Part 2 Flashcards
Multiple Myeloma
Most common primary malignancy of bone, high in IL-6 (plasma cell growth factor), can produce osteoclast activating factor (bone pain, skull and vertebrae lytic lesions, hypercalcemia), increased risk of fracture, elevated serum proteins (globulins) which presnts as M spike on SPEP. High risk of infection due to low Ab diversity. Rouleaux formation on smear due to altered blood charge. Free light chain in serum will lead to amyloidosis (Kidney)
Monocolonal Gammopathy of Undetermined Significance
M spike on SPEP no other signs of cancer, found most commonly in the elderly, may progress to Multiple Myeloma.
Waldenstrom Macroglobulinemia
B cell lymphoma with monoclonal IgM. LAD, M spike, visual and neurodeficits due to hyperviscosity, bleeding, Tx: plasmapheresis
Langerhans Cell Histiocytosis
Dendritic cells of the skin, CD1a+ and S100+, will see Birbeck granules on EM (Tennis Racket). 3 subtypes:
Letterer-Siwe: Rapidly fatal, skin rash and skeletal defects, found in infantss.
Eosinophilic Granulom: Pathologic Fracture in adolescents, benign, biopsy shows Langerhans cells and eosinophils.
Hans-Schuller-Christian Dz: Malignant, scalp rash, lytic skull lesions, diabetes insipidus, exophthalmos, found in children.
Protamine
Heparin Reversal agent
Fomepizol
Ethylene glycol toxicity agent
Aspirin Intolerant Asthma Triad
Asthma, brochospasm (aspirin), and eczema
Angiofibroma
Benign nasal tumor of blood vessels and fibrous tissue mostly seen in adolescent males. Presents with profuse epistaxis.
Nasopharyngeal Carcinoma
EBV driven tumor that presents in African children and chinese adults. Histology shows pleomorphic keratin positive epithelial cells in a background of lymphocytes.
Causitive agent of Acute Epiglottitis
H flu (B)
Laryngotracheobronchitis causitive agent
Parainfluenza virus
Small Cell Lung Carcinoma
Poorly differentiated, male smokers, central lesion, early metastasis, may secrete ADH, ACTH or cause Eaton-Lambert Syndrome
Squamous Cell Carcinoma
Keratin pearls or intercellular bridges, most common tumor in male smokers, central lesion. May secrete PTHrP.
Adenocarcinoma
Glands or mucin production, most common lung tumor in a nonsmoker/female smoker. Peripheral
Large Cell Lung Carcinoma
Poorly differentiated large cells, related to smoking, central or peripheral. Poor prognosis.
Reye’s Syndrome
Aspirin following viral infection in kids that causes fatty liver change with cerebral edema.
VSD Murmur
Holosystolic murmur at LLSB
Sensory ganglion for CNVII
Geniculate Ganglion
Aortic Stenosis
Harsh blowing murmur at the RUSB or LUSB. Calcification is most common cause.
Class IA Antiarrhythmics
Quinidine, procainamide, disopyramide
Widen QRS and prolong AP. Good for SVAs and VAs. Good for WPW.
Class IB Antiarrhythmics
Lidocaine, phenytoin, mexilitine
Shorten phase 2 and 3, highly selective for open Na channels (ventricles and ischemic tissues)
Class IC Antiarrhythmics
Flecanide, propafenone
Afib, SVAs, VAs
Contraindicated in hx of ischemia or structural defect.
Class II Antiarrhythmics
Beta blockers
Decrease sympathetic imput to the SA/AV
prolong refractory period
Good for SVas, Afib
Class III Antiarrhythmic
Amiodarone, sotalol, dofetilide, ibutalide. K+ channel blockers. Prolong phase 2 and 3. Amiodarone has class 1, 2, 3, and 4 activity. Sotalol has class 2 and 3 activity. Good for SVAs, VAs, and Afib. All can cause TdP.
Class IV Antiarrhythmic
CCBs (Nondihyropyradine) Verapamil and Diltiazem
Effects at SA and AV nodes prolonged conduction and refractory peroid. Good for Afib. Can cause heart block.
Class V Antiarrhythmic
Digoxin, Mg2+, K+, Adenosine
Digoxin: parasympathetic effects, good for afib
Mg2+: Tx for TdP
Adenosine: prolongs refractory period at AV, increases outward K+, inward Ca2+. Treatment of choice for conversion of SVTs. Sense of impending doom. Counteracted by caffeine.
