wk 5 Flashcards
What do most multiple myeloma (MM) patients have on protein electrophoresis?
An M-spike. Immunofixation is done alongside it.
What is the significance of Bence-Jones proteins in MM?
Found in 15-20% of MM patients, only contains light chains.
What imaging technique is used to examine bone lesions in MM?
Skeletal survey (most used).
What is the most common presentation of MM?
Bone pain.
What are the CRAB features of multiple myeloma?
- C: Calcium elevation (>10 mg/L) - R: Renal dysfunction (creatinine >2 mg/dL) - A: Anemia (Hgb <10 g/dL or >/= 2 g/dL decrease) - B: Bone disease (lytic lesions or osteoporosis).
What blood smear finding is seen in MM?
Rouleaux formation of RBCs with background basophilia.
What is the supportive treatment for asymptomatic myeloma?
EPO and bisphosphonates.
What is Lenalidomide used for in MM?
Prophylaxis for DVT.
What defines MGUS (Monoclonal Gammopathy of Undetermined Significance)?
M protein in serum <30 g/L, clonal plasma cells <10%, NO CRAB features.
What defines smoldering MM?
M protein >30 g/L, clonal plasma cells >10%, NO CRAB features.
What defines active MM?
Any level of M protein, clonal plasma cells >10%, with CRAB symptoms.
What immunoglobulin is associated with Waldenstrom macroglobulinemia? + manifestations
IgM
Sx:
- HYPERVISCOSITY syndrome: bleeding, neuropathy, vision
- hepatosplenomegaly
- lymphadenopathy
What is hyperviscosity syndrome in Waldenstrom macroglobulinemia?
Triad: neurological abnormalities, vision changes, mucosal bleeding.
How does Waldenstrom differ from MM?
- Waldenstrom: IgM, hyperviscosity, hepatosplenomegaly. - MM: IgG, IgA, light chains, osteolytic lesions/fractures, CRAB features.
What causes Superior Vena Cava Syndrome (SVCS)?
External compression or intrinsic obstruction of the SVC.
What are the symptoms of SVCS? gold standard dx?
Headache, lightheadedness, distorted vision, JVD, UE swelling, syncope, facial/upper body plethora, cyanosis, papilledema, dyspnea, cough, chest pain.
get a CONTRAST VENOGRAPHY - gold standard
What is the diagnostic test of choice for SVCS?
Contrast venography (gold standard).
What are the symptoms of cardiac tamponade?
Beck’s triad: muffled heart sounds, hypotension, raised JVP
Dyspnea, orthopnea, , pericardial rub, pulsus paradoxus, chest pain, cough,
What is the xray and treatment for cardiac tamponade?
Pericardiocentesis and catheter drainage. “Water bottle sign” on CXR.
What is a key EKG finding in hypercalcemia?
Short QT interval.
What causes tumor lysis syndrome (TLS)?
What are the key lab findings in TLS?
Sudden release of cellular lysis products due to tumor destruction, often from treatment.
Hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia. Can lead to renal failure.
What is the prophylactic treatment for hyperuricemia in TLS?
Allopurinol.
What defines neutropenic fever?
dx?
ANC <1500 cells/mL (severe <500) and single oral temperature >38.3°C or sustained for 1 hour at >38°C.
dx: Blood culture with a minimum of 2 sets.
What are the symptoms of acute PE? and gold standard dx?
Dyspnea, chest pain, calf/thigh pain/swelling, tachypnea, DVT signs, hypoxia, tachycardia, respiratory alkalosis, S1Q3T3.
dx: spiral CT
