Anemia + Asthma + CVD + MSK + Joint Flashcards
Correct definition about anemia is:
- decrease in O2 carrying capacity
- decrease in RBC
- decrease in getting rid CO2
Most common cause of anemia
IDA
How do drugs, acohol, and tobacco cause anemia?
Affect Stomach lining causing nutritional anemia
What cardiovascular complication is seen with anemia?
Ejection systolic murmur\ S3 gallop
What are the most important labs in anemia
CBC and smear
Best lab tool in IDA is:
Ferritin
Name high MCV + Normal RDW
- folic & B12
- Hypothyroidism
- Drug-induced anticonvulsants.
- MDS
- BM failure
Name low MCV + high RDW
- active hemolysis with brisk reticulocytosis
Name Normal MCV + Normal RDW
- Chronic disease
- Hemorrhage
- Inflammation (acute)
- Malignancy
- Transient erytheroblastopenia childhood.
Name Normal MCV + high RDW
- Hemolytic anemia (sickle cell\ G6pd\ membrane\ microangiopathies like DIC & HUS\ immune)
Name low MCV + Normal RDW
- Sideroblastic anemia
- Lead poisoning
- IDA
- Thalassemia trait
- Chronic disease
Name low MCV + high RDW
- Thalassemia (HBS-SB)
- HBC & HBE.
What will you order if you see low Hg and MCV
Lead level - Iron profile - Electrophoresis.
What will you order if you see low Hg and normal MCV
- electrophersis
- Coomb
- Osmotic fragility
- enzyme assays
- other diseases.
What will you order if you see low Hg and high MCV
- B12\folic\thyroid screen
- BM aspiration
- hemolysis
Normal MCV values is
80-100
Low:
- MCV
- Iron
- Ferritin
- TIBC
Is:
Anemia of chronic diseases
Low: - MCV - Iron - Ferritin High - TIBC
Is:
IDA
Low: - MCV High - Iron - Ferritin
Is:
Thalassemia
What is the role of mentezer index?
Identify thalassemia:
- MCV\RBC < 13
- Iron levels >30
Less than (13, 12,11) is mild anemia in …. & … & …..
1- male
2- nonpregnant women
3- pregnant women..
Is ferritin always right to diagnose IDA?
No because it might increase in some cases in reactions
Even if increased, check for TIBC and iron
Common risk factors for IDA
- increased intrauterine bleeding
- celiac
- NSAID
- Hpylori or peptic ulcer
When should we suspect malignancy in IDA?
- men
- post menapausal
- RF
- elderly
Iron therapy is:
120 elemental iron for 3m
How to take iron supplements
Empty stomach, No PPI or calcium, vit D
Falsly elevated A1c is due to:
IDA
AAP recommends screening for IDA at
1 year
UPSTSF VS AAFP\CDC for pregnancy screening of IDA is:
USPSTF: not sufficent data
But rest recommend it
What happens with
1- 2 - 3 - and 4 deletions of Hemoglobin A
1: nothing
2: nothing except in pregnancy\illness
3: HBH “splenomegaly & avoid oxidative”
4: hydrops fetalis “not surviving”
What is the major drug that should be avoided in G6pd?
Nitrofuritoin for UTI > cause hemolysis
If b12 is boarderline low, order:
Homocystine +methylmalonoic
Risk factors for future episodes of asthma attacks.
- pregnancy
- use ICS, oral steroid, high use of inhaler
- comorbidities - psychological
- exposure to allergens - eosinphilia
- low FEV1 - ICU admission
Most common ICS medication
Budsonide
Fluticasone
Ciclosonide
Most common reliever combination therapy is:
- Sertride: salmeterol + fluticasone
- Simbicort: Formeterol + Budsonide
Explain the initiation process of asthma treatment:
1: >20 no RF
2: >20 yes RF - 16 to 19
3: <16
4: <16 severe go for referral.
Explain the maintainace process of asthma treatment
- Maintain: >20 for 3 months.
- Step up: <19
How is step 3 different in child <5 than adults?
instead of laba+ICS we double dose the ICS
“Due to fear of bronchospam)
When to step down asthma treatment?
When pts is controlled after 3 months and we can find a minimum therapy to maintain good control
What do you recommend patients with adverse effect of medications?
- change medics or decrease dose\frequency
- anti-fungal therapy for severe thrush
- wash mouth after use
- use spacer
How to evaluate moderate asthma acute attack
Full sentence, agitated alert, may\not use accessory.
- RR:20-30
- HR:<120
- SaO2: >92
- PEFR: 50-70%
How to treat moderate asthma?
1- O2 to keep saturation 2- nebulization or MDI of salbutamol 3- oral prednisone STAT 4- discharge & Start on step 3 5- close follow up
How to treat severe and life-threatning asthma
1- O2 2- Salbutamol nebulizer 3- oral prednisone or 100-200 IV hydrocortisone 4- ipratropium 5- referral
Pediatric assessment score for acute asthma attack
- scalene muscle contraction
- suprasternal retraction
- air entry
- O2 sat.
A child with acute asthma attack and pram 1-3, how to manage
1- O2
2- Salbutamol Q20 for 2 doses
3- ipratropium or oral steroid
4- reassess
What test is used to confirm bronchial asthma?
Spirometery with reversibility test
A patient with known asthma present with acute presentation, what could be the cause other than asthma?
- Viral infection
- pnemonia
- smoke
- exercise
- rhinosinusitis
- GERD
- Obesity
- B-blocker, asprin & NSAID usage.
- sleep disorders
What are the findings in asthma examination
- bilateral expiratory wheez
- high pitch
Reversibility improvement in spriometery with bronchodilator is:
FEV1 (12%) + 200ml
When to preform spiromentery in children?
At 6 years
How to diagnose child with asthma?
More than 3 attacks of SOB or Wheeze in one season with more than 2 weeks of cough
How to diagnose child below 6 years with asthma
Wheeze of >3 episodes \+ (1 major) Atopy , Family hx, skin test \+ (2 minor) Eosinophilia, food allergy
How much is the recommended physical activity?
- 150\w of moderate
- 75\w of vigorous
When do we start screening men for dyslipidemia?
- No risk: 35
- Risk: 20
When do women start screening men for dyslipidemia?
- No risk: 45
- Risk: 20
When are men and women are at similar risk for dyslipidemia?
- post\early menapause
- premature ovarian failure
What are the secondary causes of dyslipidemia?
- Diet: anorexia - high fat diet
- Medications: Steroid - diuretics - amiodarone.
- Medical conditions: hypothyroidism - pregnancy - nephrotic syndrome
Name high intensity statin agents:
and how much it decreases?
- Atorvastatin 40-50
- Rosuvstatin 20-40
(50%)
Name moderate intensity statin agents:
- Atorva 10-20
- Rosuva 5-10
- Simva 20-40
30-49%
Name low intensity statin agents:
Simvastatin 10mg
When to start patients aged 0-19 on statin?
When they have hypercholestermia in the family
When to start patients aged 20-39 on statin
- family history
- premature ASCVD
- LDL >160
Normal population to start statin:
Above 40
What is the cut-off point for diabetes starting high intensity statin?
20% or LDL >190
When to consider CAC?
Between 5-<7.5
Anything from 1 and above favors statin
If >100 initiate immidiatly
What are the risk enhancers for ASCVD risk score:
- family history of premature
- LDL >160
- women condition
- metabolic syndrome
- ethnicity
- inflammatory disease
- kidney diseases
- elevated CRP- LpA-ApoB
- nephorpathy, retinopathy, neuropathy.
How to differentiate myalgia, myositis, rhabdomyolysis in statin therapy?
- Myalgia: Normal CK
- Rhabdomylsis: CK<10x ULN
- Myositis: more than ULN
In which group of population do you expect to see myalgia?
Young - female - thin - athletes - alcohol - drugs on liver metabolism
Statin works primary on:
Liver - kidney
Liver
When to stop statin therapy?
- If ALT\AST is elevated 3x ULN
- Before 3m of conception & in breast-feeding.
After statin therapy [initiation], when to repeat lipid profile test?
And for [maintenance]
- After 1m - 3m.
- After 3-12m
Statin intolerance is common in:
- Old
- Female
- Hypothyroidism
- Alcoholic
- Hemorrhagic stroke
What are the baseline laboratory investigations for statin therapy?
[TSH - BHCG - Liver\renal function - CK - Hb1c - vitamin D]
Do you stop statins if the GFR is below <30?
You only stop rousvastatin, but the rest decrease their doses.
What are the side effects of gum and lozange in smoking cessation therapy?
Hiccups and dyspepsia (avoid food\drinks)
When to initiate aspirin therapy?
Age 40-70 with no previous risk of bleeding and ASCVD of >20%
Most important risk enhancers for ASCVD are:
- LDL>160
- Family Hx of premature ASCVD
What is your next step when you see your patient with BP >160\100
Look for target oran damage.