H&PII POME Exam I

What is Multiple Myeloma?

Malignant proliferation of plasma cells causing bone destruction.

What is the usual age range for Multiple Myeloma?

65-74 years old.

Which population has higher rates of Multiple Myeloma?

African-American population.

What are the risk factors for Multiple Myeloma?

Increased BMI and agent orange exposure.

What are the clinical manifestations of Multiple Myeloma?

History of hypercalcemia, bone pain, depression, dementia, GI symptoms, renal insufficiency, anemia, and weight loss.

What are Acute Lymphomas & Leukemias?

Different subtypes with varying demographics and symptom onset.

What are the key presentations of Acute Lymphomas & Leukemias?

Anemia, neutropenia, thrombocytopenia, bone pain, arthralgias, lymphadenopathy, fever, night sweats, unintentional weight loss, hepatomegaly, splenomegaly, CNS symptoms.

What are the causes of Iron Deficiency Anemia?

Bleeding (acute or chronic), menorrhagia, hematuria, pregnancy, malabsorption, frequent phlebotomy or blood donation.

What are the symptoms of Iron Deficiency Anemia?

Fatigue, pica (ice craving), restless legs syndrome, headache, exercise intolerance, exertional dyspnea, weakness.

What are the physical exam findings in Iron Deficiency Anemia?

Pale skin, dry or rough skin, spoon nails (koilonychia), alopecia (rare), atrophic glossitis, angular cheilosis, tachycardia, functional murmur.

What are the cardiac symptoms associated with Iron Deficiency Anemia?

Tachycardia and functional murmur.

What are the microcytic characteristics of Iron Deficiency Anemia?

Microcytic red blood cells.

What is B12 deficiency anemia?

Anemia caused by decreased intake, malabsorption, autoimmune conditions, or medication causes.

What are the symptoms of B12 deficiency anemia?

Macrocytic anemia, jaundice, neuropsychiatric symptoms.

What are the symptoms of B12 deficiency anemia in infants?

Developmental delay, feeding issues, hypotonia, convulsions.

What are the symptoms of B12 deficiency anemia in adults?

Cognitive impairment, depression, irritability, insomnia, dementia, psychosis.

What are the gastrointestinal symptoms of B12 deficiency anemia?

Related to the cause of malabsorption.

What are the neurological symptoms of B12 deficiency anemia?

Lower extremity weakness, paresthesias, ataxia, spasticity, paraplegia.

What is the course of B12 deficiency anemia?

3-5 years, except for infants and use of nitrous oxide.

What can be seen on examination in B12 deficiency anemia?

Atrophic glossitis, symmetric neuro deficits, ataxia (Romberg).

What is hemolytic anemia?

Anemia caused by premature destruction of RBCs.

What are the causes of hemolytic anemia?

Drugs, illness, toxins, stress, autoimmune, congenital, DIC, transfusions.

Why is history important in hemolytic anemia?

To identify potential causes such as medications, recent health, and family history.

What are the symptoms of hemolytic anemia?

Abrupt anemia without bleeding, jaundice, dark urine, splenomegaly.

What is folic acid deficiency anemia?

Macrocytic anemia similar to B12 deficiency anemia.

What are the symptoms of folic acid deficiency anemia?

Oral ulcers, shorter course than B12 deficiency anemia.

What can cause folic acid deficiency anemia?

Alcoholism, malnourishment.

Are degenerative cord symptoms and findings of B12 deficiency present in folic acid deficiency anemia?

No.

What are the symptoms of B12 deficiency anemia even without anemia?

Globally, symptoms of macrocytic anemia, jaundice, neuropsychiatric symptoms.

What are the symptoms of B12 deficiency anemia in infants even without anemia?

Developmental delay, feeding issues, hypotonia, convulsions.

What are the symptoms of B12 deficiency anemia in adults even without anemia?

Cognitive impairment, depression, irritability, insomnia, dementia, psychosis.

What is ITP?

Autoantibodies to platelet antigens causing low platelet count.

What platelet count is considered <100k in ITP?

Platelet count less than 100,000.

What platelet count is considered <20k at risk the most in ITP?

Platelet count less than 20,000 at highest risk.

What are the primary and secondary forms of ITP?

ITP can be primary or secondary.

What are some conditions that may cause low platelet count but are not ITP?

Chronic liver disease, hypersplenism, drug-induced, infectious, marrow suppression, pregnancy.

What percentage of people with ITP are asymptomatic?

Approximately one-third of people with ITP are asymptomatic.

What percentage of people with ITP experience bleeding symptoms?

Approximately two-thirds of people with ITP experience bleeding symptoms.

What are some physical symptoms of ITP?

Petechiae in dependent areas, purpura with dry skin and wet mucous membranes, nonpalpable and nonpruritic mouth, epistaxis.

What is the percentage of severe or critical hemorrhage in ITP?

Severe or critical hemorrhage is less common, with intracranial hemorrhage occurring in 1.4% and other types in 9.6%.

What is von Willebrand's disease?

Most common inherited bleeding disorder due to a lack or dysfunction of clotting protein vW factor.

What are the inheritance patterns of von Willebrand's disease?

Various subtypes and autosomal (dominant/recessive) inheritance patterns.

What are some symptoms of mild von Willebrand's disease?

No symptoms unless challenged with NSAIDs, anticoagulants, etc. Bleeding or epistaxis lasting longer than 10 minutes in childhood.

What are some symptoms of type 1 and most of type 2 von Willebrand's disease?

Mild to severe mucocutaneous bleeding, easy bruising, bleeding with procedures (dental).

What are some symptoms of type 2 and type 3 von Willebrand's disease?

Mucocutaneous bleeding, joint, soft tissue, gastrointestinal, or surgical bleeding. Often presents during infancy (with circumcision).

What is hemophilia?

X-linked (males) recessive bleeding disorder. Hemophilia A is due to factor 8 deficiency, hemophilia B is due to factor 9 deficiency (Christmas disease).

What are some symptoms of hemophilia in infants?

Easy bruising, hemarthrosis (most common in ambulatory patients), oral bleeding or procedure-related bleeding. Infants may have CNS or extra-cranial bleed.

What are some symptoms of hemophilia in children?

Oral bleeding, bruising, joint bleeds, forehead hematomas.

What are some symptoms of hemophilia in adolescents/adults?

Joint (knee, ankle), muscle, CNS, oral, GI/GU tract bleeding.

Can heterozygous females (carriers) of hemophilia demonstrate symptoms?

Yes, heterozygous females (carriers) may demonstrate symptoms of hemophilia.

What is psoriasis?

Chronic plaque with symmetrical cutaneous plaques.

Where are the common locations for psoriasis plaques?

Scalp, extensor elbows, knees, gluteal cleft.

Where can psoriasis plaques also occur?

In intertriginous areas like auditory canal, umbilicus, palms, soles, and nails.

What do psoriasis plaques look like?

Erythematous plaques with sharply defined margins, under 1 to 10cm.

What is the characteristic feature of psoriasis plaques?

Thick, silvery scale that may be obscured by lotion or bathing.

What can happen to the palms and soles in psoriasis?

They may develop painful fissures.

What is a common symptom of psoriasis?

Pruritis (itching).

What is the relationship between psoriasis and arthritis?

Arthritis may precede skin lesions, causing joint pain and stiffness.

What are the different patterns of arthritis associated with psoriasis?

DIP, asymmetric oligoarthritis, symmetrical polyarthritis, and dactylitis.

What is the Koebner phenomenon?

Development of skin disease in sites of skin trauma.

What is the Auspitz sign?

Visualization of pinpoint bleeding after removing scale from a psoriatic plaque.

What are malignancies?

Cancerous growths in the body.

What is melanoma?

A type of skin cancer.

Where is basal cell carcinoma commonly found?

Mostly on the face or trunk.

What is the most common type of basal cell carcinoma?

Nodular.

How is basal cell carcinoma described?

Pearly, translucent often with telangiectasia.

What is a characteristic feature of basal cell carcinoma?

Rolled border (higher than center), central ulcer is common.

Where can squamous cell carcinoma appear?

On any cutaneous surface.

What are the different forms of squamous cell carcinoma?

Papules, plaques, or nodules.

How does squamous cell carcinoma appear on fair skin?

Smooth, hyperkeratotic, or ulcerated.

Where is actinic keratosis common?

Sun-exposed areas; fair skin.

What can actinic keratosis progress to?

Squamous cell carcinoma.

How does actinic keratosis appear?

Erythematous and scaly macules or papules.

What is erythema multiforme?

An acute, immune-mediated condition characterized by target-like lesions on the skin.

What are the symptoms of erythema multiforme?

Erosions or bullae involving the oral, genital, and/or ocular mucosa. Fever and arthralgias in severe cases.

How does erythema multiforme skin lesions appear?

Dark red inflammatory zone with a pale ring of edema and erythematous halo on the extreme periphery.

What is contact dermatitis?

A localized, inflammatory skin response to various agents.

What are the symptoms of contact dermatitis?

Pain, burning, stinging, or discomfort. Glazed, parched, or scalded appearance of the epidermis.

What are the characteristic features of contact dermatitis?

Scaling, hyperkeratosis, or fissuring over vesicular changes.

How does contact dermatitis improve?

When irritants are removed (decrescendo effect).

What is atopic dermatitis?

Chronic, pruritic, inflammatory skin disease.

What are the hallmarks of atopic dermatitis?

Dry skin and severe pruritus.

What is the age of onset for atopic dermatitis?

Generally under age 5.

What are the age considerations for atopic dermatitis?

0-2 years: extensor surfaces, scalp, cheeks; 2-16 years: flexor distribution with more lichenification; 16 years and over: localized and lichenified, flexor surfaces.

What causes hand-foot-mouth disease?

Coxsackievirus A.

What are the symptoms of hand-foot-mouth disease?

Mouth and throat pain, refusal to eat, possible fever, fussiness, emesis, abdominal pain, diarrhea.

What are the oral findings of hand-foot-mouth disease?

Erythematous macules progressing to vesicles with a halo of erythema; base turns gray-yellow after rupture; buccal mucosa or tongue.

What are the skin findings of hand-foot-mouth disease?

Macular, maculopapular, or vesicular rash with thin-walled, clear fluid; location on hands, feet, buttocks, legs, and arms.

Is hand-foot-mouth disease usually pruritic and painful?

No, it is usually non-pruritic and non-painful.

What is the incubation period for measles?

Around 2 weeks.

What are the prodrome symptoms of measles?

Fever, malaise, cough, coryza (rhinitis/rhinorrhea), conjunctivitis lasting 2-4 days.

What are Koplik spots and when do they appear?

Whitish, grayish, or bluish elevations with an erythematous base seen on the buccal mucosa 2 days prior to the rash.

What does the rash of measles look like?

Erythematous, maculopapular, blanching rash that starts on the face and spreads down the body.

Are the palms and soles usually involved in measles?

No, they are rarely involved.

What are other symptoms of measles?

Lymphadenopathy, splenomegaly.

What is Rubella?

Generalized maculopapular rash similar to measles.

What are the symptoms of Rubella?

Low grade fever, lymphadenopathy, nonexudative conjunctivitis.

How does the rash of Rubella spread?

Begins on face and spreads caudally over 24 hours, spares palms & soles.

What are the systemic issues in adults with Rubella?

Malaise and arthralgias.

What are the rare complications of Rubella?

Encephalitis and hemorrhage.