Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
74 Cards in this Set
- Front
- Back
|
CC: easy bruisability, petechia, purpura
what do you think? What exams do you perform? |
1. aplastic anemia
2. anemia of bone marrow malignancy exams: skin, ENT, rectal and listen to heart and lungs |
|
|
CC: SOB, fatigue and palpitation after exercise
what exams do you perform? |
mild and or chronic anemia
exams: cardiac, lungs, ENT, skin |
|
|
CC SOB, palpitations, bounding pulse, tachycardia, feel faint when rising, CHEST PAIN
what exams do you perform: |
sever anemia being compensated with high cardiac output
exams: CARDIAC, lung, skin ENT, rectal |
|
|
CC: HA, dizzy, SOB, irritable, difficulty concentrating, roaring in ears or humming in head?
what exams? |
most likely severe anemia due to cerebral hypoxia
exams: neurologic, musculoskeletal, cardiac, pulmonary, ENT |
|
|
CC: unsteady gait, dementia, peripheral neuropathy?
what exams? |
most likely B12 deficiency
exams: neurologic, musculoskeletal, ENT, skin |
|
|
CC: loss of appetite, abdominal pain, indigestion, nausea
what exams? |
severe anemia
exams: ENT, abdominal, cardiac and lung sounds |
|
|
CC: burning sensation in tongue?
exams? |
B12 or folate deficiency
exams: ENT, skin, neurologic, cardiac and lung sounds |
|
|
CC: Pica esp pagophagia
what exams? |
Fe deficiency
exams: ENT, skin, rectal/vaginal for bleeds, cardiac and lung sounds, neurologic |
|
|
CC: bone pain
what exams |
sickle cell, multiple myeloma or acute leukemia
exams: ENT, skin, abdomen (hepatosplenomegaly) |
|
|
Based on Age?
infant middle age elderly |
infant=thalassemia major or sickle cell
middle age=alpha or beta thalasemmia elderly=pernicious anemia |
|
|
Based on mode of onset?
asymptomatic? gradual? rapid? |
asymptomatic=alpha or beta thalassemia
gradual=anemia of decreased production (ex. Fe, B12, folate) Rapid=hemolytic anemia(ex. autoimmune, transfusion rxn, G6PD, TTP, acute blood loss) |
|
|
what does a recent abnormal CBC indicate?
|
that it is acquired
|
|
|
what are some common anemias of african americans?
|
sickle cell and G6PD
|
|
|
what are some common anemias of african, mediterranean and SE asian?
|
thalassemia
|
|
|
what are some common anemias of middle eastern and mediterranean?
|
G6PD
|
|
|
what are common anemias assoc with alcoholics?
|
-folate
-b12 -Fe defic from chronic liver failure -sideroblastic anemia |
|
|
what are common anemias of fad diets and tea and toast diets in the elderly?
|
folate defic
|
|
|
what are some common anemias of vegetarians?
especially when menstruating? |
fe defic
|
|
|
what are some common anemias of house painters?
|
lead poisoning
|
|
|
what are some common anemias of chemists, furniture refinishers, xray techs?
|
aplastic anemia
|
|
|
what is a cause of anemia from tropical countries?
|
malaria
|
|
|
what are some common hereditary anemias?
|
-sickle cell
-thalassemia -spherocytosis -G6PD |
|
|
what is a common anemia of a long distance runner?
|
fe def
|
|
|
if someone has peptic ulcer, colon cancer, gastritis or GI bleed what anemia shoudl you think of?
|
Fe deficiency
|
|
|
if someone has black tarry stool what should you think?
if someone has gros blood in stool (hematochezia) what should you think? |
upper Gi bleed
lower gi bleed |
|
|
if someone has had a hx of resection of stomach, sprue or crohns dz, what should you think?
|
malabsorption of B12
|
|
|
if someon has dry skin and hair, difficulty concentrating, weight gain, constipation, cold intolerance and hoarseness what condition should you think?
|
hypothyroidism
|
|
|
what type of anemia can hypothyroidism cause?
|
macrocytic
|
|
|
if someone has a hx of rheumatoid arthritis what anemia should you think?
|
anemia of chronic dz
|
|
|
if someone has hx of SLE what type of anemia do they have?
|
hemolytic anemias
|
|
|
if someone has h of pyelonephritis, renal stones, DM or HTN what can you think?
|
anemia caused by renal failure (chronic dz)
|
|
|
if a woman complains of bleeding in b/w periods, post menopausal bleeding, clots in blood then what anemia?
|
fe deficiency
|
|
|
if someone has chronic infections such as TB what should you think?
|
anemia of chronic dz
|
|
|
what should you check on skin exam?
|
palms, nailbeds, ankles
|
|
|
what if you find ulcers on ankle?
what other findings? |
ankle ulcers=sickle cell
general signs of anemia=pallor, brittle flat nails, |
|
|
what should you check in the head?
|
eyes, oral cavity and face xray(if suspect thalasemmia or sickle cell)
|
|
|
what are general signs of anemia indicated by eyes and oral cavity?
what does glossitis indicate?(what finding w/ glossitis supports dx) what does xray help dx? |
pallor of conjunctiva and mucous membranes are general
glossitis dx b12 or folate def cheilosis is also b12 and folate def xray to dx thalassemia major and sickle cell |
|
|
what will x ray show for?
thalasemmia major sickle cell |
thalassemia major=chipmunk facies
sickle cell=frontal bossing |
|
|
what dx findings will support severe anemia?
|
*increase HR
*sys ejection murmur (NOT holosystolic) in pulmonic area |
|
|
what can sternal tenderness support?
|
leukemia or multiple myeloma
|
|
|
what does splenomegaly support?
|
leukemia(chronic myelogenous or lymphocyte)
or hemolytic anemia(thalassemia major, herediatry spherocytosis |
|
|
what are some hematologic causes of splenomegaly?
|
*lymphoma
*CLL and CML *acute Leuk *polycythemia vera *hemolytic anemia such as thalassemia major |
|
|
what are some other causes of splenomegaly?
|
*congestive states
*infectious dz(mono, malaria) *storage dz) *connective tissue disorder such as SLE, rheum arthritis |
|
|
what is the only anemia with neurologic deficiency?
|
B12
|
|
|
what are some findings that support B12?
|
-peripheral neuropathy
-pos rhomberg -hyperreflexia -dementia ane memory loss |
|
|
what does a positive guiaic test support?
|
Fe deficiency
|
|
|
what are the microcytic anemias?
|
TAILS
Thalassemia anemia of chronic dz Iron Def Lead Poison Sideroblastic |
|
|
what are normocytic anemias
|
*early Fe defic
*aplastic anemia *anemia of chronic dz *chronic renal failure |
|
|
what are causes of macrocytic?
110-115 MCV 100-110 MCV? |
110-115
*B12 and folate def 100-115 *hypothyroidism *liver dz, alcoholism *aplastic anemia |
|
|
when shold you order a bone marrow bx?
what are two possible dx |
if there is pancytopenia (decreased Hgb, platelet and WBC)
aplastic anemia=low cellularity or bone marrow cancer=high cellularity |
|
|
what are causes of hemolytic anemia?
|
-Sickle cell
-DIC/TTP -Prosthetic heart valves -Thalassemia -warm and cold autoimmune -G6PD |
|
|
Systematic approach to CBC:
|
1. Hgb(anemic)
2. MCV(norm, macro, micro) 3. platelet count(thrombocytopenia) 4. WBC *if WBC, Hgb and platelet all low DO BIOPSY 5. is reticulocyte count high(hemolytic) 6. what is WBC(leukocytosis or leucopenia) |
|
|
what are three causes of thrombocytopenia?
|
1. aplastic anemia
2. marrow replacemnt 3. drugs(heparin) |
|
|
what are tests of coagulation?
|
aPTT for intrinsic(hemophilia A(VIII) and B(IX), Vit K and liver failure
and PT for extrinsic VWD and DIC |
|
|
what is tx for Fe defic anemia?
|
Oral or Parenteral Fe and increase diet
|
|
|
what is the tx of chronic dz anemia?
|
1. erythropoietin w/ oral Fe b/c erythro incresaes need for Fe
2. tx underlying dz |
|
|
what is clinical presentation of lead poisoing in kids?
in adults? |
kids=ADD, hyperactive, acute encephalopathy
adults=periph neuropathy |
|
|
if a periph smear show prominent basophilic stippling in RBC's what does this indicate?
|
lead poisoning
|
|
|
how is sickle cell inherited?
what are three major signs and sx of sickle cell? |
autosomal recessive
s&s= dactylitis, acute painful crisis and splenic sequestration |
|
|
what is the most impt cause of death in kids with sickle cell?
|
infection
|
|
|
what type of anemis is assoc with HgH dz or Hgb Barts?
|
thalassemia minor alpha
|
|
|
how is G6PD inherited?
how is this usually treated? |
x linked recessive
is self limited hemolytic crisis caused by oxidant stressor |
|
|
what does a periph smear of a bulls eye appearance show?
|
thalassemia major or minor
|
|
|
what does an Hgb A2 band indicate?
an HgbS band? |
Hgb A2=thalasemmia
Hgb S=sickle celll |
|
|
what med is Rx's to decrease mortality and painful crisi in sickle cell?
what is tx of painful crisis of sickle cell? |
hydroxyurea
painful crisis="MOHA" (morphine, oxygen, hydration and antibiotics) |
|
|
what are drugs w/ low respiratory depression risk to use in tx of painful crisi in sickle cell?
|
1. ketorolac
2. ultram(tramodol) |
|
|
what therapy may worsen thalasemmia minor?
what is a major complication of thalassemia major? |
Fe therapy
major=IRON OVERLOAD from reg transufion of packed RBC/s |
|
|
what is the leading cause of disability in sickle cell patients?
what is a major complication? |
leg ulcers cause disability
rhabdomyolysis is major complication along with pulm, renal, bone problems and priapism |
|
|
what is the median life expectancy of sickle cell homozygotes?
of thalassemia major? |
sickle cell is forties
thalassemia major is 20's unless bone marrow transplant |
|
|
what are causes of warm autoimmune acquired hemolytic anemia?
|
primary=unknown
secondary from dz, drugs, infection, SLE |
|
|
what are causes of cold autoimmune hemolytic anemia?
what are two major infections that can cause cold autoimune |
chronic or acute(post infection)
1. mycoplasma pneumonia and EBV |
|
|
what test can be used to dx warm/cold autoimmune hemolytic anemia?
|
comb's test
|
|
|
if you find schistocytes on a periph smear what are possible causes?
|
1. prosthetic heart valve
2. DIC 3. TTP-HUS |
|
|
what causes schistocytes in DIC and TTP-HUS?
what causes schistocytes in heart valves? |
DIC/TTP= Rbc's torn as pass through clots
Valves=turbulent blood flow |
