Heme/Immunology

Question 1

Types of low MCV anemia

Answer 1

This means there is not a lot of Hbg

Iron deficiency anemia - not enough production - iron supplements
Sideroblastic anemia - poor iron use - not able to put in heme ring - B6
Thalassemia - less production due to missing genes - transfusion if severe
Anemia of chronic disease - poor release and collection due to chronic inflammation - iron supplementation, manage chronic disease

Question 2

Types of normal MCV anemia

Answer 2

Anemia of Chronic disease - iron release and use impaired due to chronic inflammation - can also be low MCV
Paroxysmal Nocturnal hemoglobinuria
G6PD deficiency - increased destruction due to shape
Hereditary spherocytosis - increased destruction due to shape

Question 3

Types of high MCV anemia

Answer 3

B12 deficiency - part of the synthesis process below

Folate deficiency - unable to make new cells due to lack of DNA building materials

Question 4

Polyarteritis Nodosa?

Answer 4

Is a necrotizing inflammation of the arteries particularly at junctions - makes a node of inflammation

Tx: steroids, can mimic a lot of other things, associated with Hep B/C

Question 5

MGUS?

Answer 5

Increase of M- protein (associated with antibodies) can cause peripheral neuropathy and is associated with bone loss, take serum levels every few months/ urine protein and giver bisphosphonates - may progress to multiple myeloma

Question 6

SIRS criteria

Answer 6

HR >90
Fever >38 or <36
WBC >11 or <4
RR >20

Sepsis is SIRS + infective source

Question 7

Signs of septic shock?

Answer 7

End organ dysfunction

• decreased urine output - less than 0.5cc/hr
• mottling
• increased INR, AST, ALT
• decreased LOC
• lactate, acidosis

Question 8

Types of hyponatremia and their causes?

Answer 8

Hypovolemic hyponatremia - causes diarrhea, diaphoresis, diuretics - losing fluids including salt
Euvolemic hyponatremia - SiADH - makes kidneys hold on to water
Hypervolemic hyponatremia - CHF, cirrhosis, nephrotic syndrome - too much fluid in body

Question 9

Correction of hyponatremia?

Answer 9

Fluids - NS trial, going slowly and carefully, too rapid can lead to osmotic demyelination. Remove causes.

Question 10

Hereditary Spherocytosis that is relatively asymptomatic tx?

Answer 10

Folic acid supplementation to compensate for high folic acid turnover

Question 11

Artifact of very high blood glucose?

Answer 11

Hyponatremia

Question 12

Does giving sodium fix hyponatremia?

Answer 12

No. Humans are not beakers - more salt just = more water peed out

Question 13

Call internal medicine if? (Hyponatremia)

Answer 13

Serum Na <129 from hypovolemic hyponatremia (risk of central pontine myelinolysis, increased risk of seizure, coma, death)
And definitely if less than 126

Question 14

Hypercalcium tx?

Answer 14

Aggressive fluid resuscitation. Can kill very fast - asystole

Question 15

Ankylosis Spondylitis

Answer 15

Eye pain - consider that it might be a flare with uveitis- need prednisone risk of vision loss