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Leukemias Overview: ALL, CML, AML, APML, CLL Acute leukemias > 20% blasts in the peripheral blood smear or on bone marrow leading to a more rapid onset of symptoms. Chronic leukemia < 20% blasts with a relatively chronic onset of symptoms. ALL (Acute Lymphoblastic Leukemia): • Lymphocytes - T or B lineage • Immature • Age: 10 • 75% usually under 6 years age • 75% of ALL is of B-cell lineage ALL Symptoms: • Malaise, bleeding, infections, bone pain • Bulky lymphadenopathy • Blast cells - Blood and Bone marrow • Mature B-cell ALL can present as extramedullary disease, including gastrointestinal or testicular involvement • T-cell ALL: mediastinal mass • Rapidly rising blast cells - Blood & BM • Bulky lymphadenopathy • Cytopenia -> BM involvement • 30%: CNS involvement CML (Chronic Myeloid Leukemia): • Neutrophils (myeloid)↑ • Mature • Age: 40-60 • + (9;22) Philadelphia - BCR-ABL • ↑ Tyrosine Kinase activity • ↓ LAP Score • CML -> AML: Blast crises • Blasts > 10% leukocytes Blast Phase: • Headaches, bone pain, fever, joint pain, bleeding, infections, and lymphadenopathy CML Findings: • Splenomegaly • ↑ Leukocyte count ↑ PLT • ↑ PBS: Granulocytic cells in all phases of maturation • (Peripheral eosinophilia, basophilia, and thrombocytosis) CML Symptoms: • Fatigue, weight loss, abdominal fullness (splenomegaly), night sweats, bleeding • Pruritis after hot bath/showers • Lymphadenopathy AML (Acute Myeloid Leukemia): • Neutrophils • Immature/Myeloblasts • Age: 50-60 • Auer Rods Significant ↓ PLT: Petechiae, bruising, bleeding, infection RARE - Lymphadenopathy/HSM Leukocyte Count: • ↑ Can develop leukostasis syndrome: CNS manifestations, hypoxia, CXR - infiltrates (anemia, thrombocytopenia, or functional neutropenia) • Bone pain, dyspnea, gingival hypertrophy • Leukemia cutis (violaceous, nontender cutaneous plaques) AML Dx: • ↑ Leukocyte count • ↓Hg & PLT • Peripheral smear: Blasts APML (Acute Promyelocytic Leukemia): • Poorly differentiated leukocytes + distinctive primary granules • t(15;17) translocation • Significant bleeding: Fibrinolysis & DIC • Tumor lysis syndrome: Develops in treated pts. Intracellular Urate, Potassium and Phosphorus CLL (Chronic Lymphocytic Leukemia): • Lymphocytes • Mature • Age: 60-80 Clonal Accumulation of Mature B Lymphocytes: • In the peripheral blood, bone marrow and secondary lymphoid organs When Cancer Cells are in the Lymph Nodes: • Small lymphocytic lymphoma (SLL) CLL Symptoms: • Lymphadenopathy • HSM • Fevers • Drenching night sweats/fatigue • Exaggerated response to mosquito bites CLL -> Invade Skin: Leukemia cutis Labs: • Lymphocytosis/Cytopenias • AIHA, ITP, Agranulocytosis • Hypogammaglobulinemia, smudge cells Richter's Transformation: • Complication of Chronic Lymphocytic Leukemia (CLL) and/or Small Lymphocytic Lymphoma (SLL) • Sudden transformation of the CLL/SLL into a significantly more aggressive form of large cell lymphoma #Leukemia #Hematology #Oncology #Diagnosis

Comparing Osteoarthritis and Rheumatoid Arthritis #Osteoarthritis #Rheumatoid #Arthritis #Signs #Comparison #Features #Diagnosis

Lyme Disease - Diagnosis and Management Summary Lyme Disease Epidemiology: - Spirochete - Reservoir: small mammals & birds - Transmitted by Ixodes tick - Ixodes Scapularis in eastern and north regions of North America - Bimodal distribution: - 5-14 years old - 45-55 years old - Peak incidence: Summer months Lyme Disease Clinical Progression 1. Early Localized Disease: - Erythema Chronicum Migrans - Flu-like illness/fatigue - Swollen lymph nodes - Headache/stiff neck - Sore throat 2. Early Disseminated - Weeks to Months: - Neurological - Carditis 3. Late Disease (Months to Years): - Arthritis - Neurological features Lyme Disease Complications: • Neuroborreliosis: - Meningococcal-radiculitis - Meningitis - Meningo-encephalitis - Bell’s palsy - Vision changes - Pain, weakness, numbness • Carditis: - AV block: Fluctuating first-second-third degree block - Myopericarditis - LV failure - Pericarditis • Ocular: - Conjunctivitis - Keratitis - Iridocyclitis - Retinal vasculitis - Uveitis • Neuro: - Lyme encephalopathy - Polyneuropathy • Arthritis: - Large joints - Joint swelling/pain Lyme Disease Diagnosis: 1. Rash: distinctive enough to make diagnosis if living in an endemic area 2. ELISA: detects antibodies to B. Burgdorferi 3. WESTERN BLOT: to confirm the dx. Detects antibodies to proteins of B. Burgdorferi 4. LP-CSF: lymphocytic pleocytosis Lyme Disease Treatment: 1. Early: Doxycycline, amoxicillin 10-14 days 2. Early Disseminated: Doxycycline, amoxicillin or ceftriaxone for 14-28 days 3. Late: - IV ceftriaxone, cefotaxime or PCN G for 21 days for Neuro involvement - Oral doxycycline without Neuro disease By Dr. Ravi Singh @rav7ks #Lyme #Disease #Diagnosis #Management #treatment

Approach to Headache - Differential Diagnosis Framework Red Flags (SNOOPY) S: Systemic Symptoms N: Neuro Symptoms O: Onset - Sudden O: Older age of Onset >50 yo P: Prior Headache change Dr. Kristen Carroll @NUIM_Chiefs #Headache #Differential #Diagnosis #algorithm #neurology

Trigeminal Neuralgia [Tic douloureux] Clinical • Excruciating paroxysmal pain • Right > Left side • Precipitated by tapping nerve, eating, or movement • High rate of spontaneous remission Management • Carbamazepime (first line) • Gabapentin, Lamotrigine, Phenytoin • Surgical decompression #Trigeminal #Neuralgia #TicDouloureux #Diagnosis #Management #Headache

Causes of Headache - Differential Diagnosis Algorithm Primary: Tension, Migraine, Cluster Extracranial: Medications, Sinusitis, TMJ disorder, Cervicogenic, Glaucoma, Giant cell arteritis Vascular: Hypertension, Stroke, Venous trrombosis, Dissection, Aneurysm, Hemorrhage, Vasculitis, PRES, Moyamoya Infectious: Meningitis, Encephalitis, Abscess, Septic emboli, Toxoplasmosis Tumor: Primary, Metastatic disease CSF: Hydrocephalus, Pseudotumor Cerebri, Low CSF Other: Trigeminal neuralgia, Post-traumatic by Lauren Banaszak, MD @LaurenBzak via @uw_IMresidency #Headache #Differential #Diagnosis #Causes #algorithm

PERIPHERAL NERVE INJURIES #Diagnosis #Neurology #Peripheral #Nerves #UpperLimbs #Extremity #BrachialPlexus #Roots #Injuries #Deficits #Radial #Median #Ulnar #Axillary #Musculocutaneous #Comparison #Table

Cephalosporin Antibiotics • First Generation: Cefazolin, Cefadroxil, Cephalexin • Second Generation: Cefuroxime sodium, Cefuroxime axetil • Third Generation: Cefdinir, Cefixime, Cefotaxime, Ceftazidime, Ceftibuten, Ceftriaxone • Fourth Generation: Cefepime #Cephalosporin #Antibiotics #comparison #pharmacology #classification

Antifungal Azoles - Antibiotics Class Overview Mechanism: inhibit ergosterol synthesis (important component of fungal cell membranes) - Main metabolism is hepatic, main toxicity is elevated LFTs. - Only Fluconazole has adequate urinary penetration. Itraconazole has poor CNS penetration compared to the others. 1. Fluconazole(PO or IV) 2. Itraconazole(PO or IV) 3. Voriconazole(PO or IV) 4. Posaconazole(PO only) 5. Isavuconazole(PO or IV) #Pharmacology #Antibiotics #Review #Overview #Azoles #Antifungal #Fluconazole #Itraconazole #Voriconazole #Posaconazole #Isavuconazole

The Sympatho-Adrenal Response to Shock Showing the effect of increased catecholamines on the left of the diagram and the release of angiotensin and aldosterone on the right. Both mechanisms result in maintaining the cardiac output in shock. #Pathophysiology #Shock #Sympathetic #Adrenal #Response