1. Myelophthisic (phthinein Gk. to waste away): 
- Pushing of myeloprogenitor cells from BM into peripheral blood
- Caused by replacement of red marrow with fibrosis, granulomatous disease, or malignancy (primary, mets, lymphoma). Also marrow infections.
- You will see early myeloid forms on smear-- like nucleated RBCs
2. Testing for inherited thrombophilias:
- Do not test during or right after the acute thrombotic event-- it will influence the results of the tests.
- Anticoagulate first (i.e coumadin) then test 2 weeks after completion of the course.
- Test for: APC resistance, factor V leiden, Antithrombin III deficiency, prothrombin mutation, protein C and S deficiency, antiphospholipid antibodies
3. Antiphospholipid syndrome 
- Made up of 2 antibodies: lupus anticoagulant and anticardiolipin antibody
- Transient elevation of antibodies can be present after a viral illness. Thus you want to recheck levels 12 weeks apart (because if its positive, you commit someone to lifelong anticoagulation)
- Things that cause elevations: cancer, infections (i.e HIV), lupus, drugs (hydralazine, procinamide, phenothiazines such as perphenazine, chlorpromazine) -- however the latter will often be assoc with IgMs and not cause a hypercoagulable state
- In antiphospholipid antibody + people, annual risk of new VTE is 1% per year. In women with recurrent fetal losses, its up to 10%. In people with history of VTE and who have d/c'd anticoagulation within last 6 months.
- Causes increased risk of both venous and arterial clots.
4. Genetic hypercoagulability:
- Factor V leiden: assoc with resistance to activated protein C. Among white patients with first time symptomatic DVT, 12-20% are heterozygous for factor V leiden (vs 6% in control population)
- Prothrombin mutation (G20210A): prothrombin antigen/activity increased by 30%, among white patients with first time symptomatic DVT, 6% will have heterozygous G20210A, vs 2% control
- Hyperhomocysteinemia: increases venous and arterial clots, homocysteine levels depend on levels of folate, B12, and B6 (taking vitamins will lower plasma homocysteine levels) although supplementation of these vitamins has not been shown to reduce thrombotic events in these populations.
5. MGUS criteria + management: 
- M protein <3
- BM < 10% plasma cells
- No lytic bone lesions, no anemia, no hypercalcemia, no renal insufficiency (assoc with plasma cell dyscrasia)
- More than 5% of those over 80 may have this
- No treatment, just f/u M-protein levels-- the higher it is, the more likely it is to transform into MM
6. Multiple myeloma: need 1 major criteria or 3 minor criteria 
Major criteria:
- More than 30% clonal plasma cells on BM
- High M-protein (IgG <3.5, IgA >2)
- Bence Jones protinuria (urine protein > 1g/24 h)
Minor criteria:
- 10-30% clonal plasma cell son BM
- M protein < 3.5
- Lytic bone lesions
- Low levels of non-monoclonal proteins
7. Radiation proctitis- commonly occurs after radiation to pelvis.
- Clinical presentation: frequent loose stools, tenesmus
- Workup: flex sig
- Anticipated findings: mucosal telangiectasias, bx with submucosal fibrosis, arteriole endarteritis
- Natural history: acute - occurs within 6 weeks of radiation, self resolving after radiation is discontinued. Chronic- appears months to years after radiation, worse course.
8. Rome criteria for IBS
- 6 months of abd pain and changes in bowel habits, at least 3 days/month for 3 months.
Two or more of the following:
- Pain relieved with defecation
- Onset of pain related to a change in frequency of stool
- Onset of pain is related to a change in appearance of stool
9. Indication for antibiotics for salmonella diarrhea:
- Age <2 or >50
- Immunocompromised
- Severe illness that requires inpatient care
- Atherosclerotic plaques, implanted hardware or endovascular devices --these things can all be seeded.
10. OCP can cause cholestasis (will see increased direct bili and alk phos)