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crit care test 2 Flashcards

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1
Q

Microcytic MCV level

A

MCV less than 80

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2
Q

Types of Microcytic Anemia (MCV <80 )

A

Iron defficiency- poor intake or blood loss (asymptomatic)

Tahlassemia minor
DX is unresponsive to iron supplemetation

Medeterranean- is beta
African American Alpha

Sideroblastic -primary 2nd or congential

Anemia of chronic disease- can have defficiency

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3
Q

microcytic anemia DX/TX(MCV less than 80)

A

Check serum: ferritin, iron, TIBC, reticulocyte count
Ferritin >100 rules out dx

i

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4
Q

in mircrocytic anemia of chronic disease - iron will be —— ferritin will be ——

A

iron low

ferritin is normal

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5
Q

tx of mircrocytic anemia

A

theraputic iron trial
eval for GIB
if not responsive to iron consider thalassemia dx

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6
Q

Anemia of chronic disease- trapping of iron is present

HGB level-
Serum Iron and IBC
retic count-

serum ferritin

A

anemia is moderate 7-11

Serum Iron and IBC both down

reticulocyte count is down

serum ferritin increased

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7
Q

Macrocytic anemia MCV level

A

MCV >100

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8
Q

Macrocytic anemia MCV >100 types

A

B 12 deficiency-

Folate deficency

Hepatic disease

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9
Q

Macrocytic anemia B 12 deficiency causes and notes

A

reduced production of intrinsic factor, poor intake, occurs i the 6th decade with neuro issues and cerebral dysfunciton

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10
Q

Macocytic anemia folate deficiency causes and notes

A

poor intake, meds, this has a role in arterial and venous thrombus

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11
Q

macrocytic anemia hepatic disease causes and notes

A

booze and diet

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12
Q

Macrocytic anemia tx

A

give b12 and folate

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13
Q

normochromic and normocytic anemia

mcv level

A

80-100

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14
Q

causes of normochromic normocytic anemia

A 
Chronic disease
hemolytic
sickle cell
G6PD deficiency
Drug induced
aplastic
renal failure
hypothyroid
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15
Q

sickle cell disease with trait

A

Asymptomatic and no anemia, mild hematuria is usually present

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16
Q

sickle cell signs of intravascular sickling

A

fever and leukocytosis

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17
Q

sickle cell tx

A

Hydration, pain control, (pca vs ketorolac)

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18
Q

sickle cell tx when to give hydroxyurea

A

if 3 or more episodes in a year - kids get bone marrow transplant.

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19
Q

sickle cell complications

A

acute chest syndrome- can be caused bby infection or asthma, pulm edema, pneumonia, PE, priapism, retinoathy

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20
Q

g6pd deficiency episodic vs chronic notes

A

episodic - its sex linked
african americans
hemolysis after exposure to oxidant or infection- sulfonamides or antimalarials

chronic is Mediterranean

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21
Q

g6pd treatment

A

avoid triggers - folic acid supplemtation

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22
Q

drug induced hemolytic anemia will have a ——-test

caused by

tx

A

positive direct coombs test

caused by exposure to quinidine, PCN, or methyldopa

tx -avoid triggers

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23
Q

autoimmune hemolytic anemia

IGG
IGM

A

IGG- against RH antign, Lymphomas, Lupus, UC, CLL- (warm antibodies)

IGM- Mycoplasma, Epstien bar, Cytomegalo virus, cold antibodies

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24
Q

Aplastic anemia

is usually----
exposure to ---
idiosyncratic--
Viral-
onset is ------ and features
A

usually idopathic
marrow toxins like chemo or cytotoxic drugs

viral- HBV, Hep C, CMV, HIV parvo

gradual onset, fatigue bleeding and thrombocytopenia

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25
Renal failure anemia RBCs- Severity parralels - Once GFR is less than --anemia is present
RBCs reduce and decrease survival Severity parallels azotemia GFR below 60 = anemia
26
hypothyroid anemia is an--------- response
autoimmune response
27
blood product admin whole blood
Indications are rare massive transfusion to correct hypovolemia (trauma or shock) rare use- must be ABO identical
28
PRBC- to treat ------anemia and ---------
treat symptomatic anemia and routine blood loss during sx
29
Platelets are used to are prepared from what about bacteria theraputic dose for adults is --- some patients become ----
to prevent spontaneous bleeding or stop established bleeding in thrombocytopenic patients prepared from a single unit of whole blood due to storage this is most likley to be contaminated with bacteria dose for adults is 6-10 units and some ptients become refractory
30
FFP
used to replace labile and non labile coag factors in massively bleeders or tx things like coum overdoses
31
DIC ``` excessive generation of ----- secondary activation of ------- Results in ----- Caused by ----- ```
excessive generation of -----thrombin and formation of intravascular fibrin clots secondary activation of -------the fibrinolytic system Results in -----consumption of platelets and coag factors Caused by -----tissue injury, gram neg or positive sepsis, inflammatory disorders, endothelial sloughing secondary to acidosis, or obstetric disorders
32
DIC dx
FDP will be up D dimer is specific but not sensitive PT/PTT not reliable platelets are low
33
DIC TX
``` Tx underlying cause Replace with whole blood heparin anti fibrinolytic factors activated protein C ```
34
ITP autoimmune disorder where ----- is formed and binds to ------
IGG- platelets
35
ITP and the role of the spleen-
ITP in adults presents with bleeding and splenomeagly
36
ITP thrombocytes peripheral smear will have ----
<10,000 may be with anemia and normal CBC, Megathrobocytes
37
ITP can be seen with ``` -------- anemia hematologic ----- myleodysplasia megaloblastic anemia chronic --------- and can be induced by ```
aplastic anemia hematologic malignancies chronic etoh and induced by drugs or transfusion
38
Drug most common to cause ITP
Heparin
39
ITP tx
Prednisone 1-2 mg/kg/day increases the platelet count, and include high dose dexamethasone, slenectomy and high dose IVIG or danazol
40
HIT ------antibody reacts with platelets on the surface rises after ----- days initially asymptomatic thrombocytopenia dx is TX is
IGG antibody after four days + hit panel stop heparin
41
TTP is common or uncommon
uncommon
42
TTP - seen in ages with M/F predominance
20-50 with female prodominance
43
TTP causes
pregnancy, drugs or infection
44
TTP treatment
emergent large volume plasmapheresis, prednison and antiplatelets, splenectoy, immunosuppression
45
HUS causes labs
hemolytic uremic syndrome caused by estrogen use, post partum state,familial coumbs negative
46
AML - definition
neoplastic disease which clonal undifferentiated cells infiltrate the blood, bone marro and tissues
47
AML cuase symptoms
* Caused by genetics, radiation, medications, chemical and occupational exposures but not viral * S/S: nonspecific, general complaints, could have
48
AML- Exam
• PE: fever, organomeglia, lymphadenopathy, sternal tenderness, infection, hemorrhage
49
AML Treatment
* Treatment: Once diagnosis is made functional integrity of major organ systems need to be done, treat symptoms and blood disorders * 1. Induction chemotherapy * 2. Post remission therapy
50
CML definition
• Clonal hematopoietic stem cell disorder driven by genetics and the Philadelphia chromosome
51
CML S&S and Exam
* S/S: symptoms of anemia, fatigue, malaise,weight loss, early satiety, LUQ pain or mass, organomeglia, vasoocclusive events * PE: splenomegaly, lymphadenopathy, complications of tumor burden on major organs
52
Treatment complications
* Treatment: Once the Phila. Chromosome is identified, TKI therapy is initiated, can have stem cell transplant, splenectomy * Complications: do not give TKI during pregnancy
53
Neutropenia
* Neutropenia: low neutrophils (susceptible to infection <1000, loss of control of endogenous flora <500, loss of local inflammatory process <200 * Causes: chemo, antibiotics
54
Thrombocytopenia definition and causes
Thrombocytopenia: low platelets | • Causes: decreased bone marrow production, enlarged spleen, or platelet destruction (infection or drug induced)
55
Pancytopenia
* Pancytopenia: anemia, leukopenia, and thrombocytopenia * Causes: aplastic anemia, myelodysplasia, leukemia, lymphoma, secondary to systemic diseases such as alcohol use, TB, sarcoidosis, infection, SLE
56
Imunosuppressive therapy
• Immunosuppressive therapy: suppresses all immune responses to bacteria, fungi, malignant tumors • Used post-transplant and in some oncologic disorders • Induction therapy: reduces the risk of acute rejection and minimizes/eliminates the use of steroids • Maintenance therapy: given once acute rejection timeframe over • Complications: opportunistic infections
57
Tumor Lysis Syndrome
Oncological emergency • Caused by a large number of rapidly proliferating neoplastic cells • Hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia • Treatment • Recognize early, • Prevent with allopurinol, urinary alkalization and aggressive hydration
58
Rheumatoid arthritis:
antibodies attach to the linings of the joints causing inflammation, swelling and pain. Treated with anti-inflammatories.
59
• SLE:
antibodies attach to tissues (joints, lungs, blood cells, nerve endings, kidneys). Treated with steroids
60
• MS:
immune system attacks nerve cells causing pain, blindness, weakness, poor coordination, muscle spasms.
61
Type I DM:
antibodies attack insulin producing cells from the pancreas.
62
Guillian-Barre Syndrome:
immune system attacks nerves that control the muscles in the legs, arms and upper body. Treated with plasmapheresis.
63
• Psoriasis:
overactive T cells in the skin
64
Chronic inflammatory demyelinating polyneuropathy:
similar to GBS
65
Grave’s Disease:
antibodies overstimulate the thyroid gland
66
Hashimotos thyroiditis:
antibodies attack the thyroid gland
67
Myasthenia Gravis
antibodies bind to the nerves and slow them down causing weakness
68
Vasculitis:
immune system attacks and damages the blood vessels

test 2 (13 decks)

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