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SBL Test 2 > Hubbard: Fatigue > Flashcards

Hubbard: Fatigue Flashcards

(50 cards)

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1
Q

What is fatigue?

A

Difficulty initiating or maintaining voluntary mental/physical activity.

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2
Q
  1. Its important to distinguish fatigue from what?
  2. How is this done?
A

Perform a ROS to distinguish fatigue from;

    1. True muscle weakness
    1. Excessive sleepiness
    1. DOE
    1. Exercise intolerance
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3
Q

What are common benign disorders that cause fatigue?

A
  1. Psych diseases (depression and anxiety)
  2. Neuro disease (patients may “feel weak” ; MC = MS)
  3. Sleep disorders
  4. Liver and kidney dissease
  5. like everythinggg fuck
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4
Q

What type of fatigue can occur before a migraine?

A

Episodic fatigue before the migraine

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5
Q
  1. Describe the fatigue in Obstructive sleep apnea
  2. How do we evaluate to diagnose?
A
  1. Excessive daytime sleepiness + fatigue
  2. Overnight polysomnography, esp in those snoring, obesity, other RF
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6
Q

Fatigue + true muscle weakness + hair loss + dry skin + cold intolerance

= Dx?

A

HypOthyroidism

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7
Q

Fatigue + sweating + palpitations + heat intolerance

= Dx?

A

HypERthyroidism

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8
Q

MC drugs to cause fatigue

A
  • 1. Antidepressants
  • 2. Antipsychotics
  • 3. Anxiolytics
  • 4. Opiates
  • 5. Antispasticity
  • 6. Antiseizure meds
  • 7. Beta blockers
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9
Q

Cardiopulm causes of Fatigue

A

1. CHF

2. COPD

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10
Q

Common malginant causes of fatigue

A
  • 1. Leukemia/lymphoma
  • 2. Plasma cell disorders
  • 3. Metastatic solid tumors
  • 4. Paraneoplastic disorders
  • 5. Secondary hematologic causes (anemia)
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11
Q

1st step in diagnosing fatigue

A
  1. History and context of onset: OOOLDCAAARTS
    1. Demographics/ethnicity
    2. Menstrual status
    3. Diet
    4. Social status/living conditons
  2. PE
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12
Q

If fatigue + bleeding (GI/GU/mucocutaneous), what are DDx?

A
  • GI/GU = Defective clotting factors
  • Mucocutaneous = platelet disorders
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13
Q

Fatigue + dyspnea.

What is the DDx?

A
  • 1. Pleural effusion
  • 2. Pericaridal effusion
  • 3. Anemia
  • 4. LAD
  • 5. Constrictive pericardial disease
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14
Q

Fatigue + petachiae and purpura on PE.

DDX?

A

Thrombocytopenia: TTP, HUS, DIC

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15
Q

Fatigue + hemarthrosis

= Dx?

A

Severe hemophilia

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16
Q

Fatigue + telangiectasias

= DDx

A

CT disease or Hereditary Hemorrhagic Telangiectasias

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17
Q

Disorders that cause

↓ reticulocyte count

A

Non-hemolytic processes

  1. Iron-deficiency anemia
  2. Anemia of Chronic Disease
  3. Aplastic Anemia
  4. Chronic Kidney Disease (renal failure)
  5. Chronic diseases and marrow infiltration
  6. Megaloblastic Anemia (Vit B12/folate deficiency)
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18
Q

Disorders that cause

↑ reticulocyte count

A

Hemolysis (↑ destruction)

  1. PNH
  2. PK
  3. Hereditary Spherocytosis
  4. G6PD
  5. Spherocytosis
  6. Sickle Cell Anemia/HbC
  7. AIHA/MAHA
  8. Infection: Malaria, Babesia, Bartonella
  9. March Hemoglobinuria/Sports & Cardiac Anemia
  10. Lead/copper poisoning
  11. Portal HTN
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19
Q

If a patient presents with anemia, what is the most important work-up you should perfom?

If you were on a deserted island and could perform 1 test, what test would you perform?

Benefits/drawback?

A

Reticulocyte count:

  • Benefit = tells you how well BM is working/responding
  • Drawback = only a snapshot of what the BM is doing at that time; have to make sure if patient is on any medications to tx anemia
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20
Q

What are reticulocyte counts in the following disorders?

  1. Iron deficiency anemia
A
  1. low
    2.
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21
Q

Patient has

  1. ↓ reticulocyte count
  2. Problems with proliferation/distribution of stem cells

DDx?

Study These Flashcards
A

Aplastic anemia

22
Q

Patient has

  1. ↓ reticulocyte count
  2. Problems with the proliferation/distribution of erythroid progenitor cells

DDx?

Study These Flashcards
A

Chronic kidney disease (decreased EPO production)

23
Q

Patient has

  1. ↓ reticulocyte count
  2. Problem with DNA synthesis

DDx?

Study These Flashcards
A

Megaloblastic anemia (B12/folate deficiency)

24
Q

Patient has

  1. ↓ reticulocyte count
  2. Problem with Hb synthesis

DDx?

Study These Flashcards
A

Iron-deficiency

25
\_\_\_\_ reticulocyte count in *chronic disease and diseases with marrow infiltration*
1. ***decreased***
26
**_Iron-deficiency Anemia_** 1. Clinical Presentation 2. Labs
1. **Microcytic, hypochromic anemia** 2. Labs 1. ↓ iron 2. ↓ ferritan 3. ↑ TIBC (transferrin is less saturated with iron & ↑ capacity for transporting iron exists) 4. ↓ percent saturation
27
**_Anemia of Chronic Disease_** 1. Therapy?
1. **Iron suppliments** = NOT effective 2. Mild anemia (Hb 10-12) = _supportive_ care only 3. Severe anemia = _transfusions_ to keep Hb \>9gm
28
**Patient has** 1. ↑ reticulocyte count (↑ production of RBC) **Problem:** 1. Membrane defects or 2. Enzyme deficiency **DDx?**
1. **Membrane defects** = heriditary spherocytosis 2. **Enzyme deficiency** = G6PD deficiency
29
Patient has * **↑ reticulocyte count (↑ production of RBC)** Problem: * Mechanical * Chemical/physical DDx?
1. **Mechanical** = March hemoglobinuria/ sports & cardiac anemia 2. **Chemical/physical** = lead/copper poisoning
30
**_Patient has_** * ↑ reticulocyte count (↑ production of RBC) Problem: * Infection * Ab-acquired _**DDx**?_
_Infection_ 1. **Malaria** 2. **Babesia** 3. **Bartonella** _Ab-acquired_ 1. **AIHA**
31
**_Patient has_** * ↑ reticulocyte count (↑ production of RBC) **_Problem_**: * Hypersplenism **DDx?**
**Portal HTN**
32
What is **March hemoglobinuria?** AKA? Treatment?
1. Damage/lysis to RBCs in capillaries on plantar feet due to striking ur feet (marathon runners) 2. **AKA**: Sports anemia/foostrike hemolysis 3. **Treat**: well-padded footwear and reassurance
33
What is **Cardiac Anemia?**
**Ongoing lysis of RBC** in patients with _severe aortic stenosis_ (valve gradient \> 50mmHg) and _prosthetic valves_
34
Refer to **SBL Test 1 Brainscape/SG** for:
1. G6PD deficiency 2. AIHA 3. Polycythemia vera 4. Paraxysmal nocturnal hemoglobinuria
35
**Lead poisoning** causes what?
**Interferes with cation pump**, causing shortened RBC survival time and slows production of RBC in marrow.
36
**MCC of hemolytic anemia** in the _world_? What does it cause? Treatment?
**Malaria** 1. Causes 1. Severe hemolysis 2. Blackwater fever = dark urine d/t alot of Hb. 2. Treatment 1. Antimalarial agents
37
Treatment of **Immune-Mediated Hemolytic Anemia (warm AB hemolysis)**
1. Most patients **not in sudden danger** 2. Treatment = **high dose steroids (**mainstay tx); remissions last long 1. **Cyclophosphamide** and **Azathioprine** 2. If chronic steroid use is required = **splenectomy**
38
Symptoms/signs of **Polycythemia Vera**
1. Facial rubor 2. Hyperviscosity signs (HA, dizziness, blurred vision, heavy arms/legs) 3. Itchy after hot shower 4. Splenomegaly 5. Budd-Chiari syndrome 6. NL EPO
39
No treatment in PV causes what? MCC of death?
1. 50% mortality at 18months 1. Cause of death = pancytopenia due to progressive marrow fibrosis ("spent phase").
40
What are other causes of ***elevated*** **RBC counts** that can be a DDx in PV?
1. **COPD** 2. EPO producing tumors = RCC, Neuroendocrine tumors 3. **Hemoglobinopathy with high affinity Hb** (holds O2 more tightly =\> ischemia to tissues =\> increased RBC mass) 4. **Living at high altitude** =\> hypoxia d/t decrease FiO2.
41
W/U for **Polycythemia Vera**
1. **CBC/biochemical profile** 2. Exclude other caues of hemoconcentration: is pt dehydrated/ BUN/Cr = NL? 3. Exclude ABNL EPO levels 4. Excluse ABNL lung function (Pulse ox with ABG if ABNL; high carboxyhemoglpbin); PFT with DLCO (tests lung function and performance)
42
When both found, what is indicative of **Polycythemia Vera?**
**JAK2 kinase muation (V617F) + NL EPO level**
43
Treatment of **Polycythemia Vera**
**_Lower RBC mass to avoid hyperviscoity_** * 1. **Phlebotomy** of 250-500cc whole blood q 1-2 weeks as long as Hct \>50%. Do this q 6-12 weeks. * 2. 500-1500 mg/d of **Hydroxyurea** * **Do not use alkylating agents (busulfan/chlorambucil) d/t risk of therapy related leukemia)**
44
1. NL reticulocyte count 2. NL Hb for women 3. NL LDH
1. 1% 2. 11-13 3. 180-250
45
What weird feature do you see in iron-deficiency anemia?
Craving for crunchy shit/ice cravings = **pagophagia**
46
What is **erythromalagia**?
**Pain in digits,** MC due to **essential thrombocytopenia**
47
What causes fatigue in hematology malignancies?
Anemia + cytokine release
48
What test is done to estrablish semiquantitavely the **degree of debility** in someone with a malignancy? Why is it done?
**Performance status (PS)** = determine the tolerance to cytotoxic therapy and evaluating the effects of therapy.
49
**Performance status** Grades 0-5
* 0 = Full active, can carry on all pre-disease performance without restriction * 1 = restricted in physically strenous activity, but can walk and do light work (office work/light housework) * 2 = ambulatory and capable of self, but cant to any work activities; up and about \>50% of waking hours * 3 = Only self-limited care; confined to bed or chair more than 50% of waking hours * 4= completely disabled; cannto carry on any self-care; totally confined to bed/chair * 5 = dead
50
If patient has "**fever of unknown origin",** think \_\_\_\_\_
**NHL**

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