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random > SBL clin- hubbard, things i just have to memorize > Flashcards

SBL clin- hubbard, things i just have to memorize Flashcards

1
Q

which physical exam test of muscle weakness is indicative of true fatgue

A

breakaway wkness

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2
Q

if you only could do one test for fatigue, what would it be

A

reticulocyte count

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3
Q

anemia with foot/wrist drop, ddx?

A

lead poisening
amyloidosis
systemic autoimmune ds
vincristin therapy

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4
Q

how do B12/folate deficiency and MTX trx cause anemia

A

decreased RBC production, via xDNA

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5
Q

major causes of mechanical RBC loss–> anemia

A

march hemoglobinuria/ sports anemia

cardiac anemia

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6
Q

what chemical x cation pumps in the RBC to decrease survival and production

A

lead

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7
Q

most common cause of hemolytic anemia world wide

associated with what GU finding

A

malaria

dark urine = “blackwater fever’

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8
Q

transmission, clinical findings with Bartonellosis

A

sand flea
adhere to RBC membrane
iniial stage= hemolysis –>Oroya Fevere

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9
Q

transmission, clinical findings with
Babesiosis

abx trx=

A

intraerythrocyte protozoa, from rodents and Lyme Ds tick

Maltese Cross on Giemsa Stain of RBC,

abx trx= atovaquone+ (azithromycin or clindamycin) + quinone for 7-10 days

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10
Q

treatment for autoimmune hemolysis

A

mainstay= steroids, high dose prednisone

refractory cases= cyclophosphamide + azathioprine

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11
Q

polycythemia vera

etiology
sx
PE
associated with what syndrome
trx
A

95% have JAK2/V617F mutation and nEPO

sx= facial rubor, hyperviscosity signs, HALL= pruritis w hot shower

PE= 70% have splenomegaly, w spent phase

associated: Budd Chiari Syndrome
TRIAD: abd pain + ascities + hepatomegaly

trx: phlebotomy (blood letting)

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12
Q

clin presentation of fibromyalgia

A

chronic diffuse M pain, multiple tenderpoints on palpation

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13
Q

spontaneous hemarthrosis is hallmark for…

A

factor 8 and 9 deficiency

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14
Q

clinical presentation of osler weber rendu syndrome

how is it unique

A

hereditary hemorrhagic telangiectasia
x endoglin= only ENDOTHELIAL cause of hemostatic complication

telangiectasia, hx of bleeding, AV malformation, aneurysm-al dilations throughout body
80% have epistaxis

telangiectasias appear at puberty, then lifeline

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15
Q

what medications can cause hemorrhagic ds (inc bleeding)

A

ASA

ADP P2YR-R inhib have higher risk than ASA (clopidogrel, prasugrel, ticagrelor)

Vit E

anti-platelet drugs
-abx= cephalosporins, pencillin
H2 blockers (can replace with PPI)
IV heparin
digoxin
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16
Q

what herbs are associated with increased bleeding

A 
(antiplt)
gingko biloba               garlic
bilberry                        ginger
dong qui                     fever few
ginseng                       tumeric
meadowsweet             willow
fish oil
 concetrated omega 3 fatty acid supplement

anti(coag)
motherwort, chamomile, horse chestnut, red clover, fenugreek

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17
Q

presentation and underlying causes of DIB

A

present:
the initial thrombosis stage is clinicall MASKED: present with bleeding

=post med/surg/obstetric complication
trx by correcting underlying ds= sepsis, bowel obstruction,

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18
Q

differentiate between the clin presentation of TTP vs HUS

causes of TTP
labs and trx

A

TTP= purpura, microangiopathic hemolytic anemia, neuro sx, fever

HUS= all those + renal failure

causes= inherited or acquired xADAMTS13 (xvWF cleaving protease)

labs=smear shows schistocytes (fragments), helmet cells= Warburg Effect

trx= plasmapharesis is 100% lifesaving (from a no trx 100% mortality)

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19
Q

underlying causes of

xplt adhesion

xplt aggregation

xplt secretion

A 
xplt adhesion
     =vWD, Bernard Soulier (x gpIb)
xplt aggregation
     =glanzmann (gp IIb/IIIa)
xplt secretion
     =ASA-like condition (dec COX)
     =granulocyte storage pool
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20
Q

antithrombin III deficiency

clin presentation
trx

what other ds presents this way and how do you treat

A

clin= recurrent LE thrombophlebitis + DVT + chronic leg ulcers
50% have DVT by 30 yo, inc risk in preg (mom will become less active throughout)

trx= prophylactic anticoags for like

ONLY REPLACE ATIII IFF:
known deficiency AND have DVT AND refractory to heparin

~~~ protein C/S defiency, prophylactic warfarin (need to start an anticoag first and then monotherapy once INR normalizes)

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21
Q

what 2 ds combined are the most common diseases associated with hereditary thrombophlebitis

A

factor V leiden
(stronger risk of TE ds in homozygrous, trx w DVT prophylaxis)

prothrombin 20210 (aka G-->A ds)
inc affinity and dec regulation of prothrombin
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22
Q

causes, clin presentation, labs, and trx for antiphospholipid Ab syndome

A

acquired from things like SLE, HIV, RA

sx: thromboembolic miscarriage, thrombocytopenia, cerebral ischemia, recurrent stroke

false (+) syphillis
prolonged PTT THAT FAILES TO CORRECT in mixed test, corrects with addition of antiphospholipid

trx: subQ heparin, hydroxychloroquine

23
Q

what routine pre-op test is used to test liver function/ vit K levels

A

PT

24
Q

what do PT, and PTT test or

A

PT= F1 (fibrinogen), 2 (prothrombic), 5, 7, 10

PTT= F 11, 9, 8, 5, 2 (prothrombin), 1 (fibrinogen), prekalikrein, HMW kallikrein, F12

25
Q

when do you do…

mixing studies
specific factor assays

A

MS= to evaluate a long aPTT

SFA: in response to severe bleeding, to guide therapy

26
Q 
thrombin time and DRVVT
measure what (what levels will prolong the time)

presence of what drugs can effect this test

A

measure (fibronogen–>fibrin)
prolonged time w fibrinogen <80-100 mg/dL

heparin= prolonged TT, NORM DRVVT

dabigatran (DVT trx med) = markedly inc TT

test can show effectiveness of LMW heparin,

direct measure levels of –
unfractioned heparin
direct Xa inhib= rivaroxaban, apixaban, edoxaban

27
Q

what is the use of quantitativ D-dimer assay

A

do 4 wks after stopping anticoag

stratify risk of recurrent thrombosis

28
Q

protein C+S levels

inc
or dec

A

inc= acute thrombosis

dec= warfarin levels

29
Q

clinical signs of DVT

what testing do you do

A

homan’s sign= calf pain on dorsiflexion

moses sign: pain w compression of calf
against tibia but not w squeeze

lownberg sign: BP cuff on mid calf and pain elicited

lister’s sign: pain w percussion of anteromedial tibia

=pt w low clin likelihood– do D dimer
gold standard = venography
BUT rarely do it because a duplex US has such good sensitivity and specificity

30
Q

the four T’s of the anterior mediastinum

A

thymoma

teratoma

thyroid mass

“terrible” T cell lymphoma

31
Q

thymoma vs terrible T cell lymphoma

A

thymoma= M, >40 yo with anterior superior mass
associated with myasthenia gravis

t cell lymphoma = children

32
Q

4 Ts of heparin induced thrombocytopenia

how to grade

A

high probability= 6-8 points
intermediate probability= 4-5 points
low probability <3 points

thrombocytopenia
2 pts= >20k, falls >50%
1 pt= 10-19k, fall 30 30-50%
0 pt= plt < 10k, fall <30%

timing of plt count fall
2 pts= clear onset days 5-14, plt fall <1 day
1 pt= consistent w day 4-15 dall, but not clear or onset after day 14 or fall < 1 day prior
0 pt= plt fall <4 days without recent exposure

thrombosis or other sequelae
2 pt= new thrombosis, skin necrosis at injection site, anaphylactic rxn after IV bolus
1 pt= progressive or recurrent thrombosis, erythematous skin lesion, suspected thrombosis not confirmed
0 pt= non

oTher causes of thrombocytopenia:
2= none apparent
1pt= possible
0 pt= definite

33
Q

clinical presentation of infectious mono

A

teen w viral illness (fever, quick onset, body aches) and a palpable spleen

34
Q

immediate vs long term therapy in DVT

when do you put in an IVC filter

A

immediate anticoag = IV unfractioned heparin, LMWH for outpatient

long term: warfarin (started w heparin)
or newers (dabigatran, rivaroxaban, apixaban, edoxaban) =rapid onset, no need bridge but contra in CKD

IVC filter= only if contra to anticoag= short term decr in risk of PE but has a long term increase risk of recurrent DVT

35
Q

pulmonary embolism

virchow’s triad- causes

CXR findings

mortality is associated with what

A

Virchow’s triad= endothelial damage, venous stasis, hypercoag
hypercoag ~
—malignancy in 20% of DVT pts = lung>pancreas>colon, rectum, renal, prostate
—-drugs: tamoxifen, bevacizumab, thalidomide
—ds= polycythemia vera, APS

cxr= atelectasis
Westermark Sign= focial oligemia (no vasc can be seen distal to the PE)
Hampton Hump= peripheral, wedge-shaped density above diaphragm

mortality associated with hemodynaic changes after an acute rise in pulmonary A resistance

36
Q

Wells Criterion scoring for DVT and PE

plus some criterion that aren’t immediately obvious

A 
DVT: 
>/= 3 -- 75% risk of DVT
  0 = 3% risk
(+1) - calf swelling > 3cm, tender along deep V, UNILAT pitting edema, active CA, 
(-2)= alt dx more likely

PE:
>/= 6 - 70% risk
<2 = 2-3% risk
(+3)= clin evidence of DVT, other dx LESS likely
(+1.5)= HR>100, (immobility > 3 days, surgery within 4 weeks, previous DVT)
(+1)= hemoptysis, malignancy

37
Q

contrast venography vs doppler vs V/Q scan vs CT angio vs D-dimer

pros and cons

A

contrast venography

  • -show anatomy and flow phys
    • pain, contrast, invasive

doppler

  • —flow phys, cheap, easy, no radation
    - inc false +/-, tech dependent

V/Q scan

  • —-inc sensitivity, cheap
    - dec specificity, miss small defects

CT angio

  • —- GOLD STANDARD for sens and spec
    - contrast, may miss small clots

D-dimer

  • —– (-) test makes test unlikely
    - + test NOT diagnostic
38
Q

anticoag trx of acute DVT and PE

at what point in trx do you reassess who should keep getting trx

  • trx if the event was
  • unprovoked
  • unprovoked and recurrent
  • associated w underlying thrombophilia
  • associated w CA
  • due to transient risk
A

3 months

-unprovoked
indefinite if bleed risk allows= ASA

-unprovoked and recurrent
indefinite

-associated w underlying thrombophilia
indefinite (if APS, as long as (+) serology, may stop if serology is consistently neg)

-associated w CA
continue as long as CA lives, trx w enoxoparin (LMW heparin)

-due to transient risk
stop at 3 months

39
Q

post op anticoag trx of

who gets..

LMWH
fondaparinaux
DOACs: rivaroxibin and apixaban
DOAC: dabigatran
warfarin
A 
LMWH
  =most med+critical ts,
 w/in 4 wks of abd/pelvic CA surgery
many ortho (bid, 10 day min)
post-joint replacement- = 1 month
bariatric pts= bid

fondaparinaux
=many ortho- 10 day min
-post-joint replacement- = 1 month

DOACs: rivaroxibin and apixaban
ortho s/p THA 35 days , TKA 12 days

DOAC: dabigatran
s/p THR IFF CrCl > 30 mL,
CONTRA in renal ds (excreted..)

warfarin

  • some ortho, get goal of INR 2.5 with bridge
    - high risk s/p THR, TKR, hip fix
40
Q

drugs that cause lymphadenopathy

A 
allopurinol
atenolol
captopril
cabamezapine
cephalosporines
etrosuximide
gold 
hydralizine
imatinib
lamotragine
penicilline
phenytoin
primidine
pyrimethamine
quinidine
sulfanomaide
sulindac
41
Q

PE findings of lymphadenopathy that have diagnositc value

A

systemic ds + lymphadenopath + splenomegaly –> think lymphoma, CLL, acute leukemia

size
consistency
fixation
tender

42
Q

anterior cervical lymphadenopathy is associated with what ds/infection

A

EBV, CMV, toxo

lymphoma, CLL, H+N CA

43
Q

posterior cervical lymphadenopathy is associated with what ds/infection

A

EBV and TB

lymphoma, CLL, H+N CA

44
Q

supraclavicular lymphadenopathy is associated with what ds/infection

A

1/3-1/2 pts have a malignancy, espt if > 40 yo

R side: retroperitoneal, mediastinal, lung, esophagus

L side: intra-abd CA (virchows node, thoracic duct)

45
Q

axilary lymphadenopathy is associated with what ds/infection

A

cat scratch ds, UE melanoma, breast met, silicone breast implant

46
Q

epitrochlear lymphadenopathy is associated with what ds/infection

A

ALWAYS PATHALOGIC IF PALPABLE

hand/forearm inection, tularemia, strep, cat scratch ds
SECONDARY SYPHILLIS
sarcoid

47
Q

inguinal lymphadenopathy is associated with what ds/infection

A 
LE infection (tuleremia)
STDs= venerum, primary syphillis, genital herpes/chancroid

lymphoma, melanoma, other skin CA of LE, GU, anus rectum CA

48
Q

occipital lymphadenopathy is associated with what ds/infection

A

scalp infection

49
Q

preauricular adenopathy

A

conjuntival infections, cat scratch

50
Q

how does a thoracic adenopathy present

A

on CXR,

sx= cough/wheeze, dysphagia, swollen UE/neck

51
Q

mediastinal LAD is associated with different conditions in dif populations

young
endemic areas
old ppl

A

young – mono, sarcoidosis
endemic areas — histo (looks like lymphoma)
old ppl -primary lung CA, TB, fungi, sarcoidosis

52
Q

given lymphadenopathy with an abn CXR and (-) PPD, what other entities do you consider

A

HIV, EBV/CMV, toxo, brucella (from unpasteurized milk, soft cheese)
autoimmune CT ds

53
Q

findings that are diagnostic of hypersplenism

A

splenomegaly
cytopenia
normal or hyperplastic BM
response to splenectomy

54
Q

what triad of sx is seen in myelofibrosis

A

leukoerythroblastic anemia
poikilocytosis
splenomegaly

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