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Acute & Chronic I > Test 2 > Flashcards

Test 2 Flashcards

1
Q

causes of microcytic anemia

A

iron deficiency anemia, anemia of chronic disease, thalassemia, sideroblastic anemia

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2
Q

causes of normocytic anemia

A

anemia of chronic disease, acute blood loss, hemolytic anemia, aplastic anemia

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3
Q

causes of macrocytic anemia

A

folate deficiency, vitamin B12

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4
Q

this affects the formation of hemoglobin

A

iron

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5
Q

Iron supplement or replacements are contraindicated for anemia associated with

A

thalassemia

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6
Q

patients with excessive iron are encouraged to

A

drink tea

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7
Q

anemia of chronic disease is though to be a

A

reduction in RBC production and shorter RBC lifespan

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8
Q

pica for ice is a common symptom of

A

iron deficiency anemia

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9
Q

Rheumatoid arthritis relation to anemia

A

meds for it can cause bone marrow suppression

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10
Q

patients who have mononucleosis can develop a rash if given

A

amoxicillin

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11
Q

difference in prognosis in children and adults with idiopathic thrombocytic purpura

A

develops after a viral infection or allergic reaction in children is has a spontaneous recovery

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12
Q

causes of thrombocytopenia

A

mono, H.pylori, liver disease, alcohol, vitamin B12 and folate deficiency, RA, SLE, pregnancy

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13
Q

atbx that can cause thrombocytopenia

A

PCN, sulfa, fluconazole

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14
Q

CV drugs that can cause thrombocytopenia

A

digoxin, HCTZ, statins

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15
Q

GI drugs that can cause thrombocytopenia

A

pepcid, ranitidine (Zantac), cimetidine (Tagamet)

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16
Q

neuro drugs that can cause thrombocytopenia

A

anticonvulsants

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17
Q

Drug that decreases effect of Plavix

A

PPI

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18
Q

the action of aspirin and NSAIDs

A

inhibit COX enzyme from releasing prostaglandins

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19
Q

aspirin and NSAIDs can cause GI irritation as it affects

A

COX1 that protects gastric mucosa

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20
Q

why ASA is preferred over iburpofen for heart attack prevention

A

aspirin irreversibly inactivates COX and thromboxane for the life of the platelet, while ibuprofen only inactivities it for the drug’s halflife.

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21
Q

blood smear in leukemia

A

high blast cells and decreased neutrophils and platelets

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22
Q

presence of this on a blood smear is abnormal and should be referred to a heme-onc

A

blast cells

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23
Q

cause of neonatal jaundic

A

increased turnover of RBCs produces more bilirubin

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24
Q

breast milk jaundice occurs

A

first 3-5 days of life and peaks within 2 weeks

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25
Q

breast milk jaundice

A

infant is normal, and breastfeeding should not be stopped.

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26
Q

s/s of lead poisoning

A

behavioral and developmental issues, hemolytic anemia, abd pain

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27
Q

lead poisoning effect on vitamin D

A

inversely related; high lead can cause effects in bone and tooth development in kids

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28
Q

high levels of this is associated with heart disease

A

homocysteine

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29
Q

folic acid deficiency may cause

A

heart disease

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30
Q

folic acid reduces the amount of

A

homocysteine

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31
Q

ACD is common in those with

A

RA

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32
Q

ACD is marked by low ____ but normal or elevated ____

A

serum iron; total iron stores

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33
Q

iron stores in IDA and ACD

A

low in IDA and normal in ACD

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34
Q

life threatening condition resulting from bone marrow stem cell failure

A

aplastic anemia

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35
Q

meds associated with aplastic anemia

A

PCN, cephalosporin, sulfa, antidepressants, NSAIDs, anticonvulsants

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36
Q

diagnostic for aplastic anemia

A

low WBC, platelets, RBCs

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37
Q

treatment for children and younger patients with aplastic anemia

A

bone marrow transplant

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38
Q

treatment for adults > 40 with aplastic anemia

A

immunosuppresion therapy

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39
Q

toxins associated with aplastic anemia

A

insecticides, benzene

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40
Q

G6PD is usually precipitated by

A

infection or drug

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41
Q

G6PD is a

A

X-linked recessive disorder

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42
Q

meds that can precipitate G6PD deficiency

A

sulfa, aspirin, nitrofurantoin, Bactrim, fava beans

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43
Q

screening test for G6PD in an acute hemolytic event

A

may be negative for several weeks

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44
Q

factor VIII deficiency

A

hemophilia A

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45
Q

factor IX deficiency

A

hemophilia B

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46
Q

inheritance of hemophilia

A

x-linked recessive and only affects males

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47
Q

treatment for von willebrand disease

A

desmopressin

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48
Q

diagnostics of von willebrand disease

A

normal PT and aPTT, decreased vWF antigen

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49
Q

diagnostics for hemophilia

A

normal PT & thrombin, prolonged pTT

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50
Q

trx for hemophilia

A

desmopressin

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51
Q

most common gene mutation leading to VTE

A

factor V leiden

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52
Q

treatment for DVT

A

heparin & LMWH, then Warfarin for 3 months

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53
Q

marker of hemoglobin catabolism

A

bilirubin

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54
Q

direct cellular injury results in

A

high serum LDH

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55
Q

conditions that increase reticulocyte counts

A

hemolytic anemia, acute blood loss, hypersplenism, after trx of iron, folic acid, or vitamin B12

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56
Q

conditions that decrease reticulocyte counts

A

iron deficiency anemia, aplastic anemia, megaloblastic anemia

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57
Q

reflects total body iron stores

A

serum ferritin

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58
Q

first lab value to become abnormal when iron stores are becoming depleted

A

serum ferritin

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59
Q

Serum ferritin levels are ____ in iron deficiency anemia and ______ in anemia of chronic disease.

A

low; normal or elevated

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60
Q

reflects the amount of iron bound to transferrin

A

serum iron concentration

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61
Q

variation in RBC size

A

Anisocytosis

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62
Q

variation in RBC shape

A

Poikilocytosis

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63
Q

chief cause of anemia in children less than 1

A

iron deficiency anemia

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64
Q

iron studies in iron deficiency anemia

A

low iron, low ferritin, low transferrin, high TIBC, low reticulocyte count

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65
Q

s/s of anemia

A

fatigue, conjunctival pallor, brittle nails, tachycardia, cold intolerance

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66
Q

measure of the variability of the RBC size

A

RDW

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67
Q

education about iron supplementaion

A

take 1-2 hours before meal on empty stomach,
Don’t take with antacid or dairy
Keep out of reach of children- toxic

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68
Q

causes an overproduction of specific chains in the Hgb molecule causing hemolysis

A

thalassemia

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69
Q

very severe form of thalassemia and rarely live into adulthood

A

Cooley’s (Major) anemia

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70
Q

thalassemia is

A

autosomal recessive

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71
Q

labs for thalassemia

A

microcytic, hypochromic anemia with normal ferritin

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72
Q

trx for thalassemia

A

prevent iron overload

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73
Q

common sign of lead poisoning in adults

A

peripheral neuritis

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74
Q

diagnostic of lead poisoning

A

lead level > 10, anemia, high creatinine

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75
Q

connects muscle to bone

A

tendon

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76
Q

connects bone to bone

A

ligament

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77
Q

presence of howell-jolly bodies in

A

sickle cell

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78
Q

important for those with sickle cell to recieve

A

folic acid supplementation

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79
Q

common complications of sickle cell

A

stroke, heart disease, renal failure, skin ulcers

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80
Q

vitamin B12 absorption cannot occur without

A

intrinsic factor

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81
Q

s/s of pernicous anemia

A

disorientation, N/T, abnormal reflexes

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82
Q

those with vitamin B12 deficiency will also have these elevated

A

homocysteine and MMA

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83
Q

dietary changes for vitamin B12 deficiency

A

increase protein

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84
Q

Trx for vitamin B12 deficiency

A

vit B12 1000 mcg IM once a day for a week, then weekly for a month, then monthly for life.

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85
Q

those with pernicious anemia should also have

A

endoscopy every 5 years

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86
Q

atrophic glossitis is present in

A

vitamin B12 and folic acid deficiency

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87
Q

vitamin B12 and folic acid deficiency has ___ Hgb, ___ Hct in, and ___ MCV in

A

normal; low; high

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88
Q

food high in folic acid

A

green leafy veggies

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89
Q

in neonatal hyperbilirubinemia, there is an accumulation of

A

unconjugated bilirubin

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90
Q

risk factors for neonatal hyperbilirubinemia

A

prematurity, Rh and ABO incompatibility

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91
Q

s/s of neonatal jaundice

A

appears on head first then progresses down, resolve in opposite direction

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92
Q

elevated bilirubin can be

A

neurotoxic

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93
Q

trx for neonatal jaundice

A

increase breastfeeding, phototherapy

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94
Q

Rh incompatibility occurs with a

A

Rh- negative mom and Rh- positive fetus

95
Q

s/s of Rh incompatibility

A

jaundice, anemia, hydrops fetalis

96
Q

In Rh incompatibility, the ___ Coombs is positive in the mom and the ____ Coombs is positive in the infant

A

indirect; direct

97
Q

RhoGAM is given to Rh-negative mothers at

A

28 weeks, 72 hours after delivery of Rh+ infant, after ectopic pregnancy

98
Q

does not eliminate the possibility but decreases likelihood

A

RhoGAM for Rh incompatibility

99
Q

when all other causes of thrombocytopenia must be r/o

A

ITP

100
Q

acute ITP occurs in

A

children 2-9

101
Q

chronic ITP occurs in

A

those more than 50 y/o

102
Q

in ITP the peripheral smear shows

A

megathrombocytes

103
Q

a marked abnormality and uncontrolled production of the immature leukocytes.

A

acute lymphocytic leukemia (ALL)

104
Q

common symptoms of leukemia

A

lymphadenopathy, hepatosplenomegaly, joint and bone pain/swelling, bleeding

105
Q

common in lab results for CML

A

high eosinophils and basophils

106
Q

hallmark in diagnosis of CML

A

philadelphia chromosome

107
Q

cardinal sign of patients with CML

A

splenomegaly

108
Q

presence of Reed-Sternberg cells

A

Hodgkin lymphoma

109
Q

manifested as painless lymphadenopathy

A

hodgkin lymphoma

110
Q

peak incidence of hodgkin lymphoma

A

in 20s and then again in 60s

111
Q

peak incidence of nonhogkin lymphoma

A

60s

112
Q

trx for breastfeeding jaundice

A

stop for 12-24 hours then resume

113
Q

Progressive degenerative joint process of the articular cartilage and subchondral bone

A

osteoarthritis

114
Q

most common joints affected in OA

A

hands, fingers, cervical and lumbar spine, hip, knee

115
Q

symptoms of OA

A

stiffness/pain in morning and after activity for

116
Q

When OA involves the cervical and lumbar spine, this can develop

A

neuropathy and radiculopathy

117
Q

OA in the hands are characterized by

A

Heberdens (DIP) and Bouchards (PIP)

118
Q

diagnostic for OA

A

r/o RA (ESR, RF, CCP), xray

119
Q

trx for OA

A

Tylenol

120
Q

risks for COX2 NSAIDS

A

increase in cardiovascular risk and SJS

121
Q

Patients treated with NSAIDs should be monitored for changes in

A

renal and liver function

122
Q

example of COX2 selective NSAIDS

A

Mobic and Celebrex

123
Q

How often to given intra-articular corticosteroid injections for arthritis

A

no often than every 3-4 months

124
Q

autoimmune disorder characterized by inflammation and thickening of synovial membrane

A

RA

125
Q

these must be present for at least 6 weeks to diagnose RA

A

morning stiffness > 1 hour, swelling or 3 or more joints, swelling of at least 1 joint in wrist or hand

126
Q

s/s of RA

A

weakness, weight loss, painful/tender joints, morning stiffness > 1 hour

127
Q

In RA, joint swelling is

A

symmetric

128
Q

also commonly diagnosed with RA

A

Sjogren’s syndrome (dry eyes and mouth)

129
Q

A good measure or RA’s activity

A

ESR

130
Q

a synovial fluid in RA will reveal

A

high WBC count with poor viscosity

131
Q

Give this with DMARDs to reduce liver toxicity

A

folate

132
Q

high risk of this with RA

A

cardiovascular disease

133
Q

when passive and active ROM are limited with gradual onset of shoulder pain

A

adhesive capsulitis (frozen shoulder)

134
Q

Severe acute shoulder pain with restricted movement in an active athlete or laborer is likely

A

calcific tendinitis

135
Q

patients with rotator cuff tear with show marked weakness in

A

abduction and internal rotation

136
Q

Clinical test to help dx for rotator cuff tear

A

drop arm test and empty can test

137
Q

erythema and fever with shoulder pain suggest

A

septic arthritis

138
Q

rotator cuff tear is common in

A

those older than 40

139
Q

Shoulder arthritis is characterized by gradual onset and progression of

A

pain at rest, aggravated by movement, and loss of motion

140
Q

Stenosing tenosynovitis

A

trigger finger

141
Q

a nodule or thickened tendon that impedes tendon movement

A

trigger finger

142
Q

diagnostic for trigger finger

A

have patient try to extend finger, a pop should be felt and should be painful

143
Q

trx for trigger finger

A

splinting, NSAIDs, steroid injection, surgery

144
Q

seen in new parents who frequently lift their child using wrist strength alone.

A

deQuervain’s tenosynovitis

145
Q

Finkelstein test helps to diagnose for

A

deQuervain’s tenosynovitis

146
Q

deQuervain’s tenosynovitis trx

A

splinting and NSAIDs

147
Q

palmar fibrosis

A

Dupuytren’s contracture

148
Q

Any contracture of more than ____ degrees should be referred to a hand specialist

A

30

149
Q

carpal tunnel syndrome is best described as

A

medial nerve entrapment

150
Q

risk factors for CTS

A

pregnancy, menopause, arthritis, diabetes, HTN, hypothyroidism

151
Q

In CTS, the patient reports N/T to the

A

thumb, index, middle, and medial part of ring finger

152
Q

When the patient may describe an inability to hold objects or tendency to drop things, suspect

A

CTS

153
Q

clinical test for CTS

A

Tinel (tap on median nerve), Phalen (press hands together)

154
Q

cubital tunnel syndrome is nerve entrapment to the

A

ulnar nerve

155
Q

In cubital tunnel syndrome, there is N/T to the

A

ring and pinky finger

156
Q

Lateral epicondylitis

A

tennis elbow

157
Q

medial epicondylitis

A

golfer’s elbow

158
Q

clinical test for tennis elbow

A

apply pressure to force wrist into flexion while patient extends wrist

159
Q

clinical test for elbow sprain

A

applying valgus stretch to forearm with elbow flexed

160
Q

s/s of ulnar neuritis

A

sensory loss of pinky, diminished motor and grip strength

161
Q

loss of blood supply and subsequent death of subchondral bone tissue; it is often r/t trauma, alcohol intoxication, sickle cell anemia, or corticosteroids.

A

avascular necrosis

162
Q

diagnostic for avascular necrosis

A

MRI

163
Q

can cause rapid onset hip pain and fever

A

infection or septic arthritis

164
Q

s/s of hip fracture

A

inability to bear weight, extremity externally rotated

165
Q

Lachman test

A

flex knee, push down on femur while pulling on tibia

166
Q

Lachman tests for

A

ACL tear

167
Q

important teaching for ACL tears

A

strength quad muscle

168
Q

McMurray tests for

A

meniscal tear

169
Q

McMurray test

A

Place hand on heel and other on knee. Rotate the heel and apply valgus stress to knee. + if click is heard

170
Q

Apley tests for

A

meniscal tear

171
Q

Refers to knee pain that is localized to the anterior portion of the knee.

A

patellofemoral pain syndrome (runner’s knee)

172
Q

trx for runner’s knee

A

exercises that doesn’t stress quad (bicycling, swimming)

173
Q

treat for LBP

A

ice for 48 hours then heat for several days, increase functional movements for rapid recovery

174
Q

result from a tearing of the ligaments that bind the joint.

A

sprains

175
Q

result from an overstretching or overuse of muscles.

A

strains

176
Q

risk factors for osteoporosis

A

estrogen deficiency, hypothyroidism, steroids, sedentary lifestyle

177
Q

how to test for knee effusion

A

ballottement test: apply firm pressure to patella, if a click is heard, and effusion is present

178
Q

meds that can cause gout

A

ASA, nicotinic acid, diuretics, cyclosporine

179
Q

diagnostic for acute gout

A

ESR and WBC, uric acid not helpful

180
Q

used to increase excretion of uric acid

A

colchicine and probenecid acid

181
Q

decreases production of uric acid

A

allopurinol

182
Q

Avascular necrosis of the femoral head found in 4-8 year old boys.

A

Legg Calve Perthes disease

183
Q

s/s of legg calve perthes disease

A

progressive groin pain with limp

184
Q

Slipped capital femoral epiphysis is common in

A

11-14 year old obese boys

185
Q

Severe hip, thigh, or knee pain associated with a limp in obese boys

A

Slipped capital femoral epiphysiS

186
Q

s/s of fibromyalgia

A

widespread MS pain, nonrestorative sleep, depression, IBS

187
Q

pain on this number of trigger points is needed to dx fibromyalgia

A

11 out of 18

188
Q

trx for fibromyalgia

A

tricyclic, SSRIs, gabapentin, lyrica

189
Q

education regarding biphosphonates

A

avoid lying for 30-60 min after taking

190
Q

there is no evidence that supports taking biphosphonates for more than

A

5 years

191
Q

patellar tendinosis and traction apophysitis

A

Osgood-Schlatter disease

192
Q

Osgood-Schlatter disease is common in

A

adolescent boys and girls who play sports

193
Q

important teaching for Osgood-Schlatter disease

A

quad strengthening and stretching

194
Q

repetitive overhead activities are a risk factor for

A

rotator cuff tear

195
Q

in rotator cuff tear there is ____ active ROM and ____ passive ROM

A

decreased; normal

196
Q

labs in ALL

A

low platelets, anemia, low neutrophils, high lymphocytes, high LDH, high uric acid

197
Q

different b/t ALL and CLL

A

ALL has accumulation of immature lymphocytes where CLL has accumulation of mature but incompetent lymphocytes

198
Q

blood smear in CLL shows

A

ruptured lymphocytes “smudge” cells

199
Q

blood smear in ALL shows

A

blast lymphocytes

200
Q

which form of lymphoma is more treatable?

A

Hodgkin’s lymphoma

201
Q

in a patient with neonatal jaundice, it would be appropriate to screen for this

A

G6PD deficiency

202
Q

meds that can cause hemolytic anemia

A

macrobid, urocid, and pyridium

203
Q

most common cause of microcytic anemia is

A

bleeding

204
Q

NSAID effect on kidney

A

inhibits prostaglandin which prohibits vasodilation, thus decreasing blood flow to kidneys

205
Q

regular NSAID use should be avoided in patients taking

A

baby ASA for CV disease

206
Q

intoeing is self-limited and usually resolves by age

A

5

207
Q

most common cause of intoeing

A

metatarsus abdcutus

208
Q

intoeing causing by internal rotation of the tibia

A

tibial torsion

209
Q

exercises used to stretch and strengthen the lumbar

A

williams flexion exercises

210
Q

Gower’s sign indicates that there is

A

weakness to proximal muscles and seen in DMD

211
Q

used only as a preventative medication but not as a treatment during acute attacks of gout

A

allopurinol

212
Q

allopurinol is excreted through the

A

kidneys

213
Q

febuxostat is excreted through the

A

liver

214
Q

when should uric acid lowering meds be started

A

4-8 weeks after acute gout attack

215
Q

HRT has been approved for…

A

prevention of osteoporosis but not for trx

216
Q

major cause of kyphosis is

A

low bone density

217
Q

compression of the interdigital plantar nerves

A

morton’s neuroma

218
Q

Mulder’s sign

A

tests for morton’s neuroma. compress foot and applying pressure b/t 3rd and 4th toe. a click heard is positive.

219
Q

trx for morton’s neuroma

A

wearing wider shoes, using pads to separate toes, NSAIDS

220
Q

labs for DMD

A

high CK

221
Q

vaccine that can cause thrombocytopenia

A

MMR

222
Q

imaging should be done if there has been LBP for more than

A

6 weeks

223
Q

The RDW is ____ in iron deficiency anemia and ____ in thalassemia

A

high; normal

224
Q

In trendelenberg test, the affected leg is

A

raised higher and the unaffected leg sags

225
Q

transient synovitis of the hip occurs in

A

children 3-8 years old

226
Q

cause of transient synovitis of the hip is

A

viral illness

227
Q

when the patient has obligatory external rotation of the hip during flexion

A

SFCE

228
Q

In SFCE, the pain is often referred to

A

the knee

229
Q

diagnosing SFCE

A

it will appear normal on a AP view, but appear abnormal on an AP frog-leg lateral view

230
Q

when knees point toward the midline

A

genu valgum

231
Q

when knees point outward

A

genu varum

232
Q

radial head sublaxation

A

nursemaid’s elbow

233
Q

cause of nursemaid’s elbow

A

parents pulling kids by wrist

Acute & Chronic I (4 decks)

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