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MS3 > Step studying 10 > Flashcards

Step studying 10 Flashcards

1
Q

What causes elevated AFP in pregnancy

A

NTD, ventral wall deficits, multiple gestations

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2
Q

What causes low AFP in pregnancy

A

Aneuploidies

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3
Q

What will you see in the following in Down Syndrome

  • AFP
  • bHCG
  • Estriol
  • Inhibin A
A 
	Decreased alpha-fetoprotein
	Increased b-hCG
	Decreased estriol
	Increased Inhibin A
•	THINK: low boy (alpha) and girl (estriol)
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4
Q

What will you see in the following in Edwards syndrome (Trisomy 18)

  • AFP
  • bHCG
  • Estriol
  • Inhibin A
A

 Decreased alpha-fetoprotein
 Decreased b-hCG
 Decreased estriol
 Normal Inhibin A

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5
Q

What part of the brain is affected in Parkinson’s

A

Basal ganglia (this is where dopamine works)

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6
Q

What type of anemia will you see in liver disease

A

Macrocytic (non-megaloblastic) anemia

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7
Q

Causes of B12 deficiency

A
  • Strict vegan
  • Pernicious anemia
  • Crohn’s disease
  • Gastric bypass
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8
Q

How can you distinguish between B12 deficiency caused by nutritional deficiency vs impaired absorption

A

Schilling’s Test
o Give pt IM injection of B12 to saturate liver
o Then give pt oral B12 and check urine
o Because body is saturated, all oral B12 will be absorbed and then excreted in the urine, so pt will have positive B12 in urine IF they were able to absorb it
♣ = deficiency due to poor nutrition
o If urine is negative for B12, that means there was poor absorption
♣ = deficiency due to malabsorption

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9
Q

How should you think about total iron binding capacity (TIBC) in determining anemia cause

A

Think: opposite of Ferritin

• High TIBC (Total iron-binding capacity = # of transferrin molecules in the blood – will be elevated because the liver is pumping out more in a state of low iron in order to replenish iron

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10
Q

Does sickle cell have micro or normocytic anemia

A

Normocytic

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11
Q

What lab value can you use to distinguish leukemoid reaction from leukemia

A

♣ Leukocyte alkaline phosphatase (LAP) will be elevated

♣ Will have more mature neutrophils (metamyelocytes > myelocytes)

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12
Q

What will you see in AML (histology, chromosomes, tx, tumor marker)

A

o When you think AML, think “All My Life” = musicals
o Auer sounds like Fuer (Hitler) – Sound of music - Auer rods
o I am 16 going on 17 (15;17)
o Poke Hitler in the eye with a carrot – treat with retinoic acid

Myleoperoxidase (MPO) +

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13
Q

Which leukemia is primarily a disease of children

A

ALL

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14
Q

What positive tumor marker is in ALL

A

TdT+

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15
Q

Tx of ALL

A

Chemotherapy with CNS prophylaxis (ALL tends to infect the CNS)

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16
Q

Treatment of CML

A

Imatinib (bcr-abl tyrosine kinase inhibitor)

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17
Q

Which chronic leukemia has risk for blast crisis (transforming into acute leukemia)

A

CML

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18
Q

Tx of CLL

A

Usually occurs in older people

  • If old and asymptomatic = no tx
  • If old and symptomatic = chemo
  • If young = stem cell transplant
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19
Q

What lymphoma do you see Reed Sternberg cells

A

Hodgkin

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20
Q

What are alcohol lymph nodes

A

Nontender lymph nodes of Hodgkns lymphoma turns painful with consumptions of alcohol

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21
Q

What type of lymphoma is Burkitt’s

A

Non-hodgkins

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22
Q

What population does lichen sclerosis occur in

A

Prepubertal girls and perimenopausal/postmenopausal women

o These are all hypoestrogenic populations

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23
Q

Tx of multiple myeloma

A
  • <70 y/o with donor = stem cell transplant

* >70 or without donor = chemo

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24
Q

Diagnosis of multiple myeloma

A
  • +Serum protein electrophoresis (SPEP)
  • +Urine protein electrophoresis
  • Skeletal bone survery shows lytic lesions
  • Bone marrow biopsy >10% plasma cells
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25
Q

Diagnosis of monoclonal gammopathy of undetermined significance

A
  • +Serum protein electrophoresis
  • (-)Urine protein electrophoresis
  • (-) Skeletal survery
  • Bone marrow biopsy <10% plasma cells
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26
Q

Diagnosis of Waldenstrom

A
  • +Serum protein electrophoresis
  • (-) Urine protein electrophoresis
  • (-) skeletal bone
  • Bone marrow biopsy >10% lymphoma
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27
Q

Tx of Waldenstrom

A
  • Rituximab (treat it like a lymphoma)

* Plasmapharesis for hyperviscosity

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28
Q

Cause of TTP

A 
o	Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation
♣	No vWF degradation = abnormal platelet adhesion = microthrombi
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29
Q

Clinical presentation of TTP

A 
o	Findings (Pentad) – THINK: FAT RN
♣	F = Fever
♣	A = anemia (Microangiopathic hemolytic anemia = RBCs sheared by microthrombi)
♣	T = thrombocytopenia (platelets being used up)
♣	R = renal insufficiency (thrombi involve vessels of kidney)
♣	N = neurological symptoms – confusion, HA, seizures, coma (thrombi involve vessels of CNS)
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30
Q

Tx of TTP

A

Plasma exchange transfusion

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31
Q

Describe following lab findings in TTP:

  • Platelets
  • PT/PTT
  • Fibrinogen
  • D-dimer
A
  • Low platelets
  • PT/PTT = normal
  • Fibrinogen = normal
  • D-dimer = normal
32
Q

Describe following lab findings in DIC

  • Platelets
  • PT/PTT
  • Fibrinogen
  • D-dimer
A

♣ Increased bleeding time – low platelets
♣ Increased PT and PTT
♣ Low fibrinogen – being used up
♣ High D-dimer (fibrin split products)

33
Q

Describe cause of immune thrombocytopenic purpura (ITP)

A

o IgG autoantibodies to GP2b3a (which allow platelets to connect to each other)
o Antibodies produced by plasma cells of spleen and antibody-bound platelets consumed by macrophages of spleen
o Often associated with HIV

34
Q

Tx of ITP

A

♣ Steroids and IVIG (autoimmune treatment)

♣ Splenectomy

35
Q

Tx of leprosy

A

Dapsone + Rifampin

Add Clofazimine if severe

36
Q

What is laryngomalacia

A

♣ Caused by “floppy” supraglottic structures that collapse during inspiration
♣ Inspiratory stridor worsens when supine
♣ Peaks at age 4-8 months

37
Q

Diagnosis of laryngomalacia

A

♣ Usually clinical

♣ Confirmation by flexible laryngoscopy for moderate/severe cases

38
Q

Tx of laryngomalacia

A

♣ Reassurance for most cases

♣ Supraglottoplasty for severe symptoms

39
Q

Empiric tx for community acquired pneumonia

A
  • Moxifloxacin
  • CTX + Azithro
  • Azithro
40
Q

Empiric tx for hospital acquired pneumonia

A

Want to include coverage of MRSA and Pseudomonas

- Vanc + Pip/Tazo

41
Q

Empiric tx for meningitis

A

CTX
+ Vancomycin
+/- steroids
+/- Ampicillin (if immunocompromised)

42
Q

Tx for UTI in pregnancy

A

Amoxicillin

43
Q

Empiric tx for UTI

A
  • Nitrofurantoin (if woman)

- TMP-SMX aka Bactrim (do not use with renal failure)

44
Q

Empiric tx for pyelo

inpatient vs outpatient

A 
Inpatient = CTX
Outpatient = Cipro
45
Q

Empiric tx of cellulitis

A

♣ Vancomycin
♣ Clindamycin
♣ Bactrim

46
Q

What test is used to diagnose anti-retroviral syndrome

A

This is the acute flu-like illness that occurs with initial onset of disease

Too early to have antibodies so ELISA will be negative

Need to get PCR (viral load) for diagnosis

47
Q

Diagnosis of chronic HIV

A

ELISA first, and if positive must confirm with Western Blot

Then check viral load and CD4 count to see where you start and to follow how medications work

48
Q

What’s the bug you are worried about at CD4 <200

A

PCP

Toxo is <100
MAC is <50

49
Q

What do you do if pt had a positive PPD skin test

A

Get a CXR

50
Q

What do you do if pt has +PPD and -CXR

A

This is latent TB - treat with Isoniazid + B6

51
Q

What do you do if pt has +PPD and +CXR

A

Get an AFB smear (3 separate) to determine if they are infectious

52
Q

What do you do if pt has +PPD, +CXR, and -AFB

A

This is latent TB - treat with Isonizid + B6

53
Q

What do you do if pt has +PPD, +CXR, and +AFB

A

This is active TB - RIPE therapy

54
Q

What are the contraindications to LP

A

FAILS

  • FND
  • AMS
  • Immunosuppression
  • Lesion over site where LP would happen
  • Seizures
55
Q

Tx of asymptomatic Bartholin duct cyst

A

Observation

Can I&D if it is symptomatic or infected (abscess)

56
Q

Describe imaging in meconium ileus

A

• Contrast enema will show a narrow, undeveloped colon

57
Q

Describe imaging in Hirschprung

A

o Level of obstruction usually at the rectosigmoid junction, with proximal dilated colon

58
Q

Describe the MOA behind cyanide poisoning

A

Cyanide poisoning occurs because cyanide binds to Fe3+, inhibiting its reduction to Fe2+ and blocking production of ATP from oxidative phosphorylation

59
Q

Describe MOA of methemoglobinemia

A

Caused by nitrates/nitrites, antimalarial drugs, dapsone, sulfonamides

It causes an oxidation of hemoglobin to methemoglobin (Fe2+ to Fe3+) - oxidized form has reduced affinity for O2 and thus reduced O2 delivery to tissues

60
Q

Tx of cyanide toxicity

A

o You can induce methemoglobinemia with nitrites (will oxidize Fe2+ to Fe3+) in order to treat cyanide poisoning

Cyanide will get bound up by Fe3+

61
Q

Tx of methemoglobinemia

A
  • Methylene blue

* Vitamin C

62
Q

Tx of elevated homocysteine

A

Folate + B6

- Can also add B12 if it is deficient

63
Q

Next step in management of solitary pulmonary nodule

A
  • Check old imaging (if stable for 2-3 years, can just observe)
  • CT scan to look for malignant features
  • Biopsy or surgical excision if malignant features
64
Q

What is the pathophys of Fanconi Anemia

A

♣ Inherited DNA repair defect

♣ Bone marrow failure

65
Q

Clinical findings of Fanconi anemia

A 
♣	Short stature
♣	Hypo/hyperpigmented macules
♣	Abnormal thumbs
♣	Genitourinary malformations
\+ Pancytopenia
66
Q

Tx of Fanconi anemia

A

Stem cell transplant

67
Q

Tx of hospital acquired pneumonia

A

♣ Vanc + Pip/Tazo

Want to cover for MRSA and pseudomonas

68
Q

How do you diagnose syphilis

A 
Primary disease (chancre)
o	Darkfield microscopy
Secondary disease (fever and rash)
o	RPR  antibody

Tertiary (tabes dorsalis and Argyll Robertson pupil)
o Get an LP and check RPR of the CSF

69
Q

Tx of native valve endocarditis

A

Vancomycin

70
Q

Causes of Cushing syndrome (x4)

A

♣ Exogenous corticosteroids (most common cause)
♣ ACTH-secreting pituitary adenoma (Cushing disease)
♣ Paraneoplastic ACTH secretion (e.g. small cell lung cancer)
♣ Primary adrenal adenoma

71
Q

First step in suspected Cushings

A

♣ First give low-dose dexamethasone (synthetic glucocorticoid) + 24 hour urine cortisol or late night salivary cortisol
• If there is a failure to suppress cortisol, this is cushing syndrome

72
Q

Next step if low dose dex test is positive

A

♣ Measure ACTH:

73
Q

What does +low dose dex test + low ACTH mean

A

Adrenal tumor or exogenous glucocorticoids

74
Q

What dose +low dose dex test + high ACTH mean

Also what is next step

A

• If high, suspect Cushing disease (ACTH-pituitary adenoma) or ectopic ACTH secreting tumor
o Give high dose Dexamethasone:

75
Q

What dose +low dose dex + high ACTH + lack of suppression with high dose dex mean

A

Ectopic tumor (e.g. small cell lung)

76
Q

What does +low dose dex + high ACTH + suppression with high dose dex man

A

Cushing disease (pituitary adenoma)

MS3 (88 decks)

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