ck hematology

7/25/2019 Ck Hematology

http://slidepdf.com/reader/full/ck-hematology 1/28

HEMATOLOGY & ONCOLOGY TiKi TaKa _________________________________

. ANEMIA presentations: _______________________ . Mild -> ati!"e - loss o# ener!$ - tiredness - %alaise. . e'ere -> (ortness o# )reat( - li!(t(eadedness - *on#"sion. . +iseases ,it( si%ilar presentations H$po ia - CO poisonin! -Met(e%o!lo)ine%ia/. . 0allor - 1o, %"r%"r - pale *on2"n*ti'a.

. MIC3OCYTIC ANEMIA: ____________________ ____________________

4/ I3ON +E ECIENCY ANEMIA: ____________________________ . T(e %ost *o%%on *a"se is *(roni* )lood loss 5leedin! "l*er/. . 66 platelet *o"nt. . + -> 5est initial test -> I3ON T7+IE : - ____________________________________________ - 8 -- iron. .8 - 8 -- #erritin. .8 - 8 -- iron sat"ration. .8 - 8 66 TI5C Total iron )indin! *apa*it$/. .8 8--------------------------------------- .8 - 8 66 3ed *ell distri)"tion o# ,idt( 66 3+9/.8 - ____________________________________________ . + -> Most a**"rate test -> 5one %arro, )iops$. . T -> erro"s s"l#ate orall$ Ma$ t"rn t(e stool 5LACK )"t G"aia* test -'e/. . 0ICA -> Appetite #or non-n"triti'e s")stan*es i*e - *la$ - dirt/.

/ ANEMIA O CH3ONIC +I EA E: _______________________________ . 3(e"%atoid art(ritis. . End ta!e Kidne$ +isease E K+/. . An$ *(roni* in#e*tio"s; in1a%%ator$ or *onne*ti'e tiss"e disease. . . + -> 5est initial test -> I3ON T7+IE : - _______________________________________ - 8 -- iron. .8 - 8 66 #erritin. .8 - 8 Nor%al or -- iron sat"ration. .8 - 8 -- TI5C Total iron )indin! *apa*it$/.8 8--------------------------------------.8 - _______________________________________ < I3ON I LOCKE+ IN TO3AGE O3 T3A00E+ IN MAC3O0HAGE O3 IN E33ITIN. . Osteoart(ritis doesn=t *a"se ane%ia o# *(roni* disease . E *l"de ane%ia o# *(roni* disease i# t(ere is NO3MAL E 3



. T(e onl$ #or% o# ane%ia t(at responds to er$t(ropoietin is E K+. . T -> tt t(e "nderl$in! *a"se e.!. METHOT3E?ATE or IN LI?IMA5 #or 3A/. . Alt(o"!( iron *on*entration is lo,; Iron s"pple%entation is not )eni@*ial.. I3ON I LOCKE+ IN TO3AGE O3 T3A00E+ IN MAC3O0HAGE O3 IN E33ITIN.

/ THALA EMIA: _________________ . Ber$ s%all MCB ,it( #e, or no s$%pto%s. - D %l/. . TA3GET *ells. . + -> NO3MAL iron st"dies. . Most a**"rate test -> HEMOGLO5IN ELECT3O0HO3E I : - 5eta -> 66 H! A & H! . - Alp(a -> Nor%al Most a**"ratel$ dia!nosed )$ +NA se "en*in!/. - H! H (as 5eta F tetrads ,it( !ene deleted Alp(a t(alasse%ia. . 5 t(alasse%ia %a2or -> 5ot( 5 (e%o!lo)in are de e*ti'e. . C(ara*teri ed )$ se'ere ane%ia & trans#"sion dependen*e at an earl$ a!e/. . 5 t(alasse%ia %inor o**"rs in people (etero $!o"s #or t(e 5 (e%o!lo)in !ene. . T(e onl$ %i*ro*$ti* ane%ia ,it( a HIGH reti*"lo*$ti* *o"nt is H! H. . Mi*ro*$ti* ane%ia non responsi'e to iron s"pple%entation. . No ttt

F/ I+E3O5LA TIC ANEMIA: __________________________ . +e#e*t in (e%e-s$nt(esis. . Al*o(oli* pt. . Isonia id inta e ,it(o"t Bit. 5J pr$rido ine s"pple%entation. . Lead e pos"re. . + -> Iron st"dies -> HIGH I3ON & -- TI5C. . + -> 5one %arro, )iops$ -> 3INGE+ I+E3O5LA Ts. . Most a**"rate test -> 037 IAN 5L7E TAIN. . T -> Minor -> 0$rido ine repla*e%ent. . T -> Ma2or -> 3e%o'e t(e to in e pos"re.

. I3ON +E ECIENCY ANEMIA - AL0HA THALA EMIA MINO3 - 5ETA THALA EMIA MINO3 : _____________________________________________________________________________________ _ . He%ato*rit - He%ato*rit > - He%ato*rit > . 3+9 66 - 3+9 nor%al - 3+9 nor%al. 35C *o"nt -- - 35C *o"nt nor%al - 35C *o"nt nor%al to 66. No tar!et *ells - TA3GET *ells on s%ear - TA3GET *ells on s%ear. -- ser"% iron & #erritin - Nor. to 66 iron & #erritin - Nor. to 66 iron & #erritin. 66 TI5C - Nor%al TI5C - Nor%al TI5C. 3esponds to iron s"pple%. - No response to iron s"pple%entation. Nor%al H) Ele*trop(oresis - Nor%al H) Ele*trop(oresis - 66 H) A on H)Ele*trop(or.

. N.5. MECHANI M O ANEMIA IN MIC3OCYTIC HY0OCH3OMIC +I EA E : _______________________________________________________________



. -- #e inta e & 66 )lood loss -> I3ON +E ECIENCY ANEMIA. . +e#e*ti'e "tili ation o# stora!e iron -> ANEMIA O CH3ONIC +I EA E . . -- !lo)in prod"*tion -> THALA EMIA. . -- He%e s$nt(esis -> LEA+ 0OI ONING & I+E3O5LA TIC ANEMIA.

. MIC3OCYTIC HY0OCH3OMIC +I EA E -> IN+ING IN I3ON T7+IE : _____________________________________________________________ . I3ON +E ECIENCY ANEMIA -> -- #e; -- #erritin & 66 TI5C.. THALA EMIA -> Nor%al to 66 #e & #erritin le'els.

. ANEMIA O CH3ONIC +I EA E -> -- TI5C. . I+E3O5LA TIC ANEMIA -> Nor%al to 66 #e & #erritin le'els.

. MAC3OCYTIC ANEMIA: ____________________ ____________________ . E tra'as*"lar (e%ol$sis o**"rs in spleen & li'er so " *an=t see it on a s%ear . Ca"sed )$ Bit. 54 or 1oate de#e*ien*$. . Bit. 54 de#. -> ne"rolo!i*al @ndin!s Mostl$ perip(eral ne"ropat($- Leastde%entia/. . olate de#e*ien*$ is NOT asso*iated ,it( ne"rolo!i*al @ndin!s. . "spe*t Bit 54 de#. in T3ICT BEGETE3IAN ,it( ane%ia & ne"rolo!i**o%pli*ations. . MET O3MIN )lo* s 54 a)sorption. . 54 de#. -> %oot( ton!"e Glossitis/ & diarr(ea. . -- 54 -> -- prod"*tion o# INT3IN IC ACTO3 )$ !astri* parietal *ells; . -- 54 -> Atro(i* !astritis -> +O75LE 3I K o# GA T3IC CANCE3. . + -> 5est initial test -> C5C ,it( perip(eral s%ear -> HY0E3 EGMENTE+NE7T3O0HILs. . + -> H$perse!%ented ne"trop(ils 6 Lar!e MCB Me!alo)lasti* ane%ia.. + -> Aniso*$tosis - poi ilo*$tosis - )asop(ili* stipplin!.

. + -> 66 5ilir")in & L+H. . + -> -- 3eti*"lo*$ti* *o"nt. . + -> Most a**"rate test -> -- Bit. 54 & oli* a*id le'els. . I# " s"spe*t 54 de#e*ien*$ )"t 54 le'el is nor%al -> Order Met($l Maloni* a*idMMA/. . + -> HOMOCY TEINE is 66 in )ot( Bit. 54 & #olate de#e*ien*$. . + -> Most a**"rate test -> Anti-parietal *ell A)s & anti-intrinsi* #a*tor A)s. . T -> 3E0LACEMENT o# Bit 54 & #olate. . T -> oli* a*id ,ill *orre*t t(e (e%atolo!i*al pro)le%s. . T -> Bit. 54 ,ill *orre*t t(e ne"rolo!i*al pro)le%s. . 9at*( #or lo, potassi"% a#ter ttt 54 de#.

. N.5. 4/: ___________ . olate & *o)ala%ine 54 / are in'ol'ed in t(e *on'ersion o# (o%o*$steine to%et(ionine. . -- Bit. 54 or #oli* a*id -> 66 Ho%o*$steine le'el.

. N.5. /: ___________



. oli* a*id & 'it. 54 de#e*ien*$ *an )e distin!"is(ed )$ %eas"rin! Met($l Maloni*a*id . Bit 54 Not #oli* a*id/ is in'ol'ed in t(e *on'ersion o# MMA to s"**in$l *oA.. -- Bita%in 54 -> 66 MMA.

. -- oli* a*id -> NO3MAL MMA. . N.5. /:

___________ . La)orator$ tests ------------> 0rini*io"s ane%ia -------------> oli* a*id de#e*ien*$

_____________________________________________________________________________________ ___ . er"% 54 le'el -------------> --/ -------------> Nor%al. . er"% #oli* a*id le'el ------> Nor%al/ -------------> --/. . er"% L+H le'el -------------> 66/ -------------> Nor%al. . A*(lor($dria ----------------> present -------------> A)sent. . *(illin! test --------------> 6'e -------------> -'e. . Met($l %alon$l a*id MMA -----> 66 -------------> A)sent. . Ne"rolo!i*al si!ns ----------> 66 -------------> A)sent.

. N.5. F/: ___________ . Al*o(ol a)"se is t(e %ost *o%%on *a"se o# n"tritional #olate de#e*ien*$ in 7 A.

. N.5. /: ___________ . Ane%ia o# *(roni* idne$ disease is d"e to er$t(ropoietin de#e*ien*$. . One %"st )e *are#"l to ens"re ade "ate iron stores prior to ert(ropoietinrepla*e%ent; . 5e*. t(e er$t(ropoietin ind"*ed s"r!e in 35Cs prod"*tion %a$ *ons"%e %"*(iron; . pre*ipitatin! an iron de#e*ient state.

. N.5. J/: ___________ . A *ase o# %i*ro*$ti* ($po*(ro%i* ane%ia ,it( -- iron & #erritin; . T(e %ost *o%%on *a"se o# iron de#e*ien*$ ane%ia is GIT )lood loss. . +ietar$ iron de#e*ien*$ & %ala)sorption o# iron are rare *a"ses. . Iron s"pple%entation (elps to restore iron reser'es )"t " %"st dete*t t(e *a"se . o .. per#or% test #or o**"lt )lood in t(e stool.

. N.5. D/: ___________ . T(e %ost *o%%on *a"se o# #oli* a*id de#e*ien*$ is N7T3ITIONAL. . Eit(er d"e to poor diet or Al*o(olis%. . Ma$ )e *a"sed )$ so%e dr"!s eit(er )$ i%pairin! its a)sorption 0HENYTOIN/; . or anta!oni in! its p($siolo!i* e e*t Met(otre ate - Tri%et(opri%/.

. N.5. P/: ___________ . 0E3INICIO7 ANEMIA:



______________________ . Most *o%%on *a"se o# 'it. 54 de#e*ien*$. . A"to-anti)odies a!ainst t(e !astri* intrinsi* #a*tor re "ired #or 54 a)sorption. . More in Nort(ern E"ropeans. . Asso*iated ot(er a"to-i%%"ne diseases e.!. A"toi%%"ne t($roiditis & Bitili!o. . (in$ ton!"e d"e to atrop(i* !lossitis. . ("Qin! )road-)ased !ait ata ia. . Ne"rolo!i*al a)nor%alities ,it( loss o# pain & 'i)ration sense. . 0erip(eral )lood s%ear -> Ma*ro-o'alo*$tes; %e!alo)lasts & ($per-se!%entedne"trop(ils. . + -> +ete*tion o# Anti-intrinsi* #a*tor A)s.

. N.5. R/: ___________ . Total )od$ stores o# Bit.54 in ("%ans are - %! ,it( %in. dail$ re "ire%ent J-R%i*!. . Ani%al prod"*ts %eat & dair$/ are t(e onl$ dietar$ so"r*es o# 'it. 54 . . It ,o"ld ta e F- $ears o# a p"re 'e!an diet to *a"se dietar$ de#e*ien*$. . In *ontrast; olate stores are s%aller; *lini*al de#e*ien*$ o**"r ,it(in F- %ont(s.

. N.5. 4 /: ____________ . CHILLING TE T:

__________________ . 7sed to dete*t t(e *a"se o# 'it. 54 de#e*ien*$. . 7sed to di erentiate dietar$ de#e*ien*$ #ro% perini*io"s ane%ia & %ala)sorption. . In dietar$ de#e*ien*$; . Oral radiola)elled Bit 54 is a)sor)ed in t(e !"t & e *r. )$ idne$s in NO3MALa%o"nts. . 5"t In Mala)sorption; . Oral radio-la)elled Bit 54 is e *reted in s")-nor%al a%o"nts.

. HEMOLYTIC ANEMIA: ___________________ ___________________ . 7++EN ON ET o# (e%atolo!i*al %ani#estations. . + -> He%ol$sis ->-> 66 indire*t )ilir")in.

-> 66 reti*"lo*$te *o"nt. -> 66 L+H le'el. -> -- Hapto!lo)in. . + -> Intra'as*"lar (e%ol$sis -> -> A)nor%al perip(eral s%ear s*(isto*$tes - (el%et *ells - #ra!%ented *ells/. -> He%o!lo)in"ria. -> He%osiderin"ria.

4/ ICKLE CELL ANEMIA: ________________________ . Ber$ se'ere pain in t(e )a* ; *(est & t(i!(s. . 3etinal in#ar*tion.



. lo, %"r%"r #ro% ane%ia. . pleno%e!al$ in *(ildren & asplenia in ad"lts. . 3ales or *onsolidation #ro% l"n! in#e*tion or in#ar*tion. . in "l*ers. . Asepti* ne*rosis o# (ip. . Ne"rolo!i*al stro es.

. Ca"se o# Osteo%$elitis in si* le *ell ane%ia is ALMONELLA . Ca"se o# 5M s"ppression in si* le *ell ane%ia is 0A3BO 54R

. T -> O?YGEN - HY+3ATION ,it( NO3MAL ALINE - 0ain relie#. . I# t(ere is #e'er -> E%er!en*$ - No spleen/ -> Ce#tria one -le'o1o a*in.

. T -> E?CHANGE T3AN 7 ION i# -> -> E$e -> Bis"al dist"r)an*e #ro% retinal in#ar*tion. -> L"n!s -> 0"l%onar$ in#ar*tion ,it( ple"riti* pain. -> 0enis -> 0riapis% #ro% in#ar*tion o# prostati* ple "s o# 'eins. -> 5rain -> tro e ,ea ness & ap(asia d"e to sl"d!in! & o**l"sion o# *ere)ral'essels/.

. N.5. -> 7++EN +3O0 IN HEMATOC3IT *an )e *a"sed )$ OLATE +E ECIENCY or0A3BO 54R IN : . olate de#e*ien*$ in C+ d"e to 66 35Cs t"rno'er & *ons"%ption o# #olate in t(e5M. . +ail$ #oli* a*id s"pple%entation is re*o%%ended in all C+. . I# t(e pt is alread$ on olate repla*e%ent -> T(e *a"se is 0A3BO 54R 'iralin#e*tion . 0A3BO 54R %a$ in'ade t(e )one %arro, & *a"ses aplasti* ane%ia. . +ete*t 0ar'o 54R in#e*tion )$ 0C3 #or +NA o# 0ar'o 54R.

. On dis*(ar!e -> Gi'e #olate repla*e%ent - 0ne"%o*o**al 'a**ine. . H$dro $"rea 66 H) / is !i'en to pre'ent #"rt(er *risis.

/ HEMOGLO5IN ICKLE CELL +I EA E: ____________________________________ . A#ri*an A%eri*an pt. . a%il$ HSO o# )lood disrder. . Mild 'ersion o# si* le *ell ane%ia. . Bis"al distr"r)an*e is #re "ent. . No pain#"l *risis. . 3ENAL pro)le%s are *o%%on; . He%at"ria - Isost(en"ria ina)lilit$ to dil"te "rine or *on*entrate "rine - 7TIs/. . Isost(en"ria d"e to 35Cs si* lin! in t(e 'asa re*tae o# t(e inner renal %ed"lla. . T(e pt (a'e to ,a e to "rinate - ti%es per ni!(t despite restri*tin! 1"idinta e. . No ttt.

/ A7TOIMM7NE HEMOLY I : __________________________



. HSO o# ot(er a"toi%%"ne diseases e.!. LE perip(eral i%%"ne destr"*tion o# all*ells/. . HSO o# CLL or l$%p(o%a Enlar!ed Non tender a illar$ LNs )ilaterall$ /. . HSO o# peni*illin - alp(a %et($l dopa - "inine or s"l#a dr"! inta e. . + -> 66 L+H - 66 indire*t )ilir")in - 66 reti*"lo*$te *o"nt - -- Hapto!lo)in. . + -> perip(eral s%ear -> sp(ero*$tes. . + -> Most a**"rate test -> Coo%)s test. 9A3M A)s I!G A)s/. . T -> 5est initial ttt -> teroids e.!. prednisone. . I# t(ere is re*"rrent episodes o# (e%ol$sis -> 0LENECTOMY is t(e %ost e e*ti'ettt. . I# no response to prednisone or splene*to%$ -> Gi'e IBIG.

F/ COL+ IN+7CE+ HEMOLY I COL+ AGGL7TININs: _______________________________________________ . HSO o# %$*oplas%a or E5B in#e*tion. . Coo%)=s test -> -'e. . Co%ple%ent test-> 6'e. . No response to prednisone; spene*to%$ or IBIG. . T -> 3IT7?IMA5.

/ GL7CO E - J - 0HO 0HATE +E ECIENCY GJ0+/: _______________________________________________ . ?-lin ed disorder - Onl$ MALE pt. A#ri*an A%eri*an/. . EN YME de#e*ien*$ Gl"*ose J-p(osp(ate de($dro!enase/. . "dden onset o# (e%ol$sis. . IN ECTION is t(e %ost *o%%on predisposin! #a*tor. . HSO o# inta e o# O idi in! dr"!s "l#a - pri%a "ine - +apsone/. . HSO o# in!estion o# ABA 5EAN . . Me*(anis% o# *ell da%a!e -> O?I+ATIBE T3E . . + -> 5est initial test -> Hein )od$ test & 5ITE CELLs. . 6'e pr"ssian )l"e is indi*ati'e o# (e%osiderin #o"nd in "rine d"rin! (e%ol$ti*episode. . Hein )odies are *olle*tions o# o idi ed pre*ipitated H) e%)edded in t(e 35C%e%)rane. . 5ite *ells appear ,(en pie*es o# t(e red *ell %e%)rane (a'e )een re%o'ed )$t(e spleen. . Most a**"rate test -> GJ0+ le'el a#ter %ont(s o# s$%pto%s . A nor%al le'el o# GJ0+ i%%ediatel$ a#ter an episode o# (e%ol$sis doesn=t e *l"deit . T -> ABOI+ O?I+ANT T3E .

. N.5. 0Y37BATE KINA E +E ECIENCY: ___________________________________ -> *an lead to si%ilar presentation as GJ0++ .. 57T: -> He%ol$sis not pre*ipitated )$ s"l#a dr"!s -> No )ite *ells on perip(eral s%ear

J/ HE3I+ITA3Y 0HE3OCYTO I : ______________________________ . Nort(ern E"ropean des*ent.



. T3IA+ o# HEMOLYTIC ANEMIA 6 UA7N+ICE 6 0LENOMEGALY. . A"toso%al do%inant disorder o# spe*trin 0tn t(at pro'ides s*a oldin! #or 35Cs/.. 35Cs are not de#or%a)le -> Gets trapped in t(e #enesterations o# t(e spleen=s red

p"lp. . 3e*"rrent episodes o# (e%ol$sis. . pleno%e!al$. . 5ilir")in !all stones pi!%ented Ca )ilir")inate/ -> A*"te *(ole*$stitis. . + -> 666 MCHC Mean *ell (e%o!lo)in *on*entration 35C %e%)rane loss &de($dration/. . + -> 0erip(eral s%ear -> p(ero*$tes. . + -> -'e Coo%)=s test 6'e in AIHA A"toi%%"ne (e%ol$ti* ane%ia/. . + -> Most a**"rate test -> O MOTIC 3AGILITY test. . T -> 0LENECTOMY ,ill pre'ent (e%ol$sis as sp(ero*$tes are destro$ed in t(espleen. . olate s"pple%entation is i%portant. . T(ere is a ris #or in#e*tion ,it( 0ar'o'ir"s 54R *a"sin! aplasti* ane%ia.

D/ HEMOLYTIC 73EMIC VYN+3OME H7V/: _____________________________________ . HSO o# E-*oli 4 D:HD in#e*tion. . H7 T3IA+ A3T/: -> A"toi%%"ne (e%ol$sis -> intra'as*"lar (e%ol$sis Ane%ia - indire*t($per)ilir")ine%ia/ -> 3enal #ail"re -> 66 57N & *reatinine. -> T(ro%)o*$topenia -> -- platelets. . + -> 0erip(eral s%ear -> *(isto*$tes. . T -> Most *ases resol'e on t(eir o,n. . T -> e'ere *ases are ttt ,it( plas%ap(aresis or plas%a e *(an!e. . teroids don=t (elp . Anti)ioti*s ,orsen t(e *ase . 0latelet trans#"sion ,orsen t(e *ase

P/ TH3OM5OTIC TH3OM5OCYTO0ENIC 073073A TT0/: _______________________________________________ . HSO o# TICLO0I+INE "se. . H7 T3IA+ 6 N e'er & Ne"rol!i*al a)nor%ailities/. . + -> 0erip(eral s%ear -> *(isto*$tes. . a%e ttt as H7 0LA MA0HA3E I or 0LA MA E?CHANGE/.

R/ 0A3O?Y MAL NOCT73NAL HEMOGLO5IN73IA 0NH/: _______________________________________________ . 0an*$topenia. . 3e*"rrent atta* s o# dar "rine pe*iall$ in t(e %ornin! . . Most *o%%on *a"se o# deat( -> LA3GE BE EL BENO7 TH3OM5O I 0O3TALBEIN TH3OM5O I . . 0NH %a$ trans#or% to alpasti* ane%ia or a*"te %$elo!eno"s le" e%ia AML/. . 0O3TAL BEIN TH3OM5O I %a$ )e t(e e$ to ans,er 0NH *ase . + -> Most a**"rate test -> lo, *$to%etr$ -> Cd & C+ R anti)odies. . T -> 5est initial ttt -> Gl"*o*orti*oids prednisone/. . Trans#"sion dependent pts %a$ )e ttt ,it( E*"li o%a) -> in(i)it C *o%ple%ent.



. He%ol$ti* ane%ia 6 Beno"s t(ro%)osis 0NH.

4 / MAC3OBA C7LA3 T3A7MATIC HEMOLY I : ________________________________________ . 66 reti*"lo*$tes - 66 L+H - -- Hapto!lo)in intra-'as*"lar (e%ol$ti* ane%ia/. . ra!%ented 35Cs. . C(roni* (e%ol$sis -> iron loss -> Mi*ro*$ti* ane%ia. . +"e to %e*(ani*al tra"%a #ro% arti@*ial 'al'es or *al*i@ed aorti* 'al'es. . N.5. HE3I+ITA3Y 0HE3OCYTO I & A7TOIMM7NE HEMOLYTIC ANEMIA:

______________________________________________________________ . 0erip(eral )lood s%erar in )ot( *onditions -> p(ero*$tes ,it(o"t *entral pallor. . 5ot( *a"se e tra'as*"lar (e%ol$ti* ane%ia. . Heriditar$ sp(ero*$tosis -> A"toso%al do%inant (eriditar$ *ondition. . AIHA -> A* "ired *ondition. . p(ero*$tosis -> 6'e #a%il$ HSO & -'e Coo%)=s test. . AIHA -> -'e #a%il$ HSO & 6'e Coo%)=s test.

. N.5. 0ATHO-0HY IOLOGIC MECHANI M o# ANEMIA in 'aria)le diseases: ___________________________________________________________________ . I%paired +NA & p"rine s$nt(esis -> Bita%in 54 de#e*ien*$. . 35C %e%)rane insta)ilit$ -> Heriditar$ sp(ero*$tosis. . I%paired H) s$nt(esis -> Iron de#e*ien*$ ane%ia; si* le *ell ane%ia &

T(alasse%ia. . I%paired !l"tat(ione s$nt(esis -> GJ0++. . Me*(ani*al in2"r$ to 35Cs -> He%ol$sis ,it( arti@*ial (eart 'al'es. . MET-HEMOGOL5INEMIA:

_____________________ . (ortness o# )reat( #or no *lear reason. . Clear l"n!s on e a%ination. . 5lood lo* ed "p in an o idi ed state t(at *an=t pi* "p o $!en. . HSO o# e pos"re to dr"!s s"*( as nitro!l$*erin; a%$l nitrate; nitropr"sside &dapsone. . HSO o# e pos"re to anest(eti* dr"!s e.! lido*aine. . HSO o# )ro,n )lood . T -> Met($lene )l"e

. CA35O?YHEMOGLO5INEMIA CA35ON MONO?I+E CO/ 0OI ONING: _________________________________________________________ . HSO o# en'iron%ental ris 0t ,or in! in an en*losed spa*e -> "nder!ro"ndpar in! lot/. . 0resent ,it( (eada*(e; na"sea & di iness. . E pos"re to CO #ro% a"to%o)ile e (a"st. . CO )inds H) ,it( an aWnit$ app. ti%es t(at o# o $!en. . -- in )lood *arr$in! o $!en *apa*it$. . As a *o%pensation -> t(e )od$ 66 35Cs prod"*tion 66 HCT/.

. O5 T37CTIBE LEE0 A0NEA O A/ -> 66 E3YTH3O0OIETIN 03O+7CTION: ________________________________________________________________



. 3e*"rrent transient o)str"*tion o# t(e "pper air,a$ d"e to p(ar$n!eal *ollapse. . O)ese or o'er-,ei!(t pts (a'e e *essi'e snorin!; da$ ti%e sleepin! & %ornin!(eada*(es. . Transient episodes o# ($po ia -> sensed )$ t(e idne$s -> 66 Er$t(ropoietinprod"*tion. . Er$t(ropoietin 66 35Cs -> 0ol$*$t(e%ia. . O A doesn=t *a"se *ar)o $(e%o!lo)ine%ia

. LE7KEMIA: ___________ ___________

A/ AC7TE LE7KEMIA: ____________________ . 0an*$topenia ati!"e - )leedin! - in#e*tions/. . E *ess 95C )"t don=t ,or "n*tional i%%"node#e*ien*$/. . + -> 0erip(eral s%ear -> 5LA T . . A7E3 3O+ AML AC7TE MYELOI+ LE7KEMIA. . +IC is ass*o*iated ,it( M A*"te pro-%$elo*$ti* le" e%ia/. . C$to!eneti*s is "sed #or pro!nosis & relapse predi*tion. . I# t(e pt is at (i!( ris #or relapse a#ter *(e%ot(erap$; . 5M transplantation s(=d )e per#or%ed as *(e%ot(erap$ ind"*es re%ission. . T -> C(e%ot(erap$ idar")i*in & da"nor")i*in/ -> A*"te %$elo!eno"s le" e%ia. . T -> Add AT3A All Trans-3etinoi* A*id/ #or -> M A*"te pro-%$elo*$ti* le" e%ia. . T -> Ass intra-t(e*al Met(otre ate #or ALL A*"te L$%p(o*$ti* le" e%ia. . N.5. A*"te le" e%ia *an so%eti%es present ,it( e tre%el$ HIGH 95Cs *o"nt;

. 9(en t(e 95Cs > 4 -> sl"d!in! o# 95Cs in t(e )lood 'essels o# e$e &l"n!s & )rain. . LE7KO TA I is ttt ,it( LEKO0HA3E I 3e%o'in! o# 95Cs 'ia )lood*entri#"!ation/. . H$dro $"rea is "sed to lo,er t(e *ell *o"nt.

5/ MYELO+Y 0LA IA: ____________________ . Mild slo,l$ pro!ressi'e pre-le" e%ia V. . Ma$ pro!ress to a*"te le" e%ia. . MO T COMMON CA7 E O +EATH -> IN ECTION or 5LEE+ING. . Elderl$ pt. . 0an*$topenia ati!"e - )leedin! - in#e*tions/. . 66 MCB Ma*ro-o'alo*$tes/. . -- 3eti*"lo*$te *o"nt. . + -> pe*ial ne"trop(il ,it( lo)es 0ELGE3-H7ET/ *ells. . T -> "pporti'e ,it( trans#"sions as needed & A A*itadine. . T(ose ,it( %in"s V are ttt ,it( Lenalido%ide.

. MYELO-03OLI EA3TIBE +I O3+E3 : ________________________________

A/ CH3ONIC MYELOGENO7 LE7KEMIA CML/:



________________________________________ . 66 95Cs NE7T3O0HILs predo%inant/. . 0LENOMEGALY.. + -> 5est initial -> -- Le" o*$te Al aline 0(osp(atase LA0/.

. + -> Most a**"rate -> 0HILA+EL0HIA CH3OMO OME C$to!eni* st"d$:A)nor%al*(ro%oso%e / . #or%ed )$ re*ipro*al translo*ation o# *(ro%oso% R & . . 3e*ipro*al translo*ation -> 5C3-A5L #"sion !ene -> A5NO3MAL TY3O INE KINA EACTIBITY . X-- LA0 6 X66 95Cs CML. . X66 LA0 6 X66 95Cs LE7KEMOI+ 3EACTION 3ea*ti'it$ #ro% in#e*tion. . T -> 5est initial -> IMATINI5 Glee'a*/ T$rosine inase in(i)itor . . 5MT is t(e onl$ ,a$ to *"re CML Ne'er )est initial ttt/.

5/ CH3ONIC LYM0HOCYTIC LE7KEMIA CLL/: ________________________________________ . 66 95Cs LYM0HOCYTE predo%inant/. . 0t > $s. . As$%pto%ati* - #o"nd on ro"tine testin!. . + -> 0erip(eral )lood s%ear -> M7+GE *ells 3"pt"red n"*lei o# l$%p(o*$tes . . ta!e -> 66 95Cs.. ta!e 4 -> Enlar!ed LNs.

. ta!e -> Enlar!ed pleen. . ta!e -> Ane%ia. . ta!e F -> -- platelets.

.THE 03E ENCE O TH3OM5OCYTO0ENIA TAGE F -> 0OO3 03OGNO I . . T -> ta!e & 4 -> No ttt.

. Ot(er sta!es -> L7+A3A5INE 6 3IT7?IMA5.

C/ HAI3Y CELL LE7KEMIA: _________________________ . Middle a!ed pt ,it( 0an*$topenia & %assi'e spleno%e!al$. . + -> Tartarate resistant a*id p(osp(atase T3A0/ s%ear -> HAI3Y CELL . Na%ed so )e*. t(e l$%p(o*$tes (a'e @ne (air li e irre!"lar pro2e*tions. . T(e )one %arro, %a$ )e )e*o%e @)roti* -> 7n-s"**ess#"l aspirates +3Y-TA0/. . T -> CLA+3I5INE.

+/ MYELO I53O I : ___________________ . a%e as (air$ *ell le" e%ia -> 57T -> NO3MAL T3A0 le'el . + -> TEA3 +3O0 s(aped *ells on s%ear.. T -> LENALI+OMI+E or THALI+OMI+E ; 5MT.

E/ 0OLYCYATHEMIA BE3A 0'era/:

________________________________ . 0let(ori* #a*e. . Heada*(e - 5l"rrin! o# 'ision - di iness - #ati!"e.



. 0r"ritis (appenin! a#ter a (ot )at( or s(o,er. . pr"ritis d"e to release o# (ista%ine #ro% )asop(ils. . H$pertension *an )e one o# t(e presentations o# pol$*$t(e%ia. . 66 in*iden*e o# pepti* "l*erations 66 Hista%ine release #ro% )asop(ils/. . 66 in*iden*e o# !o"t$ art(ritis 66 *ell t"rno'er/. . + -> C5C MA3KE+LY HIGH HEMATOC3ITE & lo, MCB . + -> A5G A)sen*e o# ($po ia . . + -> -- Er$t(ropoietin Most i%portant/. . 66 95Cs & 66 0latelets. . 66 5 4 & 66 LA0 le'els. . MA3KE+LY HIGH HEMATOC3ITE %a$ lead to TH3OM5O I . . Ass. ,it( UAK %"tation. . T -> 0HLE5OTOMY. HCT F /. . T -> H$dro $"rea to -- *ell *o"nt. . T -> Gi'e dail$ Aspirin to pre'ent T(ro%)osis. . Hi!( ris o# t(ro%)osis -> +"e to 66 platelet *o"nt. . Hi!( ris o# )leedin! -> +"e to i%paired platelet #"n*tion

. N.5. . HE3I+ITA3Y TELANGIECTA IA O LE3 - 9E5E3 - 3EN+7 VYN+3OME: ____________________________________________________________________ . +i "se telan!ie*tasia 6 3e*"rrent epista is 6 9ide spread AB MAL O3MATIONs. . AB %al#or%ations in l"n! -> 5lood s("nt #ro% 3t to Lt side o# t(e (eart. . AB s("nts -> C(roni* ($po e%ia -> 3ea*ti'e pol$*$t(e%ia 66 HCT/.

/ E ENTIAL TH3OM5OCYTO0ENIA: ________________________________ . 66 0LATELET *ell *o"nt. . Heada*(e - 'is"al dist"r)an*es - pain in (ands Er$t(ro%$elal!ia/. . Most *o%%on *a"se o# deat( -> 5leedin! & t(ro%)osis. . T -> H$dro $"rea to -- *ell *o"nt.. T -> Gi'e dail$ Aspirin to pre'ent T(ro%)osis.

. 0LA MA CELL +I O3+E3 : ________________________ . ALL are *(ara*teri ed )$ 66 ser"% protein ,it( nor%al al)"%in GAMMA GA0/.

_____________________________________________________________________________

A/ M7LTI0LE MYELOMA: ______________________ . Mono*lonal proli#eration o# plas%a *ells. . C3A5 -> Cal*i"% 66 & 3enal i%pair%ent & Ane%ia & 5ones pain; l$ti* lesions &Zs. -> eletal s"r'e$ -> 0"n*(ed o"t osteol$ti* lesions i# osteo)lasti* 0rostate*an*er/. -> er"% i%%"ne ele*trop(oresis -> A)nor%al M spi e. -> er"% protein ele*trop(oresis 0E0/ -> 66 Mono-*lonal Anti)odies I!G/. -> 7rine protein ele*trop(oresis 70E0/ -> 5ENCE-UONE proteins. -> 0erip(eral s%ear -> 3O7LEEA7? #or%ation o# )lood *ells. -> 66 Ca. -> 66 E 3 > 4 .



-> 5 %i*ro-!lo)"lin dete*t pro!nosis/. -> 66 57N & Creatinine 3 /. -> Most spe*i@* test -> 5one %arro, )iops$ -> 66 0LA MA *ells > 4 . Most *o%%on *a"se o# deat( -> IN ECTION & 3ENAL AIL73E. . s"s*epti)le to in#e*tions d"e to -- 95Cs & -- a)ilit$ to prod"*e e e*ti'eanti)odies; . d"e to 5M in@ltration ,it( %ali!nant plas%a *ells. . T -> Melp(alan & steroids. . T -> Most e e*ti'e ttt -> A"tolo!o"s ste% *ells )one %arro, transplantation. . T -> H$per*al*e%ia -> H$dration & di"resis. . T -> 5one Zs -> 5ip(osp(onates. . T -> 3 -> ($dration. . T -> Ane%ia -> Er$t(ropoietin. . T -> 0rop($la is a!ainst in#e*tions ,it( 'a**inations 0ne%o'a /.

5/ MONO-CLONAL GAMMO0ATHY O 7NKNO9N IGNI ICANCE MG7 /: ___________________________________________________________ . As$%pto%ati* 66 o# I!G on 0E0. d"e to 66 ptn in old a!e/. . Elderl$ pt > D $s. . MG7 re "ire META TATIC KELETAL 5ONE ?-3AY to e *l"de l$ti* lesionss"!estin! MM . No ttt.

C/ 9AL+EN T3OM=s MAC3O-GLO57LINEMIA: ______________________________________ . 66 I! M -> H$per'is*osit$. . 5l"rr$ 'ision +ilated se!%ented tort"o"s retinal 'eins/ . *on#"sion & (eada*(e. . Enlar!ed Lns & Hepatospleno%e!al$. . + -> er"% 'is*osit$ le'el -> 66. . + -> 0E0 -> 66 I! M 0IKE . T -> 0LA MA0HA3E I . . a%e ttt as CLL -> l"dara)aine.

+/ A0LA TIC ANEMIA: _____________________ . 0ANCYTO0ENIA ,it( no identi@ed etiolo!$. . T -> 0t $s & (as a %at*( - > 5MT. . T -> 0t > $s & NO %at*( -> Anti-t($%o*$te !lo)"lin & *$*losporine.

. N.5. MONO-CLONAL GAMMO0ATHY O 7NKNO9N IGNI ICANCE Bs M7LTI0LEMYELOMA:

__________________________________________________________________________ MG7 / MM/

. A)sen*e o# ane%ia. . Ane%ia.. H$per*al*e%ia. . H$per*al*e%ia.

. 3enal ins" e*ien*$. . 3enal ins" e*ien*$. . L$ti* lesions in )ones. . L$ti* lesions in )ones.



. er"% %ono*lonal protein !Sdl. . er"% %ono*lonal protein > !Sdl. . 4 plas%a *ells in t(e )one %arro,. . > 4 plas%a *ells in t(e )one%arro,. . 66 5 %i*ro!lo)"lin.

. MG7 re "ire META TATIC KELETAL 5ONE ?-3AY to e *l"de l$ti* lesions s"!estin!MM

. LYM0HOMA: ___________ . ENLA3GE+ LNs Mostl$ CE3BICAL/. . Ane%ia d"e to 5ONE MA33O9 IN ILT3ATION )$ CANCE3O7 CELL . T,o t$pes_________________________________

8 ____________________________________________________ 8 8 .HO+GKIN=s LYM0HOMA .NON-HO+GKIN=s LYM0HOMA .__________________ ._______________________

. 5est initial test -> E?CI IONAL LN 5IO0 Y. . AME.

. 3EE+ TE3N5E3G CEL . . NO

. TAGING )$ Contrast CT & C?3 & 5M )iops$: . AME. -> 4 -> in!le LN !ro"p. -> -> LN !ro"ps on one side o# diap(ra!%. -> -> LN in'o'e%ent on )ot( sides o# diap(ra!%. -> F -> 9ide-spread disease 5 s$%pto%s #e'er - ,ei!(t loss - Ni!(t s,eats/.. R o# *ases present ,it( ta!es 4 & . . R o# *ases present ,it( sta!es & F.. T -> ta!es 4 & ,it( no 5 s$%pto%s -> radiot(erap$.. T -> ta!es & F ,it( 5 s$%pto%s ----> *(e%ot(erap$.. A5B+ -> . CHO0 ->- Adria%$*in. - C$*lop(osp(a%ide.

- 5leo%$*in. - H$dro $adria%$*in. - Bin)lastine. - On*o'in. - +a*ar)a ine. - 0rednisone.

. T7MO3 LY I VYN+3OME: _______________________ . Ass. ,it( t"%ors ,it( (i!( *ell t"rn-o'er. . E : 0oorl$ di erentiated l$%p(o%a 5"r itt=s l$%p(o%a & Le" e%ias ALL . . HY0E3 Xp(osp(ate%ia - ale%ia - "ri*e%ia . . HY0O XCal*e%ia . . 5ot( potassi"% & p(osp(ate r intra-*ell"lar ions; so *ell )rea do,n -> t(eirrelease. . 3eleased p(osp(ate )inds *al*i"% leadin! to ($po*al*e%ia. . +e!radation o# *ell proteins -> 66 "ri* a*id le'els. . TLV %a$ lead to #atal arr($t(%ias; A3 & s"dden deat(. . T -> Allop"rinol !reatl$ red"*es t(e possi)ilit$ o# a*"te "rate nep(ropat($.



. A YM0TOMATIC LOCALI E+ LYM0HA+ENO0ATHY: _________________________________________ . e'eral non-tender r"))er$ *er'i*al L$%p( nodes. . Most *o%%onl$ in "pper respirator$ tra*t in#e*tion. . Co%%onl$ o)ser'ed in *(ildren & $o"n ad"lts. . T -> O5 E3BATION

. GA T3IC MALT M7CO A A OCIATE+ LYM0HOI+ TI 7E MANAGEMENT: ______________________________________________________________ . E3A+ICATION O HELICO5ACTE3-0YLO3I . T3I0LE THE3A0Y OME03A OLE - CLA3ITH3OMYCIN - AMO?ICILLIN/.

. IN ECTIO7 MONON7CLEO I IM/: ________________________________ . A*"te; )eni!n; sel# li%itin! l$%p(oproli#erati'e *ondition. . Ca"sed )$ Epstein 5arr 'ir"s E5B/. . E5B is trans%itted )$ *lose *onta*t to in#e*ted oro-tra*(eal se*retions. . E tre%e #ati!"e - %alaise - sore t(roat - #e'er - !enerali ed %a*"lopap"lar ras(. . 0osterior *er'i*al l$%p(adenopat($ & palatal peti*(ae. . pleno%e!al$ is *o%%on. . Conta*t sports s(=d )e a'oided to pre'ent spleni* r"pt"re. . Le" o*$tosis ,it( 'ariant l$%p(o*$tes At$pi*al l$%p(o*$tes/. . + -> HETE3O0HIL ANTI5O+IE EN ITIBE & 0ECI IC/. . HETE3O0HIL ANTI5O+IE %a$ )e NEGATIBE in EA3LY disease. . -'e HETE3O0HIL ANTI5O+IE doesn=t e *l"de IM. . COAG7LATION +I O3+E3 :

________________________ ________________________

. 4 . BON 9ILLE53AN+=s +I EA E B9+/: ______________________________________ . NO3MAL 0ALTELET CO7NT & A5NO3MAL 0LATELET 7NCTION. . -- B9 -> -- platelet a*ti'ation. . "per@*ial )leedin! #ro% t(e s in & %"*osal s"r#a*es e.!. !in!i'a; !"%s &'a!ina. . Epista is is a *o%%on presentation & ,orsens ,it( t(e "se o# aspirin. . -- B9 -> desta)ili es #a*tor P -> 66 a0TT. . + -> Most a**"rate -> 3I TOCETIN CO ACTO3 A AY & B9 le'el. . I# t(e le'el o# B9 is nor%al -> 3I TOCETIN test ,ill tell i# it is ,or in! properl$. . T -> +E M0O3E IN or ++AB0 -> 9ill release s")-endolt(elial stores o# B9 &#a*tor P. . I# ++AB0 #ailed -> a*tor P repla*e%ent.

. TY0E O 5LEE+ING: ____________________ ____________________

. A -> 0LATELET TY0E 5LEE+ING:



______________________________ . peti*(ae - epista is - p"rp"ra - !in!i'a - !"%s - 'a!ina. . 5 -> ACTO3 TY0E 5LEE+ING:

____________________________ . He%oart(rosis - He%ato%a.

. A -> 0LATELET TY0E 5LEE+ING: ______________________________ . 4 . I+IO0ATHIC IMM7NE TH3OM5OCYTO0ENIA IT0/:

________________________________________________ . I%%"ne destr"*tion o# platelets. . 0latelets *o"nt . . I! G a"to-anti)odies a!ainst t(e paltelet %e%)rane !l$*oproteins 5 & Are*eptors. . Mostl$ o**"r in *(ildren. . 0t %a$ )e as$%pto%ati*. . M"*o*"taneo"s )leedin!; e**($%osis & or peti*(iae. . Ma$ #ollo, a*"te 'iral in#e*tion. . + -> I OLATE+ TH3OM5OCYTO0ENIA 4 S%l. . + -> 0erip(eral s%ear s(=d )e done to e *l"de ot(er *a"ses e.!. TT0. . + -> 5one %arro, -> 66 Me!a ar$o*$tes platelet pre*"rsors/. . + -> 7SV -> NO3MAL 0LEEN. . + -> C(e* #or (epatitis C & HIB in#e*tions. . + -> +ia!nosis o# e *l"sion. . T -> 0latelets > ; ,it(o"t )leedin! -> O)ser'e . T -> 0latelets ; or )leedin! -> Corti*osteroids 0rednisone 4st linet(erap$/. . T -> 0latelets ,it( eista is; %elena & intra*ranial (e%orr(a!e -> IBIG. . IBIG: INT3ABENO7 IMM7NOGLO57LIN -> ,(en platelet & li#et(reatenin! *ondition. . 3e*"rrent episodes -> 0LENECTOMY. . No response to splene*to%$ -> 3o%iplosti%. . N.5. HCB & HIB tests as IT0 %a$ )e t(e initial presentation o# HIB in#e*tion.

. . 73EMIA IN+7CE+ 0LATELET +Y 7NCTION: ___________________________________________ . 7re%ia pre'ents palatelets #ro% de!ran"lation. . NO3MAL 0LATELET CO7NT 6 0LATELET TY03 5LEE+ING 6 3ENAL AIL73E 0T. . NO3MAL 3isto*etin test & B9 le'el. . T -> +es%opressin - ++AB0. . 5 -> ACTO3 TY0E 5LEE+ING COLTTING ACTO3 +E ECIENCIE :

___________________________________________________________ < ACTO3 P HEMO0HILIA A:

___________________________ . Uoint )leedin! He%art(rosis/ or (e%ato%a on a MALE *(ild. . + -> Mi in! st"d$ t(en spe*i@* #a*tor le'el. . T -> Minor de#e*ien*$ -> ++AB0.



. T -> e'ere de#e*ien*$ -> a*tor P repla*e%ent.

< ACTO3 R HEMO0HILIA 5: ___________________________ . Uoint )leedin! He%art(rosis/ or (e%ato%a less *o%%on t(an #a*tor P de#./. . + -> AME. . T -> a*tor R repla*e%ent. < ACTO3 44:

_____________ . 3are )leedin! ,it( tra"%a or s"r!er$. . + -> a%e. . T -> 0 res( #ro en plas%a.

. ACTO3 4 : ____________ . No )leedin!. . + -> a%e. . T -> No ttt ne*essar$.

. ENILE 073073A: _________________ . o**"rs in areas s"s*epti)le to tra"%as in elderl$ +ors"% o# t(e (ands &#orear%s/. . +"e to 0E3IBA C7LA3 CONNECTIBE TI 7E AT3O0HY . . Lesions rapidl$ resol'e lea'in! a )ro,nis( dis*olo"ration #ro% (e%osiderindeposition. . 3e "ires no ttt.

. HE0A3IN IN+7CE+ TH3OM5OCYTO0ENIA HIT/: ___________________________________________ . HE0A3IN e pos"re > da$s t(en; . 0latelet *o"nt red"*tion > #ro% )aseline. . +espite -- platelet *o"nt ->HIT is (i!(l$ t(ro%)o!eni* -> Arterial & 'eno"st(ro%)osis. . Ne*roti* s in lesions at (eparin in2e*tion sites. . A*"te s$ste%i* anap($la*toid re*ation a#ter (eparin. . + -> E3OTONIN 3ELEA E A AY GOL+ TAN+A3+/. . TTT is started on *lini*al s"spi*ion )e#ore serotonin assa$. . T -> CE ATION O ALL HE0A3IN 03O+7CT . T -> tart Ar!atro)an dire*t t(ro%)in in(i)itor/.

. 9A3 A3IN IN+7CE+ KIN NEC3O I : _________________________________ . More *o%%on in #e%ales. . Co%%on sites: )reasts ; )"tto* s; t(i!(s & a)do%en. . Initial *o%plaint is 0AIN OLLO9E+ 5Y 57LLAE O3MATION & KIN NEC3O I . . O**"rs ,it(in ,ee s a#ter startin! t(erap$. . T -> +is*ontin"e ,ar#arin - Gi'e (eparin to *ontin"e anti*oa!"lation - Gi'e Bit. K.



. A*eta%inop(en; N AI+s & A%iodarone %a$ potentiate t(e anti*oa!"lant e e*t o#,ar#arin.

. BITAMIN K +E ECIENCY 5LEE+ING: ________________________________ . 0t ept N0O NOTHING 0E3 O3AL #or a prolon!ed period o# ti%e & re*ei'in!Anti)ioti*s. . O3 Ne,)orn (adn=t re*ei'ed prop($la*ti* 'it. K Ho%e-)orn/ #or pre'ention o#(e%orr(a!e. 6666 0T > 66 0TT.

. TH3OM5O0HILIA HY0E3COAG7LA5LE TATE : _________________________________________ _________________________________________

4/ L707 ANTI-COAG7LANT or ANTI-CA3+IOLI0IN ANTI5O+IE : __________________________________________________________ . Beno"s t(ro%)osis. . 66 a0TT 03OLONGE+ 0A3TIAL TH3OM5O0LA TIN TIME/. . Nor%al 0T; 5T; platelet *o"nt & B9 . . pontaneo"s a)ortion. +"e to pro%otion o# arterial & 'eno"s t(ro%)osis/. . alse 6'e B+3L & Tr"e -'e TA-A5 E *l"din! V$p(ilis as a *a"se o# re*"rrenta)ortions . + -> Mi in! st"d$. . + -> 3"ssel Biper 'eno% test Most a**"rate/. . T -> Heparin LM9H/ #ollo,ed )$ ,ar#arin.

/ 03OTEIN C +E ECIENCY: __________________________ . in ne*rosis ,it( t(e "se o# 9ar#arin. . + -> 0tn C le'el. . T -> Heparin #ollo,ed )$ 9ar#arin.

/ ACTO3 LEI+EN M7TATION: ______________________________ . Most *o%%on *a"se o# t(ro%)op(ilia. . + -> a*tor %"tation test. . T -> Heparin #ollo,ed )$ 9ar#arin.

F/ ANTI-TH3OM5IN +E ECIENCY: ______________________________ . No *(an!e in t(e a0TT ,it( a )lo"s o# IB (eparin . + -> Anti-t(ro%)in le'el. . T -> Lar!e a%o"nts o# (eparin or dire*t t(ro%)in in(i)itor #ollo,ed )$ ,ar#arin.

. +IC +I EMINATE+ INT3ABA C7LA3 COAG7LATION: _______________________________________________ . +oesn=t o**"r in (ealt($ pts. . Ass. ,it( sepsis - )"rns - sna e )ites - *an*er - A)r"ptio pla*enta or A E%)olis%.



. 5LEE+ING related to CLOTTING ACTO3 +E ECIENCY & TH3OM5OCYTO0ENIA . 66 )ot( 0T & 0TT.. -- platelet *o"nt.

. 66 +-di%er & +0 @)rin de!radation prod"*ts/. . -- @)rino!en le'el *ons"%ed/. . T -> 3E0LACEMENT )$ 0 3E H 3O EN 0LA MA Contains )ot( palatelets &*lot.#a*tors/.

. T3AN 7 ION 3EACTION : ________________________ ________________________

. 4 . A5O INCOM0ATI5ILITY: ___________________________ . A*"te s$%pto%s o# (e%ol$sis 9HILE t(e trans#"sion is o**"rin!. . E -> +73ING a trans#"sion; t(e pt )e*o%es ($potensi'e & ta*($*ardi*. . 5a* & *(est pain & dar "rine. . 66 L+H & )ilir")in. . -- Hapto!lo)in.

. . T3AN 7 ION 3ELATE+ AC7TE L7NG INU73Y T3ALI/ LE7KO-AGGL7TINATION3EACTION:

____________________________________________________________________________________ . A*"te (ortness o# )reat( #ro% anti)odies in t(e donor )lood a!ainst t(e repient95Cs. . E -> %ins a#ter a pt. re*ei'es a )lood trans#"sion; t(e pt )e*o%es s(ort o#)reat(. . Transient in@ltrates on C?3. . All s$%pto%s resol'e spontaneo"sl$.

. . I!A +E ECIENCY: ______________________ . presents ,it( anap($la is . In t(e #"t"re; "se )lood donations #ro% an I!A de#e*ient donor or ,as(ed 35Cs. . E -> As soon as t(e pt. re*ei'ed trans#"s.; (e )e*o%es O5; ($potensi'e &ta*($*ardi*. . NO3MAL L+H & 5ILI375IN.

. F . MINO3 5LOO+ G3O70 INCOM0ATI5ILITY: _________________________________________ . To ell; +" $; Le,is or Kidd anti!ens or 3( in*o%pati)ilit$ . +ela$ed 2a"ndi*e. . No spe*i@* t(erap$. . E -> A #e, da$s a#ter trans#"sion; t(e pt )e*o%es 2a"ndi*ed. . T(e (e%ato*rit doesn=t rise ,it( trans#"sion & (e is !enerall$ ,it(o"t s$%pto%s.

. . E53ILE NON-HEMOLYTIC 3EACTION: ______________________________________ . %all rise in te%perat"re. . No ttt re "ired.



. 3ea*tion a!ainst donor 95Cs anti!ens. . pre'ented )$ "sin! @ltered )lood trans#"sions in t(e #"t"re to re%o'e 95Csanti!ens. . E -> A #e, (o"rs a#ter trans#"sion; t(e pt )e*o%es #e)rile ,it( rise 4 de!ree inte%p. . No e'iden*e o# (e%ol$sis.

. N.5. HY0OCALCEMIA MANI E TATION 0A3E THE IA/ A TE3 5LOO+ T3AN 7 ION: _________________________________________________________________________ . O**"rs in pts ,(o re*ei'e %ore t(an one )lood 'ol"%e o# )lood trans#"sion orpa* ed 35Cs o'er F (o"rs %a$ de'elop 66 plas%a le'el o# CIT3ATE A75 TANCE A++E+ TO TO3E+ 5LOO+/ -> CHELATION o# Ca & M! )$ *itrate -> --Ca -> 0arest(esia.

. MIG3ATO3Y 70E3 ICIAL TH3OM5O0HLE5ITI T3O7 EA7=s VYN+3OME: ________________________________________________________________ . H$per*oa!"la)le disorder. . 7n-e plained s"per@*ial 'eno"s t(ro%)osis at "n-"s"al sites e.!. ar% & *(estarea. . Asso*iated ,it( OCC7LT BI CE3AL MALIGNANCY . E . Can*er in'ol'in! t(e pan*reas %ost *o%%on . . T(e t"%or releases %"*in t(at rea*t ,it( platelets #or%in! platelet ri*( %i*ro-t(ro%)i. . HSO o# (ea'$ s%o in! - a)do%inal pain - %i!rattor$ t(ro%)op(le)itis. . + -> CT A)do%en -> sear*(in! #or an o**"lt t"%or pan*reati* *ar*ino%a/.

. GL7CAGONOMA: ______________ . Ne*rol$ti* %i!rator$ er$t(e%a:--------------------------------- -> Er$t(e%ato"s pap"les S pla "es on #a*e; perine"% & e tre%ities. -> Enlar!e & *oalese ,it( *entral *learin! & )listerin! & *r"stin! & s*alin!. . +ia)etes Mellitis:--------------------- -> Mild ($per!l$*e%ia easil$ *ontrolled ,it( diet & oral a!ents. -> +on=t re "ire ins"lin . GIT s$%pto%s:---------------- -> +iarr(ea - anore ia a)do%inal pain - o**asional *onstipation. . Ot(er @ndin!s:------------------ -> 9ei!(t loss. -> Ne"rops$*(iatri* ata ia - de%entia - pro i%al %s ,ea ness/. -> Asso*iated ,i( 'eno"s t(ro%)osis . + -> H$per!l$*e%ia ,it( 66 GL7CAGON > %!Sdl. . + -> Nor%o*$ti* Nor%o*(ro%i* ane%ia.. + -> CT or M3I to dete*t t(e t"%or.

. MOKE3 6 HO3NE3=s V L7NG CANCE3:



____________________________________ . Horner=s V -> Miosis; ptosis & an($drosis. . i%ple C?3 is t(e )est ne t step to dete*t l"n! *an*er.

. MALL CELL OAT/ L7NG CA3CINOMA: __________________________________ . asso*iated ,it( V$ndro%e o# inappropriate A+H se*retion & ACTH prod"*tion.

. IA+H H$ponatre%ia & -- ser"% os%olalit$ & 66 "rine os%olalit$/. . Metastasis is alread$ present at t(e ti%e o# dia!nosis . T o# IA+H -> Mild l"id restri*tion/ or e'ere H$pertoni* saline/.

. 66 ACTH -> H$pertension - H$po ale%ia - Meta)oli* al alosis -H$perpi!%entation. . e=o"t ot(er %ani#ests o# C"s(in! V Moon #a*e - +orsal ("%p - *entral o)esit$ -striae/

. [7AMO7 CELL CA3CINOMA O THE L7NG: ______________________________________ . i!ni@*ant s%o in! HSO. . HY0E3CALCEMIA 66 Ca -> sCa66%o"s/ . Hilar %ass.

. A+ENOCA3CINOMA O THE L7NG: _____________________________ . Least asso*iation ,it( s%o in!. . Lo*ated perip(erall$. . Consists o# *ol"%nar *ells !ro,in! alon! t(e septa. . 0resents as a sloitar$ nod"le . Ma$ )e dete*ted in*identall$.

. E53ILE NE7T3O0ENIA: ______________________ . in!le te%perat"re > P. * or s"stained te%p. > P * #or > 4 (o"r in ane"tropeni* pt. . Ne"tropenia A)sol"te ne"trop(il *o"nt 4 *ellsS%l. . Mild 4 / - Moderate 4 / - e'ere /. . All re "ire anti)ioti*s. . Moderate & se'ere ne"tropenia re "ire (ospitali ation. . T(e %ost *o%%on in'adin! or!anis% is 0 E7+OMNA AE37GINO A. . T -> HO 0ITALI ATION; . 5LOO+ C7LT73E #ollo,ed )$ IB CE E0IME or 0I0E3ACILLIN TA O5ACTAM.

. [7AMO7 CELL CA3CINOMA O THE M7CO A O THE HEA+ & NECK: ___________________________________________________________ . ALCOHOLIC MOKE3. . HA3+ 7NILATE3AL NON-TEN+E3 CE3BICAL O3 75MAN+I57LA3 l$%p( node. . + -> 5est initial -> 0AN-EN+O CO0Y. . T -> 3adi*al ne* disse*tion.



. TE TIC7LA3 T7MO3: ___________________ . 0ainless (ard %ass in testi*le. . "!!esti'e "ltraso"nd. . T -> Or*(ie*to%$ 3e%o'al o# t(e testi*le & its asso*iated *ord/. . NAC or trans-re*tal )iops$ are *ontr=d )e*. t(e ris o# spilla!e o# *an*er *ells.

. I53OCY TIC +I EA E O THE 53EA T: ____________________________________ . 3"))er$; @r%; %o)ile & pin#"l %ass in a $o"n! pt. . More pain d"rin! %enses. . Aspiration o# t(e *$st -> Clear 1"id ,it( diasppearan*e o# t(e %ass. . T -> O)ser'ation o# t(e pt F - J ,ee s. . Onl$ send t(e 1"id #or *$tolo!$ i# t(eir is )lood or #o"l s%ellin!.

. INBA IBE +7CTAL 53EA T CA3CINOMA: ___________________________________ . TNM sta!in! is t(e sin!le %ost i%portant pro!nosti* tool #or )reast *an*er. . 0ro!nosis is )est dete*ted "sin! ONCOGENE AM0LI ICATION )$ I H . I H l"ores*ent in sit" ($)ridi ation. . O'er-e pression o# t(e on*o!ene HE3 *an )e dete*ted )$ I H 9orsepro!nosis/. . 0ositi'it$ predi*ts a 6'e response to T3A T7 7MA5 & ANTH3ACYCLINE*(e%ot(erap$. . E3 6'e & 03 6'e are GOO+ pro!nosti* #eat"res. . T -> T3A T7 7MA5 Her*eptin/ is "sed to ttt )reast *an*er t(at is HE3 6'e. . Trast" "%a) side e e*t -> CA3+IOTO?ICITY. . ECHOCA3+IOG3A0HY is re*o%%ended )e#ore ttt to assess t(e e2e*tion #ra*tion.

. IN LAMMATO3Y CA3CINOMA O THE 53EA T: _______________________________________ . 5reast *an*er s(=d )e *onsidered ,(ene'er a pt. ,it(o"t a prior HSO o# s indisease; . de'elops a )reast ras( t(at is non-responsi'e to standard ttt . 9(en in'asi'e d"*tal *ar*ino%a is se'ere; it *an in@ltrate into t(e der%all$%p(ati*s; . res"ltin! ede%a - er$t(e%a - ,ar%t( o# t(e entire )reast in1a%%ator$*ar*ino%a/. . 9(en t(e ras( is lo*ali ed to t(e nipple & (as an "l*eratin! e* $%ato"sappearan*e; . t(e pri%ar$ *osideration s(o"ld )e 0AGET=s +I EA E o# t(e )reast. . o# pts ,it( 0AGET=s disease (a'e an "nderl$in! )reast *an*er A+ENO-CA3CINOMA . . in )iops$ -> Lar!e *ells s"rro"nded )$ *lear (alos.

. TAMO?I EN: ____________ . Has %i ed a!onist & anta!onist a*ti'it$ on Estro!en re*eptors. . It is "sed as an ad2"'ant t(erap$ #or earl$ sta!e )reast *an*er; . It red"*es t(e ris o# re*"rren*e o# t(e ori!inal *an*er;; 57T;;



. 66 ris o# de'elopin! o# anot(er *an*er in t(e ot(er )reast . Estro!eni* e e*ts 66 ris o# EN+OMET3IAL *an*er & Beno"s t(ro%)osis.

. [7AMO7 CELL CA3CINOMA o# t(e KIN: ______________________________________ . An$ s*ar t(at de'elops into a non-(ealin!; painless; )leedin! "l*er. . "n-e posed or )"rned areas are t$pi*all$ in'ol'ed. . 3o"!( s*al$ nod"les t(at *an "l*erate & %etastasi e. . Tar deri'ati'es to)a**o s%o e/ & *(roni* radiation e pos"re are predisposin!#a*tors. . + -> 07NCH 5IO0 Y. . T -> "r!i*al re%o'al ,it( ,ide e *ision o# t(e s in aro"nd t(e t"%or.

. 5A AL CELL CA3CINOMA o# t(e KIN: ___________________________________ . Most *o%%on #or% o# s in *an*ers in 7 A. . Open sore t(at )leeds; oo es or *r"sts & re%ains open #or or %ore ,ee s. . 3eddis( pat*( or irritated area; s(in$; ,a $; s*ar li e ,it( ele'ated rolled )orders. . 3e%ains lo*al - Ne'er spreads. . T -> Mo(s s"r!er$ Mi*ros*opi* s(a'in!/ -> 4- %% o# *lear %ar!ins are e *ised. . Hi!(est *"re rate ,it( Mo(s s"r!er$. . Indi*ated in lesions lo*ated at *riti*al areas e.!. perioral re!ion; nose; lips & ears.

. E O0HAGEAL CA3CINOMA: _______________________ . Heart )"rn - si!ni@*ant ,ei!(t loss - 3e!"r!itation o# #ood - #ati!"e - s%o in! HSO. . A!e > $s. . Histolo!i*al t$pes -> "a%o"s *ell *ar*ino%a & Adeno*ar*ino%a. . CC -> Ass. ,it( s%o in! & al*o(ol *ons"%ption. . Adeno*ar*ino%a -> 5arret=s esop(a!"s GE3+ *o%pli*ation/. . + -> 5A3I7M 9ALLO9 #ollo,ed )$ EN+O CO0Y.

. MYA THENIA G3ABI : ____________________ . 0tosis & do")le 'ision )$ t(e end o# t(e da$. . + -> EMG -> +e*re%ental response in *o%po"nd a*tion potential. . + -> A*et$l *(oline re*eptor anti)od$ test 6'e.. + -> CT s*an *(est s(=d )e done in all ne,l$ dia!nosed MG pts sear*(in! #or a

THYMOMA.

. COLON CANCE3 C3EENING: _________________________ < 3O7TINE:

___________ -> Colonos*op$ at $s t(en e'er$ 4 $s. < INGLE AMILY MEM5E3 9ITH COLON CANCE3:

__________________________________________ -> Colonos*op$ at F $s;-> or .. 4 $s earlier t(an t(e a!e at ,(i*( t(e #a%il$ %e%)er (ad *an*er;



-> ,(i*(e'er is earlier t(en e'er$ 4 $s.

< HN0CC #a%il$ %e%)ers & !enerations & 4 pre%at"re $s/: ________________________________________________________________ . Colonos*op$ at t(en e'er$ 4- $s. . HN0CC is ass. ,it( (i!( ris o# e tra-*oloni* t"%ors EN+OMET3IAL CA3CINOMA/. . It is a part o# LYNCH V t$pe .

< AMILIAL A+ENOMATO7 0OLY0O I : __________________________________ . i!%oidos*o$ at 4 t(en e'er$ 4- $s. . 4 ris o# *an*er. . ELECTIBE 03OCTO-COLECTOMY s(=d )e done. < U7BENILE 0OLY0O I - 0E7T UEHGE3s - T73COT=s V - GA3+NE3=s V:

_________________________________________________________________ . No additional s*reenin!.

. 7LCE3ATIBE COLITI : _____________________ . Colonos*op$ on*e t(e dia!nosis is esta)lis(ed #or P $s t(en repeated e'er$ 4 - $s.

. MEN 4 M7LTI0LE EN+OC3INE NEO0LA IA 4: _________________________________________ . 0arat$(roid >R / -> parat($roid ($perplasia -> pri%ar$ ($perparat($roidis%-> 66 Ca. . 0it"itar$ -> prola*tino%a. . 0an*reas S GIT -> Gastrino%a E V - ins"lino%a - BI0o%a - Gl"*a!ono%a. . KEY 9O3+ -> INT3ACTA5LE 7LCE3ATION 6 HY0E3CALCEMIA -> EV &H$perparat($roidis% MEN4. . 0O T- 0LENECTOMY E0 I :

__________________________ . Aspleni* pt (a'e de#e*ti'e 0HAGOCYTO I . i%paired anti)od$ %ediated opsoni ation in p(a!o*$tosis. . Hi!( ris o# o'er,(el%in! in#e*tion )$ en*aps"lated or!anis%s; . e.!. trept. pne"%oniae; N. %enen!itidis & H. in1"en ae.

. +EE0 BENO7 TH3OM5O I +BT MANAGEMENT: __________________________________________ . 0resents ,it( pain; s,ellin! & dis*oloration. . +.+. -> 3"pt"red 5a er=s *$st - 'eno"s ins" e*ien*$ - post-t(ro%)oti* V &*ell"litis. . ail"re to anti-*oa!"late t(e pt %a$ lead to p"l%anar$ e%)olis%. . Modi@ed 9ells *riteria is a pretest propa)ilit$ o# +BT: -> 0re'io"s +BT. -> A*ti'e *an*er. -> 3e*ent i%%o)ili ation. -> Lo*ali ed tendrness alon! 'ein distri)"tion.



-> ,ollen le!. -> 0ittin! ede%a. . . 0re-test propa)ilit$ o# +BT "sin! 9ELLs *riteria .__________________________________________________ .8 ._________________________________________ .8 .8 . Not li el$ . Li el$ .____________ .________ 8 .8 . +-+i%er test 6/--------------->. Co%pression 7ltrasono!rap($

.______________ ._____________________________ .8 .8 .8 ._________________________________

.8 .8 .8 -/ 6/ -/

.8 .8 .8 . 7n-li el$ to (a'e +BT TTT ,it( Heparin & 9ar#arin/ ContrastBeno!rap($/

. Clini*al #eat"res o# META TATIC 53AIN CANCE3: _______________________________________________ . In*iden*e -> L"n! > 5reast > 7n- no,n pri%ar$ > Melano%a > Colon. . 0ri%ar$ solitar$ )rain %etastases -> 53EA T - COLON - 3ENAL CELL CA3CINOMA. . M"ltiple )rain %etastasis -> L7NG - MALIGNANT MELANOMA. . 5rain %etastasis are t(e %ost *o%%on intra*ranial t"%ors. . Heada*(e - na"sea&'o%itin! - sei "res & #o*al ne"rolo!i*al s$%pto%s,ea ness-ap(asia/.

. TY0E O THE3A0IE ______________________ . A+U7BANT -> TTT !i'en in addition to standard t(erap$. . IN+7CTION -> Initial dose o# ttt to rapidl$ ill t"%or *ells. . CON OLI+ATION -> TTT !i'en a#ter ind"*tion t(erap$ to -- t(e t"%or )"rden. . MAINTENANCE -> Gi'en a#ter ind"*tion & *onsolidation ttt to ill resid"al t"%or*ells. . NEO-A+U7BANT -> Gi'en )e#ore t(e standard t(erap$ #or a parti*"lar disease. . ALBAGE -> TTT #or a disease ,(en t(e standard ttt #ails.

. MECHANI M O ACTION o# IM0. +37G : ____________________________________ . HE0A3IN -> Anti-*oa!"lant -> 66 ANTI-TH3OM5IN -> -- T(ro%)in; R & 4 . . 9A3 A3IN -> Anti-*oa!"lant -> -- s$nt(esis o# Bit. K dep. #a*tors 4RD ; ptn C &. . A 0I3IN -> Anti-platelet -> -- *$*lo-o $!enase 4 -> -- T?A s$nt(esis. . CLO0I+OG3EL -> Anti-platelet -> )lo* platelet s"#ra*e re*eptors -> -- plateleta*ti'.

. AN+3OGEN A57 E:



_________________ . At(eletes *o%%onl$ a)"se andro!en to en(an*e per#or%an*e in *o%peteti'esports. . E : testosterone & s$nt(eti* andro!en. . 66 M"s*le %ass & stren!t( & 66 p($si*al e er*ise intoleran*e. . Men Es -> -- testi*"lar #"n*tion - -- sper% prod"*tion - testi*"lar atrop($. . Men Es -> G$ne*o%astia - %ood dista"r)an*e - a!rressi'e )e(a'ior. . 9o%en Es -> 66 A*ne - Hirs"tis% - deepenin! o# 'oi*e - %enstr"al irre!"larities. . La)s -> Er$t(ro*$tosis & 66 HCT - Hepatoto i*it$ - +$slipide%ia -- H+L & 66L+L/. . OLITA3Y 07LMONA3Y NO+7LE A003OACH:

_____________________________________ . *% or less *oin-s(aped lesion; . in t(e %iddle to lateral one t(ird o# t(e l"n!. . "rro"nded )$ nor%al paren*($%a. . Most o# t(e% are )eni!n . Cal*i@*ations o# t(e nod"le #a'ors a )eni!n lesion . 0O0 CO3N *al*i@*ation -> Ha%arto%a. . 57LL EYE -> Gran"lo%a. . Lo, ris pts F $s & non s%o ers/ -> Not a si!n o# i%%ediate alar%. . 5est approa*( -> A KING O3 AN OL+ ?-3AY . I# no *(an!e in it #or t(e last 4 %ont(s -> 5eni!n. . ollo,ed )$ C?3 e'er$ %ont(s #or t(e ne t 4 %ont(s -> I# no !ro,t( or s$%s-> Lea'e . Hi!( ris pts > F $s & s%o ers/ -> "ll in'esti!ation ,or "p

. GIANT CELL T7MO3 O 5ONE: ___________________________ . + -> ?-ra$ -> E pansile & e**entri* l$ti* area ,it( OA0 & 5755LE A00EA3ANCE. . 5eni!n )"t lo*all$ a!!ressi'e s eletal neoplas%. . Yo"n! ad"lts. . pain; s,ellin! & -- ran!e o# %otion at t(e in'ol'ed site. . 0at(olo!i* Zs are *o%%on d"e to t(innin! o# t(e )one *orte in ,ei!(t )earin!areas. . A e*t t(e epip($sis o# t(e lon! )ones distal #e%"r & pro i%al ti)ia/. . M3I -> T"%or *ontainin! )ot( *$sti* & (e%orr(a!i* re!ions. . T -> "r!er$.

. COM03E ION O THE THECAL AC or 0INAL CO3+ )$ a T7MO3: __________________________________________________________ . E -> HSO o# prostati* *an*er 6 A*"te onset )a* pain. . 3apid re*o!nition is *r"*ial to a'oid paral$sis. . 0oint tenderness o'er t(e spine pro*ess L & 4. . I%)alan*e; %s ,ea ness & ,ee re*tal sp(in*ter tone. . + -> M3I spine 57TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT . Initial %ana!e%ent ,it( !l"*o*orti*oids de a%et(asone/ is *r"*ial to -- s,ellin!; . as an atte%pt to preser'e ne"rolo!i*al #"n*tion ,(ile a,aitin! t(e res"lts o#i%a!in!.



. 0O T- 0LENECTOMY 3ECOMMEN+ATION : ___________________________________ . 3is #or sepsis a#ter splene*to%$ is present 70 TO $ears & %ore . Anti-pne"%o*o**al; Hae%op(il"s & %enin!o*o**al 'a**ine s(=d )e !i'en; . se'eral ,ee s )e#ore splene*to%$. . +ail$ oral peni*illin prop($la is #or - $s #ollo,in! splene*to%$.

. CANCE3 OBA3Y: _______________ . NO s*reenin! tests . er"% CA 4 & pel'i* 7SV %a$ (elp in dia!nosis.

. 66 HOMOCY TEINE le'els -> HY0E3COAG7LA5ILITY: _______________________________________________ . Bit. 5J; olate & Bit. 54 are in'ol'ed in t(e %eta)olis% o# (o%o*$steine. . Bit. 5J lo,ers (o%o*$steine le'els )$ a*tin! as a *o#a*tor #or *$stat(ionine 5-s$nt(ase . ,(i*( %eta)oli es (o%o*$steine to *$stat(ionine.

. 0AIN CONT3OL IN CANCE3 0ATIENT : __________________________________ . Gi'e t(e appropriate pain %edi*ation to *an*er pts e.!. I)"pro#en. . I# no response .. 7se a nar*oti* dr"! i# it is t(e %ost appropriate. . 7se HO3T ACING IB MO30HINE.

. MANAGEMENT O CHEMOTHE3A0Y IN+7CE+ NA7 EA & BOMITING: _______________________________________________________ . Bol"%e repletion 6 E3OTONIN ANTAGONI T 5lo* HT re*ptors/.

. MANAGEMENT O CANCE3 3ELATE+ ANO3E?IA & CACHE?IA: ___________________________________________________ . 03OGE TE3ONE ANALOG -> 66 Appetite & 66 ,ei!(t !ain.

. 03O TATE CANCE3 ,it( 5ONE META TA I : _______________________________________ . T -> OCAL E?TE3NAL 5EAM 3A+IATION I# t(e pt "nder-,ent or*(ie*to%$ /.

. 53AIN META TA I : ___________________ . OLITA3Y -> 73GICAL 3E ECTION #ollo,ed )$ ,(ole )rain radiation. . M"ltiple -> 0alliati'e ,(ole )rain radiation.

. MANAGEMENT O HY0E3CALCEMIA +7E TO 7N+E3LYING MALIGNANCY: ___________________________________________________________ . As$%pto%ati* or %ild -> Ca 4 %!Sdl:

_________________________________________ . U"st a'oid t(ia ides; lit(i"% "se; 'ol"%e depletion or prolon!ed )ed rest. . e'ere -> Ca > 4F %!Sdl:

___________________________



. I%%ediate ttt -> Nor%al saline ($dration 6 Cal*itonin. . Lon! ter% ttt -> 5ip(osp(onate oledroni* a*id/.

. +.+. o# ANTE3IO3 ME+IA TINAL MA F Ts/: ___________________________________________ . T($%o%a - Terato%a - T($roid neoplas% - Terri)le l$%p(o%a. . Ger% *ell t"%ors are *lassi@ed into se%ino%ato"s & non-se%ino%ato"s. . Non-se%ino%ato"s Yol sa* t"%or - *(orio*ar*ino%a - e%)r$onal *ar*ino%a/. . A %i t"re o# all t$pes o# non se%ino%ato"s !er% *ell t"%ors MI?E+ GE3M CELL

T7MO3. . e%ino%a -> 66 5-HCG & Nor%al A 0. . Non se%ino%a MI?E+/ -> 66 5-HCG & 66 A 0.

. HEMOCH3OMATO I : __________________ . NE9-ON ET +IA5ETE MELLIT7 6 A3TH3O0ATHY 6 HE0ATOMEGALY. . +"e to a)nor%al 66 intestinal a)sorption o# iron -> 66 iron deposition in tiss"es. . +a%a!e to or!ans e . li'er; pan*reas ; (eart & pit"itar$. . Li'er -> Hepato%e!al$ -> Li'er *irr(osis -> Hepato*ell"lar *ar*ino%a. . 0an*reas -> 5ron e +.M. . 0it"itar$ -> H$po!onadis%. . Heart -> 3estri*ti'e (eart #ail"re. . Uoints -> Art(ropat($. . in -> H$perpi!%entation. . + -> Iron st"dies -> 66 #e; 66 #erritin; 66 trans#errin sat"ration. . + -> Li'er )iops$ -> *on@r% t(e dia!nosis.

. LEA+ 0OI ONING: _________________ . Lead )ind to er$t(ro*$tes & disr"pts (e%o!lo)in s$nt(esis -> Mi*ro*$ti* ane%ia. . +"e to *(roni* lead e pos"re & to i*it$. . A*"te e pos"re -> A)do%inal pain & *onstipation. . C(roni* e pos"re -> ati!"e; iirita)ilit$ & inso%nia. . H$pertension - ensori-%otor ne"ropat(ies - Ne"rops$*(iatri* dist"r)an*es -Nep(ropat($ . OCC70ATIONAL HI TO3Y I BE3Y IM0O3TANT . 5ATTE3Y MAN7 ACT73ING - 0L7M5ING - MINING - 0AINTING - 0A0E3 HANGING &A7TO-3E0AI3. . + -> 5lood Lead le'el. . + -> 0erip(eral s%ear -> 5A O0HILIC TI00LING. . T -> CHELATION THE3A0Y.

+r. 9ael Ta,@* Mo(a%ed _________________________

ck hematology

Documents