Hemonc

1.rapid onset of symptoms
2.IgA def.
3. stop transfusion, Epi, IVF, Vasopressor

1. MCC of poor diet &/or ROHism
2. Drugs: phenytoin, TMP-SMX

any pt. with a chronic hemoytic anemia and compensatory reticulocytosis has >ed demand for folic acid and will have folic acid def.
So, supplement with folic A.

1. EPO +Iron supplement
2. because EPO -> surge in iron use. so, need to supplement the body's iron stores

1. Arterial or venous thrombosis = HIT
2. discontinue current tx! and begin anticoagulation w/ a direct thrombin inhibitor (ex argatroba or lepirudin)

1. Cause is Vt. K def from pt. being NPO for pronlonged period of time and receiving broad spec abx
2. FFP for management of acute hemorrhage + K supplement.

10, 9, 7, 2, and prot C and S

1. lymphomas (burkitt's) and leukemias (esp. ALL)
2. "PU!": PPU: Hyperkal, hyperphos (bc. they're both intracellular ions that are released with the breakdown of cells), hypocal (bc. phos binds to it), hyperuricemia (from degradation of cell's proteins)
3. Allopurinol to < urate nephropathy and Tx the electrolyte abnormalitites to prevent fatal arrhuthmias, acute renal failure, and sudden death

MRI to confirm Dx and glucorticoid tx while awaiting test results (in order not to risk permanent neurologic damage)

1. (1) open sore that bleeds, oozes or crusts
(2) shiny bump or pearly nodule
(3) poorly defined borders
2. burning it freezing it or cutting it off
Impotant: with 1-2 mm of clear margins!

illegal doping with androgens, autologous blood transfusions, or EPO abuse.
androgens will have addtional SEs: gynecomastia, decreased teste size, hepatotox

they regress after eradicating H. pylori w/ abx therapy

1. false pos VDRL, prolonged PTT, and thrombocytopenia
2. arterial and venous thromboses -> spont abortion
3. prophylaxis with low does ASA and LMWH to avoid pregs loss

(4Ts):
thymoma, teratoma, thyroid neoplasm, terrible lymphoma

10, 9, 7, 2, and proteins C and S
bc Vit K (fat absorbed vit) def.

1.squamous cell carcinoma of the mucosa of head and neck
2. panendoscopy = esophagoscopy, bronchoscopy, laryngoscopy

1. tx underlying disorder. ex. in rheumatoid arthritis treat the underlying disorder with infliximab for example
2. chronic inflamm dz. rheumatoid arthritis (not osteoarth which isn't an inflam dz) , infxns, CA, autoimmune disorders

1st step is CXR to check for lung CA

1. 20-40 yo women,in epiphyseal end of long bone
2. oval or spindle shaped cells mixed in with multinuclear giant cells in fibrous stroma.
3. benign but locally aggressive~
refer to orthopedic surgeon (refer all bone tumors to orthopedist)

1. migratory thrombophlebitis usually assoc. w/ occult tumor
2. adenocarcinoma
3. pancreatic > lung > stomach > leukemia > colon
4. thrombophlebitis of atypical sites ex. thrombophleb in arm and chest w/ GI symptoms would clue you into pancreatic CA
5. CT scan abdomen

1. codman's triangle and sunburst appearance
2. onion screening in diaphysis
3. soap bubble appearance

1. bruises on dorsum of hands and forarms commonly
2. perivascular connective tissue atrophy

1. it's a medical emergency
2. admit pt., get blood Cx, start empiric abx (IV ceftazidime or cefepime: should cover pseudomonas)
3. single temperature of > 101.3 F or sustained low grade in a neutropenic (absolute neutrophol count < 500 cells/mm3) pt.
4. immunocompromised (ex. pt. undergoing chemo)

Pneumococcal vaccine + penicillin prophylaxis to kids until 5 yrs old

>30 years
should receive anti-pneumo, haemophilus, and miningococcal vaccines several weeks b4 operation and daily oral penicillin prophylaxis for 3-5 years after splenectomy

1. surgical rsxn followed by whole brain radiation
2.whole brain radiation

formation of autoAbs against blood cells - Type II hypersensitivity rxn

1. (1) hyperglycemia, (2) necrotizing dermatitis (3) wt. loss
2. usually malignant w/ mets to liver
3. ^fasting glucose and serum glucagon levels + pancreatic tumor on CT
4. Qx (it doesn't respond to chemo)

1. osmotic fragility test
2. both are extravascular hemolytic anemias. both show spherocytes.
AIHI - is acquired, positive coomb's test
spherocytosis - auto dom., Neg coomb's test

1. philadelphia chromo, (9,22), BCR-ABL
2. abnormal tyrosine kinase activity
3. tyrosine kinase inhibitors (imatinib, gleevec
4. LAP low (leukocyte alka phosphatase) (in normal individual LAP is high in infection)

1. ondansetron (5-HT3 receptor antagonist)
2. progestins and corticosteroids

1. herceptin
2. Her2 pos breast CA
3. cardiotoxicity
4. echocardiogram to make sure pt. doesn't have low Ejxn Frxn

1. FNA
2. if clear fluid from FNA and FNA causes mass to disappear then next step is to: observe for 4-6 weeks

megaloblastic anemia (also hypersegmented PMNs)

ie spur cell
spiny appearance
(diff btwn spur and burr cell: burr cells have central pallor, spurs don't)

HALT:
HbC dz, Asplenia, liver dz, thalassemia

TTP/HUS, DIC

spiky with central pallor
TTP/HUS

TTP = low platelet, low brain, low kidney. vWF esterase def.
ITP = low platelet. dx of exclusion. autoimmune: antiplately Abs
(PT and PTT not affected in either: doesn't affect clotting factors)

factor Ate (8) deficiency
Desmpopressin (ADH) treats it
^PTT

factor 9 deficiency
christmas dz
^PTT

von willibrand factor dz, factor 8 affected and defect in platelet adhesion
treated by OCPs or ADH
^BT and ^PTT

-> Pulmonary embolism

CRAB
Calcemia
Renal failure
Anemia
Bone lesions
Dx: w/ serum protein electroporesis
Mspike of gamma globulin. Ig light chains in urine (Bence Jones protein)

IgM spike -> hyperviscosity symptoms (no bone lesions)

MCV<80
LITtle CS = Lead, Iron, Thallessemia, Chronic dz, Sideroblastic

TAAIL = Thallessemia, Alcohol, Anemia of chronic Dz, Iron, Lead

Cider and Ale = Sider and AIL
Alcohol, Isoniazide, Lead
Tx for acquired = EPO
Tx for hereditary = Vit B6

thalassemia and SCD

tx for dx. when the standard therapy has failed. ex. radiation therapy for prostate-specific Ag recurrence after radical prostatectomy for prostate CA

- MC type of lung CA in nonsmokers and smokers
-has the least assoc. w/ smoking
-peripheral location in lungs
-bronchoalveolar is most important: related to pulmonary scars like in fibrosis
- Mets early to adrenals, bone, CNS

- ie Cowedn syndrome
-assocd w/:
GI tract hamartomas + breastCA + thyroid CA+ nodular gingival hyperplasia

assoc. w/ juvenile polyps + alopecia+hyperpig+nail loss (onycholysis)

1. HCT > 65%
2. transient respiratory distress or CNS disturbance <- excess transfer of placental blood <- delayed clamping of umbilical cord

Cs:
Candida esophagitiis, Cervical CA, PCP, Tb, bacterial pneumonia (strep pneumo, H. influe)

Kaposi's , parasitic diarrhea (isospora, crypto sporidium),

HIstoplasmosis

toxoplasmosis, lymphoma (CNSor non-Hoddgkin's), JC virus

crypto meningitis, CMV, MAC

PAS +
TDT +
abundant blasts
imatinib

stains with myeloperoxidasse
> 30% Blasts
aur rods
retinoic acid receptor Tx with vit A
Cytarabine, Ara-C
PML : the only leukemia assoc.d w/ DIC

> 65 yr old
smudge cells
aka small lymphocytic lymphoma
Dx confirmed with flow cytometry
thrombocytopenia indicates a poor prognosis

3 relatives, 2 generations, 1 case dxed @ < 50 yo

elevated: spherocytosis
low: microcytic anemias

exchange transfusion and continue hydroxyurea

serum protein electrophoresis (ie serum immunoelectrophoresis) and urine protein electrophoresis : detect high M protein and Bence Jones protein

Test for occult blood in stool
MCC of iron-def anemia in adult male or post menopausal woman = chronic GI blood loss

strep pneu, H influ, N. gono
because of impaired Ab-mediated opsonization in phagocytosis

strep pneu, H influ, N. gono
because of impaired Ab-mediated opsonization in phagocytosis

1. <ed haptoblovin, >ed LDH and bili
2. microangiopathic : DIC, HUS, TTP
and due to destruction by prosthetic cardiac valves or calcified valves

single, round, blue inclusions on Wright stain
suggesting splenectomy

-hemolytic anemais
-portal HTN (when combined w/ caput medusa)
-leukemias and lynphomas
-etc.see wiki

1. electromyography and nerve stim
2. acetycholine receptor Ab test
3. CT of chest (possible thymoma)

-TRAP stain (tartrate-resistant acid phosphatase)
-CD11c marker
-cladribine ie chlorodeoxyadenosine (2CDA)

-criteria for dx are the absence of findings suggestive of multiple myeloma:
absence of anemia, lytic bone lesions, hypercalcemia, and renal insufficiency (CRAB)
-risk progression to MM
-monoclonal IgG on serum protein electrophoresis

lupus anticoagulant is an IgM or IgG immunoglobulin that binds phospholipids (hence antiphosph)
-prolonged PTT
-Russell viper venom test

-since it is breast conserving surgery she'll need radiation therapy and adjuvant chemo
-FISH (fluorescent in situ hybridization) or IHC (immunohistochemical) staining---- to tell you the level of HER2 expression
which tells you to use trastuzumab and anthracycline chemo

1. punch bx
2. arsenic, burns, carcinogens (tobacco), sun
3. keratinocytes

-high in leukemoid rxns due to infxn or inflammation
- generally low in CML unless infxn also present (check for phil chromo)

Radiation therapy- manages bone pain in pts with prostate CA who've undergone orchiectomy

1. fragmented cells in peripheral smear suggests microangiopathic hemolytic anemia- a characteristic finding
thrombocytopenia+renal failure+neuro symptoms
2. peripheral blood smear looking for schistocytes
3. def. of autoAb against vWf protease (ADAMTS-13)
4. emergent plasmapheresis -removes offending Abs

-happens in setting of other autoimmune conditions (ex. vitiligo, autoimm thyroid dz)
- Can't happen with veganism alone!

AD, telangiectasias+ recurrent epistaxis + AVMs

1. pt. w/ no prior history of skin dz who presents with eczematous rash near the nipple that doesn't improve w/ topical tx.s
2. breast adenocarcinoma
3. large cells surrounded by clear halos

test for mononucleosis
EBV - (+) test
CMV- (-) test