Clin Assess II: Signs & Symptoms of Hematologic/Oncologic Disease Flashcards
(130 cards)
1
Q
Blood draw: Adult site?
A
Cubital fossa
2
Q
Blood draw: Infant sites?
A
Heel or Scalp
3
Q
What are the symptoms of anemia?
A
Fatigue and pallor due to lack of O2 to body tissues
4
Q
What is the minimum lab workup for anemia?
A
- CBC with differential
- Peripheral blood smear
5
Q
What does the CBC with differential include?
A
- Hemoglobin (Hgb): O2 carrying proteins in RBCs
- Hematocrit (Hct): % of RBCs in blood
- RBC count
- RBC indices
- MCV: measures RBC volume
- MCHC: measures Hgb concentration
- WBC count
- Platelet count
- Reticulocyte count (check bone marrow)
6
Q
What can cause falsely anemic or normal “H+H” levels?
A
- Acute bleeding
- Pregnancy (“physiologic” or dilutional anemia)
- Volume depletion (hemo-concentrated)
7
Q
What defines and causes Macrocyctic anemia?
A
- MCV >100
- Causes: Vitamin B12 deficiency, Folate deficiency
8
Q
What is Normocytic anemia?
A
Anemia of chronic disease
9
Q
Symptoms of anemia
A
- exertional dyspnea
- dyspnea at rest
- palpitations
- roaring pulsatile sound in ears
- Rarely, lethary, confusion, CHF, angina, arrythmia, and/or AMI with severe anemia
10
Q
Other signs of anemia
A
- Bounding pulses
- Lymphadenopathy
- Hepatospelomegaly
- Bone tenderness –> especially over sternum
11
Q
What is the most common medical disorder worldwide?
A
Iron deficiency anemia
12
Q
What causes iron deficiency anemia in children? adults?
A
- Children: poor diet
- Adults: blood loss (e.g. GI bleed, menses)
13
Q
What are the signs/symptoms for iron deficiency anemia?
A
- Fatigue
- cheilitis (chapped lips)
- glossitis (inflammation of tongue)
- pica (eating non-food items)
- pagophagia (compulsive consumption of ice/ice drinks)
- koilnychia (spoon nails)
14
Q
Labs for iron deficiency anemia?
A
Serum ferritin
15
Q
What will a peripheral blood spear show with iron deficiency anemia?
A
Hypochromic, microcytic
16
Q
What type of anemia is Vitamin B12 deficiency?
A
Megaloblastic anemia
17
Q
What type of anemia is Folate deficiency?
A
Megaloblastic anemia
18
Q
Who has a higher risk of developing Vit. B12 and Folate deficiency?
A
Older adults, alcoholics, pure vegans, malnutrition
19
Q
How long does it take for the development of anemia with Vit. B12 and Folate deficiency?
A
Vit. B12: years
Folate: 4-5 months
20
Q
What is the workup for Vit. B12 and Folate deficiency?
A
- Step 1: check Vit. B12 and folate levels. If results are boderline or discordant with other clinical features…
- Step 2: check methylmalonate (MMA) and total homocysteine
- if Vit. B12 def: both elevated
- if folate def: only total homocysteine elevated
21
Q
What happens if you miss a Vit. B12 deficiency?
A
irreversible neurological damage
22
Q
What type pf [patients should you watch Vit. B12 deficiency in?
A
Gastric bypass, GI disease (Crohn’s, etc)
23
Q
Signs/symptoms of Vit. B12 deficiency
A
Gait disturbance, glossitis, anorexia/diarrhea, paresthesias, decreased position and vibratory sense
24
Q
What happens if you find Vit. B12 deficiency late?
A
Altered mental status
25
Tx for Vit. B12 deficiency?
Parenteral B12
26
What is Pernicious anemia?
B12 deficiency caused by lack of intrinsic factor
27
What are the signs/symptoms of pernicious anemia?
Skin tingling/burning, glossitis, fatigue, dyspnea, leg weakness/spasms, imbalance while standing (especially at night), dementia
28
What other disorders can pernicious anemia be seen with?
Other autoimmune d/o (thyroid & T1DM)
29
What are the lab findings for pernicious anemia?
Antibodies to intrinsic factor
30
What is the Tx for pernicious anemia?
IM B12
31
What is Thalassemia?
Impaired production of globin chains (genetic defect)
32
Which subsets of the globin chains are asymptomatic?
Beta and alpha minor
33
What are the signs/symptoms of Beta major Thalassemia?
Pallor, growth retardation, heptasplenomegaly, jaundice, abnormal skeletal development, "chipmunk" face
34
At what age does beta major present?
~6 months old
35
Beta major lab results?
Profound hypochromic, microcytic anemia with bizarre RBC morphology ("Target cells")
36
Treatment for Beta major?
Life long transfusions
37
What is interesting about alpha major?
Incompatible with extra-uterine life
38
What is Sickle cell anemia?
- production of abnormally-shaped RBCs
- diminished ability to function as RBCs
- vasoocclusion
- hemolysis
39
What subtype of hemoglobin causes SC anemia?
homozygous hemoglobin S
40
Signs/symptoms of SC anemia?
Dactylitis (acute pain in hands/feet), joint pain, splenic sequestration, multiorgan/multisystem dysfunction or failure
41
What occurs in a painful episode ("Sickle cell crisis") in sickle cell anemia?
- no identifiable cause- lasts 2-7 days
- can affect any area of the body
- Pain trivial to excruciating
- 1/2 of episodes accompanied by:
- fever
- swelling
- tenderness
- tachypnea
- hypertension
- nausea/vomiting
42
What is Acute Chest Syndrome (ACS) defined as?
New radiodensity (consolidation) on chest x-ray PLUS fever and/or respiratory symptoms. Unclear etiology
43
What is the leading cause of death in patients with SCD?
Acute chest syndrome
44
Signs/Symptoms of ACS?
- Temperature >38.5 C
- Tachypnea
- Intercostal retractions, nasal flaring, or use of accessory muscles
- chest pain
- cough, wheezing, rales
45
What is the Tx for ACS?
Broad spectrum abx & ICU admission
46
What is the most common enzymatic disorder of RBCs in the world?
G6PD deficiency
47
What does G6PD do and what does deficiency lead to?
G6PD protects RBCs against oxidant injury
Deficiency results in hemolysis
48
Signs/symptoms of G6PD deficiency?
- Asymptomatic
- Jaundice (neonatal, hyperbilirubinemia)
- Pallor, dark urine +/- abdominal/back pain
49
What triggers G6PD deficiency?
infection, drugs (eg nitrofurantoin), chemicals (eg methylene blue, dyes), fava beans
50
What is found on a peripheral blood smear with G6PD def?
Heinz bodies and bite cells
51
What is a screening test for G6PD def?
Fluorescent spot test
52
Tx for G6PD def?
Avoid triggers, transfusion
53
What is seen with Pancytopenia?
- neutropenia: (decrease WBCs)
- Thrombocytopenia (decreased platelets)
- Anemia (decreased RBCs)
- decreased # reticulocytes
54
How do you confirm pancytopenia?`
Bone marrow biopsy
55
What are the types of Aplastic anemia?
- Inherited congenital bone-failure syndromes ("Fanconi's)
| - Idiopathic, acquired (much more common)
56
What are the causes of acquired aplastic anemia?
Viral infection, drugs, toxic chemicals, autoimmune
57
What are the signs/symptoms of inherited bone-failure syndromes?
Abnormal skin pigmentation, short stature, renal, cardiac, GI abnormalities, microcephaly, hypogonadism, skeletal anomalies
58
What are the signs/symptoms of acquired aplastic anemia?
pallor, petechiae, purpura, ecchymosis, mucosal and gingival bleeding, vaginal bleeding, active bacterial infections
59
What is anemia of chronic disease associated with?
infectious, inflammatory or neoplastic diseases (eg CKD, RA, leukemia)
60
What would be seen on a peripheral blood smear with anemia of chronic disease?
normochromic, normocytic, hypoproliferative, and mild in degree
61
Pathogenesis of anemia of chronic disease?
- reduction in RBC production by bone marrow
- mild shortening of RBC survival
- inability to increase erythropoiesis in response to anemia
62
Signs/symptoms of lead poisoning?
- "lead colic" abdominal pain
- anemia
- headache, irritability
- confusion
63
What is lead poisoning usually caused by?
Lead exposure at work
64
What happens if you miss Dx of lead poisoning?
Irreversible damage: nervous system, kidneys, and other organ systems
65
What do you Dx lead poisoning?
Blood lead level >80 mcg/dL
66
Tx for leading poisoning?
Chelation
67
What is polycythemia vera?
Myeloproliferative disorder
68
What is often found incidentally on CBC with polycythemia vera?
- Hemoglobin >18.5 in men or >16.5 in women
| - Persistent leukocytosis & thrombocytosis
69
Signs/symptoms of polycythemioa vera?
- splenomegaly
- headache
- generalized pruritis (Post-bath)
- unusual thrombosis
- erythromelalgia
70
Tx for polycythemia vera?
Phlebotomy
71
What race is this most seen in?
Causasian
72
What are you at risk for with factor V leiden?
Venous thromboembolism (DVT or PE), although, most aymptomatic
73
What should you ask about with factr v leiden?
Hx clotting (PMH & FH)
74
Tx for factor V leiden?
Anticoagulation if clot, decreased clotting risk through lifestyle
75
Tx for factor V leiden?
Anticoagulation if clot, decreased clotting risk through lifestyle
76
What is immune thrombocytopenia (Idiopathic thrombocytopenia purpura)?
Acquired, thrombocytopenia caused by autoantibodies against platelet antigens
77
What are triggers for immune thrombocytopenia?
Viral infection & systemic (eg SLE) that disrupt immune homeostasis
78
What will you find on a physical exam with immune thrombocytopenia?
petechiae, purpura, epistaxis
79
Tx for immune thrombocytopenia?
Glucocorticoids, IVIG
80
What type of genetic disorder is Hemophilia?
X-linked recessive disorder
81
What causes type A hemophilia?
Factor VIII deficiency
82
?What causes type B hemophilia
Factor IX deficiency
83
What are the signs/symptoms for hemophilia?
Easy bruising, Hemarthrosis
84
Where is the most common site of hemorrhage in hemophilia?
80% are in joints
85
What age is hemophilia usually seen at?
1-1.5 years old
86
What are late complications of hemophilia?
Intracranial hemorrhage, joint destruction
87
What is seen on the labs with hemophilia?
prolonged PTT (partial thromboplastin time)
88
Tx for hemophilia?
prothrombin complex concentrates (PCC) and human factor VIIa
89
What is the most common inherited bleeding disorder?
von Willebrand disease
90
What is von Willebrand disease?
platelets have normal morphology but lack factor VIII/vWF complex - impacts ability to adhere
91
What are the 3 types of von Willebrand disease?
1. mild to moderate decrease vWF
2. dysfunction of vWF
3. absolute lack of vWF
92
Signs/symptoms of von Willebrand disease?
- easy bruising w/ hematoma
- skin bleeding
- prolonged bleeding from mucosal surfaces (eg epistaxis, dental/surgery, GI, menorrhagia)
93
How do you diagnosis von Willebrand disease?
increased bleeding time, normal platelet count
94
Tx of von Willebrand disease?
Tx of mild mucosal bleeding with DDAVP - desmopressin - it acts by increasing circulating levels of factor VIII an d vWF
95
What population is multiple myeloma seen in?
Older patients with atraumatic back pain
96
What causes multiple myeloma?
Plasma cells proliferate in bone marrow causing destruction of skeleton
97
Signs/symptoms of multiple myeloma?
- bone pain
- fatigue/generalized weakness
- weight loss
98
What is seen on xray with multiple myeloma?
"punched out" lesions
99
What will labs show with multiple myeloma?
Hypercalcemia, renal insufficiency, anemia
100
What will physical exam show for multiple myeloma?
decreased reflexes
101
What is the diagnostic workup for multiple myeloma?
Bone marrow biopsy
102
What are the 4 types of Leukemia?
- Acute lymphoblastic leukemia (ALL)
- Chronic lymphocytic leukemia (CLL)
- Acute myeloid leukemia (AML)
- Chronic myeloid leukemia (CML)
103
What distinguishes acute leukemia?
Rapid increased in immature WBCs (aka "blast" cells)
104
What distinguishes chronic leukemia?
Excessive buildup of mature but still abnormal WBCs
105
What are the risk factors of leukemia?
- Smoking
- Ionizing radiation
- Chemicals (eg benzene)
- Prior chemotherapy
- Down syndrome
- Family history of leukemia
106
What are the common symptoms of leukemia?
```
Systemic: weight loss, fever, frequent infections
Psychological: fatigue, loss of appetite
Lymph nodes: swelling
Lungs: easy shortness of breath
Spleen and/or liver: enlargement
Muscular: weakness
Skin: night sweats, easy bleeding/bruising, purplish patches or spots
Bones/joints: pain or tenderness
```
107
What are diagnostic studies for leukemia?
CBC with differential, Peripheral blood smear and bone marrow biopsy, gene testing
108
What is seen on CBC with differential with leukemia?
- Leukocytosis (increased WBCs) - HALLMARK
- Anemia (decreased H+H)
- Thrombocytopenia
109
What is seen in gene testing with leukemia?
Philadelphia chromosome in CML
110
What is the Tx of leukemia?
Combination of:
- chemotherapy
- radiation
- bone marrow transplant
- watchful waiting
111
What does Tx depend on in leukemia?
Type & age of person
112
Signs/symptoms of Lymphoma?
- Painless lymphadenopathy
- "B" symptoms
- fever > 38C (100.4F)
- weight loss >10% over past 6 months
- night sweats (drenching)
- Pruritus (generalized)
- Anorexia
- SOB if nodes become restrictive
113
What does it mean when the "B" symptoms are present?
AGGRESSIVE lymphoma
114
HOw to determine Hodgkins's vs Non-Hodgkins?
If Reed-Sternberg cell present --> Hodgkin's
| If Reed-Sternberg cell not present --> NHL
115
How to diagnosis Hodgkin's vs NHL?
Lymph node biopsy
116
What is the most common malignancy of head/neck in teenagers (children mostly)?
Hodgkin's lymphoma
117
What age is HL seen in?
15-35 and >55
118
What is present on physical exam with HL?
Non tender, firm, rubbery consistency cervical and/or supraclavicular node(s); mediastinal mass on routine chest x-ray
119
What is the most common type of lymphoma?
NHL --> 60,000/yr in US
120
How many types of NHL are there?
20+ types - eg Burkitt lymphoma: fastest growing tumor, most common in abdomen
121
What are some physical exam findings of NHL?
Lymphadenopathy below the clavicles, multiple peripheral nodes
122
In what population is neutropenic fever seen in?
Cancer patients receiving chemotherapy
123
What causes neutropenic fever?
The patients in chemo at risk for invasive infection due to colonizing bacteria and/opr fungi that translocate across GIU mucosal surfaces
124
What is the earliest/only sign of neutropenic fever?
Fever > 38.3C (101F)
125
Why should you Dx neutropenic fever early?
So you can initiate broad-spectrum Antibx to avoid sepsis and possibly death
126
What is neutropenia defined as?
ABSOLUTE NEUTROPHIL COUNT
127
What is an oncologic emergency?
Neutropenic fever!
128
What is absolute neutrophil count?
Total WBC count x % of polymorphonuclear cells and bands
129
Levels to be considered anemic?
Hgb
130
What defines and causes Microcytic anemia?
MCV
