buzz words

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Buzz words 8/9/10 5:37 PM Meissner corpuscles/krause end bulb: in papillary layer of dermis Langer lines, pacinian corpuscles, ruffini corpuscles: in reticular layer of dermis Ceruminous (wax glands), glands of moll, mammary glands: types of apocrine glands Acne ass. Glands: sebaceous glands Coral red fluorescence of scales under wood light: Erythrasma Corynebacterium (esp minutissimum): erythrasma Ecthyma: severe form of impetigo No regional lyphadepathy, little or no redness, often on face: bullous impetigo Complication is acute glomerulonephritis: impetigo Impetigo of brockhart or barbers itch: s.aureus folliculitis Sty: s aureus folliculitis Hot tub folliculitis org: pseudomonas Lymphatic streaking: Superificial bact inf that extends into lymphatics and primarly in adults: erysipelas How to differentiate erysipelas from cellulitis: cellulitis margins are indistinct while erysipelas are sharply demarcated Verruca vulgaris: common warts: rough surface Type of wart with smooth surface: flat wart or verucca plana Wart on eye lid: filiform Condylomata acuminata: genital or venereal warts Poxvirus causes this: molluscum contagiosum Bimodal age distribution: molluscum contagiousum Henderson-patterson bodies: molluscum contagiosum Lesion with a central pit: molluscum contagiosum Lateral borders of feet: moccasin type tinea pedis

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Page 1: Buzz words

Buzz words 8/9/10 5:37 PM

Meissner corpuscles/krause end bulb: in papillary layer of dermis

Langer lines, pacinian corpuscles, ruffini corpuscles: in reticular

layer of dermis

Ceruminous (wax glands), glands of moll, mammary glands: types

of apocrine glands

Acne ass. Glands: sebaceous glands

Coral red fluorescence of scales under wood light: Erythrasma

Corynebacterium (esp minutissimum): erythrasma

Ecthyma: severe form of impetigo

No regional lyphadepathy, little or no redness, often on face: bullous

impetigo

Complication is acute glomerulonephritis: impetigo

Impetigo of brockhart or barbers itch: s.aureus folliculitis

Sty: s aureus folliculitis

Hot tub folliculitis org: pseudomonas

Lymphatic streaking: Superificial bact inf that extends into

lymphatics and primarly in adults: erysipelas

How to differentiate erysipelas from cellulitis: cellulitis margins are

indistinct while erysipelas are sharply demarcated

Verruca vulgaris: common warts: rough surface

Type of wart with smooth surface: flat wart or verucca plana

Wart on eye lid: filiform

Condylomata acuminata: genital or venereal warts

Poxvirus causes this: molluscum contagiosum

Bimodal age distribution: molluscum contagiousum

Henderson-patterson bodies: molluscum contagiosum

Lesion with a central pit: molluscum contagiosum

Lateral borders of feet: moccasin type tinea pedis

Page 2: Buzz words

Does not involve the scrotum: : tinea cruris

Zoophilic or anthropophilic: tinea corporis

Most common mycotic inf in children: tinea capitis

Endotrix: black dot type of tinea capitus

Mousy odor: favus type of tinea capitis

MCC of diaper rash: cutaneous candidiasis

Enlarged in all three dimension: nodule

Evanescent, edematous and flat elevation: wheal (hives)

Tree bark: lichenification

Pus involving subQ: abscess

Shallow abrasion with no dermal involvment: excoriation

Cicatrix: scar

Eschar: type of ulcer

Over production of keratin: ichthyoses

Mutation in ATA2A2 on chromosome 12: darrier dz (keratosis

follicularis)

Mic app: papule shows cleft above basal layer (suprabasalar cleft) cone of compact keratotic material: darrier dz (keratosis follicularis)

Karatosis follicularis aka: darrier dz

Pink papules with silvery scales: psoriasis

Oncycholysis and nail pitting: psoriasis

Mic app: acanthosis with elongated rete ridges, paraketatosis and

absence of granular cell layer, mitosis above basal layer, collection

of neutrophils (munro abscesses within superficial ep: psoriasis

Munro abscesses: psoriasis

Koebner phenomenon: psoriasis

Suprabasalar blisters with intercellular deposits of IgG and

complement: pemphigus vulgaris (PV)

May be ass with MG or Lupus: pemphigus vulgaris

Page 3: Buzz words

Flexors and supepithelial bullae: bullous pemphigoid

Linear BMZ of IgG and complement: bullous pemphigoid

Ass with gluten sensitivity: dermatitis herpetiformis

Mic app: neutrophils, eosinophils, and fibrin at tips of dermal

papillae: dermatitis herpetiformis

Extensors and oral no oral mucosa: dermatitis herpetiformis

Flexors and yes oral mucosae: bullous pemphigoid

Granular deposits of IgA at tips of dermal papillae: dermatitis

herpetiformis

Iris lesions: erythema multiforme

Stevens Johnson syndrome: erythema multiforme

Malar area rash: chronic cutaneous (discoid) erythematousus

Butterfly rash: acute SLE

Wickham stiae: lichen planus:

Violaceous papules with white dots or lines: Wickham straie in

lichen planus

Saw tooth pattern of deep surface of ep: lichen planus

Colloid or civatte bodies: lichen planus

Liquefaction degeneration at DE junction: lichen planus

Irritating rash characterized by wheal formation: urticaria

Mic app: scanty perivascular infilitrtates of mononuclear cells, no

increase in mast cells: urticaria

Allergic rxn to eggs: angioedema. Aka giant urticaria *under

urticaria)

AD disorder due to mutation in C1-esterase inhibitor: hereditary

angioneurotic edema *under urticaria)

Affects lower extremities at sites of pressure: cutaneous necrotizing

vasculitis

Spongiosis: allergic contact dermatitis

Silicon breast implant rxn: granulomatous dermatitis

Disorder of dermal CT: scleroderma

Page 4: Buzz words

Sweat glands and hair follicles are obliterated: scleroderma

F:M 4:1 with non pitting edema of hand or fingers: scleroderma

Mask like expressionless with late stage of thick dense fibrotic and

fixed skin to underlying tissue: scleroderma

No vasculitis and no scaring: erythema nodosum

Most common form of panniculitis: erythema nodusum

Mic app: CT septa widening with edema, fibrin deposition and

neutrophilic infiltration, later replaced by lymphohistiocytic

infiltration with giant cells and eosinophils with (no vasculitis):

ERYTHEMA NODOSUM

Disorder of panniculus with vasculitis and scars: erythema

induratum

Mic app: necrotizing vasculitis affecting small to medium sized

arteries and veins in deep dermis and subcutis followed by

granulomatous inflammation and necrosis: erythema induratum

Degenerative dz of articular cartilage: OA

Oligoarticular: affects few joints: OA

Eburnated: oa

Osteophytes: joint mice: OA

Heberden nodes: OA

Osteophytes in DIP: Heberden nodes: in OA

Pain and guarding of joint: synovial inflammation in OA pain

Pain and bracing of joint: capsular inflammation (capsultitis) in OA

pain

Radiculopathy: osteophytes (bony spurs) in OA pain

Chronic inactivity can lead to muscle weakness and disability: OA

pain

Muscle spasm secondary pain: IN OA

Non suppurative inflammatory and proliferative synovitis: RA

Autoimmune chronic INFLAMMATORY CT dz: RA

Immune complex formation: RA

Prostaglandins, leukotrienes, lysosomal enz, and ROS: products of

neutrophils in RA

Pannus: RA

Page 5: Buzz words

Hyperplastic synovium rich in inflammatory cells: pannus

Rice bodies: RA: which are organized fibrin

Mass of synovium and synovial stroma consisting of inflammatory

cells, granulation tissue, and fibroblasts: pannus in RA

Systemic amyloidosis: extra-articular involvement in RA

Vaculitis and inflammatory lesions in pericardium, myocardium,

lungs, pleura, peripheral nerves, and eyes: extra-articular

involvement in RA

subQ Rh nodules: extra-articular involvement in RA

hypergammaglobulinemia: RA

Rf is anti what: IgG

Ass with diuretics/aspirin/ and nicotinic acid: secondary gout* less

likely)

Chronic hemolysis, polycythemia, leukemia, and lymphoma:

secondary gout (most commonly)

Tophus: chronic gout

Most imp complication in gout: renal dz : acute uric acid

nephropathy, nephrolithiasis, or chronic urate nephropathy

Big toe: acute gout

Chondrocalcinosis: pseudogout

Calcium pyrophosphate crystals: pseudogout (chondrocalcinosis)

Hydroxyapatite arthropathy: pseudogout (chondrocalcinosis_

Legg calve Perthes dz: avascular necrosis of femoral head in kids

Kohler dz: avascular necrosis of navicular bone

Gaucher dz: avascular necrosis

Steroid administration: avascular necrosis

Drugs:for a while

Metabolism is saturable: aspirin

Irreversible inhibitor of platelets: aspirin

Tx for salicylism: activated charcoal , correct A/B abnormalities/

alkalize urine

Page 6: Buzz words

Can worsen gout: aspirin

Reys syndrome: aspirin

Dental pain/ oa, or RA: diflunisal (Dolobid)

Tx for Tylenol overdose: gastric lavage with addition of sulfahydryl

cmps to replenish glutathione: N-acetylcystein (mucosil)

Facilitiates closure of PDA: indomethacin (Indocin)

Alternative for PDA closure if indomethacin not available: ibuprofen

(advil, motrin)

FAP and inhibits dev of colon, breast and prostate cancer: Sulindac

(Clinoril)

Gi effects, thrombocytopenia, agranulocytosis, nephrotic syndrome:

Sulindac (Clinoril

This NSAID can close PDA not recommended in preggos: ibuprofen

(motrin/advil)

Increased CV risk: naproxen (aleve/naprosyn)

May antagonize bradykinin: ketoprofen (orudis)

NSAID that also inhibits TNF a and NO SYNTHESIS: flurbiprofen

Dental bone implant preservation: flurbiprofen (ansaid, Ocufen)

Cogwheel ridgitidy, ataxia, tremor, myoclonus: flurbiprofen (ansaid,

Ocufen)

RA + juvenile form. Adverse is nervousness and anxiety: tolmetin

(Tolectin)

Used for post opt pain in place of morphine (opoids): ketorolac

(Toradol)

Long half life and only single dose NSAID: piroxicam (Feldene)

Cox2 selective combo with misoprostol: diclonfenac (Cataflam,

voltarin)

Cox2 sel for long term tx for RA, OA or ankylosing spondylitis:

diclonfenac (Cataflam, voltarin)

Inhibits thymidylate synthetase, and aminoimidazolecarboxamide

ribonucleotide transformylase: methotrexate (Rheumatrex)

Crosslink’s DNA/ metabolized to phsophoramid mustard/ a DMARD:

cyclophosphamide (cytoxam, neosar)

Decreases IL1, IL2: cyclosporine (Sandimmune, neoral)

Avoid drinking grapefruit juice: cyclosporine (Sandimmune: neoral)

Page 7: Buzz words

More frequently used for transplantation than RA: a type of DMARD:

azathioprine (Imuran)

The monoclonal antibody RA (DMARD) tx: rituximab (Rituxan)

The monoclona antibody RA (TNFa inhibitor): adalimumab (Humira)

Potent tnf alpha inhibitor that inhibits macrophages: infliximab

(Remicade)

Can worsen MS: infliximab (Remicade)

Tnf a inhibitor that can tx ulcerative colitis and juvenile arthritis and

is an recombinant fusion protein: entanercept (Enbrel)

RA tx that prevents secondary costimulatory signal for t cell:

abatacept (Orencia)

Reduces IgA and IgM and suppresses t cell activity: sulfasalzine

(Azulfidine)

Inhibits dehydrooraotate dh and do not combo with methotrexate:

leflunomide (Arava)

RA tx that can cause aplastic anemia after IM injection: gold

formulation

Bact inf of skin: favreau

Honey colored crust: bullous impetigo

Acute nephritis dev in 2-5% and streptococci induced cases acute

nephritis in 10-15%: non bullous impetigo

Well defined vs less defined: impetigo to cellulitis

Tx for impetigo: self limiting or mupirocin (bactoban)

Tx for generalized impetigo: oral atb DOC: cephalexin (Keflex)

Tx for generalized impetigo is penicillin allergy: azithromycin

Ear and lower leg are high areas of infection: cellulitis

Periorbital cellulitis: a medical emergency

Most common pathogens causing cellulitis: GRp A stretococcus,

straph aureus

How to dx cellulitis: clinical dx

Tx for what dz: elevate arm above heart: cellulitis and erysipelas

What to do if you suspect gas gangrene in cellulitis (clostridium

perfringes): xray to check for gas

Lymphatic streaking: think erysipelas

Page 8: Buzz words

80% of cases of erysipelas caused by : streptococci

FLD for erysipelas: penicillin

Drug allergy to penicillin to tx erysipelas: erythromycin or

azithromycin

This occurs in pts on long term atb tx for acne: Gram – folliculitis

Hot tub folliculitis: pseudomonas

Appears 8-48 hrs after exposure to dirty water or wet suits. :

pseudomonas folliculitis

Seen in young adults/females and eruption is due to follicular inf by

malassezia furfur (lipophilic yeast): Pityrosporum folliculitis

Dx of folliculitis is usually by: hx and PE alone

Most common pathogen for folliculitis: s. aureus

Tx for s aureus folliculitis: oral anti staph atb

Tx for pseudomonas folliculitis: usually self limiting or Cipro

Eosinophilic folliculitis tx: isotretinoin, metronidazole, UV-B

phototherapy, indomethacin, itraconazole

Tx for Pityrosporum folliculitis: topical antifungal cream/shampoo

Most common cause of carbuncles: s. aureus

Thongs: carbuncles

Can you transmit yeast by sex: yes

Satellite lesions: think candidiasis

Yeast inf in penis: candida balanitis

Ddx for tinea vesicolor that is hypopigmented and no scale: vitiligo

Fungal inf of palms and finger webs with scaling and erythema:

tinea manum

Red plaque with a silvery scale: psoriasis

Gender etiology of psoriasis: m=f

Auspitz sign: pinpoint bleeding seen when cutting into edge of

psoriasis

Tx for psoriasis: topical steroids

Page 9: Buzz words

100% TQ: herald patch: pityriasis rosea

5 ps of lichen planus: pruritic, purple, papules, planar, polygonal

khin skeletal system

cyst that contains amorphrous protein like material and lined by

fibrous tissue, few giant cells, hemosiderin-laden macrophages,

chronic inf cells and reactive bone: solitary(unicameral bone cysts)

curettage and insertion of bone chips-curative: solitary(unicameral

bone cysts)

most tumors appear near: metaphysis

more than 80% of primary tumors occur in what bones: distal femur

and proximal tibia

involves skull and facial bones such as frontal sinus (most common

site): osteoma M>f

gardner syndrom: osteoma M>F

xray finding of central radiolucent area (nidus): osteoid osteoma

M>F

non painful and predominantly affects vertebrae and long bone and

m=f: osteoblastoma (giant osteoid osteoma)

most common primary malignant tumor representing 1/5th of all

bone malignancies: osteosarcoma (osteogenic sarcoma)

may arise in ass with pagets, fibrous dysplasia, enchondroma, or

previous exposure to irradiation: osteosarcoma (osteogenic

sarcoma)

tumor suppressor genes such as p53 or 2/3rd due to Rb mutation:

osteosarcoma (osteogenic sarcoma)

conmans triangle: osteosarcoma (osteogenic sarcoma)

sun ray appearance on xray : osteosarcoma (osteogenic sarcoma)

rare variant of osteosarcoma that occurs more in females:

juxtacortical osteosarcoma

non hereditary disorder with multiple enchondromas in metaphysis

and diaphysis of various bones: ollier dz (enchondromatosis)

familial multiple form ass with hemangiomas in skin and viscera:

Maffucci syndrome

codman tumor: aka: chondroblastoma: M in second decade of life

and affects epiphyseal areas of bones

ass with trisomy 7: chondrosarcoma

Page 10: Buzz words

ass with rearrangement of chrom 17: high grade chondrosarcoma

large bossilated mass that surrounds the base of an

osteochondroma and invasion in bone: peripheral chondrosarcoma

slow growth may lead to compression of lumbosacral plexus and

thus paraplegia: peripheral chondrosarcoma

gender preference for juxtacortical chondrosarcoma vs

osteosarcoma: chondro: M vs osteo: F

snowstorm appearance: condrosarcoma

most frequent primary sites are Males: bronchus/prostate and F:

breast: metastatic bone tumors

first sign of neoplasm’s: back pain

periosteal onion skinning and sunburnt pattern of maligant

metastatic bone tumor: ewing sarcoma

tumor cells contain abundant glycogen: ewring sarcoma

osteoclastoma:aka: giant cell tumor of bone

soap bubble appearance : osteoclastoma:aka: giant cell tumor of

bone

spindle stromal cell: osteoclastoma: aka giant cell tumor of bone

osteitis deformans: paget dz of bone

irregular thickening and softening of the bones: paget dz: osteitis

deformans.

Slow virus: Paramyxovirus: paget dz: osteitis deformans.

Woven bone with mosaic pattern: initial stage of paget dz: osteitis

deformans.

Coxa vera and anterior bowing: paget dz: osteitis deformans.

Deafness, height distortion, coarsening of facial bones (leontiasis

ossea) paget dz: osteitis deformans.

Serum alkaline phosphatase elevated is the most useful lab test to

dx: paget dz: osteitis deformans.

Ass with skin pigmentation and endocrine distrubances: fibrous

dysplasia

Most common endocrine abnormality: Albright syndrome

Pigmented macules (café au lait spots) usually over buttock, back

and sacrum: Albright syndrome

Histological features of woven bone that looks like Chinese

characters: fibrous dyspasia

Page 11: Buzz words

Clubbing of digits: hypertrophic osteoarthropathy

Few hem questions:

Pt has some mile petechia and bruising: this means what: low

platelet count

TQ: hallmark of the dz requires both pancytopenia and acellular

bone marrow filled with fat, sustained (often irreversible), and

caused by stem cell injury: aplastic anemia: *the PLASTIC surgeon

put the FAT in the PAN.

What is the genetic predispositon for aplastic anemia: HLA-DR-2 (

exposure to benzene: Aplastic anemia

name the dz: pancytopenia, acellular (or marked hypocellular ) bone

marrow, CFU-GM and BFU-E decreased, decreased long term culture

initiating cells to less than 1%, flow cytometry rules out ALL or hairy

cell leukemia: Aplastic anemia

how would you dx apastic anemia: get a CBC to see pancytopenia,

get a BM biopsy to see fatty infiltration

whats the most imp tx for survival of aplastic anemia: bone marrow

transplantation

whats the prognosis of Aplastic anemia: now 75%, but 25% severe

graft vs host (GVH), 15% relapse, 25% progress to PNH, MDS, or

AML

what are the Ddx of aplastic anemia: (4): (AMP-H): ALL,

myelodysplastic syndrome, PNH, Hairy cell leukemia

what dx test of choice for AA: bone marrow aspirate and biopsy

what are you looking for on the bone marrow aspirate or biopsy:

spicules with empty fatty spaces with hypo-cellularity

whats the best therapy for AA: remove oftending agent, blood

transfusion, BM transplant, immunosuppresents (cyclosporine, anti-

thymocye globulin), corticosteroids, bone marrow stimulants (GCSF

or other cytokinesn, epo. Tincture of time

myelo means: all formed elements of blood

schisto means: fragmented cells

pancyto means: all the cells

pioklio: change in shape

reticulo: early rbc precursors

Page 12: Buzz words

blastic: early

what does a CBC test: HHRRWWPB: hct, hgb, rbc count, rbc indices,

wbc count, wbc types (differential), platelet count, blood smear

MCV: average RBC size

MCH: Hb amt per RBC

MCHC: Hb amt relative to size of cell (hb concentration) per RBC

ICT vs DCT: ICT= indirect chulmbs test= tells you atc is in the

plasma vs DCT: direct chulmbs test= atb on the RBC: D or D**

4 d’s of quantitative thrombocytopenia: decreased production,

dilution, distribution, increased destruction.

Myeloid vs lymphoid: myeloid is from the bone marrow where as

lymphoid is from the LN, thymus and spleen. Myeloid induces:

precursors for granulocytes (neutrophils, basophils, eosinophils,

monocytes, rbc, platelets. Lymphoid induces LYMPHOCYTES

Acute vs chronic: acute young malignant cells: predominaly blasts

vs chronic in which mature malignant cells predominate

Dz of adults, stem cell disorder, mature cells predominate, and BM

shows “hypercellularity”: myeloproliferative disorders

TQ:Multiple myeloma, light and heavy chain dz, benign monoclonal

gammopathy, walenstroms macroglobulinemia, amyloidosis,

plasmacytoma, plasma cell leukemia, monoclonal gammopathy of

undertermined significance Plasma cell disorders.

Pt (prothrombin time) or PTT (partial thromboplastin time:

o Extrinsic pathway:factors 2, 5, 7, 10 or fibrinogen: PT

o Factors: 8, 9, 11, 12 and rarely von willebrands factor: PTT

TQ: protein C or protein S def or HIT antibody: hypercoagulable

states

Stopped at start of hemolytic anemia lecture

Pentad of TTP: microangiopathic hemolytic anemia,

thrombocytopenia, renal failure, mental status changes, fever

Tx for TTP: plasma exchange

Panavellil heme dugs

Tx for iron toxicity: deferoxamine”

Tx for ACD: EPO

Tx for CRF: chronic renal failure: EPO

Page 13: Buzz words

Tx for bone marrow deficiency states: CSF (colony stimulating

factor)

Production of RBC by what molecules: EPO

Where is epo produced: kidney

What is epo’s trigger for release: low o2 content which then

stimulates__________ (stem cells to differentiate to proerythrocytes) ,

increases in mitosis, increase release of reticulocytes, induces hb

formation

Where is the majority of iron absorbed: in the duodenum in the

ferrous state (fe2+)

Transport plasma protein that delivers iron the bone marrow for the

incorporation into RBC hb: transferrin

Where is iron stored: in macrophages in the reticuloendothelial

system as ferritin or hemosiderin

What do RBC break down into: aa and porphyrin

Bilirubin is released into the plasma where it binds to albumin and is

transported to the LIVER for what rxn: glucoronide conjugation and

excretion via bile

Tx for IDA: iron deficiency anemia: ferrous sulfate, ferrous fumarate,

ferrous choline citrate, ferrous gluconate, polysaccharide iron

complex

How does orange juice affect IDA tx:2x the absorption

How does tea or coffee affect IDA tx: ½ the absorption

Therapeutic doses of iron increase hb by : 1g/wk

Parental iron forms: iron dextran, INFeD, dexferrum, pri-dextra,

sodium ferric gluconate complex-ferrlecit, iron sucrose (Venofer)

in IDA pts with MALABSORPTION SYNDROMES or pts INTOLERANT

TO ORAL IRON PREps a combo of what is given: ferric hydroxide and

dextran (iron dextran) containing 50mg/ml iron im or iv by multiple

slow injections

what do the reticuloendothelial cells do to the iron dextran:

phagocytize it

what is an adverse affect of IM injection of iron: tissue necrosis or

atrophy

Page 14: Buzz words

what are pre existing immune conditions that my predispose pts for

high risk adverse rxns for parenteral iron forms: SLE and RA

the newer form of parenteral iron for chronic renal disease: Ferrlecit

(sodium ferric gluconate complex)

exchange mechanism seen in which drug: iron sucrose (Venofer)

what is the form indicated for IDA in chronic hemodialysis pts who

are receiving EPO therapy: iron sucrose (Venofer)

whats an advantage of parenteral vs oral: faster

GI upsets, discoloration of feces (black): adverse rxns to parenteral

iron

What are the mech of toxicity for iron toxicity: 1 direct corrosive

effec on mucosal tissue resulting in necrosis and perforation, 2.

Cellular toxicities due to lactic acidosis and necrosis

Clinical presentation is bloody diarrhea, massive fluid loss and blood

loss into gi tract causing shock, renal failure and death: iron toxicity

What is metabolic acidosis ass with: iron toxicity even after survival

What is the chelating agent used for: its deferoxamine and its used

for iron toxicity

Orange or pink red urine: tx for iron toxicity: deferoxamine

Cyanocobalamin: b12

Cobalamin is absorbed by both: intrinsic factor dep and

independent routes

Malfunction of the parietal cell: decreases intrinsic factor which

decreases cobalamin absorption (b12) which causes pernicious

anemia

Pernicious anemia: b12

Acquired vs congential pernicious anemia: acquired if decreased

production of intrinsic factor. Congenital if dysfunction of intrinsic

factor

B12 transport protein: transcobalamin II

Addisonian anemia aka: pernicious anemia

Tx of pernicious anemia (addisonian anemia): oral b12 therapy

Which anemia can be tx with intranasal formulations: vit b12 def

with intranasal cyanocobalamin formulations.

Whats hydroxocobalamin: preferred for b12 anemia due to highly

protein bound and remains longer in circulation

Page 15: Buzz words

Hyperuricemia, hypokalemia, and sodium retention and rebound

trambocytosis leading to thrombotic events seen in: b12 induced

reticulocytosis

Schilling test: test to determine b12 def

Whats ass with colon cancer: excess homocysteine seen in folic acid

def anemia

Two drugs that can block dihydrofolate reductase and lead to folic

acid def anemia: methotrexate and trimethoprim

Are folates toxic: no known toxitcity

What is the major difference seen in folate and b12 def: in folate

def there is an absence of neurological manifestations

Tx for megaloblastic anemia: folate and cyanocobalamin

What is the glycosylated protein: EPO

Tx of renal failure anemia, aids anemia, ACD such as metastatic

cancer and RA: epo

How is epo administered: IV or SUBQ

Epo effect of rbc: increases levels

Epo effect on hct: increases and activates syn of hb

What is epo not indicated for: pts needing immediate correction of

severe anemia

What is the major side effect of epoetin therapy: elevated diastolic

pressure (Hypertension)

What causes seizures, thrombosis or iron deficieny: EPO

What does Neupogen (for wbc def) do: increases total neutrophil

count

Tx for white blood cell def: G-CSF (Neupogen), Leukine, or neulasta)

N. ditchek rheumatoloical problems lecture

What should lead to correct dx in 85% of rheumatologic problems:

hx and pe.

Functia laesa: loss of function

Rigor: stiffness

Erythema, soft tissue swelling, sausage digits, and nail changes

seen in : psoriatic synovitis

Podagra: gout in the big toe

Vesicles and pustules due to gonococcal arthritis: pustular synovitis

Pip vs dip: pip: bouchards, dip : heberdens: both in OA

Page 16: Buzz words

Non inflammatory: OA

Inflammatory : RA, SLE, psoriatic arthritis

Features of arthritis: inflam, pain in all motions (active and passive),

pain around joint, and decreased rom

What are some routine arthritis screening tests: acute phase

reactant (ESR and C-RP), RF, and ANA

ANA

PATTERNSxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

o Hemogenous histones/dna: SLE or drug effect

o Speckled ENA: MCTD, SLE, sjogrens syndrome,

poly/dermatomyositis

o Nucleolar RNA ass angtigen: scleroderma

o Peripheral (rim) DNA nuclear antigens: SLE

o Centromeric nuclear antigens Limited scleroderma (crest

syndrome)

AUTOANTIBODIES IN RHEUMATIC DZ

Anti-dsDNA: SLE

Anti-histone: SLE, drug induced lupus

Anti-ENA: (sSm or RNP (ribonucleoprotein): SLE MCTD or SLE

Anti ss-a/ro: SLE, neonatal lupus, sjorgrens syndrome

Anit ss-b/ro: sjorgrens, sle, neonatal lupus

Anti centromeric: limitied scleroderma (crest syndrome)

Anti scl-70: diffuse scleroderma

Anti jo 1: poly/dermatomyoctis, raynauds phenomenon’s

Anti PM scl: polymyositis/ scleroderma overlap syndrome

Anti mi 2: dermatomyositis

Special arthritis tests:

o Complement levels: CH 50, C3, C4

o HLA: b27, D locus alleles

o Antineutrophil cytomplasmic antibody (ANCA)

o Cryoglobulins

o Lyme titers

Routine lab studies for rhematologic studies

o Cbc

Page 17: Buzz words

o Chemistries

Glucose

Liver function test

Cpk

Uric acid

Urinalysis

What are the causes of hemarthrosis (bleeding into joint)

o Trauma

o Bleeding disorder

o Villonodular synovitis

o Pyrophosphate arthropathy

o Charcot joint

o Resolving inf

o Contamination during aspiration

Synovial effusions

o Clear colorless viscous with leukocytes <200, <25% pmn:

normal

o Clear, yellow, viscous with leukocytes 200-2000, <25% pmn:

non inflammatory: ie OA

o Cloudy, yellow, watery , glucose may be low with leukocytes

2000-100,000, >50% pmn: inflammatory: RA

o Purulent, glucose very low with leukocytes >80,000 and

>75% pmn: septic: bact inf/fungal inf, mycobacterial inf, or

acute crystal synovitis

Types of crystals found in acute gout and topheacous gout

monosodium urate monohydrate

Calcium pyrophosphate in : pseudogout, destructive arthropathy

Basic calcium phophate: acute calcific periarthritis, acute arthritis,

destructive arthropathy (Milwaukee shoulder/knee)

Calcium oxalate: acute, subacute arthritis

Lipids (fat): acute arthritis

Cholesterol: asymptomatic

Negative birefringence: urate crystals in gout

Positive birefringence : calcium pyrophosphate crystals in

pseudogout

Vasculitis

Page 18: Buzz words

Whats the key to dx for vasculitis: clinical suspicion

Pulseless, blindless, cva, and syncope: large vessel symptoms

CAD, Renal artery CVA, mononeuritis (writs/foot drop): medium

vessel

Palpable purpura and raynauds/ gangrene: small

The only medium vessel one: polyarteritis nodosa

The two large vessel ones: takaysu (rare) and most common

temporal arteritis

Past TQ: causes of leukocytoclastic vasculitis aka hypersensitive

vascultis or allergic vasculitis: viral/ bact/ atypical, meds, lupus,

idiopathic, insect bites

Livedo reticularis: mottled erythema seen in : small vessel vasculitis

Necrotizing (caseating) granulomatous vasculitis, 1.3:1 in M;f, >95%

in caucasians in 20-40s with tx of glucocorticoids +

cyclophosphamide: wegeners granuloamatosis (sm vessel)

What is ELK: main sites for wegeners granulomatosis: Ent/ upper rt:

optic, otic, sinusitis, Lower rt: lungs, Kindey

Whats the lab test for wegeners granulomatosis: C-ANCA

TQ: what is Henoch Schonlein tetrad: (Ga^2p)

o Glomerular nephritis

o Ab pain

o Arthritis

o Purpura

Markers of inflammation: Elevated ESR and C-RP

Hematologic changes in vasculitis: leukocytosis usually with

neutrophila, anemia, thrombocytosis

High RF with low complements: hepatitis related PAN, RA, or

cryoglobulinemic vasculitis

Past TQ: ANCA ass dz: wegners, microscopic polyangiitis, chrug-

strauss syndrome, drug induced anca ass vasculitis

Weight loss >4kg, livedo reticularis, testicular pain or tendernous,

myalgias, weakeness or leg tendernous, mononeuopathy or

polyneuropathy, diastolic bp>90, elevated BUN/creatinine, hep b

virus, arteriographic abnormality, bx of small or medium artery

containing PAN: polyarteritis nodosa (the only medium vessel

vasculitis)

Page 19: Buzz words

Pts at least 50 and usually white, pain at least 1 month in shoulders

and pelvis, severe morning stiffness and gelling: polymyalgia

rheumatica (large vessel)

HA, diplopia, anaurosis, jaw claudication: cranial arteritis

Giant cell arteritis aka: temporal arteritis

TQ:Elevated Westergren esr >59: temporal arteritis

Tx for temporal arterits: high dose steroids

Dx of temporal arteritis: must biopsy temporal arteries bilaterally

Fragmentation of the intima layer of vessel: temporal artertis

TQ: the most dangerous outcome of TA: ischemic optic neuritis:

demands immediate tx with high dose steroids

Jones skeletal MSK pathology

Connective tissue covering of bone: periosteum

Mononuclear cells that syn collagen and ground substance:

osteoblasts

Osteoblasts that become embedded and incorp into bone matrix

osteocytes

Multinucleated cells found along cortical endosteal surface and

trabeculae in scalloped bays called howships lacunae osteoclasts

Howships lacunae: osteoclasts locations

Haversian system: compact bone

Basic unit is trabecula: cancellous bone

Collegen laid down in parallel array: lamellar bone

Collagen laids down haphazardly : woven bone

Endochondral ossification: long bones

Intramembranous ossification: flat bones

Dz characterized by increased porosity of skel reduced bone

mass: osteoporosis

Bone mass determined by : vit D receptor allele, genes for collagen

1A1, estrogen rec, Insulin like growth factor 1 and its binding

protein, physical activity, diet, hormones

When is maximal skeletal mass attained: after 3rd or 4th decade

When does postmenopausal osteoporosis occur: 1 decade after

menopause

Page 20: Buzz words

Decreased estrogen levels in post menopausal osteoporsis results

in: increased secretion of IL1, IL6 and TNF by blood monocytes and

bone marrow cells (these cytokines activate osteoclasts)

What causes senile osteoporosis: osteoblasts reduced replicative

and biosynthetic potential

Morphology: affects the cancellous compartment of vertebral

bodies: post menopausal osteoporosis

Trabeculae are thinned: post menopausal osteoporoiss

Cortex is thinned: senile osteoporois

Haversian systems are widened: senile osteoporosis

Cannot be detected in plain radiographs until 30-40% bone mass is

lost: osteoporosis

Best dx of osteoporosis: dual energy absorptiometry and

quantitative computed tomography which measure BONE DENSITY

Major function is maintenance in normal plasma levels of ca and

phorphorus: vit D

This is required for absoption of ca from small int: vit D

Vit d def results from: dietary deprivation, fat malabsorption, lack of

sun exposure, chronic renal failure:

Vit d def or phosphate depletion in kids: rickets

Vit d def or phosphate depletion in adults: osteomalacia

Deranged bone: rickets

Undermineralized bone: osteomalacia

Wide osteiod seams: rickets or osteomalacia

Rachitic rosary (swollen costochondral junctions of ribs): rickets

Pigeon chest: rickets

Bowing of legs and arms: rickets

Xray will show thickend, irregular, lobulated epiphyseal plate:

rickets

Osteopenic x ray finding: osteomalacia

Compression fx and decreased bone thickness: osteomalacia

Dev of secondary hyperparathyroidism: osteomalacia (due to low

serum ca which stimulates parathyroid glands)

What causes 80% of primary hyperparathyroidism: adenoma of the

parathyroid gland

Page 21: Buzz words

Osteitis fibrosa cystica: refers to the anatomical changes of severe

hyperparathyroidism

Morpholgy is increased osteoclast affects cortical bone, dissecting

osteitis (in cancellulous bone what looks like railroad tracks), xray

finding of osteopenia (decreased bone density), marrow space

replaced by fibrovascular tissue, and widening of haversian canals:

hyperparathyroidism

Bone loss predisposes to microfx and secondary hemorrhages:

hyperparathyroidism’s

Brown tumors: hyperparathyroidism

Hallmark is generalized osteoitis fibrosa cystica: von

Recklinghausen dz of bone which includes increased bone

cell, peritrabecular fibrosis, and cystic brown tumors: severe

hyperparathyroidism

CRF results in phosphate retention and hyperphosphatemia: renal

osteodystrophy

What does the hyperphosphatemeia in renal osteodystrophy trigger:

secondary hyperparathyroidism hypocalcemia develops

intestinal ca absorption decreased due to high levels of phosphorus

inhibiting renal hydroxylase, PTH secretion increases with a

decrease degration and excretion of PTH which results in secondary

hyperparathyroidism which increases osteoblast activity. Metabolic

acidosis is ass with renal failure which stimulates bone resorption

and the release of calcium hyroxyapatite from matrix

Aluminum: renal osteodystrophy

What are sources of aluminum: dialysis sol. Or oral al phosphate

binders.

What does aluminum do: interferes with deposition of calcium

hydroxyapatite and thus promotes osteomalacia

Kimmel lecture 1 RA and OA

Genetic predisposition: OA

Worse with use. Improves with rest: OA

Bony changes localized to weight bearing surfaces/ joints: oa

Osteophytes: oa

Hylans: tx for oa

Decrease life expectancy: steroids

Page 22: Buzz words

Increase life expectancy: DMARDS

7 criteria for RA: (must be present for >6 wks

o 3 jnts

o hands and wrists

o AM stiffness

o Symmetry

o Nodules

o Rf +

o X ray changes

Immunological disorder: RA

Worse at rest better with use, inflammatory/ systemic complaints:

RA

Lab findings for RA: RF, CCP, ESR, CRP

Xray finding for RA: juxta-articular osteoporosis, jt space narrowing

diffusely and errosions

DMARDS: increase life expectancy

o Mild:

plaqenil (hydroxychloroquine)

azulfidine (sulfasalazine)

o stronger

Rheumatrex/Trexall (methotrexate)

Avara (leflunomide)

Biological DMARDS

o Inhibitors of TNF

Soluble receptor: etanercept (Enbrel)

Monoclonal ab: adalimumab (Humira)

Golibumab (simponi)

cerulizumab (cimzia)

infliximab (Remicade)

o IL1 inhibitor: anakinra (kenneret)

o IL6 inhibitor: tocilizumab (actimra)

o B cell inhibtor: rituximab (Rituxan)

o T cell inhibitor: abatacept (Orencia)

o oral biological DMARDS: protein kinase inhibitors

abnormalilty in collagen type II gene (aberrant COL2A1 gene): OA

no ass with HLA: OA

Page 23: Buzz words

HLA-DR4: RA in white people

HLA-DR1, DR10, DRw6: RA in non white

Life expectancy of RA: 10 years less than normal

In OA which cause decrease in matrix syn: IGF 1, TGF beta

In oh which cause increase in matrix degradation: cytokines, enz,

NO

Major cell type in RA in synovial fluid: neutophils

Major cell type in pannus: t lymphocytes and macrophages

Minor cell types in pannus: fibroblasts, plasma cells, endothelium,

dendritic cells

Crepitus: oa

Polyarticular: RA

Joints involved in primary OA: cervical/lumbar vertebrae, hip,

dip/pip, 1st CMC, knee, 1st MTP

Diagnostic joints for early ra: wrist, 2 or 3rd MCP, MTP

Lab result of ESR <20 : OA

Most specific xray finding for Oa: osteophytes

Can Rf be negative in early RA: yes

When does symmetry of joint involvement occur in RA: late ra

RF+ but ANA -: RA with no SLE

Spondyloarthropathy lab finding: RF- and ANA –

Erosions: RA

Glucosamines use: OA ONLY>>>>>

Fentanyl patches, codeine, oxycodone, propoxyphene, or morphine:

opioids

Which opioid is long acting an will have fewer CNS side effects and

less addictive potential: morphine

Cox-2 specific: celecoxib (celebrex), vioxx and Bextra

Selective cox 2: meloxicam (Mobic), and nabumetone (Relafen)

Hylans: hyalgen, Synvisc, orthovisc, Supartz, euflexxa

What are the indications for hylans: tx of knee or hip Oa in pt unable

to respond to steroid injections. DO NOT USE FOR small joints or

inflam arthritis (RA)

Hypopigmentation: steroid side effect

Diabetes flare: steroids side effect

Page 24: Buzz words

What are the indications for joint replacement: persitent pain

despite medical PT, loss of joint function, fracture

Absolute contraindications for joint replacement: infection

Relative contraindications for joint replacement: age, obesity, poor

health, poor bone stock, deformities, prior infection

Which ones slow dz progression in RA tx: DMARDS

DMARD side effects TQ

o Macular damage: hydroxycholorquine

o Myelosuppresion, GI: Azulfidine

o Gold oral: myelosuppresion, rash, proteinuria, GI

o Leuflunomide: hepatotoxic, GI no in preggo

o Methotrexate: hepatoxic, pulmonary, myelosuppression, No in

preggo

Contraindications are MS or TB inf, CHF, vaccines (zoster): tna

antagonist

Criteria for dx of adults stills dz:

o All required:

Fever >39 c

Arthralgia or arthritis

Rh factor <1:80

ANA <1:100

o In addition to any of the following

Wbc >15000

Stills rash : faint salmon colored rash on trunk or UE

Pleuritis

Pericarditis

Hepatomegaly or splenomegaly or generalized

lymphadenopathy

Complication of adult stills: hepatic necrosis

Tx for adult stills: biological tx IL1 inhibitor: anakinra (kinneret)

Dx of feltys syndrome

o Seropositive rheumatoid arthritis

Page 25: Buzz words

o Splenomegaly

o Granulocytopenia

How long should you use contraception after on MTX: 3-6 months

How long should you use contraception after on leflunomide (Arava)

2 years

Khin msk skeletal system

80% of primary bone tumors occur in: distal femur or proximal tibia

frontal sinus: osteoma

gardners syndrome: osteoma

nidus: osteoid osteoma: usually LE and small bones of foot

pagets, fibrous dysplasia, enchondroma or exposure to irradiation

association: osteosarcoma

codmans triangle: subperiosteal elevation seenin osteosarcoma

sun ray appearance on xray: osteosarcoma

codmans tumor: aka chondroblastoma

codmans tumor (chondromblastoma affects

_____________(epiphyseal area) where as chondromyxoid fibroma

affects ___________(metaphyses)

ass with trisomy 7: chondrosarcoma

ass with rearrangement of chromosome 17 high grade

chondrosarcoma

large bossilated mass: peripheral condrosarcoma

gender preference for juxtacortical chondrosarcoma vs juxtacortical

otsteosarcoma: chondro: men, osteo: women

snowstorm appearance condrosarcoma

MC sites for metastatic tumors of bone in M: bronchus and prostate,

F: breast

Onion skinning and sunburnt pattern: ewing sarcoma (a type of

metastatic bone tumor)

Ass with reciprocal translocation t(11;22): ewing sarcoma (a type of

metastatic bone tumor)

Tumor cells with abundant glycogen: ewing sarcoma (a type of

metastatic bone tumor)

Page 26: Buzz words

Soap bubble appearance: giant cell tumor of bone (osteoclastoma)

Gender pref for giant cell tumor of bone (osteoclastoma): females

slightly

Mic app of giant cell tumor of bone (osteoclastoma): composed of

plump spindle cells among scattered multinuclearted giant cells.

The neoplastic cell is the spindle stromal cell

Irregular thickening and softening of bone: paget dz (osteitis

deformans)

Woven bone with mosaic pattern: paget dz (osteitis deformans)

Vertebral compression, height distortion, coarsening of facial bones

(leontiasis ossea): paget dz (osteitis deformans)

Serum alkaline phosphatase elevated and is the most use lab test to

dx this dz: paget dz (osteitis deformans)

Ass with skin pigmentation and endocrine disturbance: fibrous

dysplasia

Most common endocrine abnormality: Albright syndrome

Café au lait spots over buttocks, back and sacrum: Albright

syndrome

Lucent ground glass appearance and bones appear as Chinese

characters : albrights syndrome

Cellular fibroblastic tissue with scattered lipid laden macrophages

and multi nucleated giant cells, no bone formation or anaplasia:

nonossifying fibroma (fibrous cortical defect

Clubbing of digits: hypertrophic osteoarthropathy

Jones infection inflammatory and reactive arthritic conditions

Most common organisms of infectious arthritis (PEGS3)

o Pseudomonas

o Ecoli

o Gonoccus

o Staph

o Strep

o Salmonella

Main causative agent for infectious arthritis in children and adults:

s. aureas

Same as above but in late adolescence and young adulthood:

gonococcus

Page 27: Buzz words

If sickle cell more prone to infect arthritis by this organism:

salmonella

Sudden acutely painful, hot and swollen joint, restricted rom, fever,

leukocytosis and elevated ESR: infectious arthritis

Disseminated gonococcal inf sites vs intravenous drug abuse sites:

gon: single joint where as IV drug is axial articulations such as

spine, sacroiliac or sternoclavicular

Chronic progressive/ monoarticular dz occurring in all age groups:

tuberculous arthritis

What joints are affected in tuberculous arthritis: weight bearing

joints

Mycobacterium stain: red (fite stain)

Clinical lab aids in dx

o Gram stain:

Always performed as routine

75% sen for staph

50% sen for most gram –

<25% for gonococcal

o blood cultures

obtained before atb given

positive 50% for staph aureus

less frequently + for other org

o synovial fluid

75-95% sen for non gonococcal joint inf

can be turbid, serosanguineous or purulent

high number of neutrophils

protein/ LDH/ elevated

glucose low

fluid should be examined for crystals to r/o other causes

cultures are + > 90% of time

Page 28: Buzz words

non inflammatory:

o oa, traumatic arthritis, PVNS

inflammatory

o RA, sle, reiter syndrome, rheumatic fever, acute crystal

induced arthritis

Purulent (infectious) effusion

o Bac/fungal/tb joints

Hemorrhagic effusions

o Traumatic, PVNS, synovial hemangiomas, hematologic

disorders, thrombocytopenia, anticoagulant therapy

Bamboo spin in : ankylosing spondyloarthritis

What are the seronegative spondyloarthropathies (3)

o Ankylosing spondylitis

o Reactive arthritis (reiters syndrome and enteritis ass arthritis)

o Psoriatic arthritis and arthritis ass with IBD (ulcerative colitis

or crohn dz)

What do the seronegative spondyloarthropathies have in common:

ass with HLA-b27

Rheumatoid spondylitis and marie stumpell dz aka: ankylosing

spondyloarthritis

Which one especially affects the sacroiliac joint: ankylosing

spondyloarthritis

Gender preference for spondyloarhtris: men 2-3x>F

What is the SI joint infiltrated with in ankylyosing spondyloarhtritis:

CD4 and CD8 t cells, macrophages and high tnf Alpha

Inflammation of tendinoligamentous insertion sites and ossification

aka syndesmophytes: ankylosing spondyloarthritis

Complications in this dz may include fx of spine, uveitis, aortitis,

and amyloidosis: ankylosing spondyloarthritis

Defined as an episode of non infectious arthritis of the appendicular

skeleton that occurs within one months of a primary inf localized

elsewhere in the body: reactive arthritis

Ass with genitourinary (chlamydia) and GI tract inf (shigella,

salmonella, Yersinia, campylobacter): reactive arthritis

Page 29: Buzz words

The triad of arthritis, non gonococcal urethritis or cervicitis, and

conjunctivitis is called: Reiter syndrome

Define reiter syndrome: The triad of arthritis, non gonococcal

urethritis or cervicitis, and conjunctivitis

What are most affected joints in reactive arthritis: ankles, knees and

feet often asymmetrical pattern

Sausage like finger or toe: reactive arthritis

Inflammatory balanitis (circinate), conjunctivitis, cardiac conduction

abnormalities, aortic regurgitation: extraarticular involvement in

reactive arthritis

Ganglions, synovial cysts, and osteochondral loose bodies aka:

reactive tumor like lesions

What do the above result from: trauma or denerative processes and

they are more common than neoplasm’s

Involves the synovium of a joint, involves one or more joints

DIFFUSELY, and happens in 20-40s in m=f: pigmented villonodular

synovitis (PVNS)

Occurs as DISCRETE nodule on tendon sheath in 20-40s and m=f:

giant cell tumor of tendon sheath( GCT)

Giant cell tumor of tendon sheath aka localized nodular

tenosynovitis

Grossly these lesions are red brown to mottled orange-yellow: PVNS

and GCT

Resembles a small walnut: GCT

Tangled mat of red brown folds and finger like projections and

nodules in the knee: PVNS

the tumor cells are POLYHEDRAL, moderately sized and resemble

synoviocytes: GCT and PVNS

Hemosiderin depostits, FOAMY macrophaes, multinucleated giant

cells, and zones of sclerosis: GCT and PVNS

pts complains of pain, locking and recurrent swelling of knee: PVNS

Which one is aggressive and painfull and which one is solitary,slow

growing and painless mass: aggressive +painful =pvns. Solitary

slow growing: GCT

Frequently involves the tendon sheaths along wrists and fingers and

is the most common mesenchymal neoplasm of the hand: GCT

Page 30: Buzz words

Where do synovial sarcomas occur: majority dev in deep soft tissue

in vicinity of the large joints of the extremities, 60-70% occurring in

LE, esp knee and thigh

Biphasic and monophasic: synovial sarcoma

Hallmark is eh dual line of differentiation of the tumor cells (ie

epithelial like and spindle cells): synovial sarcoma

Epithelial like cells are cuboidal to columnar and form glands or gro

in solid cords are aggregates: synovial sarcoma

Spindle cells; synovial sarcoma

Most synovial sarcomas are: monophasic

Immunohistochemistry for synovial sarcoma: + for keratin and

epithelial membrane antigen (EMA)

+ for keratin and epithelial membrane antigen (EMA) : synovial

sarcoma.

Old test tq info:

the can inhibit methotrexate activey and is used as a rescue agent

in mtx toxicity: luecorvin

what is a concern about mtx: concurrent use of NSAIDS deceases

the clearance of MTX so toxicity can dev rapidly: (death from severe

bone marrow suppression) has been linked to ibuprofen/mtx use.

(ibuprofen same as motrin and advil)

causes undersecretion of uric acid:

o dehydration,

o ketosis,

o renal abnor.

o Drug: directics, low dose ASA,

o toxins such as ethanol, or lead,

o hypothyroidism

causes overproduction of uric acid

o ethanol

o def of HGPRT or G6PD

o superactive PRPP synthetase

o Myeloproliferative disorders

o Psoriasis

Page 31: Buzz words

Clubbing of digits: usually occurs in pts with bronchial carcinomas

but sometimes with pleural tumors, pulmonary metastes,

mediastinal Hodgkin dz, chronic lung inf, and chronic liver dz

Complication of tnf alpha inhibitor injections: activation of recurrent

TB inf

Albrights ass with: polyostotic bone lesions, endocrine dysfunctions,

acromegaly, cushion syndrome, hyperparathyroidism, pigmented

macules (café au lait spots) over butt, back and sacrum, Chinese

characters

What does colchicine tx: attack of gout

Sunburst or sun ray vs sunburnt:

o sunburst/ray: osteosarcoma (osteogenic sarcoma)

o sunburnt pattern: ewing sarcoma (which is a metastatic tumor

of bone)

histological pattern hallmark in mosaic pattern: pagets dz

best test to dx osteoporosis: DEXA scan

osteopenia defined as BMD score of: btw -1.0 SD and -2.5 SD below

normal

osteoporosis defined as BMD score of : less than -2.5 SD below

normal

benign tumor of young persons, M>F and usually in LE including

small bones of foot. Pain with more sever at night. Xray shows

central radiolucent area (NIDUS) surrounded by reactive sclerotic

bone: osteoid osteoma

crystals found in synovial fluid

o monosodium urate monoydrate: acute gout, tophaceous gout

o calcium pyrophosphate dihydrate: acute psueogout,

destructive arthropathy

o basic calcium phosphate: acute, subacute arthritis

o lipid: acute arthritis

o cholesterole: asymptomatic

anca ass with

o wegeners granulomatous, microscopic polyangiitis, churg

strauss syndrome, drug induces vasculitis

KIMMEL: best way to differentiate btw RA and OA; Hx and PE

Page 32: Buzz words

Bizarre pleomorphic cells with hyperchromatic irregular nuclei and

abundant mitoses: osteosarcoma (osteogenic sarcoma)

Formation of osteoid and bone in this highly malignant tumor:

soteosarcoma (osteogenic sarcoma)

Inhibits IL1 AND IL2 and don’t drink grapefruit juice: cyclosporine

(Sandimmune, neoral)

Pulmonary hypertension and centromeric ab: limited cutaneous

sclerocerma (LcSSc)

SCL-70: diffuse cutaneous scleroderma (DcSSc)

This scleroderma has a good prognosis: localized scleroderma

Boutonniere deformity : seen in RA with PIP hyperflexed and DIP

hyperextended

Whats a major contraindication for infliximab (Remicade): MS

Wegeners granulomatous constists of

o Nasal or oral inf (oral ulcers or bloody nasal drainage)

o Abnormal chest radiograph (nodules, fixed infiltrates, cavities

o Urinary sediment >5rbc/hpf or RBC casts

o Granulomatous inf on bx (in wall of artery or arteiole,

perivascular or extravascular)

Churg strauss syndrome (allergic granulomatosis and angitits)

o Asthma

o Eosinophilia (>10% wbc

o Mononeuropathy or polyneuropathy

o Transitory pulmonary infiltrates

o Paranasal sinus abnormalities

o Bx with extravascular eosinophils

Polymyalgia rheumatica

o Pt over 50 and usually white

o Muscle pain for at least 1 month in shoulders and pelvic girdle

o Severe morning stiffness and gelling

TA or giant cell arteritis

o Over 50

o New HA

o Temporal artery abnormality (tender or decreased pulse)

o ELEVATED ESR> OR = 50MM/HR

Page 33: Buzz words

o Abnormal art bx with mononuclear cell infiltrate,

granulomatous inf usually with multinucleated giant cells.

Polyarteritis nodosa

o Weight loss >4kg

o Livedo retularis

o Testicular pain or tendernous

o Myalgias, weakness, or leg tendernous

o Mono or polyneuropathy

o Diasoltic >90

o Elevated bun or creatinine

o Heb B virus

o Arteriographic abnormatily

o Bx of small or medium artery containing PAN

In osteoporosis there is a loss of height and multilevel fx that can

lead to lumbar lordosis or kyphoscoliosis. What would you also find

to be elevated: IL1, IL6 and TNFalpha, rank, and rankL, osteoclast

activity.

o You would find decreased: serum estrogen, response of

osteoprogenitor cells, osteoblast act, and Physical activity

You might find secondary hyperparathyroidism in this: osteomalacia

due to low vit D. (undermineralized bone)

Dry eyes and dry mouth: sjogrens syndrome

Anti-SSA (ro) and anti SSb (la): sjogrens syndrome

Rose Bengal staining/ schrimer test: sjogrens syndrome

Lip bx: sjogrens syndrome

Tx for eyes in sjogrens syndrome: restasis

Tx for oral sx: Evoxac/ Salagen

What should be started within 6 months of dx of RA: dmards

How long to wait for preggo in lefunamide (Arava): 2 years

How long to wait for mtx: 3-6 months

Xray of knee showing medial joint space narrowing: OA

Tx for PVNS or GCT: surgery

Xray finding of thickened irregular and lobulated epiphyseal plate:

rickets (children vit d def)

Rachitic rosary (swollen constocondral junctions of ribs) and pigeon

chest: rickets

Page 34: Buzz words

Bowing of arms and legs: rickets

Osteopenic x ray pattern: osteomalacia

Compression fx and decrease in bone thickness: osteomalacia

Osteomalacia will also result in: secondary hyperparathyroidism

Eburnation: oa

In gout what is the tophus composed of: macrophages,

lymphocytes, fibroblasts, and foreign body giant cells

Drug that inhibits lymphotoxin alpha: entanercept (Enbrel)

o Also inhibits tnf alpha and beta

Can tx ra, juvenile arthritis, and ulcerative colitis

Adverse: opportunistic inf and lymphomas

Jones tq 100%

o Non inflammatory

Leukocyte ct <3000/uL, few neutrophils

Oa, traumatic arthritis, PVNS

o Inflammatory

Leukocytes ct btw 3000-75,000/uL, 50% > neutrophils

RA, sle, reiter syndrome, rheumatic fever, acute

cystic induced arthritis

o Purulent

Leukocyte ct >50,000, >90% neutrophils

Bac, fungal, tuberculous joints

o Hemorrhagic

Traumatic, PVNS, synovial hemangiomas, hematological

disorders, thrombocytopenia, anticoagulant therapy

Inhibits uric acid formatin by inhibiting xanthine oxidase for tx of

gout: allopurinol

Non purine xanthine oxidase inhibitor for gout: febuxostat

Breaks down uric acid in gout: uricase

Page 35: Buzz words

To tx attack in gout: colchicine, nsaids, steroids

What are the uricosuric drugs for gout: Probenecid/ sulfinpyrazone

Osteitis deformans: pagets dz

Brown tumors: osteitis fibrosa cystica

Osteoclastoma: spindle shaped cells (aka giant cell tumor of bone)

Sickle cell: salmonella

Late adolescence and young adulthood: s. aureus

Older children and adults: s. aureas

Methotrexate can cause cirrosis

Anti-jo-1: polymyositis/ dermatomyositis

Anti ds dna: sle

Anti-ribonuclear antibodies: (anti-RNP)::: mixed connective tissue dz

(MCTD)

Shaft of a long bone: diaphysis

Where does the ewing sarcoma originate in the bone: medullary

cavity

Which form of scleroderma is ass with pulmonary hypertension:

limited cutaneous scleroderma

Anti-phospholipid antibody syndrome: cardiolipin abs: ass with

abortions

Round hyperchromatic cells with little cytoplasm and virtually no

stroma: ewing sarcoma

Defect in intercellular matrix: mutation in gene ATP2A2 on chrome

12: darrier dz aka keratosis follicularis

Onycholysis: psoriasis

Acanthosis with elongated rete ridges: psoriasis

What are munroe abscesses: neutrophils in psoriaais

What atb is involved in pemphigus vulgaris: IgG

Which skin disorder is ass with mg and lupus: pemphigus vulgaris

Linear BMZ deposits of IgG and complement: bullous pemphigoid

Page 36: Buzz words

trif

what are the dual roles of articular cartilage hyaline type at ends of

bone:

o friction free movements

o absorption of shock and weight

layers of the synovium

o macrophages with lysosomal enz and dense bodies

o cells secrete hyaluronic acid

the synovial fluid controls:

o diffusion

o ingestion

o secretion of hyaluronate, immunoglobulins, and lysosomal enz

o lubrication by secretion of glycoproteins

what is the main source of nutrients for articular cartilage since it

lacks blood supply: synovial fluid

elastic and high tensile strength: hyaline cartilage

what is hyaline cartilage made up off

o type 2 collage fibers: tensile strength and transmits vertical

load

o water and proteoglycans for: turgor and elasticity and limit

friction

o chondrocytes: syn matrix and digest matrix

layers of chondrocytes from superficial to deep

o tangential or gliding:

elongated, flattened and parrell

o transitional:

chondrocytes are larger, ovoid and more randomly

distributed

o radial zone:

Page 37: Buzz words

small and arranged in short columns like in the

epiphyseal plate

o calcified zone: Deepest

small chondrocytes and heavily calcified matrix

what controls matrix turnover: chondrocytes

cytokines/growth factors needed for osteoclast differentiation

o IL1, IL3, IL6, IL11, TNF, GM-CSF, M-CSF

Stimulate osteoclast progenitor cells

Participate in Paracrine system in which osteoblast and

marrow stromal cells play central role

Mediators of the paracrine system

o Rank

o rankL

o osteoprotegerin

what types of cells in rank mostly on: macrophage/monocytic

lineage such as pre-osteoclasts

what types of cells is rankL on: cell membranes of osteoblasts and

marrow stromal cells

what initiates osteoclastogenesis: rank binding to rankL

what inhibits osteoclastogenesis: OPG by acting as a decoy that

binds RankL.

Ehler-danlos, marfans or osteogenesis inperfecta: secondary Oa

Achondroplasia, congenital hip dysplasia: secondary Oa

Macro trauma or repeated microtrauma: secondary Oa

Fibrillation (flaking: oa

Subchondral bone cysts: oa

Joint mice: oa

Page 38: Buzz words

Pain and guarding of the joint: synovial inflammation in oa

Dull aching pain in oa: when full thickness cracks or erosions in

articular cartilage allow joint fluid to be forced through subchondral

bone plate

Pain and bracing of the joint: capsular inflammation

Non suppurative inflammatory and proliferative synovitis: RA

What forms the Rf factor: B cells

What activates the macrophages to produce cytokines in RA: t cells

What activates neutrophils: IC and complement

What are the mediators of inflam and destruction that are produced

by the neutrophils: prastaglandins, leukotrienes, lysosomal enz, and

ROS

What produces RankL: t cells and synovial fibroblasts

Is there genetics in RA: yes: HLA-DR

Pannus consist of: inflammatory cells, granulation tissue, and

fibroblasts

Extra articular involvement in RA

o subQ rheumatoid nodules

o vasculitis and inf lesions in pericardium, myocardium, lungs,

pleura, peripheral nerves, and eyes

o systemic amyloidosis in some pts

o lab finding of hypergammaglobulinemia: RA

ass with gout:

o chronic hemolysis, polycythemia, leukemia, lymphoma,

diuretics, aspirin, nicotinic acid

o

gauchers dz, sle, or osteo radio necrosis after radiation: avascular

necrosis etiology

pale infarct or sequestrum and separtaiton of overlying cartilage

from bone: avascular necrosis morphology

avascular necrosis of the femoral head in children: legg calve

Perthes dz

JONES lymphoid neoplasm’s:

Part of LN where primary or secondary follicle (germinal center:

mantel zone) is: cortex

Page 39: Buzz words

Part of LN where sinuses are located: medulla

Def: LN undergo reactive changes whenever they are challenged by

microbiologic agents, cell debris, or foreign matter introduced into

wounds or into circulation: lymphadenitis (NOT THE SAME AS

LYMPHADENOPATHY)

Acute or chronic no specific lymphadenitis:

o Nodes are swollen, grey-red and engorged: acute

o Distention of capsule causes tendernous to touch: acute

o Which one has three types: chronic

What are the three diff morphological alterations in

chronic non specific lymphadenitis:

1. Follicular hyperplasia

2. Paracortical lymphoid hyperplasia

3. Reticular hyperplasia.

What are the etiological factors in lymphoid neoplasm’s:

o Chromosomal translocations and oncogenes

o Inherited genetic factors

o Viruses

o Env agentes

o Iatrogenic

Whats the difference in leukemia and lymphoma

o Leukemia: use for lymphoid neoplasm’s presenting with

WIDESPREAD involvement of the bone marrow, usually with

presence of large number of tumor cells in the peripheral

blood.

o Lymphoma: used to decribe proliferations as DISCRETE tissue

masses.

What does the REAL chassification system use as the most

important criteria: immunophenotype

o Also: genetic aberrations

Precursor b cell neoplasm: neoplasm of immature b cell

Peripheral b cell neoplasm: neoplasm of Mature b cells

Precurso t cell neoplasm: neoplasm of immature t cell

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Peripheral t cell and NK cell neoplasm: neoplasm’s of mature t/NK

cells.

Neoplasm’s of reed Sternberg cells and variant: hodgkins lympoma

What are the vast majority of lympoid neoplasm’s (80-85%): of b

cell origin

Nodular sclerosis and mixed cellularity seen in : V. Hodgkin

lymphoma

What is ALL: acute lymphoblastic leukemia/lymphoma

Most occur in kids under 15, 2x as common in whites, and more

frequent in boys than girls, and 85% are of precursor b cell tumors:

ALL

Abrupt stormy onset, bone pain and tendernous, generalized

lymphadenopathy, splenomegaly, or hepatomegaly and cns

manifestions: ALL

Lymphoblasts with scant cytoplasm and nuclear chromatin is

delicate and finely stippled: ALL

TdD is positive in >95%: ALL

blasts almosts always express the pan b cell molecule CD19/CD10:

ALL

How is early and late ALL distinguished: early doesn’t have

cytoplasmic IgM heavy chain ( mu chain)

35% or > # of blasts in the bone marrow is essential for dx: ALL

POOR prognosis Markers in ALL

o Age <2

o Presentation in adolescence or adulthood

o Peripheral blood blasts counts greater than 100K,

o Cytogenic aberrations such as t(9;22) (****the PHILADELPHIA

CHROMOSOME)

Favorable prognosis markers in ALL:

o Onset of dz between age of 2-10

o Low white count

o An early pre-B phenotype

The dx criteria is an absolute lymphocyte count > what ????? in

chronic lymphocytic leukemia/small lymphocytic lymphoma: >4000

per mm (cubed)

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Most pts present at ages over 50 (median age is 60): chronic

lymphocytic leukemia/small lymphocytic lymphoma

Gender pref in chronic lymphocytic leukemia/small lymphocytic

lymphoma: M 2x

LN architecture is diffusely EFFACED by predominant pop of small

lympocytes 6-12 micro meters in diameter containing round to

slightly irregular neuclei with condensed chromatin and scan

cytoplasm: chronic lymphocytic leukemia/small lymphocytic

lymphoma

Smudge cells: chronic lymphocytic leukemia/small lymphocytic

lymphoma

B cel markers in chronic lymphocytic leukemia/small lymphocytic

lymphoma: CD19, CD20, CD23, CD5

Of the above which one is the t cell marker that is expressed on

only a small subset of normal b cells in chronic lymphocytic

leukemia/small lymphocytic lymphoma: CD5

Diffuse large b cell lymphoma transformation: Richter syndrome:

under chronic lymphocytic leukemia/small lymphocytic lymphoma

Heterogeneous group of tumor that constitute 20% of all NHL and

60%-70% of aggressive lymphoid neoplasm’s: diffuse large b cell

lymphoma

What is the median age for diffuse large b cell lymphoma: 60

This is fatal but easily treatable: diffuse large b cell lymphoma

Large cell (centroblastic) size (usually 4-5 x the diameter of a small

lymphocyte) and a diffuse pattern of growth: diffuse large b cell

lymphoma

What are the markers on b cell tumors in diffuse large b cell

lymphoma: CD19, CD20

Variable expression of germinal center markers CD10, and BCL6

and most have surface Ig, and all are negative for TdT: diffuse large

b cell lymphoma

African (endemic) Burkitt lymphoma

Sporadic (nonendemic) Burkitt lympoma

Faintly basophilic or amphophilic cytoplasm: burkitts lymphoma

Mitotic figures are numerous and evidence of APOPTOSIS: burkitts

lymphoma

Page 42: Buzz words

Starry sky pattern: Burkitts lymphoma

Tumor cells are mature b cells expressing surgace IgM, monotypic

kappa or lambda light chain, CD19 CD20, CD10, and BCL6: Burkitts

lymphoma

All forms of burkitts lymphoma are ass with the translocation of

the :c-myc gene on chromosome 8

What age does most Burkitts lymphoma affect: children and young

adults

Mass involving the mandible, abdominal viscera particularly the

kidney, ovaries, and adrenal glands: Burkitts lymphoma (endemic

form)

Most often presents as ab mass involving ileocecum and

peritoneum: Burkitts lymphoma (sporadic form)

Prognosis of BL: good when tx with high dose chemotheraphy for

short term

Another name for multiple myeloma: plasma cell myeloma

The most imp and most common symptomatic monoclonal

gammopathy: multiple myeloma

Gender preg in multiple myeloma: men

High serum levels of IL-6 are ass with poor prognosis; multiple

myeloma

Most often affects the verterbral column: multiple myeloma

The bone lesions appear as punched out defects 1-4 cm on xray:

multiple myeloma

Flame cells: multiple myeloma

Mott cells: multiple blue grapelike cytoplasmic droplets and cells

containing variety of other inclusions such as fibrils, crystallien rods,

and gobules sometimes russell bodies (cytoplasmic) or dutcher

bodies (nuclear): multiple myeloma

Rouleaux formation caused by high levels of serum M proteins in :

multiple myeloma

99% of pts with show increased levels of immunoglobulins in blod

and or light chains in urine known as BENCE JONES PROTEINS:

multiple myeloma

most common serum monoclonal immunoglobulin (m protein) in

multiple myeloma: IgG

Page 43: Buzz words

prognosis of multiple myeloma: variable but generally poor

high incidence in adults infected by HTLV-1: adult t cell

leukemia/lyphoma

hypercalcemia: adult t cell leukemia/lyphoma

cells have multilobulated nuclei called cloverleaf or flower cells;

adult t cell leukemia/lyphoma

prognosis of adult t cell leukemia/lyphoma: death within 1 months

to 1 year even with aggressive chemo

mycosis fungoides progresses to : Sezary syndrome

different manifestations of a tumor of cd4 helpter t cells

characterized by a marked predilection to involve the skin.: mycosis

fungoides/Sezary syndrome

shows three distinct stages of

o 1:inflammatory premycotic phase,

o 2. Plaque phase

o 3. Tumor phase

Answer: mycocsis fungoides

Manifests as generalized exfoliative erythroderma: Sezary

syndrome

o

o

Neoplastic giant cells seen in HL: reed Sternberg cells

What are reed Sternberg cells derived from in HL: from germinal

center or post germinal center b cells

Most common form of malignancy in young adults with ave age of

dx of 32: HL

Prognosis of HL: curable in most cases

Nodular sclerosis pts usually present as: stage 1 or 2 M=F

Mixed cellularity pts usually present as: state 3 or 4 M>F

Lacunar cells: type of reed Sternberg cell seen in HL

Mummification: HL

Spread of HL: nodal dz firstsplenic dz hepatic finally marrow

and extranodal involvement

Most common form of HL: nodular sclerosis type

Nodular type most common cell type: lacunar cell type

Page 44: Buzz words

Collagen bands: nodular type of HL

CD15 CD30 and neg for CD45 and b cell and t cell markers: nodular

type of HL

Which type of HL has strong ass with EBV: mixed cellularity type

Which has best prognosis: nodular type

Which one has night sweats and weight loss: mixed cellularity type

Lytic lesions: Multiple myeloma

Mott cell: multiple myeloma

\

HEME OLD TEST QUESTIONS

Common translocation is the IgH locus t(8:14) but there may also be

t(2;8) or lambda (8;22) light chain locus: burkitts lymphoma

Jaw involvement: endemic burkitts lymphoma

Philadelpha chromosome: poor prognosis in ALL

Majority of cells have terminal deoxynucelotideyltransferase (TdT)

(+ in >95%) of cases): ALL

Absolute lymphocytic count >4000 per mm cubed: CLL

Intranasal cyanocobalamin for : tx fof vit b12 def

Inhibits dehydroooratic acid dehydrogenase: luflunamide (arava)

Smudge cells: CLL

In the anemia, RBC hemolysis results in

o Increased internal viscosity

o Hb aggregation

o Decreased cell water

o And precipitated hb as Heinz bodies:

Answer: G6PD def

What can cause G6PD def to unmasked:

o Exposure to some drugs: ex sulfonamide

o Inf

o Diabetic acidosis

o Neonatal period

o Ingestion of FAVA beans

Fava: g6pd def

Page 45: Buzz words

Osmotic fragility: hereditary spherocytosis

Whats the tx for hereditary spherocytosis/elliptocytosis:

splenectomy

Defect in the RBC membrane results in these two disease:

hereditary spherocytosis and hereditary elliptocytosis

Found in southern japan, west Africa, and Caribbean basin: adult T

cell leukemia/lymphoma

Starry sky appearance: burkitts lymphoma

In an indirect coombs test where is the ab: in the plasma

In a direct coombs test, where is the ab: on the membrane

Hematuria vs hemoglobinuria: in hematuaria the rbc is intact where

as in hemoglobinuria the rbc is lysed.

Which one of the above is ass with uti or kidney problems:

hematuria.

Which one of above is associated with hemolytic anemia:

hemoglobinuria

Polycythemia aka: erythrocytosis

In relative polycythemia due to dehydration, hct levels are: high

In relative polycythemia due to spurious, hct levels are low

What are the macrocytic anemia: (mcv <80)

o Find those small cells henry

Fe def or pb poisoning

Thalassemias

Sideroblastic (80%)

Chronic dz

Hemoglobinopathy

What is the purpose of a reticulocyte count: it shows how fast rbc

cells called reticulocytes are being made and put into the blood.

o The reticulocyte count can rise in dz where there is a loss of

blood or premature destruction of rbc such as in : hemolytic

anemia

Petechia: platelets

What are the four d’s of quantitative thrombocytopenia:

o Increased destruction

Page 46: Buzz words

o Decreased production

o Dilution

o Distribution

What are the myeloid cells:

o Basophils

o Rbc

o Eosinophils

o Monocytes

o Platelets

o

What are the lymphoid cells

o Lymphocytes

o Lymph nodes

o Extranodal tissue

Myeloproliferative disorders affect what age: adults

Myeloproliferative disorders are disorders of: stem cells

What does the peripheral smear show in Myeloproliferative disorder:

increased platelets

What does the bone marrow show in myeloproliferative disorders:

HYPERcellularity

Myeloproliferative disorders:

o Name the predominant phenotypes

Chronic myeloid leukemia: granulocytes, basophils,

eosinophils

Page 47: Buzz words

Polycythemia vera: erythocytes

Essential thrombocythemia myelofibrosis:

platelets/megakaryocytes

Chronic myelomonocytic leukemia: monocytes

Walenstroms macroglobulinemia: plasma cell disorder

What are all the plasma cell disorders

o MM

o LIGHt/heavy chain dz

o Benign monoclonal gammopathy

o Waldenstroms macroglobulinemia

o Amyloidosis

o Plasmacytoma

o Plasma cell leukemia

o Monoclonal gammopathy of undertermined significance

How to evaluate coagulopathy

o Whats the best way: Hx and PE

o CBC with smear

o PT: prothrombin time

Extrinsic pathway: factors 2, 5, 7, 10 and fibrinogen

o INR: international normalized ratio

Ratio of pts PT to normal PT

o PTT: partial thromboplastin time

Factors: 8,9,11,12, and rarely von villebrands factor

Page 48: Buzz words

o Platelet count

What are the inherited defects in anti-clot enz ass with

hypercoagulable states: protein C and protein S def.

o Also (HIT ab)

What are the clinical manifestations of anemia (TQ 100%)

o Fatique/weakness

o Dizziness/ syncope

o Intermittent claudication

o Muscle cramps at night

o HA/ lightheadedness

o Angina

o Tinnitis

What is on a peripheral smear in hemolytic anemia: spherocytes

TQ 100%: general lab features of hemolytic anemia

o Low Hgb/Hct

o HIGH reticulocyte count

o Increased LDH

o DECREASED haptoglobulin

o Increased bilirubin

What are the SPECIFIC lab features of hemolytic anemia

o Schistocytes/poikliocytes/spherocytes/ovalcytes/sickle cells

o Hemoglobin electrophoresis

Page 49: Buzz words

o Hemoglobinemia/hemoglobinuria

o Osmotic fragility

o DAT/IAT/ eluates

o G6PD level

o ETC

Priapism: perpetual erection seen in sickle cell

What is the most commonly used anti-sickling agent tx for sickle

cell: hydroxyurea

Which one do you use an RBC exchange: sickle cell anemia

Beta thal minor: thal triait: 1 gene abnormal: normal hb

Beta thal intermeida: 2 genes abnormal but some beta globin

produced: mild to moderate anemia

Beta thal major: 2 genes abnormal and little beta globin produced:

severe anemia: high Hgb F -1 to 5% HgbA

Alpha thalassemias

o Silent carrier: 1 missing gene, normal Hgb: no dz

o Alpha thalassemia trait/alpha thalassemia minor: 2 missing

genes: mild anemia

o Hemoglobin H: three missing genes mod to severe anemia

o ***** it takes three lines to make an H)

o alpha thalassemia major or hydrops Fetalis: all Four genes

missing: death before or shortly after birth

tx is none except transfusion and IRON Chealation with BAL:

thalassemias

Heinz bodies: eating fava beans in G6PD def

Whats does WAIHA stand for: warm autoimmune hemolyic anemia

Page 50: Buzz words

Is warm ab auto or Alloimmune: autoimmune

Is HDN auto or allo: Alloimmune

Penicillin: Alloimmune

Lupus is ass with : autoimmune

What are the lab values in hemolytic anemia

o Anemia

o In vivio hemolysis

o +DAT

o + IAT

o eluate to ID antibody

o reticulocytosis

o spherocytes

o splenomegaly

o

what is the antibody in WAIHA: IgG

TTP is a type of : acquired hemolyic anemia

What is the pentad of TTP

o Microangiopathic hemolytic anemia

o Fever

o Renal failure

o Mental status changes

o Thrombocytopenia

Adempts 13 def: TTP

Page 51: Buzz words

Tx is plasma exchange: TTP

What is the disorder in AA: the pluripotent stem cell

What are the hallmarks of AA:

o Requires both

Pancytopenia

Acellular bone marrow filled with fat

What is the cuase of AA: stem cell injury

What are you looking for on AA bone marrow bx: spicules with

empty fatty spaces

What is the total lab eval in AA

o Pancytopenia

o Acellular or hypocellular BM

o Decreased CFU-GM

o Decreased BFU-E

o Decreased Long term culture initiating cells to les than 1%

o Flow cytometry rules out ALL or hairy cell leukemia

What rules out ALL and hairy cell leukemia in AA: flow cytometry

Tx for AA: bone marrow transplant

What test to order to r/o myelodysplastic syndrome: cell

morphololgy/ cytogenetics, cell surface markers

Test to r/o PNH: + sucrose hemolysis test/ abnormal CD59

ALL: cell surface markers/marrow

Hairy cell leukemia: cell surface markers and special stains

Page 52: Buzz words

Kimmel last days before exam

Paste features seen in what: generalized discoid lupus (DLE)

What does paste stand for

o Follicular Pluggin

o Epidermal Atrophy

o Scale

o Tenangiectasia

o Erythema

Which type of cutaneous lupus has the greatest risk for SLE (70%):

acute LE (ALE)

What are the possible involved areas in systemic lupus (SLE): old TQ

o Skin, joints, kindneys, lungs, brain, heart, blood forming

organs

Photosensitivity and malar rash: SLE

What are the hematological levels in SLE:

o Hemolytic anemia

o Leukopenia: <4K

o Lymphopenia: <1.5k

o Thrombocytopenia: <100K

Pt with the following: ds dna, sm, antiphospholid with false + VDRL,

cariolipin ab, and lupus anticoagulant: SLE

If you get a neg ana for sle: much less likely that you have SLE

If you get a + ana what is next step: further testing

What are the major specific serologies for SLE

Page 53: Buzz words

o DS DNA

o ENA

o ACL abs

What is the sensitive but not specific serology for SLE: ANA

What do you tx the skin in sle with:

o Antimalarials

o Steroids

o Dmards (anti metabolites, MTX, Leflunomide, MMF, aza)

o Cytotoxic: CSA, CTX)

What do you tx the joints in SLE

o NSAIDS: only if no kidney dz

o Anti malarials

o Steroids

o Dmards

o Biologicals

Major inter organ tx in sle:

o High dose steroids

o +/- cytotoxic agent

for SLE kidney tx

o focal proliferative : steroids

o diffuse proliferative: steroids + Cytoxan/MMF or BM transplant

o membranous: steroids +/- IMURAN/ cyclosporin A

Page 54: Buzz words

what do you tx the thrombocytopenia in SLE with if its

o mild: Plaquenil or danazol

o severe: prednisone (others in notes)

what is usually not affected in drug induced lupus: major internal

oragn dz or DNA abs

TQ: what are the drugs that can cause drug induced lupus

o P(2x)HIC Q

Procainamide

penicillamine

Hydralazine

Isoniazid

Chlorpromazine

Quinidine

Increased PTT time not corrected by mixing study:

anti=phospholipid ab syndrome

What is the tx of the above: anticoagulant

Cardiolipin ab: anti-phospholipid ab syndrome

What things can be false + in pt takig anticoagulants in anti-

phospholipid syndrome: lupus anticoaguland and PTT time

Tx in anti phosopholid ab syndrome for pts with previous

thromobotic episodes: Warfarin with INR

Morphea: localized scleroderma

Crest: limited cutaneous scleroderma

Page 55: Buzz words

Pulmonary HTN: limited cutaneous scleroderma

SCL-70: diffuse cutaneous scleroderma

Cancer risk such as lung cancer in: scleroderma

Manifestions such as raynauds, digital ulcers, calcinosis, MSK, GI,

renal, pulm, and cardiac : scleroderma

Tendon inflammation/ friction rub/tenosynovitis in: PSS

Ace inhibitor or vasodilator: tx option for PSS

Name the dz: symmetric proximal muscle weakness, elevated

Muscle enz such as (CPK, aldolase, and transaminase, LDH),

myopathic EMG abnormalities, typical changes in muscle bx,

heliotropic rash: polymyositis and dermatomyositis

What are the ab ass with dermatomyositis: JO-1, PM-1

If you have myositic what tests should you have: age related

malignancy eval on first dx + CXR and CT scan abdomen/pelvis and

yearly thereafter

Antibody for Mixed CT dz: anti ribonuclear *anti RNP

Ditcheks lectures

Best for spatial resolution: plain radiograph

Initial for trauma: plain radiograph

Good for pre-opt: CT

High contrast resolution:MRI

No radiation and used to differ btw cystic and solid lesion:

Ultrasound

Avascular necrosis (AVN): MRI

Achilles tendon: ultrasound

Foreign body such as WOOD: Ultrasound

Advantage is a head to toe scan: bone scan

What is bone densitometry (DEXA) used for : osteoporosis

Page 56: Buzz words

T scoring:

o Normal: within 1

o Osteopenia: 1-2.5 below the young normal bone density

o Osteoporosis: >2.5 below

Def of comminuted: >2 fragments

Impactation: bone teloscopes into itself

Pathological fx: through abnormal bone such as in pagets dz

Lipohemarthrosis: fat and blood in joints: means there is a crack in

the blood and the BM fat and blood leaked out.

Pain and tendernous on outstretched hand: scaphoid fx

For knee trauma to visualize ligaments, tendons, and cartilage such

as PCL or meniscus tear: MRI

Best for comminated fx: CT

Ped fx vs adult: peds bones more water content so they bend before

breaking. Can result in bent bone

Buckling on xray: torus fx

Bowing fx: from microfractures

Look at salter harris classifications: TQ 100%

Exits through metaphysis: type II

Exits through epiphysis: type 3

Exits through both: type 4

Fat pads in elbow: elbow fx

o You should never see a posterior fat pad. Maybe you could

see a anteriorly normally

Posterior rib fx: child abuse

Bucket handle or corner fxs: child abuse

Multiple fx in varying stages of healing

What are the ABCDS of arthritis

Page 57: Buzz words

o Alignment

o Bone mineralization

o Cartilage (joint space)

o Distribution

o Soft tissues

Ulnar deviation and periarticular osteopenia: RA

Joint space narrowing and erosions: RA

Young males, proximal large joints (spine/SI joint), and bamboo

spine: ankylosing spondylitis

Non erosive, subluxations, distribution similar to RA (MCP) joints:

SLE

First MTP: podagra: gout

Distal joints in hands and erosive and productive and SI joints/spine

involved: psoriatic arthritis

Which is the only one without erosions: SLE

TQ: signs of non aggressive lesions

o Narrow zone of transtition

o Benign patterns of periosteal rxn

Thick

Wavy

Dense

o No cortical destruction

TQ: signs of aggressive

o Wide zone of transition

o Permeative or moth eaten lytic pattern

o Aggressive periosteal rxn

Sunburst, onion skin, codmans triangle

Page 58: Buzz words

o Cortical destruction

Monostotic: one location

Which test to see monostotic vs polyostotic or increased bone

turnover: bone scan

Soft tissue mass: MRI

Rupture of rotator cuff: MRI

Metastatic breast cancer: CT scan or MRI

Evaluation pros for nuclear med for osteomyeltitis

o High sensititivity (bone turnover)

o Detects earlier than plain radiograph

o No artifact from prosthesis (unlike mri)

Cons:

o Low specific

o Low resolution

o No info on soft tissues such as abscesses

Best for osteomyeltits marrow edema: MRI

Weisberg

Of the hodgkins which is more common: NHL

Viral genomic material is found in 50% of HL tumors: EBV

What is the gender preg for HL: Male

Is HL genetic: Yes

Painless lymphadenopathy, granulocytic leukocytosis with

eosinophila: HL

What is the alkaline phosphate level in HL pts: elevated

What are the B symptoms: Fever, night sweats, weight loss more

than 10% total body weight

Page 59: Buzz words

What cell origin is HL: B lymphocytic origin

Immunoperoxidase rxn in HL will detect what two antigens helpful in

dx HL: Leu-M1 (CD15) and Ki-1 (CD30)

What is the most common type of HL: nodular: also this is the best

prognosis also

o COTSWORLD STAGING CLASSIFICATION

Waldeyers rings: stage I

2 or > and on same side of diaphragm: II

what is the consistency in HL lymph nodes: rubbery

what does X mean: bulky dz

o greater than 1/3 widening of mediastinum

o greater than 10 cm dimension of nodal mass

E stands for : involvement of a single extranodal site

Unfavorable prognosis factors of localized dz (stage I or II)

o Elevated ESR >30

o Histology: mixed cellularity or lymphocyte deplated

o Bulk dz: ratio of mediastinal mass to thoracid diameter >1:3

o 4 sites on same side of diaphragm

what are some unfavorable prognosis factors in advanced dz

o serum albumin <4g

o Hb <10.5

o Male

o Stage IV

o WBC >15,000

o Age >26

o Lymphocyte count <600 or <8% of white count

Page 60: Buzz words

what makes pain worse in HL when drinking it: alcohol

tx for stage IA or IIA

o radiation and often preceded by brief chemo

what are the long term effects of radiation therapy

o HYPOthyroidism

o Radiation fibrosis

o Effusions

o Late occurring solid tumors in field of irradiation

o Sterility

What is the tx for advanced age dz of HL (IIIA, IIIB, or IV)

o Combination chemotherapy as primary therapy with the

possibility of radiation for residual masses

In the above what does combonation therapy consists of

o MOPP

Mustargen

Oncovin

Prednisone

Procarbazine

o Or ABVD---------------->>>> first line now

Adriamycin

Bleomycin

Vinblastine

Dacarbazine

What are the drugs in the HIGH dose therapy options for pt that

relapse

Page 61: Buzz words

o CBV

Cyclophosphamide

Carmustine

Etoposide

o BEAM

Carmustine

Etoposide

Cytarabine

Melophalan

NON HODGKIN LYMPHOMA

What are the cell types involved: B cell, T cell or NK lymphocytes

What is the tx of choice for NHL: Rituxan

Low grade lymphomas in NHL are: seldom curable

o But tx can often be delayed with no consequences

TQ: what are the infection agents knows to cause NHL

o EBV

o HTLV1

o H. pylori

What are the physical or chemicals ass with NHL

o Diphenylhydantoin

o Dioxin

o Solvents

o Radiation

Page 62: Buzz words

o Prior chemo

o Prior radiation

Inherited immunodeficiency dz’s

o Klinefelters

o Chediak higashi syndrome

o Ataxia telangictasia syndrome

o Wiscott Aldrich syndrome

o Common variable immunodef syn

Acquired immunodeficiency dz

o Iatrogenic immunosuppression

o Acquired immunodeficiency syn (HIV)

o Acquired hypogammaglobulinemia

Autoimmune dz

o Sjogrens

o Non tropical sprue

o RA

o SLE

What are the mature (peripheral) b cell neoplasm’s

o B cell lymphocytic leukemia/small lymphocytic lymphoma

o Follicle center lymphoma, follicular (most common)

o Mantel cell lymphoma

o Diffuse lare cell b cell lymphoma

o Burkitts lymphoma/Burkitt cell leukemia

What are the precursor t cell neoplasm’s

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o Precursor t lymphoblastic lymphoma/leukemia

What are the mature (peripheral) t cell and NK cell neoplasm’s

o Mycosis fungoides/Sezary syndrome

What is the most common site of MALT lymphomas: stomach

What are the causes of gastric MALTomas: H pylori thus (TQ) you

can tx MALT with an antibiotic

Whats the t cell ones: mycosis fungoides and Sezary syndrome

Localized vs advanced

o Localized (must have all three)

1. Ann arbor I or II

2. No tumors >10cm

3> no B symptoms

o advanced (May include any of the three)

1. Ann arbor III or IV

2. Tumors >10cm (bulky dz)

3. B symptoms present

explain the IPI pts

o APELS

Age over 60: 1 pt

Performance exam > or = 2: 1 pt

Extranodal sites >1: 1 pt

LDH above ave: 1 pt

Stage III or IV: 1 pt

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What is the difference in the FLIPI index

o The number of LN involvement has to be 4 and HB <12.

Tx for indolent lymphomas

o Alkylating agents: chlorambucil, cyclophosphamide,

bendamustine

o Anthracyclines: doxorubicin

o Purine analogues: fludarabine

o RUTUXAN: chimeric ab with anti CD20 activity

o

What are some signs of progression to aggressive lymphoma in NHL

o New or worsening B symptoms

o Facial or UE swelling

o Ab pain

o Jaundice

o Constipation

o Bowell obstruction

o Painful, rapidly enlarging LN

o Tender splenomegaly

o Superior vena cava syndrome

o LE edema

o Thrombocytopenia

o Granulocytopenia

o Rising serum creatinine

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o Hyperbilirubinemia

o Hydronephrosis on CT

What are the chemotherapy tx for NHL

o Single alkylating agent

Chlorambucil, Cytoxan

CHOP, CVP

New agents: bortezomide, bendamstine,

radionucleotides

Intravascular hemolysis anemias

o Hemolytic anemia

Hemoglobinemia and hemoglobinuria

Jaundice

FEMALE preference

RA

Juxtacortical osteosarcoma

Giant cell tumor of bone (osteoclastoma)

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