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PCM 4 > Heme and Lymph > Flashcards

Heme and Lymph Flashcards

1
Q

Patients with _____ are at a significantly increased risk for infections compared to the population in general. They may also have infection present in an atypical fashion

A

CLL (CD 19, 20, 5, 23)

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2
Q

What organisms are pts wit CLL most at risk of? Why?

A

encapsulated organisms (strep pneumo, h flu), bc risk of infection wtih humoral immunosuppression inherent to dz and related ts.

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3
Q

What is the most frequent and severe of common localizations for infections in CLL?

A

pneumonia.

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4
Q

What is the most frequent and severe of common localizations for infections in neutropenic pts?

A

bacteremia and septicemia

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5
Q

Patients no longer require a bone marrow examination to substantiate or refute a diagnosis of ___. Instead,
________ done on lymphocytes can establish a diagnosis with a near-100% accuracy

A

CLL

peripheral blood FLOW CYTOMETRY (CD 19, 20, 5, 23)

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6
Q

What would you expect to see on a peripheral smear of CLL? What do the cells represent?

A

smudge cells - fragile malignant lymphocytes sheared by lab tech making smears

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7
Q

Typical “B” sx

A

unintential wt loss, fever, night sweats, fatigue

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8
Q

What sx is waxing and waning and non-resolving in CLL?

A

cervical LAD

Most are ASX and are diagnosed after CBC shows LYMPHOYTOSIS and further lab work is performed

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9
Q

Define the difference between petechiae and purpura

A

Petechiae 5mm

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10
Q

Is thrombocytopenia palpable or NON palpable?

A

NONpalpable

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11
Q

Is intussusception less common in adults or children?

A

less common in adults (happens after inflammation of intestinal lining secondary to vasculitis during normal peristalsis) –> to abd series

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12
Q

Always consider ___ with purpuric lesions

A

menigococcemia

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13
Q

Tetrad for __:

  1. Palpable purpura, no thrombocytopenia and coagulopathy
  2. Arthralgia
  3. Abdominal pain
  4. Renal disease - IgA nephropathy
A

Henoch Schonlein Purpura

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14
Q

What is this?
may follow a streptococcal infx (sore throat), and present with generalized arthralgias, myalgias, rash, palpable purpura, abdominal pain, and renal insufficiency.

A

HSP

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15
Q

Chief concern for management of HSP

A

Assess renal status, overall fluid and electrolytes, determine need for CS.

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16
Q

Goal of tx of HSP until labs return:

A

IV fluids (saline/D5/LR) and monitor

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17
Q

Activity of rHSP

A

up adlib

18
Q

when are GC given in HSP?

A

for extremely bad abdominal pain

19
Q

What is this: inflammation secondary to infection or fat embolism from necrotic bone in a person with HbSS

A

acute chest syndrome

20
Q

In ACS, endothelial dysfunction of pulmonary microvasculature leading eventually to ___ and/or ___

A

endothelial dysfunction of pulmonary microvasculature leading eventually to thromboembolism and /or hemolysis

21
Q

Define dx of ACS

A
  • New pulmonary infiltrates on CXR AND

- One or more of the following: chest pain, temp >38.5, tachypnea, wheezing, cough, or increased WOB

22
Q

Four characterisitc features of…

  1. splenic enlargement and tenderness/pain
  2. drop in Hgb concentration of at least 2g/dL
  3. thrombocytopenia
  4. reticulocytosis
A

splenic sequestration in HbSS

23
Q

Parvovirus B19 and aplastic crisis may predispose a HbSS pt for what?

A

splenic sequestration.

24
Q

What drug for HbSS:
reduces the incidence of painful episodes and hospitalization rates prolongs survival it basically boosts the level of HbF and reduces the amount of HbS

A

hydroxyurea

25
Q

What prophylactic drug should be given for SSD pts 3mo-5 years? why?

A

Prophylactic penicillin because…patients with SSD are susceptible to infection with bacteria and viruses because of the functional asplenia (due to infarction) that begins to occur very early in childhood. This makes these kids particularly susceptible to encapsulated organisms (strep pneuo, H. flu, N. meningititis).

26
Q

What is this: bilateral dorsal swelling of the hands and feet sometimes seen in patients with sickle cell anemia. It most often occurs early in childhood and is often the presenting symptom of HbSS disease in children.

A

dactylitis (Hand-Foot syndrome).

Rarely occurs after 3yo (poor prognostic indicator)

27
Q

What causes dactylitis?

A

microinfarction of bones of hands/feet

28
Q

What things can precipitate a sickling crisis?

A 
Cold weather 
**hypoxia
Infection 
**dehydration
Acidosis 
**etoh intoxication 
Emotional stress 
*********Pregnancy
29
Q

____ from from atelectasis, pulmonary edema, bronchospasm, and V/Q mismatch in ACS.

A

regional alveolar hypoxia

30
Q

four etiologies of ACS

A

infection
vaso-occlusive crisis
asthma
chronic hypoxia

31
Q

All are tx for…

  • hydration
  • pain control
  • respiratory support
  • **bronchodilators
  • antibiotics
  • ***transfusion
  • maybe steroids?
A

ACS

**bronchodilators - asthma may predispose SS pt to ACS

32
Q

Five key signs that suggest severe respiratory distress.

A
  1. Retracitons and use of accessory mm to breath
  2. inability to speak full sentences.
  3. inabilty to lie flat
  4. extreme diaphoresis
  5. restlessness, agitation, declining levels of conciousness
33
Q

Three signs of IMMINENT respiratory arrest

A
  1. DECREASED LEVEL OF CONSCIOUSNESS
  2. inability to maintain resp effort
  3. cyanosis
34
Q

CXR location in ACS

A

upper lobe

35
Q

what will cover mycobacteria?

A

azithromycin

36
Q

sand paper like sound on auscultation

A

pleural rub - fluid around lungs is inflamed…

37
Q

MC cause of Community Acquired Pneumonia

A

S. pneumo

38
Q

palmar purpuric lesions, think….

A

meningococcal disease

39
Q

encapsulated orgs that prevail in SSD and CLL

A

Strep pneumo and H flu

40
Q

rhabdo v. HSP

A

increased CPK in rhabdo

41
Q

CURB mortality:

A

For CAPneumonia: confusion, BUN >20, >65yo, low BP, RR>30

42
Q

an obscured R heart border indicates…

A

middle lobe consolidation

PCM 4 (4 decks)

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