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DNA Viruses
Notes
Plasma Cell Disorders
Multiple Myeloma Etiology Plasma cell monoclonal proliferation Osteoclast activating factor (OAF) ⇒ Lytic lesions Presentation CRAB C → ↑Ca R → Renal failure A → Anemia B → Bone pain Most common → Bone pain → Pathologic fracture ↑Ca Infection ↑ Uric acid → Nuclear material turnover Anemia Renal failure Immunoglobulin accumulation...
Read moreLymphoma
Non-Hodgkin Lymphoma Etiology Proliferation of lymphocytes inside lymph nodes and spleen Similar to CLL → NHL is solid, CLL is liquid Stages 1 → 1 lymph node group 2 → ≥2 lymph node groups on one side of diaphragm 3 → Both sides of diaphragm 4 → Widespread Pathologic classification B-Cell Follicular Middle-aged Indolent,...
Read moreLeukemia
Leukemoid Reaction ↑ WBC after infection Acute inflammatory response Neutrophils Left shift Distinguish from leukemia → LAP (Lymphocyte alkaline phosphatase) ↑LAP → Leukemoid reaction ↓LAP → CML or another leukemia AML/ALL Etiology ALL Children 85% cured Poor prognosis Age <1y, >10y WBC >50k t(9;22) CNS involvement ↑ incidence in Down syndrome...
Read morePolycythemias
Polycythemia Vera Etiology JAK2 protein mutation All cells rise → RBC most prominent Hyperviscosity Presentation Older patient with Hyperviscosity Syndrome Headache Blurred vision Tinnitus Pruritus → After warm shower → ↑Basophils Hypertension Fatigue Splenomegaly Bleeding → From engorged vessels Easy bruising Thrombosis CHF Diagnosis Best initial → CBC ↑Hematocrit >60% ↑PLT ↑WBC Normal...
Read moreAnemia (General)
Anemia Etiology Microcytic Iron deficiency Thalassemia Sideroblastic Anemia of chronic disease Macrocytic B12 deficiency Folate deficiency Sideroblastic Alcoholism Liver disease Hypothyroidism Myelodysplastic syndrome Drugs Azathioprine 6-MP Hydroxyurea Methotrexate Zidovudine Phenytoin Cold agglutinins → cell clumping → False ↑MCV Normocytic Rapid blood loss Eventually iron deficiency → Microcytic Rapid hemolysis Eventually ↑Retic → Macrocytic...
Read moreARDS
Etiology Lung injury ↓Surfactant Leaky alveoli → Fluid in lungs Causes Sepsis Aspiration Lung contusion Near-drowning Burns Pancreatitis Transfusion lung injury (TRALI) → <6h following transfusion Presentation Phase 1 Acute injury Normal exam Respiratory alkalosis Phase 2 6-48h Hyperventilation → ↓CO2 ↑ A-a gradient Phase 3 Dyspnea ↑RR Respiratory failure ↓...
Read moreObstructive Sleep Apnea
Etiology Obesity Presentation Daytime somnolence Loud snoring Headache Impaired memory/judgement Depression Hypertension Arrhythmias ED Bull neck Diagnosis Most accurate → Polysomnography → Multiple apnea episodes Arrhythmias ↑RBC Treatment Weight loss Avoid alcohol CPAP Uvuloplatopharyngoplasty Avoid sedatives Oral appliance → Keep tongue out
Read morePulmonary Hypertension
Definition → Pulmonary pressure >25/8 mmHg Etiology Idiopathic COPD Fibrosis PE Hypoxia ⇒ Pulmonary vasoconstriction Presentation Dyspnea on exertion Fatigue Syncope Chest pain Wide splitting S2 S4 Right sided CHF Edema Ascites JVD Diagnosis Best initial → Echo, CXR, CT Proximal artery dilation Distal vessel narrowing (pruning) Most accurate → Swan-Ganz...
Read morePulmonary Embolism
Etiology Clot (DVT) 70% → Leg veins 30% → Pelvic vein Virchow Triad Stasis Immobility Joint replacement CHF Obesity ↑ Central venous pressure Endothelial injury Trauma Surgery Fracture Thrombophilia Pregnancy Smoking OCP Coagulation disorders Factor V Leiden Protein C/S deficiency Antiphospholipid syndrome Malignancy Severe burns Amniotic fluid → Postpartum Fat →...
Read moreSarcoidosis
Etiology Idiopathic Presentation Young Black Woman with hilar adenopathy Northern European Fever, cough, malaise, weight loss Lung SOB on exertion Fine rales NO wheezing Erythema nodosum Lymphadenopathy Arthritis Parotid enlarged CNS Facial palsy Other Heart Heart block Restrictive CMP Eye Uveitis Iritis Löfgren Syndrome Arthritis Erythema nodosum Bilateral hilar...
Read moreInterstitial Lung Disease (DPLD)
Interstitial Lung Disease (Diffuse Parenchymal Lung Diseases) Etiology Idiopathic Interstitial pulmonary fibrosis Radiation PaO2 Ventilator Drugs Bleomycin Busulfan Amiodarone Methylsergide Nitrofurantoin Cyclophosphamide Pneumoconiosis History Imaging Notes Asbestosis Shipyard worker Pipe fitting Insulators Tile/brake lining Demolition Lung bases Linear opacities Fibrosis Calcified pleural plaque Alveolar septum Ferruginous bodies Present 15-20y...
Read moreSolitary Pulmonary Nodule
Etiology High probability Malignant >40y Enlarging Smoker Spiculated border >2 cm Atelectasis Adenopathy Sparse eccentric calcification Abnormal PET scan Intermediate probability Age 30-40y 1-2 cm Low probability Malignant <30y No size change Nonsmoker Smooth border <1 cm Normal lung No adenopathy Dense central calcification (Popcorn) Normal PET scan Presentation...
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