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Hematology and Lymph > Hematology/Lymph MDTs > Flashcards

Hematology/Lymph MDTs Flashcards

1
Q

What condition can poor diet lead to?

A

Folic acid deficiency, which can contribute to iron deficiency.

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2
Q

What is the most common cause of iron deficiency in adults?

A

Bleeding

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3
Q

Anemia is defined as a hematocrit level of?

A

Less than 41 in males.

Less than 37 in females.

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4
Q

Anemia signs and symptoms

A

Lymphadenopathy, hepatosplenomegaly, bone tenderness.

Smooth tongue (suggests megaloblastic anemia). Brittle nails, cheilosis.

Fatiguability, tachycardia, palpitations, tachypnea.

Pica (craving ice chips/food often not rich in iron).

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5
Q

A ferratin value of what indicates anemia?

A

<12 mcg/L

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6
Q

What is the most common cause of anemia worldwide?

A

Iron deficiency

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7
Q

What increases the chance of anemia?

A

Menstruation, pregnancy, and frequent blood donating.

Aspirin/NSAID use also contributes.

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8
Q

Medication treatment of anemia

A

Ferrous sulfate PO

  • 325mg TID x 3-6 months
  • Causes constipation, so stool softeners should be given. Constipation often leads to medication noncompliance.

Parenteral iron IM
-Indicated if patient has intolerance to PO iron, GI disease, or continued blood loss that cannot be corrected.

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9
Q

Serum levels of less than what indicate B12 deficiency

A

<100 pg/mL

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10
Q

B12 deficiency physical findings

A

Glossitis

Anorexia

Diarrhea

Late stages: paleness, paresthesia, difficulty with balance

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11
Q

B12 deficiency lab findings

A

CBC with differential will show a hallmark sign of megaloblastic anemia (large RBCs). A characteristic finding is macro-ovalocyte with hypersegmented neutrophils.

MCV will be strikingly elevated.

Abnormally low B12 serum level (<100 pg/mL).

Elevated LDH and bilirubin.

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12
Q

Treatment of B12 deficiency

A

IM injection of B12.

Daily for the first week
Weekly for the first month
Monthly for life

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13
Q

Hemophilia A is a congenital deficiency of what coagulation factor?

A

VIII

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14
Q

Hemophilia B is a congenital deficiency of what coagulation factor?

A

IX

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15
Q

This condition is a systemic process with the potential for causing thrombosis and hemorrhage

A

Disseminated Intravascular Coagulation

It is an acute, life threatening emergency.

In DIC, the processes of coagulation and fibrinolysis become abnormally activated leading to ongoing coagulation and fibrinolysis.

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16
Q

Common bleeding manifestations seen in DIC

A

Petechiae

Ecchymoses

Blood oozing from wound sites, IV lines, catheters, and mucosal surfaces

Venous thromboembolism

Arterial thrombosis

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17
Q

Symptoms and findings of DIC

A

Bruising without know incidence

Bleeding into joint spaces

Epistaxis

Bleeding from eyes

Very heavy vaginal bleeding

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18
Q

Labs to test for DIC

A

PT, PTT, INR, CBC

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19
Q

This is an X-linked recessive disorder commonly seen in black men, affecting __% of that population

A

G6PD

10-15%

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20
Q

G6PD is described as what?

A

Episodic hemolysis in response to oxidant drugs or infection

Reduced levels of glucose-6-phosphate dehydrogenase between those hemolytic episodes

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21
Q

What are Heinz bodies?

A

These occur when oxidized hemoglobin denatures and forms into precipitants that are called Heinz bodies. These cause membrane damage which leads to the removal of the Heinz bodies by the spleen.

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22
Q

Exposure to what drugs can cause oxidative stress seen in G6PD

A

Dapsone

Primaquine

Quinidine

Quinine

Sulfonamides

Nitrofurantoin

Aspirin

Ciprofloxacin

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23
Q

How will Heinz bodies be seen on a blood smear?

A

Crystal Violet

They are not seen on the usual Wright-Giesma stained blood smear

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24
Q

What is an important administrative measure for the care of G6PD personnel?

A

Red dog tags and the marking of HRECs

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25
Q

This is a recessive disorder in which abnormal hemoglobin leads to chronic hemolytic anemia

A

Sickle cell anemia (caused by Hemoglobin S)

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26
Q

The Hgb S gene is carried in what amount of the American population?

A

8% of black people, and 1 out of 400 black children.

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27
Q

Chronic hemolytic anemia produces what symptoms?

A

Jaundice, pigment, gallstones, hepatosplenomegaly, poorly healing ulcers over the lower tibia.

Acute, painful episodes in the bones (back and long bones) and the chest. These episodes last hours to days and may produce a low grade fever.

Cardiomegaly.

Non-healing ulcers of the lower leg and retinopathy.

Chronic pain.

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28
Q

A hematocrit value of ___-___% will typically be seen in people with sickle cell trait

A

20-30%.

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29
Q

A hallmark of hyposplenism seen in sickle cell trait is called what?

A

Howell-Jolly bodies and target cells

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30
Q

Allogeneic hematopoietic stem cell transplantation performed before the onset of significant end organ damage can cure more than __% of children with sickle cell anemia.

A

80%

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31
Q

What is the average life expectancy of a patient with chronic multi system damage due to sickle cell anemia?

A

40-50 years.

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32
Q

What activities can cause acute painful episodes of sickle cell trait?

A

Vigorous exertion at high altitudes and flying in unpressurized aircraft

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33
Q

What are the two types of leukemias and who do they primarily affect?

A

Acute lymphoblastic leukemia (ALL)
-80% of acute leukemias in children. Remaining 20% affects adults.

Acute myeloid leukemia (AML)
-Seen in adults aged 60

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34
Q

Symptoms and findings seen in leukemia

A

Fatigue

Bleeding in the skin and mucosal surfaces (gingival bleeding, epistaxis, menorrhagia)

Infection due to neutropenia - cellulitis, pneumonia, perirectal infections

Gum hypertrophy and bone/joint pain

Hepatosplenomegaly and lymphadenopathy

Bone tenderness in the sternum, tibia and femur

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35
Q

What is the hallmark lab result of leukemia

A

Pancytopenia with circulating blasts

More than 20% of blasts is enough to diagnose leukemia

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36
Q

Treatment of leukemia

A

MEDEVAC

Referral to hematologist

Chemotherapy and radiation

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37
Q

What is referred to as an abnormally low amount of circulating platelets

A

Thrombocytopenia

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38
Q

What factors can be used to evaluate thrombocytopenia

A 
Location of bleeding
Onset of symptoms
Clinical context
Personal history
Family history
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39
Q

The risk of clinically relevant bleeding in thrombocytopenia does not increase until platelet count falls below what range?

A

10K-20K/mcL

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40
Q

Symptoms seen in thrombocytopenia

A

Petechia

Mucocutaneous bleeding

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41
Q

Thrombocytosis is an abnormally high amount of platelets above what amount?

A

> 450K

42
Q

Symptoms of thrombocytosis

A

50-60 years of age

Elevated platelets (first sign)

Increased risk of thrombosis

Erythromelagia (painful burning of hands)

Spleomegaly seen in 25% of patients

43
Q

When should you refer a thrombocytosis patient to hematology?

A

If there is no infectious cause or the condition does not resolve within 2-4 weeks

44
Q

How large are normal lymph nodes?

A

<1cm

45
Q

Lymphadenopathy can be categorized into what two groups?

A

Generalized - 2 or more regions

Localized - only one region involved (i.e. axilla)

46
Q

What are common causes of lymphadenopathy?

A

HIV

TB

Lupus

Infectious Mono

Malignancy

47
Q

Lymphadenopathy can commonly be associated with what things?

A

Infection
-Cat scratches, undercooked meat (toxoplasmosis)

Tick bites
-Lyme disease

Travel to endemic areas

High risk behavior
-HIV, IV drugs

48
Q

Lymphadenopathy with constitutional symptoms such as fever, night sweats or weight loss indicate what disease processes?

A

TB, lymphoma, other malignancy

49
Q

What medications can cause lymphadenopathy?

A

Atenolol, Cephalosporins, Penicillins, Sulfonamides

50
Q

What are the 5 components of a lymphadenopathy exam?

A

Location

Size

Consistency
-Hard or Firm and Rubbery

Fixable vs. Mobile

Tenderness

51
Q

What does the consistency of lymph nodes indicate?

A

Hard indicates cancer

Firm and rubbery indicates lymphoma

52
Q

What do fixated vs. mobile lymph nodes indicate?

A

Normal lymph nodes are freely moveable in the subcutaneous space.

Abnormal nodes become fixed to adjacent tissue by invading cancer.

53
Q

How long will patients with localized lymphadenopathy be observed for?

A

Three to four weeks if there is nothing else in the history, exam, or labs to suggest malignancy.

Biopsy is appropriate if an abnormal node has not resolved after four weeks.

54
Q

What labs/imaging should be ordered for a patient with generalized lymphadenopathy?

A

CBC, CXR, HIV

55
Q

This is a condition of painless, persistent edema in one or both lower extremities

A

Lymphedema

Essentials to diagnose are pitting edema without ulceration, varicosities, or stasis pigmentation. There may be episodes of lymphangitis and cellulitis.

56
Q

Who does lymphedema primarily effect?

A

Young women.

57
Q

What are the two generalized forms of lymphedema and what are their etiologies?

A

Primary form is due to congenital development abnormalities (lymphatic hypoplasia) that impairs lymph flow from the extremity.

Secondary form involves inflammation or mechanical lymphatic obstruction due to trauma, regional lymph node resection, irradiation, or malignancy/filariasis.

58
Q

Symptoms of lymphedema

A

Aching discomfort with the sensation of heaviness or fullness

Hypertrophy of the limb with markedly thickened and fibrotic skin and subcutaneous tissue (late sign).

Pitting edema.

59
Q

How many stages of lymphedema are there?

A

Four.

60
Q

What imaging should you order for a patient with lymphedema?

A

MRI

Lymphangiography

US to evaluate for DVT

61
Q

How do you treat lymphedema with medications?

A

Diuretic therapy

  • Furosemide (Lasix) 40mg PO daily
  • Bumetanide (Bumex) 1mg PO daily
62
Q

Adverse reactions to diuretic therapy (lymphedema)

A

Hypokalemia

Metabolic alkalosis

Ototoxicity

Hypomagnesmia

Hypotension

Muscle cramps

Rash

Tinnitus

63
Q

Contraindications to diuretic therapy (lymphedema)

A

Hypokalemia

Use caution if patient is in shock or severe renal disease

64
Q

How can secondary cellulitis to a limb effected with lymphedema be avoided?

A

Good hygiene and treatment of any trichophytosis of the toes

65
Q

Generalized allergic reactions generally occur how long after exposure?

A

60 minutes (immediate) or many hours to days after exposure (delayed).

66
Q

This is a serious and life threatening manifestation of mast cell and basophil mediator release

A

Anaphylaxis

67
Q

How is anaphylaxis defined?

A

Allergen exposure followed by acute onset of illness involving the skin or mucosal tissue and either respiratory compromise or hypotension.

Important: systolic blood pressure of less than 90 mmHg or 30% less than the known baseline.

68
Q

How long does it take an immediate food reaction to manifest?

A

2 hours of ingestion of food.

Much less common in adults vs. children.

Most acute systemic food ALLERGY is caused by proteins in milk, egg, wheat, soy, fish, shellfish, peanuts and tree nuts.

Most common causes of ANAPHYLAXIS are shellfish, peanuts, and tree nuts.

69
Q

What is required to diagnose a food allergy?

A

History, skin tests, and specific IgE tests.

70
Q

How long does it take a medication reaction to manifest?

A

30 minutes after initial exposure.

71
Q

What are the manifestations of the following body systems in a medication reaction?

Skin
Respiratory
GI
Hypotension

A

Skin: urticaria, flushing, blotchy rashes, pruritus

Respiratory: respiratory distress, wheezing, stridor, bronchospasm, airway angioedema

GI: cramping, emesis, diarrhea

Hypotension: lightheadedness, dizziness, syncope

72
Q

Treatment of anaphylaxis

A

Epinephrine IM at the onset of anaphylaxis is the cornerstone of treatment

Dose: 0.2-0.5mg SC or IM q5-15 minutes, max dose is 1mg

73
Q

Adverse reactions to epinephrine

A

Pulmonary edema, arrhythmias, hypertension, palpitations, tachycardia, anxiety, tremors

74
Q

What antihistamines are recommended to treat allergies?

A

Loratadine (Claritin) 10mg PO once daily

Cetirizine (Zyrtec) 10mg PO once daily

Fexofenadine (Allegra) 60mg PO twice daily or 120mg PO once daily

75
Q

What are adverse effects and contraindications of oral antihistamines?

A

Adverse effects: headache, dyspepsia, cough, myalgia, somnolence, dizziness

Contraindications: renal impairment, allergy to medication

76
Q

Adverse reactions and contraindications of albuterol

A

Adverse reactions: hypertension, angina, arrhythmia, hypokalemia, nervousness, tremor, headache, tachycardia

Contraindications: ischemic heart disease, severe hypertension, arrhythmias

77
Q

Adverse reactions and contraindications to corticosteroids

A

Adverse reactions:

  • Adrenal insufficiency if taken longer than 7 days in a row.
  • Cushings Syndrome with long term use.
  • GI bleeding, hypertension, emotional lability.

Contraindications: systemic fungal infection, TB, uncontrolled hypertension, CHF, uncontrolled DM

78
Q

How long must a patient treated for anaphylaxis be monitored?

A

4 hours, monitoring for delayed repeat anaphylaxis.

79
Q

When should patients with anaphylaxis be evaluated by an allergist?

A

Patients with new or unexplained onset of anaphylaxis.

80
Q

What is the definition of urticaria

A

Eruptions of evanescent wheals or hives

Itching is intense but rarely may be absent

Special forms have features such as dermatographism, cholinergic urticaria, solar urticaria, or cold urticaria.

81
Q

How long do most incidents of urticaria last?

A

Acute and self limiting in 1-2 weeks

82
Q

Chronic urticaria lasts longer than how many weeks?

A

6 weeks, and it may be due to an autoimmune issue.

83
Q

Urticaria is most commonly caused by what immunologic mechanism?

A

IgE

Less commonly involves the complement cascade.

84
Q

Individual lesions in true urticaria typically last how long?

A

<24 hours, often 2-4 hours.

85
Q

What triggers cholinergic urticaria and how does it manifest?

A

Triggered by a rise in core body temperature (hot showers or exercise), the wheals are 2-3mm with a large surrounding red flare.

86
Q

How does cold urticaria occur?

A

It is acquired or inherited and triggered by exposure to cold and wind.

87
Q

Streaked urticarial lesions will be seen in what time frame before blisters appear due to what exposure?

A

Seen in the 24-48 hours before blisters appear in acute allergic plant dermatitis (exposure to poison ivy, oak, etc).

88
Q

Complications of urticaria

A

Cellulitis from intense itching

Anaphylaxis

Asthma attacks

89
Q

Angioedema is defined as what, and swelling will be seen in what parts of the body?

A

Swelling of vascular tissue involving deeper subcutaneous tissue with swelling of the lips, eyelids, palms, soles, and genitalia.

90
Q

In hereditary angioedema, there is typically positive family history of angioedema, along with symptoms from what other body systems?

A

GI and respiratory symptoms.

91
Q

What are common triggers of angioedema?

A

NSAIDs

ACEis

Estrogens

ASA

CCBs

Amiodarone

92
Q

Treatment of angioedema

A

If it involves the mouth, face, or airway, then monitor for airway compromise and prepare for intubation if necessary

If it develops into anaphylaxis then give epinephrine, antihistamines and steroids

93
Q

This is an inflammatory autoimmune disorder characterized by autoantibodies to nuclear antigens which can affect multiple systems.

A

Systemic Lupus Erythematosus

94
Q

__% of SLE occurs in what gender?

A

85% of SLE occurs in females.

95
Q

What are the signs and symptoms of SLE?

A

Butterfly (malar) rash seen in less than half of patients

Alopecia is common

Mucous membrane lesions occur during exacerbations

Fever, anorexia, malaise, weight loss

Joint symptoms are the earliest manifestation and occur in 90% of patients

96
Q

What are ocular manifestations seen in SLE?

A

Conjunctivitis, photophobia, transient or permanent monocular blindness, blurred vision

97
Q

Respiratory and Cardiac symptoms seen in SLE

A

Pleurisy, pleural effusion, bronchopneumonia, pneumonitis

The pericardium is affected in the majority of patients. Heart failure can occur from myocarditis and hypertension. Cardiac arrhythmias are common.

98
Q

Neurologic symptoms of SLE

A

Psychosis

Cognitive impairment

Seizures

Peripheral and cranial neuropathies

Transverse myelitis

Strokes

99
Q

What is a serious renal condition that can occur in a patient with SLE?

A

Glomerulonephritis

With proper treatment, survival rate is favorable but may require renal replacement therapy

100
Q

What lab test is nearly 100% sensitive for SLE?

A

Antinuclear Antibody tests (ANA)

Nearly 100% sensitive for SLE but not specific.

101
Q

What would you educate a patient with lupus about?

A

Avoid sun exposure, use protective lotion when out of doors.

Minor joint symptoms can be relieved by rest and NSAIDs.

Hematology and Lymph (3 decks)

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