Sasha: Clinical Assessment Heme/Onc Flashcards
(160 cards)
1
Q
Blood Draw:
Adult site
Infant site
A
Adult sites: Cubital fossa, medial vein
Infant sites: Heel, Scalp
2
Q
Is a venipuncture clean or sterile?
A
well… it depends -usually? CLEAN so what does this mean? use alcohol prep…start on the inside making circular motions and work your way out cleaning the site. when would we do sterile blood draw? transfusions/blood culture so that way you don’t introduce bacteria into the sample
3
Q
When would you want an arterial sample?
A
BLOOD GAS you order these when your patient has an altered mental state you want to know how much oxygen is in the brain
4
Q
What is anemia?
A
Disorder of RBC there are numerous types and etiologies
5
Q
what symptoms do all anemia’s share?
A
All share fatigue and pallor as symptoms
why do you have these symp? Lack of oxygen to body tissues
6
Q
what is pallor? and where do you look for it on the body?
A
Pallor= pale Look for this in conjunctiva mucosa and on skin of hands and nails—can mean low anemia
7
Q
what (at minimum) lab work do you do for anemia
A
CBC with differential
Peripheral blood smear (usually), shows morphology of RBC
8
Q
What does CBC stand for?
A
Complete blood count
I know you got this one….good job!!!!!
9
Q
what is the difference between a CBC w/ differential and a CBC without differential and what does a CBC include?
A
Differential- gives more information…more to interpret..
all the different types of WBC (neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils)
Gives the percentages of WBC
what does a CBC include:
- Hemoglobin (Hgb)
- Hematocrit (Hct)
- Red blood cell (RBC) count
- RBC indices
- White blood cell (WBC) count
- Platelet count
- Reticulocyte count (√ bone marrow)
10
Q
what is hemoglobin ? (Hgb)
A
oxygen carrying protein in RBC
11
Q
what is hematocrit? (Hct)
A
percentage of RBC in blood
12
Q
What are RBC indices?
A
MCV – measures RBC volume (macro/normo/microcytic)
MCHC – measures Hgb concentration in single RBC (hypo/hyperchromic)
13
Q
what is reticulocyte count?
A
assessment of bone marrow function
14
Q
describe this pictureand the arrows :)
A
to understand abnormal we have to be able to describe normal first
red arrow: center should be 1.3 diameter of whole RBC
Black arow- platlets- not a lot of platlets on blood smears
blue arrow- WBC not a whole lot of WBC on normal blood smears
15
Q
What is anemic referring to?
What is an H&H?
what is hematocrit?
What are the normal values for Women and Men?
A
Referring to hemoglobin level when they say “I’m anemic”
H&H- hemaglobin and hemoatocrit
Hematorcrit=number of RBC in a sample=H&H
Low hemoglobin=low hematocrit (directly proportional)
If someone has a low hemoglobin level, they are going to have a low hematocrit.
- Hgb <13.5 g/dL or Hct <41% in men
- Hgb <12.0 g/dL or Hct <36% in women
16
Q
why do men have higher values to be reached in their H+H?
A
Muscle mass for men, higher= men need more oxygen to muscles to function so there number is higher
17
Q
what happens to your hemoglobin when you are bleeding ?
what about acute bleeding ? aka trauma
A
stays normal ….because its just a portion…
In trauma Hemoglobin is normal but you know its not normal because half of the blood has come out and is on the floor in the ER
36-48ish hours later you will see the drop in hemoglobin after acute bleeding and more plasma…H&H will be low
18
Q
SO what are the 3 things that can cause falsely anemic or normal H+H levels…
A
- *–Acute bleeding**
- *–Pregnancy** (“physiologic”=increased blood volume so RBCs diluted but ok! aka dilutional anemia)
- *–Volume depletion** (hemo-concentrated) “dehydration makes it look like higher [hemoglobin]
19
Q
how does pregnancy show on an H+H
A
during pregnancy you can increase your blood volume by 50% !!!!!!!! but does not rise the hemoglobin level….they will have more plasma in blood sample…. Appears she has less hemoglobin but she does not
isnt this CRAZY
20
Q
what about volume depletion how does that affect our H+H
A
let’s say you’re really dehydrated…. You will have less volume in the blood which makes the [hemoglobin] look higher since all of the cells are closer together
Ruth’s Explanation: regarding the dehydration= higher H+H - She misspoke if she said that you will have more plasma if you are dehydrated. If you are dehydrated your blood will have a lower percentage of serum, or plasma, to RBC/WBC/PLT, thus increasing the percentage of your blood that is made up of those cells. Like when you cook down tomatoes to make tomato sauce - as the water cooks off, the sauce gets thicker. It still has the same amount of sugar and fiber etc, they just make up a larger percent of it.
21
Q
Morphology of RBC
Define:
Microcytic
Macrocytic
Normocytic
give me there MCV numbers and what deficencies you see in each
A
Macrocytic (larger cells)
Microcytic (abnormally small cells)
•Microcytic (MCV < 80)
–Iron deficiency
–Thalassemia
–Lead poisoning
•Macrocytic (MCV > 100)
–Vitamin B12 deficiency
–Folate deficiency
•Normocytic
–Anemia of chronic disease
22
Q
what does MCV stand for
A
mean corpuscular volume
23
Q
So what other symptoms do we see with Anemia -low hemaglobin (5)…
and then
what other other signs do we see depending on underlying pathology for anemia? (4)
A
OTher symptoms
•Exertional dyspnea- shortness of breath during exercise
•Dyspnea at rest- SOB
•Palpitations
•Roaring pulsatile (pulsating) sound in the ears
•Rarely, lethargy, confusion, CHF, angina (not getting enough O2), arrhythmia, and/or AMI with severe anemia
Other signs- depends on underlying pathology
•Bounding pulses
•Lymphadenopathy (disease of lymph nodes)
•Hepatosplenomegaly (enlargement to liver and spleen)
•Bone tenderness, especially over the sternum
24
Q
my sternum is killing me? how come?
A
a lot of bone marrow and RBC are made in sternum…..so could have pain there if anemic
25
what is the number 1 cause of anemia
IRON DEFICIENCY ANEMIA!
GREAT JOB :)
26
what is it typically cause by in infants?
why is it typically caused by in children?
why is it typically caused by in adults?
it is referring to Iron deficiency Anemia.... sorry :)
infants-who love breast milk and have hard time transitioning to food
•Children – typically due to poor diet
•Adults – typically due to blood loss (eg, GI bleed, menses)
27
signs and symptoms of Iron deficiency Anemia (6)
•Signs/Symptoms
–Fatigue
–Cheilitis, glossitis
–Pica and pagophagia (want to eat paint/rocks)
–Koilonychia "spoon nails"
cards on what these wierd words mean later... no worries :)
28
what Labs for Iron deficieny am i going to order and what am i going to see for results (3 labs tests)
•Lab – **low serum ferritin** \<15mcg/L, **↑ TIBC**
TIBC= total iron binding capacity
•**Peripheral blood smear** – hypochromic, microcytic (these definitions will come up in a card a little later )
the RBC will look small
29
hypochromic?
RBC look pale due to lack of hemoglobin
30
microcytic
look small and then middle part smaller etc.
think back to the picture of normal blood smar
31
melena
black tarry stool..... yum
32
hematochezia
bright red stool from distal GI bleed
33
Pica
eating non food product
ie. dirt, rocks, and paint!
34
Pagophagia
eating ice!
35
Koilonychia
spooning of nails
36
what is this?
Cheilitis=lesions on corner of mouth
37
annnd... what is this?
Glossitis=smooth sore tongue
Key for "nuitritonal deficient anemia" (B12, folate, and iron)
38
so if iron deficient anemia happens from my diet then what foods have iron in them?
Red meat, pork, poultry, seafood, beans, leafy greens, dried fruit (raisins), iron fortified cereals, breads, pasta
39
Mother presents wth her 12 month old babe they do labs and find out she has iron deficiency anemia... why is it so common in a 12 month old?
weaning from breast milk starts to occur and they can start to get iron deficiency… if they are having a hard time weaning then it can be a problem they just want mom's milk… they need real food to not get iron deficient .
CBC will show anemia
40
what are the three things in your work up for someone with iron def. anemia
1. CBC-abnormal
2. History
3. Iron level/ iron panel / total iron binging capacity (TIBC)
if you don’t have a lot of iron you will have a lot of TIBC because its waiting to bind to iron.
41
So we are still talking about nutritional deficiencies if you were wondering....
what are two types of megaloblastic anemias
Vitamin B12 & Folate Deficiency
42
who is at higher risk of devloping Vitamin B12 & Folate Deficiency (4)
–Older adults (maybe not getting a good diet)
–Alcoholics (spending money on other things)
–Pure vegans (in animal products)
–Those with malnutrition
43
how long do i have to have nutirional deficiency to get these anemia's?
–Vitamin B12: takes years
–Folate: takes 4-5 months
44
WHAT ARE THE TWO STEPS FOR
Vitamin B12 & Folate Deficiency Workup
•Step 1 – check vitamin B12 and folate levels... DUH
•If results are borderline or discordant with other clinical features…
•Step 2 – check methylmalonate (MMA) and total homocysteine
–If vitamin B12 deficiency: **both elevated**
–If folate deficiency: **only total homocysteine elevated**
MMA AND TOTAL HOMOCYSTEINE WILL ALWAYS LEAD YOU TO THE ANSWER OF EXACTLY WHICH DEFICENCY IT IS!
45
what do i NEED to rule out when doing a workup of vit B12 and folate defic.? WHY?
**HAVE TO RULE OUT B12**
Have to evaluate for b12 because it can cause **irreversible neurologic damage**
46
ALRIGHT.... let's talk about
Vitamin B12 Deficiency
who do we see it in?
Watch for especially in patients with gastric bypass, GI disease (Crohn’s, etc)
again DONT MISS THIS! can cause irreversible neurological damage!
47
Vitamin B12 Deficiency
SIGNS AND SYMPTOMS (4...well kinda 5)
what are some S/S with late findings (1)
**–Gait disturbance
–Glossitis
–Anorexia/diarrhea**
**–Paresthesias** (damage to peripheral nerves, pins and needles, tingly), **decreased sensory of position** (is it up is it down..remember that test?) and **vibratory sense**
•Late finding – **altered mental status**
and you know why? because if you miss this it causes _IRREVERSIBLE NEUROLOGICAL DAMAGE_
48
Treatment of
Vitamin B12 Deficiency
in PERNICIOUS ANEMIA
TX – parenteral B12
FACT: **B12 is absorbed in ileum** **with intrinsic factor,** so want to get it parenteral (injection) because if they have pernicious anemia then they don't have intrinsic factor and can't absorb it if you take it as a pill. you will have issues...so PARENTERAL IT IS!
(intrinsic factor is too expsensive to give instead of parentral B12!)
49
What is Pernicious Anemia? and what does it cause?
What is it? **lack of intrinsic factor**
stomach does not make Intrinsic factor in Pernicious anemia
why is this bad aka what does this cause...... so due to a lack of intrinsic factor we get _B12 deficiency_
so: Pernicious leads to B12 deficency since intrinsic factor absorbs B12
or
B12 Deficency happens BECAUSE you lack intrinsic factor (pernicious anemia)
sorry to say this so many different ways! she just kept stressing this so i wanted to say it as many ways as possible so everyone understands :)
50
Pernicious Anemia Signs and symptoms (6)
–Skin tingling/burning
–Glossitis
–Fatigue, dyspnea
–Leg weakness or spasms
–Imbalance while standing (especially at night)
–Dementia
51
is Pernicious Anemia associated with other autoimmune disorders?
YES!
•Associated with other autoimmune d/o (thyroid & T1DM)
52
PERNICIOUS ANEMIA
LAB FINDINGS
TREATMENT
LABS: antibodies to intrinsic factor (IF)
TX: IM B12
53
Thalassemia PATHO
Impaired production of globin chains (genetic defect)
54
4 TYPES of Thalassemia? and their symptoms/signs
1) Beta minor - asymptomatic
2) alpha minor – asymptomatic
3) Beta Major- (present ~6 months old) –
–Pallor
–Growth retardation
–Hepatosplenomegaly(HSM), jaundice
–Abnormal skeletal development, **“chipmunk” facies**
4) Alpha major – incompatible with extra-uterine life
55
Beta Thalassemia Major (BTM)
what ar the characteristics on the blood smear? what specific cell do you see characteristic of this?
treatment for BTM?
name two types in thalassemia that require different treatments?
* BTM – _profound_ (KEY!) hypochromic, microcytic anemia with bizarre RBC morphology **(“Target cells”)**
* **BTM TX** – life-long transfusions
**2 types**: heterozygote's (minor)– much more mild symptoms
homozygote's (major) – life-long transfusions (BTM)
56
what type of anemia is Thalassemia?
INHERITED ANEMIA (not nutritional)
People may have minors (remember the four types there were two types of minors that were asymptomatic) and never know it
Around 6 months the infant now produces its own hemoglobin but there is a defect and it now causes a defect in the child.
again blood smear apperance : Hypochromic, microytic, profoundly low
57
Tell me about the apperance and symptoms that happen in a child with Beta Thalassemia Major?
Child will fall off the growth cord!
Facial and skull features will be deformed
hoffman described this as a: Chipmunk face
58
what is unique in the Beta Thalassemia Major peripheral blood smear?
It will have target cells!
59
what will children with Beta Thalassemia Major need for life?
Will need life long transfusions
60
What is sickle cell anemia?
HEMOLYTIC ANEMIA
•Production of abnormally-shaped RBCs
–Subtype causing anemia: homozygous hemoglobin S
•Diminished ability to function as RBCs
–Vasoocclusion
–Hemolysis
61
Signs and Symp. of Sickle Cell Anemia (4)
–Dactylitis (acute pain in the hands and/or feet) [the vessels more easily occulde causing issues]
–Joint pain
–Splenic sequestration
–Multiorgan/multisystem dysfunction or failure
62
what age does sickle cell show up at?
AGE 2
63
tell me all about this picture and whats the problem with it?
Crescent or “Sickle” shaped
## Footnote
They look sharp…. They get stuck in blood stream--- spleen gets big because its trying to clean up the messed up RBC
64
painful episode? what is that? how long can it last?
Previously referred to as SICKLE CELL CRISIS
•No identifiable cause; lasts 2-7 days
•Can affect any area of the body..... it is basal occulding
•Pain trivial to excruciating
•½ of episodes accompanied by:
–Fever
–Swelling
–Tenderness
–Tachypnea
–Hypertension
–Nausea/vomiting
65
What do you not want to miss with SICKLE CELL ANEMIA
Acute Chest Syndrome (ACS)
this should be at the TOP of your differential with Sickle Cell Disease (SCD)
66
what is Acute Chest Syndrome (ACS)
definition?
**•Leading cause of death in patients with SCD**
•Defined as:
–New radiodensity (consolidation) on chest x-ray PLUS fever and/or respiratory symptoms
•Unclear etiology
67
Acute Chest Syndrome (ACS)
signs/symptoms
–Temperature ≥38.5°C
–Tachypnea
–Intercostal retractions, nasal flaring, or use of accessory muscles
–Chest pain
–Cough, wheezing, rales
\*\*\*\*\*\*\*Always look for it; progresses rapidly
68
Acute Chest Syndrome (ACS)
treatment
•TX – broad spectrum abx & ICU admission
69
what is going on here?
Acute Chest Syndrome
Left side- radioopaque…. Probably fluid collection
70
Glucose 6-phosphate dehydrogenase (G6PD) Deficiency
what is it?
as if we have not heard about this deficiency enough!
Anemia caused by enzymatic disorder of RBC
* **Most common enzymatic disorder of RBCs in the world** (up to 400 million people)
* G6PD protects RBCs against oxidant injury; deficiency results in hemolysis
Kids born with it
They don’t have enzyme at all
Newborns when born are screened for this
71
Glucose 6-phosphate dehydrogenase (G6PD) Deficiency
signs and symptoms
–Asymptomatic
–Jaundice (neonatal, hyperbilirubinemia)
–Pallor, dark urine ± abdominal/back pain
72
Can you have G6PD and not know as an adult?
sure thing!
## Footnote
Adult may present with this with no history of diagnosis because they are fine and have mild disorder (enzyme but not a lot of it) but then they can get a **fava bean** and then come to your office and BAM THEY HAVE IT
73
Triggers of G6PD Deficiency
Triggers:
* infection
* drugs (eg, nitrofurantoin)
* chemicals (eg, methylene blue, dyes)
* fava beans
74
how does a blood smear look with G6PD Deficiency
what is the important cells only seen in this disease?
•Peripheral blood smear:
–Heinz bodies
**–Bite cells**
75
Screening tests for G6PD deficiency?
–Fluorescent spot test
76
Treatment for G6PD Deficiency
mild form: avoid triggers
severe form: transfusion
77
What is Aplastic Anemia
and what do you have to get?
basically LOW EVERYTHING
•Pancytopenia= deficiency of all three cellular components of the blood (red cells, white cells, and platelets)
* Neutropenia (↓ WBCs)
* Thrombocytopenia (↓ platelets)
* Anemia (↓RBCs)
* Decreased # reticulocytes
you get a bone marrow biopsy...
78
what are the **two types** of aplastic anemia
–Inherited congenital bone-failure syndromes
•eg, “Fanconi’s”
–Idiopathic, acquired (much more common)
79
what are potential causes of aquired aplasic anemia (4)
•Potential causes of acquired:
–Viral infection
–Drugs
–Toxic chemicals
–Autoimmune
80
Inherited Bone-Failure Syndromes (Fanconi’s)
signs and symptoms
–Abnormal skin pigmentation
–Short stature
–Renal, cardiac, GI abnormalities
–Microcephaly
–Hypogonadism
–Skeletal anomalies
81
Acquired Aplastic Anemia signs and symptoms (7)
•Signs/symptoms (insidious onset):
–Pallor
–Petechiae (pinpoint dots on the skin from micro-hemmoraging)
–Purpura
–Ecchymosis
–Mucosal and gingival bleeding
–Vaginal bleeding
–Active bacterial infections
Fine up until trigger that causes bone marrow to stop producing those cells
82
Whats wrong with having decreased platelets, WBC, RBC in Aplastic Anemia?
No platelets-Can’t clot=Bruising = bleed more
NO WBC- get sick
No RBC- O2 carrying capacity out the window
83
Difference between Ecchymosis/purpura/petechiae
= all bleeding into skin… not much difference
84
Differene between Petechiae and rash
Determine if there is blanching or not.
Petechiae **will not blanch**. This is because petechiae is caused from blood vessels breaking under the skin, therefore with applied presure to the area, it will stay red.
However, a rash **will blanch.** This is because rashes involve blood vessels that have remained intact. When you apply pressure to the rash, you are occluding the blood vessels in the dermis, therefore the skin will turn white (blanch). When you release the pressure, the skin will return back to red because you are releasing pressure off of the blood vessels.
85
Petechiae
what is it? what is it caused by?
little pinpoint dots on the skin that come from microhemmoraging
caused by decreased platelets, thrombocytopenia
86
whats this?
petechiae
87
what this?
purpura
they are bigger!
88
what's this?
ecchymosis
biggest
89
what is **Anemia of Chronic Disease**
## Footnote
**and its PATHO?**
* Associated with infectious, inflammatory or neoplastic disease (eg, CKD, RA, leukemia)
* Typically normochromic, normocytic, hypoproliferative, and mild in degree
•**Pathogenesis**:
–reduction in red blood cell (RBC) production by bone marrow
–mild shortening of RBC survival
–Inability to ↑ erythropoiesis in response to anemia
\*\*\*\*\*\*\*Side comment Hoffman said: \*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*
RBC look normal but there are not. Does not happen acutely it is after several years of having a chronic disease.
90
Signs and Symptoms of Lead Poisoning
Has vague symptoms:
–“Lead colic” abdominal pain
–Anemia
–Headache, irritability
–Confusion
91
Where do you get the most lead exposure?
most due to lead exposure at work (ie. glass industry, auto industry)
92
SO, I'm a new provider what happens if I miss lead poisoning?
•If you miss it – irreversible damage (nervous system, kidneys & other organ systems)
GREAT! SO DON'T MISS IT! :D
93
HOW DO YOU DIAGNOSIS LEAD POISONIG?
(by lab value)
•DX – blood lead level \>80 mcg/dL
94
AHHH, WHAT IS WRONG WITH ME?
lead collects on the gum line... so check it out!
95
what is so unique to the lead poisoning blood smear? if you see this word you 100% KNOW ITS LEAD POSIONING?
**_BASOPHILIC STIPPLING_ ON PERIPHERAL BLOOD SMEAR! = LEAD POISONING**
96
HOW DO YOU TREAT LEAD POISONING
chelation
97
I KNOW IT'S A LOT!
BUT GUESS WHAT!
WE ARE DONE WITH ANEMIA!
now onto Disorders of the RBC's
98
what is Polycythemia Vera
what are the levels for hemoglobin that indicates this?
•Myeloproliferative disorder=Disorder of RBC-makes a ton of RBC's
•Often found incidentally on CBC
–Hemoglobin \>18.5 in men or \>16.5 in women
–Persistent leukocytosis (elevate WBC) & thrombocytosis (Elevated Platelets) because bone marrow over producing
99
signs and symptoms of Polycythemia Vera (5)
–Splenomegaly
–Headache
–Generalized pruritus (post-bath)-severe ithching
–Unusual thrombosis (clotting)
–Erythromelalgia (hands turn colors)
100
How do we treat Polycythemia Vera
PHLEBOTOMY to remove excess RBC
only makes sense ... :D
101
Erythromelalgia
hands change colors
normal pulse but change in color of hands
\*\*specific to polycynthemia vera\*\*
102
Coagulopathies (3 things she mentioned)
Coagulopathies: "Royal disease" (cause a queen had it or something ) (also called clotting disorder and bleeding disorder) is a condition in which the blood's ability to clot (coagulate) is impaired. This condition can cause prolonged or excessive bleeding, which may occur spontaneously or following an injury or medical and dental procedures.
1. Hemophilia- A disorder in which blood doesn't clot normally.
2. Hypercoaguable State: the blood shouldn’t clot when it’s just moving through the body. If blood tends to clot too much, it is referred to as a hypercoagulable state or thrombophilia.
3. Hypocoaguable State: so just the other way around... you don't clot.
103
What is the most inheritied hypercoagulability disorder in Caucasian's
Factor V Leiden
104
What is a risk with Factor V Leiden?
how do people with this usually present?
•Risk of venous thromboembolism (DVT or PE) although most asymptomatic
A lot of time they present with a clot
105
What do you ALWAYS ASK ABOUT BECAUSE OF Factor V Leiden
•Ask about hx clotting (PMH & FH)
## Footnote
Blood clots in family members? During history
\*\*\*\*\*\*Before going on Birth control- ASK! because estrogen in BC causes blood clots
So then put on progesterone instead
**NEVER BE ON ESTROGEN** with history of blood clots.
106
Treatment of Factor V Leiden
TX
* anticoagulation if clot,
* ↓ clotting risk through lifestyle
* modify risk
107
What is Immune Thrombocytopenia
Former term: idiopathic thrombocytopenia purpura (ITP)
•Acquired, thrombocytopenia caused by autoantibodies against platelet antigens
Thrombocytopenia: deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury.
108
How do patients present with Immune Thrombocytopenia
aka what do you see on your exam?
petechiae, purpura, epistaxis
show up complaining of bleeding
109
What is this?
purpura
110
Triggers of Immune Thrombocytopenia
viral infection & systemic conditions (eg, SLE) that disrupt immune homeostasis
111
Treatment of Immune Thrombocytopenia
glucocorticoids unless actively bleeding than IVIG (IV immunoglobulin)
112
What is Hemophilia?
what are the two types?
* X-linked recessive disorder
* A – Factor VIII deficiency; B – Factor IX deficiency
Bleed into the joints ---2 year old with huge knee…
Joint destruction from so much bleeding
113
signs and symptoms of Hemophilia
Late complications?
–Easy bruising
–Hemarthrosis (80% of hemorrhage occurs in joints)
•Late complications – ICH (intracranial hemorrhage), joint destruction
114
at what age is this usually presented and why? (hemophilia)
Usually present @ 1-1.5 years old
Kids around 1 year of age –start walking and start falling
parents bring them in because OMG MY KID WON'T STOP BLEEDING
115
WHAT LAB DO YOU GET FOR HEMOPHILIA
prolonged PTT: partial thromboplastin time
116
What is the treatment of Hemophilia
factor VIII for hemophilia A
factor IX for hemophilia B
117
Is hemophilia rare?
yes more likely child abuse (which is so sad)
Prof. Hoffman said always air on the side of caution and do a child abuse workup to make sure its not that :(
She gave the example of a head contusion she said that is more likely child abuse then hemophilia.
118
what are spontaneous hemarthrosis
large joints in hemophilia
119
What is von Willebrand Disease
* Most common inherited bleeding d/o
* Platelets have normal morphology but lack factor VIII/vWF complex – impacts ability to adhere
120
What are the three types of von Willebrand Disease
•3 types:
1. mild to moderate decrease vWF
2. dysfunction of vWF
3. absolute lack of vWF
121
what is the most common hypocoagulative disorder?
von Willebrand Disease
122
TO see if someone is Hypocoagulative what kinds of questions can you ask?
When you go to the dentist to you bleed A TON?
After surgery do you need blood transfusion?
Heavy heavy menstrual cycle?
123
signs and symptoms of von Willebrand Disease
–Easy bruising w/ hematoma
–Skin bleeding
–Prolonged bleeding from mucosal surfaces (eg, epistaxis, dental/sugery, GI, menorrhagia)
124
how do you diagnosis von Willebrand Disease
increased bleeding time, normal platelet count
## Footnote
Platelets are normal they just can't adhere
Bleeding time will see how well they can adhere
125
What is the treatment of von Willebrand Disease
•TX of mild mucosal bleeding with DDAVP – **desmopressin** –it acts by increasing circulating levels of factor VIII and vWF
126
Alright guys almost there.... lets start Oncology
and just remember this is the only lecture for CA for the exam so by doing these flashcards you are almost done with studying for CA
:)
127
what is Multiple Myeloma
* Classic – older patients with **atraumatic back pain**
* Plasma cells proliferate in bone marrow causing destruction of skeleton "punched out lesions"
Cancer of bone marrow!
128
What are signs and symptoms of Multiple Myeloma (4)
–Bone pain "punched out lesions"
–Fatigue/generalized weakness
-decreased reflexes
–Weight loss
129
What do x-rays look like in Multiple Myeloma
•X-ray shows “punched out” lesions
## Footnote
Get an x ray
Plasma cells are proliferating in bone and causes this punched out thing on x-ray
Then bone scan to see where lesions are
Raadiolucent air where the holes are
130
What will Multiple myeloma x ray show
punched out
131
What labs do you do for multiple myeloma
hypercalcemia, renal insufficiency, anemia
132
What does the exam reveal for multiple myeloma?
what are some Ddx that you should be thinking of?
•Exam – decreased reflexes
Ddx- osteoarthritis, vertebral compression factor, herniated disc
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What is going to be your diagnostic workup for multiple myeloma?
•Diagnostic workup: bone marrow biopsy
In the hip…. Posterior superior iliac crest
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Multiple Myeloma blood smear
see a lot of B cells
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What are the 4 types of Leukemia and differntiate acute from chronic?
Leukemia=blood cancer
90%of all leukemia's are in adults!
If it is child Leukemia then most common is acute
1. Acute lymphoblastic leukemia (ALL)- rapid development of immature cells (mostly blast cells) most common in kids
2. Chronic lymphocytic leukemia (CLL)
3. Acute myeloid leukemia (AML)
4. Chronic myeloid leukemia (CML)
**•Acute** – rapid ↑immature WBCs (aka “blast” cells)
•**Chronic** – excessive buildup of mature but still abnormal WBCs
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Casue
and
risk factors of leukemia (6)?
•Exact cause of leukemia is unknown
•Risk factors:
–Smoking
–Ionizing radiation
–Chemicals (eg, benzene)
–Prior chemotherapy
**–Down syndrome**
–Family history of leukemia
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symptoms of leukemia
(hint: it's a whole diagram of symptoms)
_NONSPECIFIC_
## Footnote
comes into your office is "Soooo run down, extremely tired, can’t get rid of the cough"
you say alright lets give it another week or two
Symptoms failed to resolve and he went back
Extremely high WBC count—he had leukemia
Hoffman told us this story... who knows if she'll take questions from experiences she's had. so here it is :)
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LeuKemia Cutis
Rash primarily on face and chest
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what is this?
splenomegaly in leukemia
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Leukemia Diagnostic Studies
* CBC with differential
* **Leukocytosis (↑WBCs) – hallmark (crowds out other cells which is why you se decrease in other stuff)**
* Anemia (↓H+H)
* Thrombocytopenia
* _Peripheral blood smear_ & bone marrow biopsy abnormalities
* Gene testing (do this with a chronic type)
* Philadelphia chromosome in CML
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What is the hallmark in Leukemia?
high WBC count
And then low everything else because WBC hogging all the space
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Leukemia treatment
TX (depends on type & age of the person)
–Usually combination of:
•Chemotherapy
•Radiation
•Bone marrow transplant
•and/or Watchful waiting
older age - watch and wait
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Signs and symptoms of Lymphoma (5)
1. Painless lymphadenopathy
2. “B” symptoms (if present, aggressive lymphoma) these things happen EVERY NIGHT!
* Fever \>38ºC (\>100.4ºF)
* Weight loss **\>10% over the past 6 months**
* **Night sweats (drenching)**
3. Pruritis (generalized itching)
4. Anorexia
5. SOB if nodes become restrictive
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How does patint present with lymphoma?
Non tender palpable lymph node
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Descirbe X-ray findings for lymphoma
Could pick it up on chest x-ray and having a large mediastinal mass
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Hodgkin’s vs Non-Hodgkin’s
explain key difference between the two?
* If Reed-Sternberg cell present -Hodgkin's
* If Reed-Sternberg cell not present - NHL
* DX – lymph node biopsy
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What does the Reed Sternberg cell look like on a blood smear
OWL'S EYES
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Most common malignancy of head and neck in children (teenagers mostly)
Hodgkin’s Lymphoma
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Hodgkin’s Lymphoma
age of onset?
Exam findings?
* Ages: 15-35 and \>55
* Exam – nontender, firm, rubbery consistency **cervical and/or supraclavicular node(s) neck and above!!! KEY!;** mediastinal mass on routine chest x-ray
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Non-Hodgkin’s Lymphoma
what is it?
exam findings?
* Most common type – 60,000/yr in U.S.
* Group of 20+ types
* eg, Burkitt lymphoma – fastest growing tumor, most common in abdomen
* EXAM Findings: Lymphadenopathy below the clavicles, multiple peripheral nodes
* Can die within days because tumor is so fast growing
Doubles every 24 hours
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what is Neutropenic Fever
_oncology emergency_
•Cancer patients receiving chemotherapy – at risk for invasive infection due to colonizing bacteria and/or fungi that translocate across GI mucosal surfaces
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what could be your only sign for Neutropenic Fever
•Fever may be earliest & only sign of infection
EMERGENCY!
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What do you have to do early with Neutropenic Fever and what do you do to treat it?
•Recognize early; initiate broad-spectrum antibx to avoid sepsis & possibly death
## Footnote
If present with fever this has to be TOP OF LIST.
**IV ABX need to be given 60 min from presentation!**
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What is neutorpenia related to neurtopenic Fever
•Neutropenia defined as **absolute neutrophil coun**t \<500 cells/microL
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okay great, so now we know what neutropenia.... what does **Absolute Neutrophil Count** mean?
ANC = total white blood cell (WBC) count x percentage of polymorphonuclear cells (PMNs) and bands
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Is Neutopenic Fever an emergency?
what must the fever be?
* Fever \>38.3°C (101°F)
* Oncologic emergency!
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NICE JOB GUYS!
hope these helped!
only thing not on here is that little paper packet she gave us with normal lab values on it that we have to know..
I may add those in later this weekend :)
other then that... enjoy and happy studying!
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how many more times is the hematocrit than the hemoglobin? (usually)
3x more!
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what is the fastest growing tumor and where is it found?
burkitts lymphoma, in abdomen
doubles in size every 24 hours and pt can die within days
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what does the term left shift mean
increase in release of immature cells, sometimes called "stabs" indicating inflammatory response
