Source / episode info
- **Episode:**128
- **Published:**2019-07-28
- Source:Episode page
One-liner
This episode reviews high-yield patterns in hematologic malignancies (Myeloma, Leukemia), systemic vasculitis (GPA/MPA), connective tissue diseases (Scleroderma), and cardiac physical exam findings, emphasizing differential diagnosis over rote memorization.
High-yield summary
- Multiple Myeloma: Classic triad includes hypercalcemia, renal insufficiency, anemia, and bone pain due to osteoclast activation; lytic lesions are common. The mnemonic for associated cancers causing lytic lesions is L-T-R (Lung, Thyroid, Renal) + Multiple Myeloma.
- Acute Leukemias: Remember the age extremes: ALL in childhood/young adults; CLL in elderly patients. Smudge cells are pathognomonic for CLL.
- CML Management: CML is associated with the Philadelphia chromosome ({t}(9;22)) and BCR-ABL fusion protein, treated with a tyrosine kinase inhibitor (TKI) like Imatinib.
- Vasculitis Differentiation: Granulomatosis with Polyangiitis (GPA) is strongly associated with c-ANCA positive findings. Microscopic Polyangiitis (MPA) and other ANCA vasculitides are typically p-ANCA positive.
- Scleroderma Diagnosis: The limited form is characterized by the CREST criteria (Calcinosis, Raynaud's phenomenon, esophageal dysmotility, Sclerodactyly, Telangiectasia). Anti-centromere antibodies are associated with the limited form.
- Cardiac Murmur Workup: Any systolic murmur 2/6 or any murmur needs workup (Echo), unless it is a very faint systolic ejection murmur (1/6).
Learning objectives
- Differentiate between various acute and chronic leukemias based on age of onset, peripheral smear findings, and immunophenotype.
- Apply the mnemonic L-T-R to identify potential sources of lytic bone lesions in multiple myeloma.
- Distinguish between primary systemic vasculitides (e.g., GPA vs MPA) using specific ANCA antibodies and clinical presentations.
- Recognize the key features and associated antibodies for limited versus diffuse cutaneous systemic sclerosis.
- Interpret physical exam findings, particularly cardiac murmurs, to determine the necessity of advanced imaging (Echo).
Board exam buzzwords