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CA 125 tumor marker elevation
Ovarian, Fallopian tube, Cervical, Hepatic, Pancreatic
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CEA tumor marker elevation
Monitoring of peristent, metastatic or recurrent cancer of Colon or Breast
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SPF # needed for skin cancer prevention
SPF #15
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Higher risk of testicular- ethnicity
White male
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What increases risk of Anal Cancer?
STDs, Anal intercourse, Increase in number of sexual partners
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What are the microcytic anemias?
Thalassemias, and Iron Deficiency Anemia
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What are the macrocytic anemias?
B12 deficiency, Folate Deficiency, and Pernicious anemia
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what goes wrong with RBC in Thalassemia?
Decreased hemoglobin synthesis, malformed RBC, increased RBC hemolysis
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Who gets alpha Thalassemia?
Alpha: AAA Alpha, Asian, African
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Who gets Beta Thalassemia?
Beta: BAMME Beta, African, Mediterranean, Middle eastern
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What are the drugs that can cause anemia?
Anti-seizures: Tegretol, Dilantin, Valproic Acid. AZT, ETOH
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What immune response RXN is anaphylaxis?
Systemic antibody-antigen RXN. Type I immune response, (hypersensitivity RXN)
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IgE antibodies respond in response to allergen and cause degradation of Mast cells. What then occurs.?
Release of histamine. Vasodilation. Mucous gland stimulation. Tissue swelling.
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Two types of Type I hypersensitivity RXN?
Atopy (allergic rhinitis, asthma) Anaphylaxis. (Systemic IgE mediated RXN.)
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What physical symptom can be seen in B12 deficiency?
Stocking glove neuropathy, paresthesias and mouth irritation, stomatitis, koilonychia, glossitis
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Name vitamins and nutrients important in RBC production?
Vitamin Bs, Vitamin C, iron, protein, appropriate nutrition and the absorption ability
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What will vegan need to supplement diet with?
B 12 (only found in animal products)
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When do you see a hemic murmur?
Dehydration, profound anemia, fever, thyrotoxicosis
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Best time of day to take iron?
On empty stomach
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What antibiotics should be taken separate from Iron?
Tetracyclines, Doxycycline, Fluoroquinolones,
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What electrolyte needs to be monitored when anemia tx is instituted?
Potassium. Reticulocytosis causes potassium to move into cell and will increase potassium consumption.
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What medication should not be in stomach with B12?
Vitamin C
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What medications decrease B12 absorption?
Aminoglycosides, colchicine, Potassium supplements
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What stomach cell destruction is implicated in pernicious anemia?
Parietal cell destruction, due to autoimmune disease, therefore no intrinsic factor is produced and unable to ABSORB Vitamin B12.
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Causes of Pernicious Anemia?
B 12 deficiency due to gastrectomy, strict vegans, autoimmune, small bowel disease
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What age is Karposi Sarcoma abnormal and requires further workup?
Less than age 60. Must check for HIV
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Infections common to HIV?
Candidiasis of airway, cryptococcosis, cryptosporidiosis, CMV, HSV, mycobacterium avium, toxoplasmosis
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What cancers can be linked to tobacco use?
Bladder, and pancreatic. Cancers of mouth, airway, esophagus and gastric.
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Increased risk for pancreatic cancer seen in?
Smokers, diabetics, high fat diet
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African American and cancer rate?
Highest over-all cancer rate, highest cancer mortality
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Multiple Myeloma is malignancy of what?
Plasma cells (B lymphocyte cell cancer)
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What is the mnemonic for Multiple Myeloma?
CRAB. Calcium (elevated), Renal failure, Anemia, Bone tumors,
- What site of GI cancers are most effectively picked up by FOBT?
- Sigmoid colon cancers
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Where and what is the Virchow's Node?
Left supraclavicular node, typical site of nodal metastasis to tumor from below diaphragm
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IgE is elevated in?
Atopic disorders and parasites. Allergic rhinitis, allergic asthma, atopic dermatitis.
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IgG is elevated in?
Gone. Late stage: Bacterial infections, Bacterial Toxins, viruses(Gammaglobulin).
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IgM is elevated in?
Miserable. Early infection or chronic infection. HAV, HBV, SLE, RA, AIDS, Sjogrens
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IgA is elevated in?
SLE, RA, Glomerulonephritis, chronic liver disease
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What does IgA do in body?
Provides local protection to exposed mucous membranes and prevents virus from binding to mucous membranes
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Example of immune-complex mediated hypersensitivity?
Seen in skin testing, causes erythema and edema.
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Example of delayed hypersensitivity reaction?
Histamine release causing hives, wheal. Also Anaphylaxis
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Another name for delayed Hypersensitivity RXN?
Cell mediated reaction
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What kind of reaction is a Transfusion reaction?
Cytotoxic reaction
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What is G6PD deficiency?
X linked genetic d/o of Af Am. RBCs cant deal with oxidative stress.
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What should be avoided in G6PD deficiency?
ASA, Sulfa drugs, Bactrim, Nitrofurantoin, fava beans, INH. All can cause RBC auto-lysis
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Sickle cell is autosomal.?
Recessive.
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Hemophilia, who is affected?
Males, but females are carriers and unaffected
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When are Eosinophils (Eosinophilia) elevated on CBC/diff?
Allergic. Atopic. Autoimmune. Hypersensitivity RXNs. Paralytic infections
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When are Neutrophils (Neutrophilia) elevated on CBC/diff?
Acute infection. Pyogenic infections. S/E of steroids. Stress response. Leukemia.
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When are Basophils (Basophilia) elevated on CBC/diff?
CML, Hypersensitivity RXN,
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When are Monocytes (Monocytosis) elevated on CBC/diff?
Chronic infection or inflammatory disorders or autoimmune disorders, Viral or protozoal infections,
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What does decreased lymphocytes indicate (lymphocytopenia)?
Immunodeficiency disease. Long Term corticosteroid treatment, or Hodgkins, SLE, etc
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What does increase lymphocytes indicate?
Viral infection more so than bacterial. Hepatitis, Mono, CMV, Herpes)
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Where does Ewings sarcoma arise from?
Bone marrow
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When would you see increased platelets?
Myeloproliferative leukemia, PCV, s/p splenectomy
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When would you see decreased platelets?
DIC, increased plt destruction, mono, ITP, aplastic anemia, s/p XRT, s/p chemo,
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What does elevated AFP indicate (carcinoma)?
Tumor of Germ Cell. Hepatocellular carcinoma. Also AFP checked in pregnancy
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What does elevated HCG indicate?
Germ cell tumors, Teratoma, HCG is never normally in males.
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CA 15-3 tumor marker?
Breast cancer
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Ddx for generalized lymphadenopathy?
Disseminated hematological malignancy. Collagen vascular disease. Infectious, mono, CMV, AIDS
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What habit may decrease vitamin C absorption?
Smoking. Smoking increases all vitamin requirements also
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Gold Standard test for sickle cell anemia?
Hemoglobin Electrophoresis
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Burkitts leukemia is a type of?
Acute lymphoblastic leukemia (ALL)
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What is Burkitt's lymphoma associated with?
Infection from Epstein Barr Virus
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What lab values are diagnostic for Mononucleosis?
Leukopenia with lymphocytosis and atypical lymphocytes
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Eye exam findings in CMV infection?
Retinitis. Hemorrhage, cotton wool, exudates, loss of peripheral vision, blurriness and partial blindness
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What happens in sideroblastic anemia?
Body has iron, but unable to incorporate into hemoglobin therefore can't form heme molecules
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What are some causes of sideroblastic anemia?
Lead Poisoning, inherited enzyme deficiency, B6 or copper deficiency,
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What is the characteristic lymph node enlargement of Hodgkin's lymphoma?
Asymmetrical adenopathy
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What is the characteristic lymph node enlargement of non-Hodgkin's lymphoma?
Disseminated adenopathy
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What is glossitis?
Sign of pernicious anemia (B12 deficiency) tongue inflammation, tender, pale or bright red, swollen.
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What are asplenic patients more susceptible to?
Bacterial infections, because spleen removes bacteria, especially important to rid body of encapsulated bacteria i.e. streptococcus pneumoniae. Reason for pneumovax indication in aspenic patient
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