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Comps - Mod 2 > Anemia > Flashcards

Anemia Flashcards

1
Q

Definition of anemia

A

Men - < 13. Women - < 12. Pregnancy women - < 11

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2
Q

What does CBC measure

A

Decreased Hct and Hgb

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3
Q

What does MCV measure

A

Mean corpuscular volume - measures size of RBC. Normal 80-100

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4
Q

What does MCHC measure

A

Mean corpuscular hemoglobin concentration - measure how fully the RBC volume is filled with hemoglobin. Normal - 31-36

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5
Q

What does serum ferritin measure

A

Body’s major iron storage protein and correlates with total body iron stores. Normal 16-300 for men and 4-161 for women. Decreased with iron deficiency anemia

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6
Q

What is TIBC

A

Total iron binding capacity - Capacity to bind iron calculated from transferrin levels. Normal 250-460. Increased with iron deficiency anemia

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7
Q

What is a reticulocyte count

A

Immature RBC that are associated with RBC production. Normal 33-137. Decreased in iron deficiency anemia and anemia of chronic disease

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8
Q

Serum iron levels

A

Plasma iron concentration. Normal 50-175. Decreased in iron deficiency anemia

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9
Q

Types of microcytic anemias

A

MCV < 80. Iron deficiency anemia and thalassemia

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10
Q

Types of normocytic anemias

A

MCV 80-100. Anemia of chronic disease. Sickle cell. Acute blood loss. Early iron deficiency anemia

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11
Q

Types of macrocytic anemias

A

MCV > 100. Vitamin B12 deficiency - pernicious anemia is most common form. Folate deficiency.

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12
Q

Most common causes of microcytic anemias

A

Men and post-menopausal women from chronic GI blood loss, menstruating women, and children from nutritional deficiencies. May be asymptomatic.

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13
Q

Common symptoms of microcytic anemias

A

Fatigue, weakness, dyspnea with exertion, and lightheadedness.

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14
Q

Medicine history of microcytic anemias

A

History of PICA. Medications including antacids, H2 blockers, PPIs, chronic NSAID use, chronic ASA use, use of zinc or manganese supplements.

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15
Q

History of pt with microcytic anemia

A

History of inflammatory bowel disease or gastric surgery. Family hx of bleeding disorders or colon cancer. Hx of smoking or alcohol intake.

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16
Q

Physical assessment of pt with microcytic anemia

A

Cannot be reliably diagnosed by clinical presentation. Abnormal physical findings usually found only with severe, chronic anemia. Pallor and poor cap refill, pale conjunctiva, angular stomatitis, atrophic glossitis, tachycardia, spoon-shaped nails, pale palmar creases, brittle nails, cold hands and feet.

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17
Q

Differentials of microcytic anemia

A

Thalassemia. Lead poisoning. Anemia of chronic disease

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18
Q

Diagnostics with microcytic anemia

A

Low H&H, low MCV & MCHC, low serum ferritin (most specific and one of first indices to change), high TIBC, low serum iron

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19
Q

Treatment of microcytic anemia

A

Identify and treat cause. Increase dietary iron. Oral iron supplement. Typical dosing 50-100 mg TID. Normal Hgb usually achieved in 2 months unless continued blood loss. Continue iron therapy for 6 months in severe deficiency. Recheck retic count in approximately 2 wks.

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20
Q

Education of microcytic anemia

A

Keep out of reach of children. GI upset. Take 2 hr apart from meals, antacids, calcium supplements, fluroquinolones, penicillins, tetracycline, thyroid meds. Increased absorption with vitamin C

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21
Q

Thalassemia

A

Hereditary. Characterized by reduction in synthesis of Hgb chains. Most common in Asian, African, and Mediterranean descents. If 2 of 4 alpha genes affected - alpha thalassemia minor. If homozygous for defective B chain - B thalassemia intermedia or major. Intermedia or major are move severe and diagnosed within first few yrs of life.

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22
Q

Milder forms of thalassemia and iron deficiency anemia

A

Must differentiate because treatment with iron in thalassemia can result in iron overload and lead to life limiting organ damage. Minor thalassemia pt will not respond to iron therapy and will have normal iron studies.

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23
Q

History, physical, and management of thalassemia

A

Most often found by accident. Physical unremarkable. Management - none other than education. Offer genetic counseling.

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24
Q

Vitamin B12 deficiency

A

Macrocytic anemia - Pernicious anemia most often found in older people secondary malabsorption from lack of gastric intrinsic factor. Also with chronic alcoholism, H. Pylori infection, long-term use of antacids, H2 receptor antagonists, or PPIs, long use of metformin. Dietary deficiency is rare.

25
Q

Symptoms of vitamin b12 anemia

A

Irritability, mild memory impairment or dementia, depression, psychosis, personality change, sensory deficits or parasthesias, ataxia, jaundice. Polyneuropathy - onset of hands is sudden.

26
Q

History of vitamin B12 anemia

A

Long-term use of acid reducing meds and metformin. Gastric surgery, Chron’s, Whipple, or celiac disease, frequent UTIs, hypofertility, vegetarian, chronic ETOH.

27
Q

Physical of vitamin B12 anemia

A

Jaundice. Smooth, shiny beefy red tongue. Polyneuropathies, ataxis, Babinski, congnitive imparement, atrophy of vaginal mucosa may occur.

28
Q

Diagnostics of vitamin B12 anemia

A

MCV significantly elevated, but can be normal. Serum B12 level 1 of elevated serum methylmalonic acid or elevated homocystein level. Absence of renal failure, folate deficiency, or vitamin B6 deficiency. Retic count is low. Folate is normal.

29
Q

Management of B12 anemia

A

B12 supplement - 1000-2000 mcg/daily. IM - 100-1000 MCG daily or every other day for 1-2 wks, then 100-1000 every 1-3 months. Intranasal as 1 spray once weekly after normal parameters. Treat underlying factors such as alcohol use. Repeat serum B12, homocystein, and methylmalonic acid levels in 2-3 months after starting treatment.

30
Q

Folate deficiency

A

Most common cause is inadequate dietary intake. Phenytoin and sulfa drugs may interfere with absorption. Elevated requirements during pregnancy. Recommend 0.4 mg/day to prevent neural tube defects.

31
Q

Predominant symptoms of folate deficiency

A

Fatigue, anorexia, gastritis, low-grade fever, dyspnea, palpitations, mild jaundice. Weakness, lightheadedness, and pallor may be seen.

32
Q

Physical assessment of folate deficiency

A

Pallor or hyperpigmentation, glossitis, or mild icterus

33
Q

Diagnostics of folate deficiency

A

Serum folate < 7, RBC < 305, normal methylmalonic acid with elevated homocysteine indicates likely folic acid deficiency.

34
Q

Management of folate deficiency

A

Ensure adequate folate intake. Folic acid 1 mg daily - will replenish in 3 wks. Reduce ETOH intake. CBC 10-14 days after starting treatment should show increased Hgb and decreased MCV. Full response within 8 wks.

35
Q

Normocytic anemia

A

Mild or moderate anemia caused by chronic systemic disease. Common cause chronic infection or inflammation from autoimmune diseases, cancer, liver disease, or renal failure.

36
Q

Symptoms of normocytic anemia

A

Most are asymptomatic, fatigue, weakness, dyspnea with exertion. History of inflammatory conditions or chronic kidney disease. Likely no specific physical findings. May see pallow

37
Q

Diagnostics of normocytic anemia

A

Hgb 8-9.5. MCV 81-99. Low reticulocyte count. Low serum iron concentration, low or normal transferrin, low transferrin saturation, normal or increased serum ferritin

38
Q

Management of normocytic anemia

A

Mild may not need treatment. Control underlying condition. Should be managed by provider who is managing underlying disease.

39
Q

Neck pain and paresthesias - cervical radiculopathy

A

Compression of cervical nerve roots. Caused by age related changes, injury, herniated disks, muscle spasms. Most commonly affects C6&C7.

40
Q

Clinical exam of neck pain and paresthesias - cervical radiculopathy

A

Elevate ROM, Spurling’s maneuver. Palpate for tenderness, muscle spasm, lymphadenopathy. Assess sensory and motor function, DTRs. Treatment - refer if nerve involvement.

41
Q

Neck pain - strain or sprain

A

“Whiplash” usually C7 ligament is torn. Full neck x-ray post trauma. If no broken bones - soft c-collar, ice for 24 hrs then alternate, NSAIDS.

42
Q

Low back pain

A

80% of adults affected and most common disability.

43
Q

Clinical exam of low back pain

A

Inspect, palpate, straight leg raise, ROM, sensory, motor function, DTRs, abdominal exam

44
Q

Diagnostics of low back pain

A

None on first visit. If more than 6 wks conservative Rx, then x-ray. If radiculopathy present, refer and let neurologist decide on MRI

45
Q

Management of low back pain

A

Usually self-limited - 90% resolve 1-6 wks. Tylenol, NSAIDS, muscle relaxants. Activity as tolerated (no longer than 2 days), walk.

46
Q

Shoulder pain

A

Common conditions - diagnosed with history, exam, and plain x-ray

47
Q

Rotator cuff tear symptoms

A

Lateral deltoid pain and weakness, “reached overhead and felt something give in shoulder”, “empty can” test.

48
Q

Treatment of rotator cuff syndrome

A

Resting, NSAIDS, refer if no better in 6 wks

49
Q

Management of elbow pain

A

Rest, ice, NSAIDS, splinting, physical therapy

50
Q

Management of carpal tunnel syndrome

A

Neutral wrist position splint - at night, NSAIDS, reduce fluid retention, referral if no improvement

51
Q

Management of hip pain

A

DJD - tylenol, NSAIDS, capsaicin. Bursitis - avoid aggravating activities, moist heat, ROM, NSAIDS.

52
Q

Knee pain - Meniscus tear

A

Positive McMurry sign. If no mechanical problem - RICE, crutches. Traumatic - refer

53
Q

Criteria for diagnosis of fibromyalgia

A

Pain in axial skeleton and all 4 quadrants for 3 or more months. Excessive tenderness of 4 kg of point pressure in 11 of 18 specific tendon sites.

54
Q

Intertrigo

A

Inflammation of skin folds caused by friction between skin surfaces. Macerated areas are susceptible to bacterial and fungal infection. Co-morbidities such as diabetes may worsen infection. Treat with antifungal powder and keep dry.

55
Q

Treatment of mild acne

A

Topical meds only - Retin-A, Differin, Azelex. Improvement in 6-8 wks.

56
Q

Treatment of inflammatory acne

A

Topical agents - single or combined - e-mycin, clincamycin, benzoyl peroxide

57
Q

Treatment of moderate and severe acne

A

Moderate - oral antibiotics, oral contraceptives. Severe - Accutaine - referral to dermatologist.

58
Q

Treatment of rosacea

A

Mild soaps or cleaners. Exfoliating agents should be avoided. Use mild moisturizers daily. Sunscreen is strongly recommended. Avoid triggers - physical, food, emotional, temperature, dairy, citrus, hot or alcoholic beverages, cosmetics

59
Q

ABCDEs of skin cancer

A

Asymmetry. Borders are irregular. Color change or variation. Diameter larger than pencil eraser. Elevation from a flat lesion to a raised one.

Comps - Mod 2 (9 decks)

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