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Int Med B
Internal Med
| Question | Answer |
|---|---|
| Ankylosing spondylitis Pathophysiology | Epi - M>F, W>AA, ?50% native Am; assoc with: uveitis, IBD, enthesitis, ?reactive arthritis |
| Ankylosing spondylitis Sx/Sx | Schober test (+) (spine curve inc <5cm on flexion); LBP worsens with rest improved with activity |
| Ankylosing spondylitis DDx | OA, psoriatic arthritis (fx DIPs; arthritis mutilans); reactive arth; infxn; vert fx; bony mets; onchronotic arthropathy |
| Ankylosing spondylitis DDx: reactive arth | soon after infxn, no org isolated from affected joint (CT, Yersinia, S/S/C); usu heel or LBP; dactylitis (sausage digits); conjunctivitis, urethritis |
| Ank spondylitis Dx studies | xray (bamboo spine); HLA-B27 |
| Ank spondylitis Tx | NSAIDs max dose; MTX; sulfasalazine; TNF-alpha inhib (Enbrel, Humira, Remicade); injxn of SI joint |
| Osteoporosis Pathophysiology | Decrease in bone density with increased resorption that can be contributed to use of SSRI, postmenopausal |
| Osteoporosis Dx studies | Image: DXA => overestimate taller and underestimate shorter person; CT for taller/shorter person; T score < -1 => osteopenia, osteoporosis, fx |
| Osteoporosis Labs: | serum Ca+, phosphate, PTH are normal; Low vitamin D (need serum 25-hydroxyvitamin D) |
| Osteoporosis Tx | Vitamin D/Ca => higher dose in winter/prolong hospitalization; Bisphosphonate (alendronate, risedonate) => inhibit osteoclast resorption; HRT; Calcitonin |
| Felty syndrome triad: | RA, leukopenia, SM |
| Gout Pathophysiology | monosodium urate crystal deposition; local trauma => crystal shedding => inflammation (complement, prostaglandins, leukotriene B4); Tophaceous; arthropathy; uric acid urolithiasis |
| Gout RFs: | trauma, surgery, starvation, fatty foods/meat/seafood, dehydration, drugs (allopurinol, uricosuric agents, thiazide or loop diuretics, low dose aspirin, niacin, cyclosporine), familial, ETOH (low renal excretion) |
| Gout Sx/Sx | 3 stages: Acute gouty arthritis, Intercritical (or interval) gout, Chronic recurrent and tophaceous gout. Severe pain, dusky redness, swelling; early attacks resolve in days/weeks; 80% involve single joint, often LE, 1st MTP (podagra) |
| Gout DDx | CPPD (pseudogout), septic arthritis, Reiter’s, monoarticular RA, Lyme, sarcoid, cellulitis |
| Gout Dx studies | Polarizing microscopy: intracellular needle shaped neg birefringent (yellow when parallel & blue when perpendicular, with red compensator); CPPD: pos birefringent rhomboid; often chondrocalcinosis on xray; tx NSAIDs/glucocorticoids |
| Gout Tx: acute gout: | Ppx for attacks = colchicine, NSAIDs (usually indomethacin); uricosuric = probenecid; uric acid synth inhibitor = allopurinol (for long term if >3 episode/month), febuxostat |
| Gout Tx: Chronic gout: | colchicines, NSAIDs, glucocorticoids (given when NSAID are CI) |
| Polyarteritis nodosa Pathophysiology | prob multifactorial & immune complex mediated; systemic necrotizing vasculitis that typically affects medium-sized muscular arteries (sometimes smaller mx arts) |
| Polyarteritis nodosa Sx/Sx | typically systemic sxs: kidneys (most commonly involved organ), skin, joints, mxs, nerves, and GI tract; SPARES LUNGS |
| Polyarteritis nodosa: Skin: | tender erythematous nodules, purpura, livedo reticularis, ulcers, and bullous or vesicular eruption, usu on LE, may be edema |
| Polyarteritis nodosa Neuro sx: | mononeuropathy multiplex (or asymmetric polyneuropathy) affecting named nerves (eg, radial, ulnar, peroneal), typically with both motor and sensory deficits; myalgia, weakness; may see wrist or foot drop; abd pain, n/v/melena |
| Polyarteritis nodosa DDx | infxs dz affecting vasc (IE, mycotic aneurysm, hep B or C, HIV); other vasc mimics (atherosclerosis , embolic dz (L atrial myxoma, chol crystals), thrombotic d/o (antiphospholipid syndrome), fibromx dysplasia, ergotism, radiation fibrosis |
| Polyarteritis nodosa Dx studies | ANCA is NEGATIVE in PAN; acute phase reactants elevated; also get Cr, mx enzymes, LFTs, HBV / HCV, UA ; get CXR & blood cx to exclude other vasculitides; Tissue bx (medium art inflammation in renal bx is pathognomonic); arteriography and x-section imaging |
| Polyarteritis nodosa Tx | glucocorticoids; may also require cyclophosphamide |
| Polymyositis Pathophysiology | idiopathic; mx fiber necrosis, degeneration/regeneration, inflam cells invade mx fibers (scattered thru fascicle); increased CD8+ cells, enhanced MHC Ag expression |
| Bohan & Peter criteria: for: | Polymyositis; prog proximal UE, LE, neck mx weakness; high mx enzymes; myopathic changes on EMG; mx bx abnml & absence of histopath sxs of other myopathies; |
| Polymyositis S/S | Bohan-Peter; also: 25% dysphagia; CO2 retention 2/2 resp mx weakness; myalgias; mechanic’s hands |
| Polymyositis DDx | giant cell arteritis; DM (Gottron’s papules, shawl sign, heliotrope rash, generalized erythroderma); inclusion body myositis, MG, ALS, HIV, MD, hypothyroid |
| Polymyositis Dx studies | inc CK, LFTs, ANA; myositis-specific Abs (anti-Jo-1, anti-SRP, anti-Mi-2); mx bx (endomysial inflam), EMG (inc insertional activity / spont fibrillations; abnl myopathic low amp, short–duration polyphasic MPs, complex repetitive discharges); MRI |
| Polymyositis Tx | corticosteroids (alt: azathioprine, MTX) |
| Carpal tunnel syndrome Pathophysiology | Compression of median nerve; from repetitive movement or injury |
| Carpal tunnel Sx/Sx | Burning, tingling pain worsened with activity; worse at night; may radiate to the forearm and also to neck and shoulder; (+) Tinel and Phalen (tingling in fingers after 30 seconds) |
| Carpal tunnel Tx | Splinting for 2-6 weeks with NSAID; if worsens: corticosteroid injection or surgery |
| Low back pain Sx/Sx | SLR (L4-L5), sensation (L5-S1 determines neurologic deficit), examine decreased ROM |
| LBP DDx | lumbar strain (improves in 1-4 wks), OA, disk hernia (radn to leg 2/2 n. root impinge), Ao aneurysm, mets (night pain; prostate, Br, lung, lymphoma); ank spond; cauda equina (b/l leg weak, bowel/bladder); hip arth (can => LBP, buttock or groin pain) |
| LBP Dx studies | Plain film good for locating infection, cancer, fracture |
| LBP Tx | NSAID + education + yoga (best); Opioid: severe pain and for only 1-2 weeks; Diazepam, cyclobenzapine, carisoprodol=muscle relaxant (1-2 wk); Epidural corticosteroid: short term relief only, ineffective for chronic |
| Osteoarthritis (DJD) Pathophysiology | Joint dz of aging w/ degeneration of cartilage / hypertrophy of bone at articular margins; Obesity is RF for hip and knee |
| Osteoarthritis Sx/Sx | Insidious onset, worsened with activity/wt bearing and better with rest; crepitus; limited ROM; joint enlargement is bony hard and cool (spongy and warm in RA) |
| OA Dx studies | Imaging shows narrow joint space with sharp articular margin, osteophyte formation, and dense subchondral bone |
| OA Tx | Weight reduction and vitamin D; acetaminophen for mild dz; NSAIDs for those not responsive to acetaminophen; corticosteroid injection |
| Fibromyalgia Sx/Sx | Present with MS pain w/multiple tender points, fatigue, HA, IBS, numbness; Pain / stiffness all over but worse in neck, shoulder, low back, hips |
| Fibromyalgia Tx | amitriptyline, fluoxetine, pregabalin, and cyclobenzaprine: modest efficacy. Exercise has some benefits; NSAIDs, tramadol+APAP (Ultracet), opioid & csteroid ineffective |
| Myasthenia gravis Patho | autoimmune; hyperplastic germinal centers in thymus which has clusters of myoid cells expressing AChR; Ab’s to AchR or MuSK |
| Myasthenia gravis Epi | may be assoc w/thymic tumor or thyrotoxicosis; most common females w/HLA-DR3 (or men w/thymoma) |
| Myasthenia gravis Sx/Sx | fluctuating weakness/fatigability of voluntary mx (diplopia, ptosis, difficulty swallowing); resp difficulty, limb weakness (worsened w/activity); bulbar sxs (dysarthria, dysphagia, fatigable chewing) |
| Myasthenia gravis DDx | motor neuron dz, LEMS, botulism; thyroid ophthalmopathy; chronic progressive external ophthalmoplegia; myotonic dystrophy / oculopharyngeal dystrophy; brainstem and motor CN pathology |
| Myasthenia gravis Dx studies | edrophonium test; NCS (decrementing response); EMG (jitter, variability); high serum Ach Ab or MuSK Ab |
| Myasthenia gravis Tx | short-acting acetylcholinesterases (neostigmine, pyridostigmine), poss csteroids; avoid exacerbating meds (aminoglycosides); poss thymectomy |
| Parkinson dz Pathophysiology | DA depletion from basal ganglia (extrapyramidal) 2/2 nigrostriatal system degen => disruptions in connections to thalamus / motor cortex => parkinsonian sxs (TRAP) |
| Parkinson RF | nonsmokers, lack of exercise |
| Parkinson Sx/Sx | TRAP: resting, pill rolling tremor, rigidity, akinesia/bradykinesia (shuffling/festination), postural instability; poss dementia, psychosis, mood d/o; masked facies, scalp seborrhea; Myerson sign (tapping on bridge of nose elicits sustained blinking) |
| Parkinson DDx | multi systems atrophy, essential tremor, Lewy body, PSP, drug induced |
| Parkinson Dx studies | response to DA tx; MRI? |
| Parkinson Tx | sxs: levodopa or C-L (Sinemet); MAO B inhib (selegiline, rasagiline); DA (Mirapex, requip, rotigotine, apomorphine); COMT inhib (tolcapone, entacapone) |
| TIA Pathophysiology | AHA/ASA defn: transient episode of neuro dysfn 2/2 focal brain, spcord, or retinal ischemia, w/o acute infarct; often 2/2 embolizn; mechm: Lg artery low-flow TIA; embolic (artery-to-artery, or 2/2 cardioaortic); lacunar |
| TIA Sx/Sx | if carotid: contra weakness & heaviness (arm, leg, face); vertebrobasilar: vertigo, ataxia, diplopia, dysarthria, paresthesia on 1 or both sides; |
| TIA DDx | seizure, migraine aura, syncope/hypoglycemia |
| TIA Dx studies | ABCD2 score: age (>60), BP (>140/90), clinical (uni weakness, speech), duration, DM; CT, MRI, EKG; poss CTA, MRA, u/s |
| Hospitalize for 1st TIA if: | within past 24-48 hrs; crescendo TIAs; sxs >1 hr; symptomatic ICA stenosis >50 percent; cardiac source of embolus (A fib); hypercoagulable state; high risk of early stroke after TIA |
| TIA tx: | anticoag if TIA 2/2 cardiac embolus; prevention of future stroke; ASA if noncardiac |
| GAD Sx/Sx | apprehension, worry, irritability, difficult concentrating, insomnia, somatic complaints; poss tachy, GI (n/v, epigastric), neuro (HA, syncope); somatic sxs (fatigue, mx tension, memory loss, insomnia) |
| GAD Dx studies | to r/o other: cbc, chem, thy, ua, uds, ekg |
| GAD - usually comorbid: | phobia, social phobia, panic d/o, depression |
| GAD RF | FH, stressful events, h/o abuse; sub abuse, med AEs |
| GAD Tx | Firstline: SSRI (parox, sert, cital); 2ndline: TCA (imipramine) or benzo [xanex, valium (used more, absorbed faster); flumazenil: for benzo OD (antagonist)] or buspar ( GI symptoms and dizziness); often with CBT |
| GAD Tx algorithm: | SSRI => other SSRI => SNRI => TCA or other |
| Somatoform disorder RF | F>M, low SES, ethnic minority; FH, childhood abuse |
| Somatoform disorder Types | conversion; somatization d/o; hypochondriasis; factitious |
| Somatoform disorder Tx | Schedule reg visits; collaborative, tx alliance; acknowledge sxs; eval/tx med dz; limit dx tests/referrals; reassure dz r/o; assess pt for psych/sub abuse; set tx goal= fnl improvemt; poss LD SSRI for hypochondriasis or BDD; avoid opioids |
| Mood disorder Pathophysiology | internal factors (devt probs, neurotic), ext factors [genetic (neurotransmitter dysfn)], adversity/psychosocial stresses |
| MDD Neurotransmitters | Monoamines (serotonin, norepinephrine, and dopamine), GABA, glutamate |
| MDD Sx/Sx | Depressed mood, anhedonia, insomnia, wt change, withdrawal from activities, low energy, poor concentration, thoughts of worthlessness or guilt, recurrent thoughts about death or suicide |
| MDD DDx | schizo, seizure, organic brain syndrome, panic d/o, anx d/o |
| MDD Depression assoc with: | panc, lung, brain ca; cushing; hypothyroid, PD, stroke, Huntington dz |
| MDD Dx studies | 5 item Geriatric Depression Scale; 2 item scale; PHQ-9; Beck Depression Inventory |
| MDD Tx | Pt educ; tx w/ psychotherapy will take months; SSRI [Prozac, Effexor (long acting SNRI)]; TCA; MAOIs; antipsychotics; mood stabilizers; anxiolytics; poss hospitalization if suicide risk |
| MDD AE | HA, n/v, insomnia, nervousness; HD or w/MAOI (selegiline) serotonin syndrome (rigidity, hyperthermia, myoclonus, delirium, coma) |
| Somatoform: conversion d/o | neuro sxs w/o neuro prob |
| somatization d/o | preoccupation with physical sxs; numerous sxs in multiple organ systems, tend to be migratory; dramatic, demand med attention; CP, pseudoneurologic, GI, GU, sexual c/o |
| Alcohol dependence Pathophysiology | EtOH is NMDA antagonist, GABA receptor facilitator, metabotropic glutamate receptors involved; assoc w/small amygdala, hippocampus, ventral striatum |
| Alcohol dependence Epi | lifetime prev 12%, M>F, high M |
| Alcohol dependence Sx/Sx | tremulousness, elevated BP, rhinophyma (bulbous ruddy nose), telangiectasias, tachycardia, HSM, peripheral neuropathy, evidence of physical trauma |
| Alcohol dependence Dx studies | macrocytosis +/- anemia, high LFTs/GGT, carbohydrate deficient transferrin |
| Alcohol dependence Screen | AUDIT, CAGE; at risk: >14/4 drinks (M), >7/3 (F) |
| Alcohol dependence Tx | psychotherapy (CBT), hosp, pharma (naltrexone, oral or depot; acamprosate; disulfiram; possibly topiramate, baclofen, opiate agonist Nalmefene) |
| Tobacco use/dependence M | 440k US deaths/yr (1 in 5); M>F, CV, COPD, lung ca, higher risk of oral, throat, esophagus, panc, kidney, bladder, cervical ca; stroke, PUD; hip/back fx |
| Tobacco use/dependence Tx | screening, in-person counseling; pharma: patch, gum, lozenge, inhaler; bupropion (AE: reduces seizure threshold); varenicline (Chantix) |
| Psoriasis pathophysiology | immune-mediated: T lymphs & dendritics; hyperprolifn & abnml diff of epidermis + inflam cell infiltrates & vasc changes => erythema and scaling: shortened cell cycle time for keratinocytes (36 hr vs 311 hr nl skin); dec epidermis turnover time |
| Psoriasis Epi / RF | genetic/environ; RF: FH, smoking, high BMI, EtOH; Comorbids: coronary art calcification/MI, malig |
| Psoriasis: some meds may worsen: | beta blockers, antimalarials, statins, lithium |
| Psoriasis: Sx/Sx | erythematous papules / plaques w/silver scale; palmoplantar pustulosis; Koebner phenom (plaques at site of trauma) |
| Psoriasis: types | Plaque (most common), Guttate (eruptive; abrupt appearance of multiple lesions), Pustular, inverse, Nail, and erythrodermic psoriasis. |
| Psoriasis DDx | SLE, pityriasis rosea, seborrheic dermatitis, mycosis, onychomycosis, SCC, actinic keratosis, eczema, lichen planus |
| Psoriasis Tx: mild-moderate | Pt Education; mild-mod: topical (emollients, steroids, vit D analogs, calcineurin inhibs/tacrolimus, UV light) |
| Melanoma Pathophysiology | devt: neural crest => melanocytes => nevi => junctional nevus => compound nevus (radial growth phase, usu curable by excision); melanoma may migrate beyond basement mem, poss vertical growth phase (less often curable) |
| Invasive melanoma subtypes: | superficial spreading (75%); lentigo maligna (sun-damaged areas in older pts, begins as a freckle-like tan-brown macule); Acral lentiginous (palmar, plantar, subungual, & mucosal surfaces); nodular. Mets to lung, brain |
| Melanoma Epi | leading cancer COD (8100), 60,000 new cases/yr in US |
| Melanoma RFs | FH, atypical nevi, high nevus count |
| Melanoma Sx/Sx | ABCDE (asymmetry, border, color, diameter >6mm, evolution) |
| Melanoma DDx | nevus, seb keratosis, BCC, actinic keratosis, dermatofibroma |
| Melanoma Dx studies | dermoscopy, skin bx |
| Melanoma Tx | excision w/wide margins; poss adjuvant tx (interferon-alpha); if mets: IL-2 |
| Cellulitis Pathophysiology | GABHS & SA; often lower legs |
| Cellulitis Sx/Sx | pain, chills, fever; edematous, diffuse erythematous spreading infxn of dermis/subQ, warm plaque +/- vesicles/bullae |
| Cellulitis DDx | DVT, necrotizing fasciitis, gas gangrene, toxic shock syndrome, bursitis, osteomyelitis, herpes zoster, erythema migrans |
| Cellulitis Dx studies | high WBC, poss + blood cx |
| Cellulitis Tx | IV abx, cover SA & GABHS; clinda, TMP-SMZ, doxy, or linezolid; if suspect CA-MRSA: vanc, clinda, or TMP-SMZ + beta-lactam |
| VZV Pathophysiology | Develop immunization with chickenpox (varicella) and shingles (herpes zoster); Body builds antibodies and loses it => need vax; Remains dormant in cranial nerve and become herpes zoster |
| VZV Sx/Sx | Fever, pruritic rash; form pustules then crusts after 7-14 days; Shingles affect dermatome with similar pustules as varicella |
| Hutchinson sign | VZV; involve trigeminal nerve => eye and nose |
| Ramsay Hunt | VZV; affect external ear, facial palsy, and geniculate |
| VZV Tx | acyclovir for non complication; Tx w/TCA, opioid and capsaicin for complicated; Live attenuated VZV vaccine to 60+ |
| Psoriasis Tx mod-severe: | Pt Education; systemic (phototx, MTX (folate inhib)(watch liver tox), retinoids, calcineurin inhibs/cyclosporine, anti-TNF agents: adalimumab/Humira, etanercept) |
| Aplastic anemia Pathophysiology | diminished/absent hematopoietic precursors in BM, usu 2/2 stem cell injury |
| Aplastic anemia Etio | congenital (Fanconi); more commonly acquired [drugs (chloramphenicol, antiseizure, sulfonamides, nifedipine), chem, rad, virus] |
| Aplastic anemia Sx/Sx | fatigue, cardiopulmonary compromise; recurrent infxn (invasive fungal infxn common COD), mucosal hemorrhage & menorrhagia; pallor, petechia; NO HM/SM/LA |
| Aplastic anemia DDx | leukemia, MDS, megaloblastic anemia, PNH, HIV infxn, viral hemophagocytic syndrome |
| Aplastic anemia Dx studies | CBC: pancytopenia, RBC usu normo / macro; BM bx: hypocellular (fat cells & stroma), no malig/infiltration/fibrosis |
| Aplastic anemia Dx criteria: | Moderate (<30% normal cellularity), severe (<25%), very severe (Severe + WBC <2) |
| Aplastic anemia Tx | better prognosis if younger & higher baseline cell counts; <20 yo: hematopoietic cell txp (HCT); 20-45 yo: HCT if donor, or immunosuppressive tx (IST): ATG +/-cyclosporine; >45yoL IST |
| Coag disorder Pathophysiology | Factor XIII def (hemophilia A); Factor IX def (hemo B, Xmas); both x-linked recessive |
| Coag disorder Sx/Sx | petechia, ecchymoses, menorrhagia; sites of bleeding: CNS, hemarthrosis (from synovial vessels, within joint cavity), skeletal mx, head & neck, GI, GU, posttraumatic bleed |
| Coag disorder DDx | drug-induced, von W (Pos ristocetin cofactor test) |
| Coag disorder Dx studies | Dz severity: Severe <1% factor activity, Mod 1-5%, mild >5%. Dx: FH, |
| Coag disorder Labs: | hemo A, B, heparin, factor VIII def: nl plt & PT, long aPTT |
| Coag disorder Tx | factor replacement tx; desmopressin, antifibrinolytic tx; for hemarthrosis: steroids to target joints |
| Leukemia Sx/Sx | fatigue, wt loss, fever, pallor, ecchymoses, petechia, dyspnea, dizziness, palps, recurrent infxns |
| ALL Pathophysiology | lymphoid neoplasm; precursor B-cell ALL arises from precursor B cells at varying stages of differentiation |
| ALL Epi | 80% kids; 10-20% of adult leuk; T or B lymph |
| ALL RF | h/o malig, prior chemo, exp to rad/toxins, smoking, genetics, FH |
| ALL Sx/Sx | leukemia S/S, HM/SM/LA |
| ALL DDx | precursor B Cell ALL vs precursor T Cell ALL (dx by immunophenotypic analysis) |
| ALL Dx studies | BM aspirate +/- bx: >20% blasts; CBC: pancytopenia, hyperleukocytosis (>200k) |
| ALL Tx | aggressive chemo (2 yrs: induction, consolidation, & maintenance phases): induction tx (anthracyclines, cyclophosphamide, asparaginase, prednisone, CNS ppx); BM transplant |
| CLL Pathophysiology | lymphoid neoplasm; 60% cases, 40%, derived from naive B cells; CLL lymphs are clonal B-cells arrested in the B-cell differentiation pathway between the pre-B-cell and mature B-cell |
| CLL Epi | most common leukemia (30%), usu >50 yo, M>F |
| CLL Sx/Sx | usually indolent growth |
| CLL DDx | 25% Asx; night sweats; freq infxns; wt loss; LA |
| CLL Dx studies | RAI system for staging; high WBC/lymphs, smudge cells; HM/SM/LA |
| CLL Tx | Chemo (FCR), BMT; XRT for bulky LA; surg for dx only |
| AML Pathophysiology | may be assoc w/toxins (benzenes, rad, chemo) |
| AML Sx/Sx | similar to ALL; HM/SM |
| AML Dx studies | smear: Auer rods; high ESR |
| AML Tx | Chemo:; induction + 3 consolidation; BMT; tumor lysis ppx (allopurinol) |
| CML Pathophysiology | slow progressing, too many myeloid WBCs produced in BM; 3 phases: chronic, accelerated, acute/blast crisis (>30% of BM cells are blasts); poss 2/2 radiation exp |
| CML Epi | 20% of leukemia; median age 42 |
| CML Sx/Sx | fever, bone pain, SM/LUQ pain, night sweats |
| CML Dx studies | Phila chromosome (FISH for bcr/abl: quantitative; RT-PCR for bcr/abl: qualitative); WBC 170,000; low plt |
| CML Tx | allo BMT; Gleevec |
| HL Pathophysiology | arises from germinal center or post-germinal center B cells. Nodular sclerosing (80%, esp in younger), lympho-predominant, or mixed cellularity; assoc w/EBV; enlargement of lymphoid tissue, spleen, liver |
| HL Epi | Incidence 7900; 20-40 yo and >50 yo; usu M 15-45 yo; FH |
| HL Sx/Sx | Painless cervical , SC, mediastinal LA; constitutional B sxs: fever, night sweats, wt loss; SOB common with mediastinal mass |
| HL Dx studies | CT of chest, abd, pelvis; PET; BM bx: Reed-Sternberg cells (bilobed nuclei) |
| HL Tx | chemo (ABVD), then XRT |
| NHL Pathophysiology | arise from cells in lymphoid tissue (90% B lymph); types: Follicular, Burkitt, Diffuse lg b-cell, Marginal zone, Cutaneous T-cell, anaplastic large cell |
| NHL Sx/Sx | Painless LA (abd, retroperitoneal); B sxs: fever, night sweats, wt loss; abd pain, n/v, bleeding, edema; bulky LA → jaundice, hydronephrosis, SVC syndrome, SBO, wasting |
| NHL Dx studies | CBC usu normal; LDH is tumor marker; CT of chest, abd, pelvis; PET; BM bx |
| NHL Tx | depends on type/grade: watch&wait to chemo (Rituxan-CHOP, R-ICE) +/- XRT; tumor lysis ppx; poss BMT |
| Multiple myeloma Sx/Sx | fatigue, anemia, bone pain (2/2 lytic lesions), recurrent infxn |
| Multiple myeloma Dx studies | Triad: plasmacytosis, M spike on SPE, lytic lesions on xray; also CBC: anemia, rouleaux; Bence-Jones pro in urine; high Ca, renal fail |
| Multiple myeloma Tx | Chemo (VAD, DVD); auto BMX |
| Lone star vector: | Ehrlichia |
| Maltese cross on microscopy | Babesia microti (Parasitic): significant in asplenia |
| Lyme dz Pathophysiology | Borrelia (spirochete); deer have complement that clear infxn; deer amplify tick population; Ixodes (black leg tick); most transmission to humans, esp in spring/June-July; young males |
| Lyme Sx/Sx | erythema migrans (target); neuroborreliosis; arthralgia/arthritis; AV block & myocarditis & pericarditis |
| Lyme Dx studies | Step 1: ELISA or IFA; step 2: western blot |
| Post-Lyme syndromes | MS pain, neurocog impairment, poly neuropathy, fatigue |
| RMSF Pathophysiology | a few (10) orgs can be infxs; inc inoculation dose = dec incubation time |
| RMSF: vector | Am dog tick (Dermacentor); brown dog tick |
| RMSF Sx/Sx | rash; Multisystemic dz; usu mod-severe; 4-10 d (usu 7d); fever, HA, malaise, myalgia |
| RMSF rash | rash on day 3-5: 5-15% pts; maculopapular, then petechial & defined; centripetal: starts on limbs, moves to trunk |
| RMSF DDx | meningiococcemia, TSS, scarlet fever, leptospirosis, viral exanthem, other tick-borne |
| RMSF Dx studies | Plt<150, dec Na, inc BUN, mild inc ALT/AST; IFA titer >1:64; CSF: mononuclear cell pleocytosis; elevated protein, normal glucose |
| RMSF Tx | doxy 100mg PO BID x5-7 days (alt: chloramphenicol) |
| Ehrlichiosis | Small obligate GNR; blood smear: morula (berry-like); pathognomonic (but low sensitivity) |
| Sarcoidosis Sx/Sx | Bilateral hilar LA, Pulmo reticular opacities; Skin, joint, +/- eye lesions (uveitis); malaise, fever; unknown etio |
| Sarcoidosis Dx studies | bx: noncaseating granuloma; high ACE level |
| Sarcoidosis Tx | glucocorticoids |
| SLE s/s | presenting sx often fatigue, wt loss, fever; myalgia, Raynaud, renal/GN, pericarditis, malar & discoid lesions; arth, swan neck deformity, osteonecrosis |
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Abarnard
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