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B & L > Clinical Lectures > Flashcards

Clinical Lectures Flashcards

1
Q

What kinds of things should you gather from history?

A
  • Ask about bleeding with: surgery, trauma, menstrual period, dental procedures
  • Meds (anticoagulants, NSAIDs, antiplatelets, corticosteroids, antibiotics, antidepressants, alcohol, fish oil, garlic, gingko, vitamin E all can cause easy bruising)
  • Nutritional deficiency (vitamin C, K, protein)
  • Family history of easy bleeding, bruising, or clotting disorders
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2
Q

What kinds of things should you gather from physical?

A
  • Common sites for bruising are on the distal extremities
  • Bruising on face, trunk, and back should raise suspicion for bleeding disorder or physical abuse
  • Bruising on toddlers foreheads are probably normal
  • Does the bruising pattern and mechanism correlate
  • Bruises initially purple-blue then can turn red-brown and eventually will turn green-yellow
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3
Q

Petechiae

A
  • Capillary bleeding
  • 2-3 mm
  • Mostly not normal
  • Think abnormality in platelet number or function
  • DOES NOT BLANCH
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4
Q

Purpura

A
  • Larger than petechiae (4-10 mm)
  • can be palpable or non-palpable (macular)
  • Macular typically non-inflammatory
  • Palpable lesion sign of vascular inflammation
  • Also non-blanching with diascopy
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5
Q

Ecchymosis

A
  • Larger than purpura or petechiae
  • > 1 cm
  • color can help date onset but use caution dating
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6
Q

Categories of rashes

A
  • Infection (serious bacterial illness, viral infection, rickettsiae)
  • Hematological (thrombocytopenia - ITP, TTP, vWD)
  • Mechanical (coughing or vomiting, local pressure or traction)
  • Vascular (Henoch-Schonlein purpura, scurvy, drugs)
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7
Q

Life-threatening conditions presenting with petechiae/purpura

A
  • Meningococcemia
  • Rocky mountain spotted fever
  • Disseminated intravascular coagulation (DIC)
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8
Q

Hemathrosis

A
  • Bleeding into a joint space

- Think about clotting factor deficiency

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9
Q

Hemophilia A

A

-Factor VIII deficiency

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10
Q

Hemophilia B

A
  • Factor IX deficiency

- AKA Christmas disease

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11
Q

Platelet defects

A
  • Mucocutaneous bleeding
  • Excessive bleeding after minor cuts
  • Petechiae common
  • Ecchymoses generally small and superficial
  • Hemarthroses and muscle hematomas uncommon
  • Bleeding with procedures often immediate with degree of bleeding dependent upon severity of defect
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12
Q

Clotting factor deficiencies

A
  • Deep tissue bleeding
  • Not usual to have excessive bleeding after minor cuts
  • Petechiae uncommon
  • May develop large subcutaneous and soft tissue hematomas
  • Hemarthroses and muscle hematomas common in severe deficiency states or in association with injury
  • May be associated with procedural or delayed bleeding (surgery) depending on type and severity
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13
Q

Fatigue

A
  • Difficulty initiating activity
  • Reduced capacity with activity
  • Mental fatigue
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14
Q

Sensation of difficult or labored breathing

A

Dyspnea

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15
Q

Feeling that extra effort is required to move limbs

A

Muscle weakness

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16
Q

Sleepiness or drowsiness

A

Somnolence

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17
Q

Fatigue >6 months differentials

A
  • Hematologic
  • Idiopathic
  • Psychological (major depression, panic disorder, somatization)
18
Q

Ferritin

A
  • found in cytoplasm of cells
  • directly proportional to total iron stores
  • sensitive test for early Iron Deficiency
  • acute phase reactant
19
Q

Sequence of Fe depletion

A 
First: iron stores depleted
-Low ferritin
-Normal Hb/Hct
Second: normocytic mild anemia
-Low ferritin, Hb, Hct
Third: microcytic severe anemia
-Low ferritin, Hb, Hct
20
Q

Female athlete triad

A
  • Low energy
  • Menstrual dysfunction
  • Low bone density
21
Q

Expected labs in iron deficiency and IDA

A
  • Low iron
  • low ferritin
  • high TIBC
22
Q

What should be done for men and post-menopausal females when suspecting IDA?

A

Look in GI for cancer!!!

23
Q

What could be a cause of IDA in kids?

A

Too much cow’s milk or cow’s milk before age 1

24
Q

If what is less than 15 you should think IDA…

A

Serum ferritin

25
Q

What will you see in a blood smear with lead poisoning?

A

Basophilic stippling

26
Q

What would you see on blood smear with a macrocytic anemia likely due to folate/B12 deficiency?

A

Hypersegmented neutrophil

27
Q

What is different about B12 deficiency versus folate deficiency?

A

B12 will present with neurologic symptoms as well

28
Q

What labs are expected for hemolytic anemia?

A

Increased LDH, increased unconjugated bilirubin, decreased haptoglobin

29
Q

What is a mono-spot test?

A

Determines if there are proteins in the blood called heterophile antibodies produced by the immune system as a response to EBV infection

30
Q

What medications can make OCs ineffective?

A
  • Erythromycin

- Rifampin

31
Q

High overall WBC count would indicate…

A

Infection, inflammation

32
Q

Increased neutrophil count (neutrocytosis) indicates…

A

Acute infection (bacterial, some viral, etc.)

33
Q

Decreased neutrophil count (neutropenia) indicates…

A

Bacterial infection (brucellosis), or viral (hepatitis, measles, mono, rubella, flu, chicken pox, etc.)

34
Q

Increased lymphocyte count (lymphocytosis) indicates…

A

Viral infection: infectious mono, herpes, measles, mumps
Bacterial: brucellosis
Other: toxoplasmosis

35
Q

Senstivity

A
  • Proportion of all people with disease who test positive

- Value approaching 100% is desirable for ruling OUT disease

36
Q

Specificty

A
  • Proportion of all people without disease who test negative

- Value approaching 100% is desirable for ruling IN disease

37
Q

Centor Criteria for GABHS

A
  1. Swollen and tender anterior cervical LN
  2. Temp >100.4
  3. absence of cough
  4. tonsillar exudates or swelling

AGE
3-14 = +1
15-44 = 0
45+ = -1

Score
0 - no further testing or treatment
1-3 - perform rapid strep
4+ - empiric treatment with antibiotics (can do test if choose)

38
Q

Most common cause of sore throat

A

VIRAL

39
Q

Treatment for GAS

A
  • Penicillin VK

- Azithromycin

40
Q

Fusobacterium necrophorum (Lemierre’s syndrome) treatment

A

Penicillin VK

B & L (4 decks)

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