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127 Cards in this Set
- Front
- Back
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2 goals of Healthy People 2010
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1) increase quality and years of healthy life
2) eliminate health disparities |
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what is the purpose of Healthy People 2010?
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identify the most significant preventable threats to health and to establish national goals to reduce these threats
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Leading Health indicators established by Healthy People
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Physical Activity
Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care |
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Define term specificity and sensitivity
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Specificity: the proportion of people who are truly free of a specific disease
Sensitivity: the proportion of people who truly have a specific disease |
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Define Primary prevention
Examples |
Avoid the development of disease!
"Those provided to individuals provided to prevent the onset of a targeted condition" Examples: SBE prophylaxis, counseling- smoking cessation, std education; chemoprophylaxis, immunizations |
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Define Secondary prevention
Examples |
Focus is on early detection of asymptomatic disease that occurs commonly and has significant risk for negative outcome without treatment.
Activities are aimed at early disease detection, thereby increasing opportunities for interventions of the disease and emergence of symptoms Examples: cancer screening, mammography, |
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Define Tertiary prevention
Examples |
Reduces the negative impact of an already established disease by restoring function and reducing disease-related complications
Examples: rehabilitation, palliative surgical intervention |
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normal BMI
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18.5- 25
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overweight BMI
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25.1-29.9
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obese BMI
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> or =30
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Benefits of strength training
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increase strength
increase muscle mass improve posture decrease risk of osteoporosis increase functional status |
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Name barriers to preventive services
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-clinician time is very limited
-reimbursement patterns -illness oriented system -uncertainty among clinicians about what to do |
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how do you calculate BMI
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weight in pounds
divided by height in inches X height in inches multiplied by 703 |
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what are the top 2 leading health indicators for healthy people 2010
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physical activity
obesity |
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what medical condition is 1.9 times more likely to develop in a physically inactive person?
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Coronary heart disease
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There is strong evidence that states physical activity prevents or improves what medical diagnoses?
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Improves HTN, obesity, diabetes, mental health problems, and osteoporosis
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what are RED EYE red flags?
and other associated symptoms of red eye? |
*Photophobia (critical)
*Visual loss/visual changes (critical) *Pain (critical) * CALL THE OPTHALMOLOGIST ther associated symptoms: discharge h/a, n/v lesions, bumps (herpetic) allergies, URI symptoms itching, burning |
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Name some causes of red eyes
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conjunctivitis
eye lids/eye lashes corneal abrasions iritis scleritis/episcleritis glaucoma foreign body/trauma |
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Describe Allergic Conjunctivitis
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usually bilateral
severe pruritis degree of injection 2+, mild red eye moderate tearing discharge type- stringy, watery, thin mucoid |
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what is the treatment for allergic conjunctivitis?
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1) Systemic antihistamines
OTCs or prescription loratadine (claritin), fexofenadine (allegra), cetirizine (zyrtec) 2) Topical vasoconstrictor/antihistamine QID Naphcon-A; Vasocon-A 3) Topical antihistamine (Livostin) QID 4) Topical NSAID (Acular) QID |
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Describe Viral Conjunctivitis
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Bilateral or Unilateral
burning, general soreness degree of injection 4+ minimal pruritis, profuse tearing discharge type- watery *preauricular lymphadenopathy history of URI |
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what is the treatment for Viral Conjunctivitis?
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Handwashing
good hygiene time |
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Describe Bacterial Conjunctivitis
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symptoms unilateral or bilateral
burning, general irritation degree of injection 3+ (not as red as viral) minimal pruritis, moderate tearing discharge type- heavy mucopurulent lids may be adherent in the a.m. |
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What is the treatment for Bacterial Conjunctivitis?
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-Broad spectrum antibiotics
Fluroquinolone drops: moxifloxacin, ciprofloxacin, levofloxacin PolymixinB, trimethoprim (Polytrim) alternative For Hyperacute infections like gonorrhea, pseudomnas, chlamydia REFER OUT! |
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Describe a Hordeolum (STYE)
what's the treatment? |
-painful nodule, pustule of the eyelid
-usually caused by staphylococcal infection -obstruction/infection of the lash follicle gland -superficial, develops around skin surface Treatment: hot compress on eye oral diclox or TMP/SMX-ds |
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Describe a Chalazion
what's the treatment? |
-enlargement of an oil producing gland in the eyelid called meibomian gland. A chalazion forms when the gland opening becomes clogged with oil secretions.
-minimally tender nodule of the lid-usually symptom free -well demarcated nodule just below the lid margin -usually grayish discoloration visible on the conjunctival surface treatment: hot compress to eyelid |
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Describe Blepharitis
what's the treatment? |
an inflammation of the eye lash follicles, along the edge of the eyelid.
-staph (associated styes) -seborrheic (dandruff brows/scalp) Symptoms include: -irritation, burning and foreign body sensation -excessive tearing (epiphora) -photophobia, intermittent blurred vision -erythema of lid margins -seborrheic: dandruff (scurf)-scales around lashes (collarettes) -staph- eye lash loss, may have associated conjunctivitis Treatment: scrub lid with baby shampoo to remove collarettes and bacteria antibiotic ointment- erythromycin or bacitracin |
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Describe Orbit Cellulitis
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symptoms include:
-warm erythematous, tender swelling of the lids that may extend over the nasal bridge to the opposite side -visual loss, may have double vision -low grade fever and elevated WBC -proptosis (protrusion of the eye), restricted motility, sluggish pupillary reflex and decreased vision (secondary to optic nerve involvement) REFER FOR ADMISSION and ANTIBIOTICS |
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what are some causes of orbit cellulitis?
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URI-sinusitis
lid trauma superficial infection (stye, impetigo) conjunctivitis dacrocystitis |
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S/S of dacrocystitis
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inflammation/infection of tear duct
tearing (obstruction and infection) Pain (infection) discharge (infection) tenderness *CONSULT OPTHALMOLOGY |
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which has more pain?
episcleritis or scleritis? |
scleritis has severe pain
episcleritis had mild pain or no pain |
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Scleritis is associated with what?
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associated with exacerbation of potential serious systemic disease (rheumotologic diseases)
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S/S of episcleritis
*know how it's different from scleritis |
-ACUTE onset of redness, diffuse or sectoral
-no pain or mild pain described as dull ache in eye -visual acuity normal -recurrent episodes -vessels engorged, vascular pattern not disturbed -if nodule, MOBILE no discharge or corneal involvement |
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S/S of scleritis
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-GRADUAL onset, engorgement of vessels
-*severe PAIN with radiation to temple jaw -*photophobia and tearing -visual acuity normal or mildly decreased -globe tender to palpate -if nodule, NONMOBILE -associated with SYSTEMIC DISEASE *REFER TO OPTHALMOLOGY* |
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what areas of concern involving the cornea?
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clouding/opacity
ciliary flush abrasions dendrites- herpes simplex |
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If there are any signs of inflammation or infection of the cornea or internal eye, when should referral be made?
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within 24 hrs
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Describe Subconjunctival Hemorrhage
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acute dense "blood red" discoloration of the subconjunctival space
IF there was trauma: REFER -often occurs with valsalva maneuver -no treatment, usually resolves withing 2 weeks, check BP and clotting studies -occurs with HTN - |
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Describe Pinguecula
Describe Pterygium |
Pinguecula:
elevated fleshy conjunctival masses located in the interpalpebral region -most common nasal side, yellow/light brown -symptom free (inflamed) -associated with repeated trauma, dry and windy conditions Pterygium white mass extending to the cornea |
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when do you send a patient with a pinguecula to the opthalmologist?
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when it affects the iris
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Hyphema
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blunt trauma
decreased vision; pain |
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Iritis
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REFER to Opthalmology
s/s: redness, photophobia, pain vision is normal or decreased unilateral or bilateral conjunctival injection (ciliary around cornea constricted pupil usually associated with a systemic disease |
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Acute Glaucoma S/S
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EMERGENCY, send to opthalmology!
-intense ocular pain & photophobia -blurred vision, usually unilateral -halos seen around light fixtures -vasovagal symptoms- diaphoresis, n/v -middilated pupil -conjunctival injection and lid edema -cornea edema with blurring of the light reflex -IOP elevated 60-80mm Hg |
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Retinal Detachment
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EMERGENCY- needs surgery to preserve vision!
-fluid separates the retina from the underlyin retinal pigment epithelium symptoms: -flashes occur, floaters are seen -visual field loss, described as a curtain, shadow, or bubble of fluid -vision is wavy or distorted (metamorphopsia) -vision is decreased -relative afferent pupillary defect observed -visual field loss is unilateral -retinal hydration lines or rugae (appear like ripples on a pond) |
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Cataracts
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-clouding of the natural lens
-gradual loss of vision -colors may look dimmer and poor night vision is frequent -4/10 person >60 yrs develop cataracts Treatment: surgical removal -refer to opthalmology |
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Macular degeneration
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-deterioration of the macula
-slow or sudden painless loss of vision -straight lines may look wavy, vision seems fuzzy, shadowy areas in central vision -leading cause of blindness in ppl >65 yrs - no cure |
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serous otitis media
causes? |
fluid in middle without infection
etiology unclear but could be secondary to barotrauma, eustachian tube dysfunction, allergies, chronic ear infections, GERD -can affect speech and learning |
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what are some clinical singns and symptoms of serous otitis media?
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-not acutely inflamed, but appears to contain fluid
-complaint of fullness of ears and dereased hearing -usually hx of vira URI, flare of allergic or vasomotor rhinitis -asymptomatic -moderate conductive hearing loss of 25db -pneumatic otoscopy reveals immobile TM |
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risk factors of otitis media
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genetic predisposition (american indians, males, caucasians)
high risk pops (cigarette smoking, day care) |
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what is the preferred treatment of serous otitis media?
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watchful waiting (80-90% cases resolve spontaneously)
Systemic antibiotics for 10-14 days (amoxicillin, erythromycin, bactrim) Decongestants, antihistamines (not very helpful except topical nasal decongestant) |
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Acute otitis media
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-common bacterial illness in children
-fluid in middle ear space -s/s of acute local or systemic illnes -eustachian tube dysfunction -less that 2-3 weeks |
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Common organisms of acute otitis media
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-streptococcus pneumoniae
-haemophilus influenzae -m. catarrhalis -other less common: s. areus, b-hemolytic sreptococcus |
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Symptoms of actue otitis media
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-ear pain, recent history of URI
-TM injected (red), loss of luster, loss of landmarks, and possibly bulging, distorted light reflex - no edema or tenderness outer ear -hallmark of establishing a diagnosis: use of pneumatic otoscope- the TM is immobile |
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what is the management of acute otitis media?
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-pain relief the 1st 24 hrs
-observation on 1st 48-72 hrs -systemic antibiotic for 10 days Amoxicillin 80-90mg/kg/day, cephalosporins -tylenol or NSAIDS for otalgia (ear pain) recovery should occur in 1-4 weeks. If symptoms persist, REFER TO ENT to r/o subacute mastoiditis |
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what are complications of acute otitis media?
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-perforation of TM
-mastoiditis -cholesteatoma |
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Cronic otitis media
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-frequent acute otitis media (2 or more in 6 months or 3 in 12 months)
- possibly foul-smellin otorrhea -possible hearing loss |
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what are clinical manifestations of chronic otitis media?
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perforation
purulence, otorrhea conductive hearing loss retraction cholesteatoma |
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Cholesteatoma
what is the management? |
-skin tumor of the ear drum
-marginl peforations -posterior/superior quadrant of the TM -ossicle errosion *REFER TO ENT for surgical intervention and lifelong monitoring |
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what ear diseases must be refrerred to ENT?
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-recurrent otitis media
-chronic otits media -acute otits media unresponsive to antibiotics -suspect cholesteatoma |
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Otitis externa
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infection of outer ear and ear canal
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causes of otitis externa
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predisposing factors:
-wet external ear canal -anatomoical conditions (narrow, har ear canals, hearing aids, ear plugs) -mechanical injury such as bobby pins, cotton-tipped swabs -cereumen impaction -medical conditions such as dermatologic conditions (psoriasis) and DM |
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Clinical presentation of otitis externa
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erythematous, pus
-initially, pruritus, sensation of fullness with tragal tenderness -later- tender, edematous ear canal with purulent, often foul smelling discharge |
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how do you diagnose otitis externa
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history and physical
-if no improvement in 2 weeks, then obtain ear culture |
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what is the management of otits externa?
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-clean ear canal
-topical medications (acetic acid, antibiotics and steroid--cortisporin otic suspension, ofloxacin gtts) -heating pad -analgesics (opiates, tylenol 3) -systemic antibiotics- dicloxacillin |
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what is the follow-up time after intial treatment for otitis externa?
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follow-up in 3 days
REFER if recurrent! |
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What are complications and concerns of otitis externa?
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-osteomyelitis of temporal bone (pt may need to be admitted)
-elderly, diabetic, and immuno-compromised pt are at risk for necrotizing otitis externa cause by p. aeuruginosa -s/s: deep seated nocturnal pain, presence of granulation tissue in ear canal POTENTIAL MEDICAL ER |
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Conductive hearing loss
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component of anatomic structure of outer or middle ear involved
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sensorineural hearing loss
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-normally occurs from d.o of inner ear
-associated with cochlea, CN VIII, brain |
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Factors influencing rate of hearing loss
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genetics
meds infections exposure to noise disease (endocrine, systemic, metabolic systems, autoimmune d.o) |
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Ototoxicity
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hearing loss caused by drugs
-antineoplastics -salicylates -aminoglycosides -furosemide -quinine-related drugs |
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cerumen impaction
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#1 cause of hearing loss
causes: over producer, narrow canal, obstruction s/s: fullness, hearing loss, itching, discomfort, tinnitus, dizzines, p/e: light yellow dark brown mass; limited visualization of TM |
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what are inner ear disturbances?
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labyrinthitis
meniere's disease tinnitus |
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labyrinthitis
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acute unilateral labyrinthine dysfunction
severe vertigo, n/v, disequilibrium few days followed by vertigo/disequilibrium with rapid head movement for weeks to months |
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meniere's disease
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idiopathic, seen with both hearing loss and vertigo
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tinnitus
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ears ringing, percetion of sound when there is none
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A patient with allergic rhinitis typically has personal or family history of what other 3 diseases?
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1. asthma
2. eczema 3. atopic disease |
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what are the symptoms and the clinical presentation of allergic rhinitis?
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Symptoms: sneezing, rhinorrhea, nasal congestion, pruritus of nose ears eyes palate throat, popping of ears, post nasal drip, throat clearing, coughing, irritability, attacks of nasal blockage, severe cases (systemic: fatigue, h/a, cognition)
Clinical presentation: pale enlarged or boggy turbinates, clear watery nasal discharge, nasal polyps, allergic shiners, serous otitis, gelatinous conjunctival discharge in am, tonsils cobblestone |
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How do you diagnose allergic rhinitis?
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history
wright's stain (presence of neutrophils or esinophils) skin tests (patch or scratch) RAST (IgE radioallergosorbent test) |
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How do you manage Allergic rhinitis?
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-Internasal steroids ie fluticasone ii puffs QD
-oral antihistamines (ie loratadine, fexofenadine) -intransal antihistamines -montelukast (singulair)-leukotriene receptor antagonist- good for pts with coexisting asthma |
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How do you maximize nasal steroids for allergic rhinitis?
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take daily
point straight back 1 week to start working 3-4 weeks for max effect add antihistamines right away start meds months to a known season *pt must be on meds before they are referred to allergy clinic |
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Idiopathic Rhinitis
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symptoms occur year round
not caused by an infection or allergy etiology unknown Environmental triggers cause high reactivity of nasal membrane -exposure to cold bedrooms or bathrooms -stress -exercise -odors -spicy foods -sunlight -medications: beta blockers, ACE inhibitors Clinical presentation: year round nasal congestion with little discharge. if discharge, it is watery. Nasal mucosal erythema NOT associated with itching of eyes and nose or sneezing. if sneezing seen, it is a response to temp change. If polyps are seen, exclude idiopathic rhinitis, think allergic rhinitis. |
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How do you manage Idiopathic rhinitis?
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-intranasal steroids
-internasal antihistamines -environmental avoidance best treatment |
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Viral Upper Respiratory Infection (URI) aka cold
what are the symptoms? Treatment? |
Symptoms
-rhinitis and congestion -sore throat, cough, malaise -if a fever, low grade -lasts 3-7 days, but as long as 14 days -pharynx red and mildy edematous, but tonsils are nonexudative Treatment: supportive, treat symptoms with nyquil, good hygiene |
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Rhinitis Medicamentosa
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symptoms of nasal congestion resulting from chronic administration of sympatholytic drugs, NSAIDs, or topical decongestants (AFRIN)
-nasal mucosa suffers rebound engorgement through increased blood flow -cure is to discontinue medication -pt may need to use 1-2 weeks course of nasal steroids during withdrawal |
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what are the most common organisms that cause sinusitis?
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50-60% of sinusitis is caused by streptococcus pneumoniae and hemophilus influenzae
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what is the clinical presentation of a pt with sinusitis?
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-nasal congestion
-facial or dental pain -post nasal drip -headache -fever (occurs in less than half of adults) -yellow or green nasal discharge-thick and purulent -common cold, allergic, or idiopathic rhinitis antecedents to acute rhinitis -sore throat from post nasal drip -gastrointestinal symptoms -nasal turbinates erythematous and edematous -pharynx- post nasal drip, erythema, and lymphoid hypertrophy -eyes- may see periorbital swelling, erythema -ears-may have middle ear infections -pain with percussion over teeth |
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what are best predictors of acute sinusitis?
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- maxillary toothache
- history of colored nasal discharge (yellow or green) -purulent nasal secretion -poor response to decongestants -transillumination result (useful only if negative)--- normally sinuses transilluminate! If the sinus is filled with fluid or pus, there will be no transillumination |
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How would you make the diagnosis for acute sinusitis?
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H&P- eyes periorbital swelling,, nose, sinus palpation, teeth pain, pharynx, ears
Other diagnostic tests: -transillumination -xray sinus films -CT/MRI for diagnosis if diagnosis is difficult -CBC: increased WBC |
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Viral rhinosinusitis treatment
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antihistamine
NSAID decongestant or cough suppressant |
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Bacterial sinusitis treatment
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antimicrobial therapy (10-14 days)
high dose of amoxcillin therapy (80mg/kg/day) Augmentin cephalosporins decongestants (topical or systemic) saline washes |
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what are complications of sinusitis?
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orbital cellulitis
subperiosteal orbital abscess intracranial complication (meningitis, brain abscess) |
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what are the sinusitis subclassifications?
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- Acute sinusitis- resolves with treatment 2-3 weeks
-subacute >3 weeks but <3 months -chronic sinusitis- prolonged over extended time> 8 weeks |
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Chronic sinusitis
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results from acute sinus infection that has not completely resolved.
-nasal congestion, discharge and cough that last for 30 days |
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how many episodes of sinusitis despite treatment for 2 months should a patient be referred to allergy clinic for evaluation?
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4 or more episodes
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define pharyngitis
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infection or irritation of the pharynx and tonsils
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what are causes of noninfectious pharyngitis?
and causes of infectious pharyngitis? |
noninfectious:
-referred pain, trauma, cancer, psychosomatic illness, or irritation from dust, smoke, dryness, inhaled toxins Infectious: viruses, bacteria or uncommonly fungi or parasites common cause of bacterial infections are streptococcus pyogens and Group A Beta-hemolytic streptococcus (GABHS) |
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what are the clinical presentations of a noninfectious pharyngitis and infectious pharyngitis (viral & bacteria)?
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noninfectious pharyngitis
-sore throat -environmental allergens may report rhinorrhea, watery eyes, post nasal drip infectious pharyngitis (viral or bacteria -sudden onset of sore throat -fever or malaise -cough, h/a, myalgias, fatigue -GABHS- painful swallowing, n/v, abd pain |
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On physical examination, what would you see on a patient with viral pharyngitis compared to a patient with bacteria pharyngitis?
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Viral
-mild erythema with little or no exudate -painful or tender lymphadenopathy (not typical) Bacterial -marked erythema of throat and tonsils -patchy, discrete, white or yellowish exudate -tender anterior cervical adenopathy -uvula may be edematous -fever than 101 (not typical -occasionally GABHS seen with persistent erythematous sore throat with little fever and no exudate |
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How would you diagnose pharyngitis?
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-throat culture
-rapid antigen detection test (RADT) -ASO titer -CBC-reveals leukocytosis |
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what is the most common organism for acute pharyngitis?
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Group A Beta-Hemolytic Streptococcal (GABHS)
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what is the drug of choice to treat streptococcal pharyngitis?
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Penicillin V 500mg BID x7-10 days
alternative: azythromycin for PCN allergy |
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what are nonsuppurative complications of GABHS Pharyngitis?
and suppurative complications? |
nonsuppurative
-rheumatic fever -poststreptococcal glomerulonephritis suppurative -cervical lymphadenitis -peritonsillar or retropharyngeal abscess -sinusitis -mastoiditis -otitis media -meningitis -bacteremia -endocarditis -pneumonia |
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Peritonsillar Abscess
s/s |
Emergency! ENT needs to drain abscess!
-fever 102 or greater -chills, fatigue, malaise, fould breath -odynophagia (unable to swallow saliva or take liquids) -drooling -early dehydration -muffled "hot potato" voice -trismus (spasms of masticatory muscles) -systemic toxicity- acutely ill -marked edema, erythema of peritonsillar tissue and soft palate -tissue fluctuant and covered with exudate -almost always unilateral -tonsil displaced and downward and medially -uvula edematous and displaced to opposite side -tender cervical adenopathy, tachycardia, signs of dehydration -feelings of intense anxiety, agitation- signaling an emergent airway disaster |
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what is the managment of a peritonsillar abscess?
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SURGERY REQUIRED!
needle aspiration incision and drainage, or tonsillectomy Abx not sufficient! serious and potential complications; -abscess can result in airway obstruction -rupture of abscess with aspiration severe sequeale |
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Acute epiglottis
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EMERGENCY!
rapid onset of symptoms sore throat dysphagia muffled voice no URI symptoms fever may or may not be present drooling cervical adenopathy stridor respiratory distress tripod position-sitting up on hands with the tongue out and the head forward hypoxia mild cough severe pain on gentle palpation of larynx toxic appearance to pt |
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cause of mononucleosis
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epstein-barr virus, spread via respiratory routes, relatively intimate contact appears to be necessary
incubation period is 4-7 wks |
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what is the classic triad of symptoms with mononucleosis?
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Fever
exudative pharyngitis adenopathy (posterior cervical) other symptoms: fatigue eye lid edema h/a pain behind eyes pharyngeal erythema tonsillar hypertrophy white to gray-green exudate palatal petechial rash hepatomegaly and splenomegaly jaundice, not usual |
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how do you diagnose mononucleosis?
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CBC with differential
monospot sedimentation rate (ESR) consider LFTs throat culture (3-30% of patients with strept infection) |
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how do you treat mononucleosis?
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patient with streptococcal pharyngitis
-treat with erythromycin -do not treat with PCN may cause rash supportive care: -rest, fluids, NSAIDS -avoid use of ASA and contact sports, due to risk of subscapular splenic hemorrhage (1 month) |
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Apthous Stomatitis
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chronic inflammation of the oral mucosa tissue with ulcers (canker sores)
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how do you treat Apthous stomatitis (canker sores)?
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-hydrogen peroxide solution (1:1 solution)
-xylocaine (lidocaine 2%) viscous solution-- apply to lesions every 3 hrs or use 15ml as a gargle or mouth wash and swallow every 3 hrs, max dose 8 doses QD -benadryl elixir mixed 1:1 kaopectate or aluminum hydroxie or maalox -kenalog paste -tetracycline syrup -avoid spicy, acidic foods and drinks -inform pt that they are not contagious |
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How do you treat an abscess?
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lance the abscess
(abx cannot penetrate the abscess) |
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what is the treatment for cellulitis?
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-elevate the affected extremity
*treat or not treat for MRSA? -if they have had it before -if they are at risk -if the community rate of cultured cellulitis has a 30% or greater rate of MRSA -if they are really sick -if not likely MRSA- Kelflex 500mg Q6 or dicolxacillin 500mg Q6 -if MRSA likely-clindamycin 300mg Q6 or PCN 500mg Q6 plus Septra or doxycycline |
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when do you admit a patient with cellulitis?
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admit if they are sick, or if the cellulitis has progressed quickly
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what is the treatment for erysipelas?
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if systemically ill, admit to hospital
-with mild infection, it can be treated with erythromycin, cefazolin, augmentin, azithromycin |
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what is the difference between cellulitis and erysipelas?
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cellulitis: deeper infection, deep dermis and subcutaneous fat, acute onset, constitutional symptoms
erysipelas: more superficial and clear demarcation, slow, insideous onset |
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when should you consider abx for cellulits?
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when abscess is > 5cm in size
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what is red flag with an abscess?
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abscess or infection over a joint is a red flag
-infections in joints destroy joints -any red, hot joint require a needle aspiration to evaluate the synovial fluid and IV abx |
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what population is at risk for MRSA?
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people who are immunosuppressed, who have wounds, catheters, drains, and non-intact skin
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what Hgb lab value indicates anemia for men? and for women?
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Men Hgb < 14g/dl = anemia
Women Hgb < 12g/dl = anemia |
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what lab values of MCV indicate normocytic , marocytic, and microcytic?
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Macroctyic >100
Normocytic 80-99 Microcytic <80 |
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what are causes of macrocytosis?
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-increase in number of reticulocytes
-alcoholism -deficiency of folic acid or vitamin B12 -antiviral treatment of HIV infection -use of chemotherapeutic agents -presence of the myelodysplastic syndrome -megaloblastic anemia -pernicious anemia |
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what are causes of microcytosis?
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-Fe deficiency
-congenital -thalassemias -anemia of chronic disease -lead poisoning -copper deficiency |
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What does the USPSTF recommend for screening for Fe deficiency?
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No USPSTF recommendations for routine screening for Fe deficiency anemias, however!!!
**USPSTF reccommends screening for Fe deficiency anemia in asymptomatic pregnant women *don't order labs without an indication |
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what are red flags for anemia?
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attention to bleeding
history of cancer weight loss |
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what is the most common cause of malabsorption of B12?
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pernicious anemia
(macrocystc anemia) |
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what lab indicates if a macrocytic anemia is B12 deficient or folate deficient?
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MMA is elevated in B12 deficiency
MMA is normal in folate defiiciency Homocysteine is elevated in both! |
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if a postmenopausal woman or man has iron deficiency anemia, what should you suspect?
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GI bleed
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