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Heme/Onc > Clin Assess II: Signs & Symptoms of Hematologic/Oncologic Disease > Flashcards

Clin Assess II: Signs & Symptoms of Hematologic/Oncologic Disease Flashcards

1
Q

Blood draw: Adult site?

A

Cubital fossa

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2
Q

Blood draw: Infant sites?

A

Heel or Scalp

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3
Q

What are the symptoms of anemia?

A

Fatigue and pallor due to lack of O2 to body tissues

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4
Q

What is the minimum lab workup for anemia?

A
  • CBC with differential

- Peripheral blood smear

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5
Q

What does the CBC with differential include?

A
  • Hemoglobin (Hgb): O2 carrying proteins in RBCs
  • Hematocrit (Hct): % of RBCs in blood
  • RBC count
  • RBC indices
    • MCV: measures RBC volume
    • MCHC: measures Hgb concentration
  • WBC count
  • Platelet count
  • Reticulocyte count (check bone marrow)
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6
Q

What can cause falsely anemic or normal “H+H” levels?

A
  • Acute bleeding
  • Pregnancy (“physiologic” or dilutional anemia)
  • Volume depletion (hemo-concentrated)
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7
Q

What defines and causes Macrocyctic anemia?

A
  • MCV >100

- Causes: Vitamin B12 deficiency, Folate deficiency

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8
Q

What is Normocytic anemia?

A

Anemia of chronic disease

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9
Q

Symptoms of anemia

A
  • exertional dyspnea
  • dyspnea at rest
  • palpitations
  • roaring pulsatile sound in ears
  • Rarely, lethary, confusion, CHF, angina, arrythmia, and/or AMI with severe anemia
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10
Q

Other signs of anemia

A
  • Bounding pulses
  • Lymphadenopathy
  • Hepatospelomegaly
  • Bone tenderness –> especially over sternum
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11
Q

What is the most common medical disorder worldwide?

A

Iron deficiency anemia

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12
Q

What causes iron deficiency anemia in children? adults?

A
  • Children: poor diet

- Adults: blood loss (e.g. GI bleed, menses)

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13
Q

What are the signs/symptoms for iron deficiency anemia?

A
  • Fatigue
  • cheilitis (chapped lips)
  • glossitis (inflammation of tongue)
  • pica (eating non-food items)
  • pagophagia (compulsive consumption of ice/ice drinks)
  • koilnychia (spoon nails)
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14
Q

Labs for iron deficiency anemia?

A

Serum ferritin

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15
Q

What will a peripheral blood spear show with iron deficiency anemia?

A

Hypochromic, microcytic

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16
Q

What type of anemia is Vitamin B12 deficiency?

A

Megaloblastic anemia

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17
Q

What type of anemia is Folate deficiency?

A

Megaloblastic anemia

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18
Q

Who has a higher risk of developing Vit. B12 and Folate deficiency?

A

Older adults, alcoholics, pure vegans, malnutrition

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19
Q

How long does it take for the development of anemia with Vit. B12 and Folate deficiency?

A

Vit. B12: years

Folate: 4-5 months

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20
Q

What is the workup for Vit. B12 and Folate deficiency?

A
  • Step 1: check Vit. B12 and folate levels. If results are boderline or discordant with other clinical features…
  • Step 2: check methylmalonate (MMA) and total homocysteine
    • if Vit. B12 def: both elevated
    • if folate def: only total homocysteine elevated
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21
Q

What happens if you miss a Vit. B12 deficiency?

A

irreversible neurological damage

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22
Q

What type pf [patients should you watch Vit. B12 deficiency in?

A

Gastric bypass, GI disease (Crohn’s, etc)

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23
Q

Signs/symptoms of Vit. B12 deficiency

A

Gait disturbance, glossitis, anorexia/diarrhea, paresthesias, decreased position and vibratory sense

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24
Q

What happens if you find Vit. B12 deficiency late?

A

Altered mental status

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25
Q

Tx for Vit. B12 deficiency?

A

Parenteral B12

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26
Q

What is Pernicious anemia?

A

B12 deficiency caused by lack of intrinsic factor

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27
Q

What are the signs/symptoms of pernicious anemia?

A

Skin tingling/burning, glossitis, fatigue, dyspnea, leg weakness/spasms, imbalance while standing (especially at night), dementia

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28
Q

What other disorders can pernicious anemia be seen with?

A

Other autoimmune d/o (thyroid & T1DM)

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29
Q

What are the lab findings for pernicious anemia?

A

Antibodies to intrinsic factor

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30
Q

What is the Tx for pernicious anemia?

A

IM B12

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31
Q

What is Thalassemia?

A

Impaired production of globin chains (genetic defect)

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32
Q

Which subsets of the globin chains are asymptomatic?

A

Beta and alpha minor

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33
Q

What are the signs/symptoms of Beta major Thalassemia?

A

Pallor, growth retardation, heptasplenomegaly, jaundice, abnormal skeletal development, “chipmunk” face

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34
Q

At what age does beta major present?

A

~6 months old

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35
Q

Beta major lab results?

A

Profound hypochromic, microcytic anemia with bizarre RBC morphology (“Target cells”)

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36
Q

Treatment for Beta major?

A

Life long transfusions

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37
Q

What is interesting about alpha major?

A

Incompatible with extra-uterine life

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38
Q

What is Sickle cell anemia?

A
  • production of abnormally-shaped RBCs
  • diminished ability to function as RBCs
    • vasoocclusion
    • hemolysis
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39
Q

What subtype of hemoglobin causes SC anemia?

A

homozygous hemoglobin S

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40
Q

Signs/symptoms of SC anemia?

A

Dactylitis (acute pain in hands/feet), joint pain, splenic sequestration, multiorgan/multisystem dysfunction or failure

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41
Q

What occurs in a painful episode (“Sickle cell crisis”) in sickle cell anemia?

A
  • no identifiable cause- lasts 2-7 days
  • can affect any area of the body
  • Pain trivial to excruciating
  • 1/2 of episodes accompanied by:
    • fever
    • swelling
    • tenderness
    • tachypnea
    • hypertension
    • nausea/vomiting
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42
Q

What is Acute Chest Syndrome (ACS) defined as?

A

New radiodensity (consolidation) on chest x-ray PLUS fever and/or respiratory symptoms. Unclear etiology

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43
Q

What is the leading cause of death in patients with SCD?

A

Acute chest syndrome

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44
Q

Signs/Symptoms of ACS?

A
  • Temperature >38.5 C
  • Tachypnea
  • Intercostal retractions, nasal flaring, or use of accessory muscles
  • chest pain
  • cough, wheezing, rales
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45
Q

What is the Tx for ACS?

A

Broad spectrum abx & ICU admission

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46
Q

What is the most common enzymatic disorder of RBCs in the world?

A

G6PD deficiency

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47
Q

What does G6PD do and what does deficiency lead to?

A

G6PD protects RBCs against oxidant injury

Deficiency results in hemolysis

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48
Q

Signs/symptoms of G6PD deficiency?

A
  • Asymptomatic
  • Jaundice (neonatal, hyperbilirubinemia)
  • Pallor, dark urine +/- abdominal/back pain
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49
Q

What triggers G6PD deficiency?

A

infection, drugs (eg nitrofurantoin), chemicals (eg methylene blue, dyes), fava beans

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50
Q

What is found on a peripheral blood smear with G6PD def?

A

Heinz bodies and bite cells

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51
Q

What is a screening test for G6PD def?

A

Fluorescent spot test

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52
Q

Tx for G6PD def?

A

Avoid triggers, transfusion

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53
Q

What is seen with Pancytopenia?

A
  • neutropenia: (decrease WBCs)
  • Thrombocytopenia (decreased platelets)
  • Anemia (decreased RBCs)
  • decreased # reticulocytes
54
Q

How do you confirm pancytopenia?`

A

Bone marrow biopsy

55
Q

What are the types of Aplastic anemia?

A
  • Inherited congenital bone-failure syndromes (“Fanconi’s)

- Idiopathic, acquired (much more common)

56
Q

What are the causes of acquired aplastic anemia?

A

Viral infection, drugs, toxic chemicals, autoimmune

57
Q

What are the signs/symptoms of inherited bone-failure syndromes?

A

Abnormal skin pigmentation, short stature, renal, cardiac, GI abnormalities, microcephaly, hypogonadism, skeletal anomalies

58
Q

What are the signs/symptoms of acquired aplastic anemia?

A

pallor, petechiae, purpura, ecchymosis, mucosal and gingival bleeding, vaginal bleeding, active bacterial infections

59
Q

What is anemia of chronic disease associated with?

A

infectious, inflammatory or neoplastic diseases (eg CKD, RA, leukemia)

60
Q

What would be seen on a peripheral blood smear with anemia of chronic disease?

A

normochromic, normocytic, hypoproliferative, and mild in degree

61
Q

Pathogenesis of anemia of chronic disease?

A
  • reduction in RBC production by bone marrow
  • mild shortening of RBC survival
  • inability to increase erythropoiesis in response to anemia
62
Q

Signs/symptoms of lead poisoning?

A
  • “lead colic” abdominal pain
  • anemia
  • headache, irritability
  • confusion
63
Q

What is lead poisoning usually caused by?

A

Lead exposure at work

64
Q

What happens if you miss Dx of lead poisoning?

A

Irreversible damage: nervous system, kidneys, and other organ systems

65
Q

What do you Dx lead poisoning?

A

Blood lead level >80 mcg/dL

66
Q

Tx for leading poisoning?

67
Q

What is polycythemia vera?

A

Myeloproliferative disorder

68
Q

What is often found incidentally on CBC with polycythemia vera?

A
  • Hemoglobin >18.5 in men or >16.5 in women

- Persistent leukocytosis & thrombocytosis

69
Q

Signs/symptoms of polycythemioa vera?

A
  • splenomegaly
  • headache
  • generalized pruritis (Post-bath)
  • unusual thrombosis
  • erythromelalgia
70
Q

Tx for polycythemia vera?

A

Phlebotomy

71
Q

What race is this most seen in?

72
Q

What are you at risk for with factor V leiden?

A

Venous thromboembolism (DVT or PE), although, most aymptomatic

73
Q

What should you ask about with factr v leiden?

A

Hx clotting (PMH & FH)

74
Q

Tx for factor V leiden?

A

Anticoagulation if clot, decreased clotting risk through lifestyle

75
Q

Tx for factor V leiden?

A

Anticoagulation if clot, decreased clotting risk through lifestyle

76
Q

What is immune thrombocytopenia (Idiopathic thrombocytopenia purpura)?

A

Acquired, thrombocytopenia caused by autoantibodies against platelet antigens

77
Q

What are triggers for immune thrombocytopenia?

A

Viral infection & systemic (eg SLE) that disrupt immune homeostasis

78
Q

What will you find on a physical exam with immune thrombocytopenia?

A

petechiae, purpura, epistaxis

79
Q

Tx for immune thrombocytopenia?

A

Glucocorticoids, IVIG

80
Q

What type of genetic disorder is Hemophilia?

A

X-linked recessive disorder

81
Q

What causes type A hemophilia?

A

Factor VIII deficiency

82
Q

?What causes type B hemophilia

A

Factor IX deficiency

83
Q

What are the signs/symptoms for hemophilia?

A

Easy bruising, Hemarthrosis

84
Q

Where is the most common site of hemorrhage in hemophilia?

A

80% are in joints

85
Q

What age is hemophilia usually seen at?

A

1-1.5 years old

86
Q

What are late complications of hemophilia?

A

Intracranial hemorrhage, joint destruction

87
Q

What is seen on the labs with hemophilia?

A

prolonged PTT (partial thromboplastin time)

88
Q

Tx for hemophilia?

A

prothrombin complex concentrates (PCC) and human factor VIIa

89
Q

What is the most common inherited bleeding disorder?

A

von Willebrand disease

90
Q

What is von Willebrand disease?

A

platelets have normal morphology but lack factor VIII/vWF complex - impacts ability to adhere

91
Q

What are the 3 types of von Willebrand disease?

A
  1. mild to moderate decrease vWF
  2. dysfunction of vWF
  3. absolute lack of vWF
92
Q

Signs/symptoms of von Willebrand disease?

A
  • easy bruising w/ hematoma
  • skin bleeding
  • prolonged bleeding from mucosal surfaces (eg epistaxis, dental/surgery, GI, menorrhagia)
93
Q

How do you diagnosis von Willebrand disease?

A

increased bleeding time, normal platelet count

94
Q

Tx of von Willebrand disease?

A

Tx of mild mucosal bleeding with DDAVP - desmopressin - it acts by increasing circulating levels of factor VIII an d vWF

95
Q

What population is multiple myeloma seen in?

A

Older patients with atraumatic back pain

96
Q

What causes multiple myeloma?

A

Plasma cells proliferate in bone marrow causing destruction of skeleton

97
Q

Signs/symptoms of multiple myeloma?

A
  • bone pain
  • fatigue/generalized weakness
  • weight loss
98
Q

What is seen on xray with multiple myeloma?

A

“punched out” lesions

99
Q

What will labs show with multiple myeloma?

A

Hypercalcemia, renal insufficiency, anemia

100
Q

What will physical exam show for multiple myeloma?

A

decreased reflexes

101
Q

What is the diagnostic workup for multiple myeloma?

A

Bone marrow biopsy

102
Q

What are the 4 types of Leukemia?

A
  • Acute lymphoblastic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL)
  • Acute myeloid leukemia (AML)
  • Chronic myeloid leukemia (CML)
103
Q

What distinguishes acute leukemia?

A

Rapid increased in immature WBCs (aka “blast” cells)

104
Q

What distinguishes chronic leukemia?

A

Excessive buildup of mature but still abnormal WBCs

105
Q

What are the risk factors of leukemia?

A
  • Smoking
  • Ionizing radiation
  • Chemicals (eg benzene)
  • Prior chemotherapy
  • Down syndrome
  • Family history of leukemia
106
Q

What are the common symptoms of leukemia?

A 
Systemic: weight loss, fever, frequent infections
Psychological: fatigue, loss of appetite
Lymph nodes: swelling
Lungs: easy shortness of breath
Spleen and/or liver: enlargement
Muscular: weakness
Skin: night sweats, easy bleeding/bruising, purplish patches or spots
Bones/joints: pain or tenderness
107
Q

What are diagnostic studies for leukemia?

A

CBC with differential, Peripheral blood smear and bone marrow biopsy, gene testing

108
Q

What is seen on CBC with differential with leukemia?

A
  • Leukocytosis (increased WBCs) - HALLMARK
  • Anemia (decreased H+H)
  • Thrombocytopenia
109
Q

What is seen in gene testing with leukemia?

A

Philadelphia chromosome in CML

110
Q

What is the Tx of leukemia?

A

Combination of:

  • chemotherapy
  • radiation
  • bone marrow transplant
  • watchful waiting
111
Q

What does Tx depend on in leukemia?

A

Type & age of person

112
Q

Signs/symptoms of Lymphoma?

A
  • Painless lymphadenopathy
  • “B” symptoms
    • fever > 38C (100.4F)
    • weight loss >10% over past 6 months
    • night sweats (drenching)
  • Pruritus (generalized)
  • Anorexia
  • SOB if nodes become restrictive
113
Q

What does it mean when the “B” symptoms are present?

A

AGGRESSIVE lymphoma

114
Q

HOw to determine Hodgkins’s vs Non-Hodgkins?

A

If Reed-Sternberg cell present –> Hodgkin’s

If Reed-Sternberg cell not present –> NHL

115
Q

How to diagnosis Hodgkin’s vs NHL?

A

Lymph node biopsy

116
Q

What is the most common malignancy of head/neck in teenagers (children mostly)?

A

Hodgkin’s lymphoma

117
Q

What age is HL seen in?

A

15-35 and >55

118
Q

What is present on physical exam with HL?

A

Non tender, firm, rubbery consistency cervical and/or supraclavicular node(s); mediastinal mass on routine chest x-ray

119
Q

What is the most common type of lymphoma?

A

NHL –> 60,000/yr in US

120
Q

How many types of NHL are there?

A

20+ types - eg Burkitt lymphoma: fastest growing tumor, most common in abdomen

121
Q

What are some physical exam findings of NHL?

A

Lymphadenopathy below the clavicles, multiple peripheral nodes

122
Q

In what population is neutropenic fever seen in?

A

Cancer patients receiving chemotherapy

123
Q

What causes neutropenic fever?

A

The patients in chemo at risk for invasive infection due to colonizing bacteria and/opr fungi that translocate across GIU mucosal surfaces

124
Q

What is the earliest/only sign of neutropenic fever?

A

Fever > 38.3C (101F)

125
Q

Why should you Dx neutropenic fever early?

A

So you can initiate broad-spectrum Antibx to avoid sepsis and possibly death

126
Q

What is neutropenia defined as?

A

ABSOLUTE NEUTROPHIL COUNT

127
Q

What is an oncologic emergency?

A

Neutropenic fever!

128
Q

What is absolute neutrophil count?

A

Total WBC count x % of polymorphonuclear cells and bands

129
Q

Levels to be considered anemic?

130
Q

What defines and causes Microcytic anemia?

Heme/Onc (4 decks)

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