CIS Pales Flashcards
definition lymphadenopathy
feel abnormal
painful to touch
what fungi can cause lymphadenopathy
histoplasmosis, coccidiodes
supraclavicular nodes drain from where
thorax and abdomen
what is panniculitis
inflammation of abdominal fat
heterophile test
mono
one very suspicious lymph node on neck
what imaging is gold standard
CT
factor VII intrinsic or extrinsic
intrinsic
14 y.o F heavy menstruation, weakness lack concentration, Sx 7-8 mo periods heavy and last 7-9 days easy bruising, bleed after tooth extraction age 7 normal vital signs WN/WD, pale, no bruises Hb 9.5 MCV 69 ddx?
Fe deficiency anemia
bleed disorder- vwD, hemophilia
14 y.o F heavy menstruation, weakness lack concentration, Sx 7-8 mo periods heavy and last 7-9 days easy bruising, bleed after tooth extraction age 7 normal vital signs WN/WD, pale, no bruises Hb 9.5 MCV 69 Labs to order?
CBC PT PTT platelet count PS Iron panel PFA platelet function analyzer
14 y.o F heavy menstruation, weakness lack concentration, Sx 7-8 mo periods heavy and last 7-9 days easy bruising, bleed after tooth extraction age 7 normal vital signs WN/WD, pale, no bruises Hb 9.5 MCV 69 normal PTT PT platelet count elevated bleeding time, elevated PFA
not problems in coagulation cascade
qualitative problem with platelets
medicaitons that can cause qualitative problems with platelets
aspirin, NSAIDs
clopidogrel, abcixumab (IIa/IIIB inhibitor)
What is type 2N vwD
normal levels vWF, RIPA and multimer pattern
low factor VIII (prolongs PTT)
how will low VIII change PT PTT
prolonged PTT
20 mo boy with Hx joint swelling and bruising
deep hematomas in thigh mm, not walking on own
no Hx bleeding problems in parents, or 3 siblings
pale wd/wn
tenderness around ankles dec ROM b/l
no petechial rashes
ddx?
hemophilia
ITP
single factor deficiency
what do you have to check with rashes
blanching or not?
20 mo boy with Hx joint swelling and bruising
deep hematomas in thigh mm, not walking on own
no Hx bleeding problems in parents, or 3 siblings
pale wd/wn
tenderness around ankles dec ROM b/l
no petechial rashes
tests to order?
platelet count bleedting time PT PTT PFA CBC
20 mo Hx hematomas
elevated PTT normal PT
ddx?
inherited deficiency VIII, IX, XI deficiency facotr XII vwD acquired: heparin, inhibitor VIII, IX XI XII acquired vwD
normal PTT long PT
ddx?
inherited factor VII deficiency
acquired: factor VII def, vit K def, liver disease, coumadin/warfarin, inhibitor factor VII
prolonged PT and PTT
ddx?
liver disease
DIC!!!
heparin and warfarin
inherited: combined def, def prothrombin etc…
how can you differentiate between factor deficiency and factor inhibitor problems?
mixing study: mix plasma with normal plasma
if corrects PTT then was deficiency
if does not correct there is an inhibitor
factor VII shows deficiency and when mixed with normal plasma PTT was corrected
what 2 diseases need to check for
Hemophilia A
vwD
boy with hemophilia, what family Hx do you look into
males on mothers side
bleeding in minor cuts more likely platelets or hemophilia?
platelets
large subcutaneous soft tissue hematomas more likely in hemophilia or platelet deficiency
hemophilia
Pt PTT and BT for DIC
long BT, long PT long PTT
55 y.o F Hx HTN and RA
on lisinopril, aspirin, methotrexate and ibuprofen
no Hx easy bruising or bleeding
WBC7.5, Hb 11.1 MCV98, platelets 84 (low)
repeated platelets 85
why no Sx?
Sx start between 10 and 20k
first thing to do when see asymptomatic patient with thrombocytopenia
redo it
could have pseudothrombocytpenia (clumping from EDTA)
platelet levels needed for minor surgery? major?
minor >80
major >100
What can cause thrombocytopenia from decreased production
viral infecito, chemo
alcohol
BM aplasia
Vit B12/folate deficiency
what can cause thrombocytopenia from increased destruction
ITP, autoimmune, viral infection, drugs, MAHA= DIC, TTP, HUS HELLP syndrome (pregnancy)
what are weird causes of thrombocytopenia
dilution (after big transfusion)
splenic sequestration
what do you want to known in patient with low platelets but asymptomatic
some macrocytic cells
viral infection
nutrition
recent Hx hospitalization requiring DVT prophylaxis
tests to order for asymptomatic thrombocytopenic patient
PS to look for schistocytes PT PTT Fibrinogen BM biopsy HIV
alcohol can cause what in blood
thrombocytopenia by suppressing bone marrow and increase splenic sequestration
PS normal, PT normal, PTT normal, fibrinogen normal, BM biopsy normal
in asymptomatic thrombocytopenic patient
most likley?
Ab to platelets
ITP
DIC labs
PT PTT fibrinogen levels!!!
fibrinogen(II) levels in DIC
decreased because used up
what are confirmatory tests for ITP
Dx by exclusion
Tx ITP
steroids and splenectomy
59 y.o M alcoholism, severe pneumonia, intubated and got a rash, melena
high WBC, Hb8.1 platelets 17 (LOW) PTT 71 PT 21 (both high)
on antibiotics, pantoprazole(PPI) prophylaxis enoxaparin for DVT, DT, delerium tremons prophylaxis diazepam
ddx?
HIT liver cirrhosis/liver disease alcohol related BM suppression infection splenic sequestration DIC
59 y.o M alcoholism, severe pneumonia, intubated and got a rash, melena
high WBC, Hb8.1 platelets 17 (LOW) PTT 71 PT 21 (both high)
on antibiotics, pantoprazole(PPI) prophylaxis enoxaparin for DVT, DT, delerium tremons prophylaxis diazepam
tests to order?
liver enzymes fibrinogen retic count free plasma Hb U/s spleen PS haptoglobin
normal coagulation studies with non-blanching rash
vasculitis until proven otherwise
C-ANCA elevated
biopsy shows leukocytoclastic vasculitis
wegeners GN
26 y.o F ER with SOB hemoptysis and painfully swollen left leg, no previous medical or surgical Hx, takes Yaz, MVI, parents and siblings healthy, CBC and CMP normal
labs?
PT PTT U/S leg
CXR
V/Q scan
CT
after labs F with swollen leg and SOB has DVT found on U/s and V/Q mismatch showing PE
CT scan shadow in pulmonary artery, clot in L side
causes?
genetic predisposition- factor V leiden, protein C or S deficiency, antithrombin III def, antiphospholipid Ab
virchows triad
procoagulant drugs: birth control pills
what are primary hypercoagulable states
deficiencies of antithrombotic factors: antithrombin III, protein C or S
excess of prothrombotic factors: factor V leiden and prothrombin mutation
what are secondary causes of hypercoagulable states
cancer, pregnancy, BCP
anti-phospholipid syndrome
trauma, surgery and immobilization
what disorders predispose to arterial AND venous clots
antiphospholipid syndrome (SLE) hyperhomocysteine
clotting tx duration if not genetic
3-6 mo
