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20 Cards in this Set
- Front
- Back
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61. abdominal findings for Sickle Cell Anemia?
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a. Splenomegaly and children
b. absence of spleen and adults |
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62. chest findings for Sickle Cell Anemia?
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a. Rales or consolidation from infection or infarction.
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63. Extremity findings for Sickle Cell Anemia?
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a. Skin ulcers (unclear etiology in sickle cell)
b. aseptic necrosis of hip. |
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64. Neurological findings for Sickle Cell Anemia?
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a. Stroke, current or previous
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65. Next best step-treatment of sickle cell anemia?
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a. Oxygen
b. Hydration with normal saline continuously c. pain medication. |
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66. If a fever is present with sickle cell anemia, what else should you give?
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a. One of the following with the first screen:
1. ceftriaxone 2. levofloxacin 3. Moxifloxacin. |
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67. Is fever emergency in a patient with sickle cell disease?
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a. Yes, because the patient has no spleen.
b. Hence, for a question of “most urgent next step?” answer antibiotics when fever is present. 1. This is more important than waiting for results of testing |
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68. If it is a CCS question about sickle cell, one should you answer for what to order?
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a. Blood cultures
b. urine analysis c. reticulocyte count d. CBC e. chest x-ray f. Order all of these with the first screen as well, but if fever is present, do not wait for results. |
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69. When do you answer “exchange transfusion”in sickle cell disease? (4 key times)?
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a. Eye: visual disturbance from retinal infarction.
b. Lung: pulmonary infarction, leading to pleuritic pain and abnormal x-ray. c. Penis: priapism from infarction of prosthetic plexus of veins. d. Brain: stroke |
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70. A patient admitted for sickle cell crisis has a drop from her usual hematocrit of 34 to 26 over two days in the hospital. The reticulocyte count is 2%. What is the diagnosis? What is the most accurate test? What is the treatment?
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a. Answer: sudden drops in the hematocrit in sickle cell patients or those with hemoglobinopathy can be caused by parvovirus B19 or folate deficiency.
b. Sickle cell patients should universally be on folate replacement. c. If the patient is on replacement therapy, then the diagnosis shifts to parvovirus B19, which is an infection that invades the marrow and stops production of the cells at the level of the pro-normaloblast |
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71. most accurate diagnostic test for parvovirus?
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a. PCR for DNA of the parvovirus.
b. This is more accurate than IGM or IgG antibody testing or bone marrow. |
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72. Treatment of parvovirus infection in a sickle cell patient?
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a. Transfusions and IVIG.
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73. What should be prescribed when a patient with sickle cell anemia is ready for discharge?
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1. Folate replacement
2. pneumococcal vaccination 3. hydroxyurea to prevent further crises if they happen (>4x/year). b. Presentation of hemoglobin sickle cell (SC) disease? 1. This condition is like a mild version of sickle cell disease with fewer crises. 2. Visual disturbances is frequent. 3. Painful crises do not occur 4. renal problems are the only significant manifestation. |
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74. Renal manifestations of hemoglobin sickle cell disease?
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a. Hematuria
b. Isosthenuria (inability to concentrate or dilute the urine) c. urinary tract infections |
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75. Treatment of hemoglobin SC disease?
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a. There is no specific therapy for hemoglobin SC disease.
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76. Current presentation of sickle cell trait?
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a. Renal manifestations are the only finding
b. They are hematuria and a concentrating defect. |
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77. Presentation of autoimmune hemolysis?
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a. Look for other autoimmune diseases in history, such as SLE or rheumatoid arthritis.
b. Other clues are history of chronic lymphocytic leukemia (CLL), lymphoma, or medications such as penicillin, alpha-methyldopa, quinine, or sulfa drugs. |
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78. Diagnostic testing for autoimmune hemolysis?
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1. LDH
2. indirect bilirubin level 3. reticulocyte count b. each of the above three will be elevated with all forms of hemolysis. c. The haptoglobin level can be decreased in both intravascular and extravascular forms of home office. |
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79. Peripheral smear with autoimmune hemolysis will demonstrate?
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a. May show spherocytes
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80. most accurate diagnostic test for autoimmune hemolysis?
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a. Coombs test
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