Capsid contains 3 enzymes required for HIV infection reverse transcriptase

Integrate
Protease

283
Q

HIV

A

Capsid contains 3 enzymes required for HIV infection reverse transcriptase

Integrate
Protease

284
Q

Infectivity HIV

A

Integrates into Cd4 T cells altering cell mediated immunity

285
Q

Symptoms HIV

A

Immunodeficiency from viral replication

286
Q

Life cycle HIV

A

Enter CD4
Replicate and cause cell fusio or death
Latent when cell into genome
Cd4 wall

287
Q

How get

A 
Receptive anal
Sharing needles with HIV infected 
Blood transfusion
Vaginal
Vaginal
Worse with inflamed ulcerative mucosa 
Born to mom with
Needlestick
Mucosal splash
288
Q

What increases HIV transmission

A

Genital ulcer disease

289
Q

How many Americans have HIV and undiagnosed

A

1.1 million

15%

290
Q

HIV icnreaseing in white and blacks

A

Blacks increase decrease whites even gays and increase most in Latino gay men

291
Q

So whose getting HIV

A

Latinos blacks

292
Q

Country where his common

A

Africa, South Africa

293
Q

What HIV cause

A

Immunodeficiency
Autoimmunity
Allergic and hypersensitivity reactions

294
Q

Immunodeficiency

A

Direct from effect on CD4 cells

Indirect on inflammation and immune activation from chronic viral infection

295
Q

Autoimmunity

A

From disordered cellular immune function or b lymphocyte dysfunction

Thrombocytopenia, lymphocytic interstitial pneumonitis

296
Q

Allergic hypersensitivity reactions

A

Yea eosinophilia pustular folliculitis (itchy red bump)

Fever rash with tmp-six

297
Q

500

A 
Bacterial
TB
Herpes
Vaginal candida
Hairy leukemia
Kaposi
298
Q

200

A 
Pneumocytsosis
Toxoplasmosis
Cryptococcus
Coccidiodomycosis
Cryptosporidosis
299
Q

50

A

Disseminated MAC
Histoplasmosis
CMV retinitis
CNS lymphoma

300
Q

First signs HIV

A

Thrush oral hairy leukoplakia

TB

301
Q

Last signs AIDS

A

CMV and MAC

302
Q

250-500

A

Pneumococcal pneumonia, TB
Herpes
Oral candidiasis

303
Q

<200

A

PJP
Histoplasmosiskaposi
Extrapulmonary miliary Tb

304
Q

<100

A

Cryptococcal meningitis
Esophageal candidiasis
Toxoplasmosis

305
Q

<50

306
Q

How long to develop aids

A

10 years asymptomatic till then

307
Q

Specific for HIV signs

A

Hairy leukoplakia of tongue
Disseminated kaposi sarcoma
Cutaneous bacillary angiomatosis

308
Q

Early infection

A

Generalized LAD

309
Q

Diagnose HIV

A

Immunoassay for Ab with test for p24 Ag

-p24 Ag becomes detectable a week before Ab in acute infection

Confirm with additional test

310
Q

How confirm test

A

Test sample with HIV-1/2 Ab differentiation immunoassay

Detection of HIV1/2 Ab confirms

311
Q

Sample negative on Ab

A

Tested with HIV nuclei acid amplification test NAAT

If positive with negative Ab then acute HIV

False positive if negative

312
Q

Non specific HIV findings

A 
Anemia
Leukopenia
Elevated erythrocyte sedimentation rate
Polyclonal hypergammaglobinemia
Hypocholestermia
Cutaneous anergy
313
Q

Limitations to cd44 count

A

Diurnal variations
Depression with intercurrent illness
Intra laboratory and inter laboratory variability

314
Q

When start MAC prophylaxis

315
Q

HIV viral load

A

Tests assess level of viral replication (CD4 cant do this) provides useful prognostic information independent of the information provided by cd4 counts

316
Q

Pulmonary HIV

A

Pneumocytsit jirovicci-most common opportunistic infection aids

317
Q

PJP

A

Best radiograph is diagnosis

Diffuse or perihilar infiltrates are msot characteristic

Pleural effusions

318
Q

Pleural effusions

A

Bacterial pneumona, TB, pleural kaposi

319
Q

Definitive diagnosis PJP

A

Giemsa stain of DFA of septum

Bronchioalveolar lavage
0when negative sputum in whom suspected

320
Q

Pneumocystitis pneumonia

A

Elevate LDH

Serum beta glucan more sensitive than LDH

Normal DLCO of CT of chest with no interstitial lung disease makes diagnosis unlikely

Unlikely if CD4>250 in past months

Pneumothoraces can be seen in HIV infected patients

321
Q

Chest c ray PJP

A

Cystic appearing areas or pneumatosis

322
Q

Community acquired pneumonia

A

Most common cause of pulmonary disease in HIV

-TB

323
Q

CNS

A

Toxoplasmosis
CD4<100

Multiple subcortical lesions with a predilection for basal ganglia
Multiple ring enhancing lesions with surrounding areas of edema

324
Q

CMV

325
Q

Kaposi sarcoma

A

Low grade vascular tumor HHV8

Popular, ranging from ml to cm

Pulmonary involvement can occur SOB

Clin Medicine (28 decks)

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