Osce Review: Heme

Front 1

What are sx of anemia?

Back 1

fatigue, dizzy, lightheaded, DOE, HA, cold

Front 2

What neurological sx accompany B12 deficiency?

Back 2

paresthesias, abnl reflexes, confusion, numbness, decreased vibration, ataxia, vertigo

Front 3

What are signs of anemia

Back 3

*tachycardia *pallor
*ecchymosis *petechiae
*jaundice *orthostasis

Front 4

What labs should be done to evaluate for anemia?

Back 4

*CBC *retics
*peripheral smear
*stool - FOBT

Front 5

Define mild, moderate, and severe anemia with respect to Hgb.

Back 5

*mild: 10-12
*Mod: 8-10
*severe: <8

Front 6

Define the following lab vaules:
1. Hgb
2. HCT (% RBC in volume)
3. MCV (RBC size)
4. MCH (avg mass of Hbg/RBC)
5. MCHC ([Hgb]/RBC)
6. Retics
7. WBC
8. Plts
9. Albumin
10. RBC

Back 6

1. F: 12-16, M: 13-17
2. F: 35-45, M: 39-49
3. 80-100
4. 27-32
5. 32-36
6. 0.5-1.5%
7. 4.5-11
8. 150-400,000
9. albumin 3.5-5.5
10. F: 4-5.2; M: 4.3-5.6 (in general 4-5.5)

Front 7

If MCV <80 and MCHC <32 what type of anemia is this? Provide 3 examples

Back 7

*Microcytic & hypochromic
*Fe deficiency, anemia of chronic dz (late), sickle cell, thalassemia

Front 8

If MCV = 80-100 & MCHC = 32-36, what type of anemia is this. Provide 3 examples

Back 8

*normocytic & normochromic
*anemia of chronic dz (early), renal failure, autoimmune anemia

Front 9

If MCV >100 & MCHC >36, what type of anemia is this? Provide 3 examples

Back 9

*macrocytic & hyperchromic
*B12 def, FA def, liver dz, hypoTH, drugs

Front 10

What are common causes of iron deficiency anemia?

Back 10

*F: menses, Pg
*M: GI bleed
*worldwise: parasites

Front 11

What are sx of iron deficiency anemia?

Back 11

*PICA
*spooning of nails
*cheilosis (angular chelitis)

Front 12

What are the lab values for iron deficiency anemia for:
1. serum Fe
2. TIBC
3. ferritin
4. retics
5. transferrin

Back 12

1. low serum Fe (nl: 41-141)
2. high TIBC (250-400)
3. low ferritin (F: 10-150, M: 30-250)
4. no reticulocytosis
5. low transferrin (nl: 200-400)

Front 13

What is the treatment of iron deficiency anemia

Back 13

Ferrous sulfate (Feratab), iron salt, 325mg PO TID (on empty stomach, OJ = ok)

Front 14

What is the 2nd MCC of anemia and when is it dx?

Back 14

*anemia of chronic dz
*when a pt is hospitalized

Front 15

How can anemia of chronic dz be dx?

Back 15

*increased ferritin
*nl/low TIBC
*low transferrin
*low retics

**ferritin & TIBC differ from Iron deficiency**

Front 16

What is the treatment of anemia of chronic dz?

Back 16

*tx underlying conditions
*Darbepoetin alfa (Aranesp), recombinant human EPO, 0.45mcg/kg IV or SQ per wk

*Fe = CI (b/c ferritin is high)

Front 17

What situations lead to low levels of Vitamin B12?

Back 17

*low intrinsic factor (pernicious anemia)
*decreased in diet (vegan)
*gastric bypass
*Crohn's dz

Front 18

What are sx of Vit B12 deficiency?

Back 18

*neurological abnl
*smooth red tongue (glossitis)
*stocking glove distribution of peripheral neuropathy

Front 19

What diagnostic tests are utilized for Vit B12 deficiency?

Back 19

*hypersegmented PMNs
*Schilling test (absorption of B12)
*low serum B12 (279-996)

Front 20

What is the treatment of Vit B12 deficiency anemia?

Back 20

*Cyanocobalmin (12-Resin-K), Water soluble vitamin, 1mg qd x1wk, qwk x 1mo, qmo IM
(or 1-2mg PO qday)

Front 21

What are some conditions (4) that lead to folate deficiency & anemia?

Back 21

*diet
*Pg
*EtOH
*TMP/SMX

Front 22

What are sx and dx features of FA deficiency anemia?

Back 22

*sx = glossitis
*dx = hypersegmented PMNs, low serum folate (nl = 5.4=18)

Front 23

What is the treatment of FA deficient anemia?

Back 23

*Folic Acid (Folate), water soluble vitamin, 1-5mg PO qd x 4mo

Front 24

What are 3 characteristics of hemolytic anemia?
What are 2 types of hemolytic anemia?

Back 24

*increased reticulocytosis, hyperbilirubinemia, jaundice
*thalassemia, sickle cell anemia, immune-mediated (hot/cold)

Front 25

How can hemolytic anemia be diagnosed?

Back 25

*spherocytes & schistocytes
*Direct Coomb's test

Front 26

How are warm and cold antibody hemolytic anemia treated?

Back 26

*Warm = glucocorticoids
*cold = chemo

Front 27

Thalassemia:
1. MC type
2. common ethnicities
3. Tx

Back 27

1. MC = beta (overall = MC genetic disorder)
2. mediterranean, Africa, SE Asia
3. transfusion, Fe chelate (@ risk for overload)

Front 28

HIV/AIDS
1. cause
2. how the virus attacks
3. what to assess in a pt

Back 28

1. retrovirus
2. attach, fuse, reverse transcriptase, integration, assembly, bud
3. CD4 count (immune system health) & viral load (# of viron in blood)

Front 29

HIV/AIDS
1. dx
2. start ART

Back 29

1. HIV antibody test & confirm w/ Western Blot, CD4 <200 @ anytime or AIDS opportunistic infxn
2. Hx AIDS defining illness, CD4<350 (350-500), Pg, HIV associated neuropathy, Hep B coinfect

Front 30

Pharm tx of HIV
1. drug name
2. category
3. dose

Back 30

1. Atazanavir (Reyataz)
2. Protease inhibitor
3. 400mg PO Qd

Front 31

vonWillebrand Dz
1. describe
2. changes in labs

Back 31

1. MC inherited bleeding disorder
2. plt fx = prolonged, +/- PTT prolonged (nl = 26-40sec)

Front 32

Hemophilia
1. describe
2. lab changes

Back 32

1. x-linked, A = classic
2. prolonged PTT (nl 26-40sec)

Front 33

Describe Factor V Leiden

Back 33

*MCC thrombosis
*Factor V activates protein C

Front 34

Heparin Induced Thrombocytopenia (HIT)
1. Describe
2. Tx

Back 34

1. decrease plts below baseline (50%), clotting (antibodies venous/arterial), thrombocytopenia 5-10d after start hep
2. stop heparin, alternative anticoag

Front 35

Immune Thrombocytopenic Purpura (ITP)
1. describe
2. signs

Back 35

1. antibodies bind plts & increase clearance (rarely life threatening)
2. non-palpable spleen

Front 36

Disseminated Intravascular Coag (DIC)
1. describe
2. labs
3. tx

Back 36

1. use all clotting factors up --> bleed (pt = sick)
2. increase INR, increased PT (13-15 sec), increased PTT (26-40 sec)
3. life-threatening, transfuse

Front 37

Acute Myeloid Leukemia (AML)
1. Info
2. s/s

Back 37

1. immature cells, MC older adults, poor prognosis
2. fatigue, bruise, decreased wt, bone pain, bleed, pallor, splenomegaly

Front 38

AML
1. Dx
2. Tx

Back 38

1.Auer rods (myeloid blasts) pancytopenia, inc WBCs
2. refer, chemo

Front 39

Acute Lympohid Leukemia (ALL)
1. info
2. s/s

Back 39

1. immature lymph, MC in children
2. anemia, thrombocytopenia, fever/infxn, bone pain, HSM (hepatosplenomegaly)

Front 40

ALL
1. dx
2. tx

Back 40

1. bx
2. 50% cure w/ chemo

Front 41

Chronic myeloid leukemia (CML)
1. info
2. s/s

Back 41

1. mature myeloid (leukocytosis)
2. fatigue, night sweats, fever, decrease wt, splenomegaly, bleed

Front 42

CML
1. dx
2. tx

Back 42

1. Philadelphia chromosome, leukocytosis
2. refer, tyrosine kinase inhibitors, chemo

Front 43

Chronic Lymphoid Leukemia (CLL)
1. info
2. s/s

Back 43

1. MC form of leukemia, mature lymphocytes
2. HSM, lg lymph, bleed, B sx (fever, night sweat, decrease wt, fatigue)

Front 44

CLL
1. dx
2. tx

Back 44

1. Smudge cells
2. poor prognosis (6 yr survival), palliative

Front 45

Hodgkin's dz
1. info
2. s/s

Back 45

1. B cell (related to Epstein Barr virus), lymph --> non-lymph
2. lymphadenopathy, B sx (night sweats, fever, decrease wt, fatigue)

Front 46

Hodgkin's dz
1. dx
2. tx

Back 46

1. Reed-sternberg cells, CT scan
2. curable (chemo/rads)

Front 47

Non-Hodgkin's Lymphoma
1. info
2. s/s
3. tx

Back 47

1. pre B, pro T
2. diffuse lymphadenopathy
3. none, non-curable

Front 48

Multiple Myeloma
1. info
2. s/s

Back 48

1. plasma cell CA
2. CRAB (hypercalcemia (moans, groans, stones, bones), renal failure (bencee jones proteins), anemia, bone lesions), wt loss, pathological fx, recurrent infxn

Front 49

Multiple Myeloma
1. dx
2. tx

Back 49

1. Bencee Jones proteins (renal failure)
2. bisphosphonates, dexamethasone, rads, tx pain