Iron deficiency anemia: Diagnosis - ✔✔ - Serum Ferritin <12
- Caused by bleeding unless proved otherwise
- Responds to Fe therapy
Iron
... [Show More] deficiency anemia: S/S - ✔✔ Easy fatigability, tachycardia, dyspnea on exertion
Iron deficiency anemia: Treatment - ✔✔ Oral Iron (Ferrous sulfate 325mg PO daily), parenteral iron
What is hemolytic anemia? - ✔✔ group of disorders in which RBCs survival is reduced, either episodically or continuously
Hemolytic anemia lab values - ✔✔ Reduced haptoglobin
Aplastic anemia: essentials - ✔✔ Pancytopenia, no abn hematopoietic cells, hypocellular bone marrow
What is aplastic anemia? - ✔✔ A condition of bone marrow failure that arises from suppression of the hematopoetic stem cells
What happens to the bone marrow in aplastic anemia? - ✔✔ it becomes hypoplastic, failing to produce mature blood cells and pancytopenia develops
Causes of aplastic anemia - ✔✔ Autoimmune, congenital, chemotherapy, toxins, medications, post-viral hepatitis, non-hepatitis viruses (EBV, CMV), pregnancy
Aplastic Anemia: S/S - ✔✔ Weakness, fatigue, neutropenia causes vulnerability to infections
Aplastic anemia: physical S/S - ✔✔ Mucosal and skin bleeding - pallor, purpura, and petechiae
Aplastic Anemia: lab values - ✔✔ Pancytopenia (early only 1 or 2 cells may be reduced)
Aplastic Anemia: Treatment (mild) - ✔✔ Mild cases: supportive care including erythropoietic or myeloid growth factors, RBC transfusion, platelet transfusion PRN, abx to tx infx
Aplastic Anemia: treatment (Severe) - ✔✔ HLA-matched sibling is allogeneic bone marrow transplant
Chronic myeloid leukemia (CML): what is it? - ✔✔ Overproduction of myeloid cells - characterized by a specific chromosomal abnormality
CML: S/S - ✔✔ Fatigue, night sweats, low-grade fevers r/t hypermetabolic state caused by overproduction of WBCs, elevated WBCs, splenomegaly, sternal tenderness
CML: lab values - ✔✔ Markedly left-shifted (mature cells dominating) myeloid series but w/ a low percentage of promyelocytes and blasts
What gene is present w/ CML? - ✔✔ BCR/ABL gene (Philadelphia chromosome)
CML: Treatment - ✔✔ - Goal: normalization of the hematologic abnormalities and the suppression of bcr/abl-expressing clone
- Imatinib mesylate (tyrosine kinase inhibitor)
CML: prognosis - ✔✔ pts w/ good response to TKI, 100% survival
CML: complications - ✔✔ Extreme Hyperleukocytosis (priapism, respiratory distress, visual blurring, AMS) --> tx w/ emergent leukapheresis w/ myelosuppression therapy
DIC: essentials - ✔✔ Prolonged Pt, aPTT & a low fibrinogen - thrombocytopenia
DIC: what is it? - ✔✔ caused by uncontrolled local or systemic activation of coagulation, which leads to depletion of coagulation factors and fibrinogen, leading to thrombocytopenia
What disorders can cause DIC? - ✔✔ Sepsis, cancer, trauma, burns, pregnancy
DIC: S/S - ✔✔ Bleeding at multiple sites, purpura fulminans. Malignancy-related DIC may manifest principally as thrombosis (Trousseau syndrome)
DIC: lab values - ✔✔ Progressive thrombocytopenia, prolongation of the PT, dec. fibrinogen, elevation of aPTT, D-dimer elevated
DIC: tx - ✔✔ Tx underlying causative disorders must be treated, also achieve hemostasis Plt
If bleeding persists d/t severe consuption that requires excessive blood products, consider using ____________ - ✔✔ Heparin gtt
ITP: what is it? - ✔✔ Autoimmune condition where pathogenic antibodies bind platelets, accelerating their clearance from the ciruclation
ITP is a diagnosis of ______________ - ✔✔ Exclusion
ITP: essentials - ✔✔ Isolated thrombocytopenia, assess for causative medications, HIV, Hep B, Hep C infx
What is ITP? - ✔✔ Autoimmune condition in which pathogenic antibodies bind platelets, accelerating their clearance from the circulation
ITP: S/S - ✔✔ Mucotaneous bleeding, bruising, epistaxis, gingival bleeding
ITP: lab values - ✔✔ Isolated thrombocytopenia - if bleeding has occurred, anemia may also be present.
ITP: Treatment - ✔✔ Short course corticosteroids w/ or w/o IVIG, platelets are given if active bleeding
Fever of unknown origin (FUO): essentials - ✔✔ Illness <3w in duration, fever over 38.3 on several occasions, dx has not been made after 3 OP visits or 3d of hospitalization
Many _______________ can present as FUO - ✔✔ Cancers
What is the most common cause of FUO? - ✔✔ Infection
What imaging should someone w/ FUO have? - ✔✔ CXR, CT A/P
FUO: Treatment - ✔✔ Empiric antibiotics is sometimes considered
HIV: transmission - ✔✔ Sexual, parenteral, vertical transmission
HIV: S/S - ✔✔ Hairy leukoplakia of the tongue, disseminated Kaposi sarcoma, and cutaneous bacillary angiomatosis, generalize lymphadenopathy
HIV: lab values - ✔✔ ELISA (screening test), Western blot (confirmatory test), absolute CD4 lymphocyte count (predictor of HIV progression), HIV viral load (actively replicating HIV virus)
HIV: systemic complaints - ✔✔ Fever, night sweats, weight loss
AIDS: presentation - ✔✔ Anorexia, nausea, vomiting - resulting in weight loss and wasting syndrome
Many AIDS patients have a ____________ metabolic rate - ✔✔ Increased
How to slow AIDS wasting - ✔✔ Antiretroviral treatment (since it treats the underlying HIV infx)
Pneumocystis PNA - ✔✔ Most common opportunistic infx associated w/ AIDS
Pneumocystis PNA: symptoms - ✔✔ Fever, cough, SOB
What might you see on CXR on a pt w/ pneumocystis PNA? - ✔✔ Apical infiltrates
HIV prevention/vaccines - ✔✔ when handling bodily fluids - globes, gown, mask, goggles for procedures that may result in splashing
Kaposi Sarcoma - locations - ✔✔ Lesions (eyelids, conjunctiva, pinnae, palate, toe webs), can be visceral as well
Kaposi Sarcoma - mild (treatment) - ✔✔ no specific tx needed, usually resolve w/ effective antiretroviral tx
Kaposi Sarcoma - diagnosis - ✔✔ Shave biopsy (if HIV dx is not official)
What is another name for Kaposi Sarcoma? - ✔✔ Herpes virus-8
When does HIV become AIDS? - ✔✔ CD4 lymphocyte count < 200, HIV w/ an opportunistic infection or malignancies, dementia, wasting
What part of the body does HSV-1 affect? - ✔✔ Oral
What part of the body does HSV-2 affect? - ✔✔ Genitals
HSV S/S - ✔✔ Mucotaneous disease, ocular disease, neonatal and congenital infx, CNS disease, disseminated infx, esophagitis, erythema multiforme
What can be a cause of Bell's palsy? - ✔✔ HSV-1
How is herpes keratitis diagnosed? - ✔✔ by branching (dendritic) ulcers that stain w/ fluorescein
How do you decrease mortality in pts w/ HSV that have Meningitis? - ✔✔ IV acyclovir q8h for 10d [Show Less]