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ER EOR > Heme Geriatrics > Flashcards

Heme Geriatrics Flashcards

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1
Q

MCC anemia worldwide

A

IDA

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2
Q

MCC IDA

A

chronic blood loss - in adults it’s colon CA until proven otherwise

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3
Q

sx IDA

A

pagophagia - craving for ice
PICA
koilonychia - spooning of nails
nonspecific - fatigue, weakness etc

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4
Q

dx IDA

A

CBC - decreased MCV and decreased MCHC

iron studies - decreased ferritin (< 30), decreased transferrin saturation, decreased serum iron, increased TIBC

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5
Q

tx IDA

A

iron replacement (can take with vitamin C - ascorbic acid to increase absorption) - GI ADE MC

325 mg once daily or every other day

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6
Q

B12 is also called

A

cobalamin

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7
Q

where do we get natural sources of B12

A

fish
meat
eggs
dairy products

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8
Q

where is B12 absorbed

A

distal ileum

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9
Q

MCC b12 deficiency

A

pernicious anemia - decreased intrinsic factor

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10
Q

other causes of B12 deficiency

A

Crohn dz
H2RA or PPI use
vegans
chronic alcohol use

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11
Q

sx B12 deficiency

A

similar to folate deficiency but associated with spinal cord involvement

symmetric paresthesias and numbness MC initial

gait ataxia, weakness, vibratory, sensory, and proprioception deficits

decreased DTR!!

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12
Q

dx B12 deficiency

A

CBC - increased MCV, megaloblastic anemia (macro-ovalocytes and hypersegmented neutrophils with > 5 lobes)

Decreased serum B12

Increased homocysteine
Increased methylmalonic acid (MMA)

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13
Q

tx B12 deficiency

A

sx - IM B12 weekly until corrected and then once monthly

patients with pernicious anemia need lifelong monthly IM therapy

otherwise can do oral

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14
Q

MC vitamin deficiency in US

A

folate deficiency

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15
Q

what is the function of folate

A

required for DNA synthesis; deficiency causes abnormal synthesis of DNA

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16
Q

how long do folate stores last

A

2-4 months

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17
Q

MCC folate deficiency

A

inadequate dietary intake - alcoholics, unbalanced diet, anorexia

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18
Q

other causes of folate deficiency

A

increased requirements - pregnancy, infancy, malignancy, psoriasis

impaired absorption - celiac, IBD, chronic diarrhea

meds - methotrexate, trimethoprim

dialysis

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19
Q

sx folate deficiency

A

NO NEURO ABNORMALITIES

fatigue, pallor

glossitis, aphthous ulcer, diarrhea

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20
Q

dx folate deficiency

A

CBC - increased MCV > 100, + megaloblastic anemia (hyperhsegmented neutrophils, macro-ovalocytes)

Decreased serum folate < 2

Increased homocysteine
Normal methylmalonic acid

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21
Q

tx folate deficiency

A

oral folic acid first line - 1-5 mg/day
diet rich in fruits and veggies

22
Q

what is anemia of chronic disease

A

anemia due to decreased RBC production in the setting of chronic dz

23
Q

pathophys of anemia of chronic disease

A

increased hepcidin - acute phase reactant that bocks the release of iron from macrophages and reduces GI absorption of iron
increased ferritin - acute phase reactant that sequesters iron into storage

24
Q

dx anemia of chronic disease

A

CBC - normocytic normochromic anemia classic but may present with microcytic hypo chromic anemia early on

decreased reticulocytes

Iron studies - normal to increased ferritin + normal or decreased TIBC + decreased serum iron

25
Q

tx anemia of chronic disease

A

treat underlying
erythropoietin-alpha if renal disease or low erythropoietin levels

26
Q

chronic lymphocytic leukemia is also called

A

small lymphocytic lymphoma

27
Q

MC leukemia in adults

A

CLL

28
Q

sx chronic lymphocytic leukemia

A

usually asx
pancytopenia - fatigue MC
lymphadenopathy
splenomegaly

29
Q

dx chronic lymphocytic leukemia

A

CBC - lymphocytosis hallmark; increased WBC with > 80% lymphocytes

absolute lymphocytosis > 5000/mcL

scattered smudge cells

hypogammaglobulinemia - decreased IgG, IgA, IgM

flow cytometry - most acute - clone of mature B cells

Bone marrow aspirate and bx required

30
Q

tx chronic lymphocytic leukemia

A

stages 1 and 2 - observation
stages 3 and 4 - chemo

curative - allogeneic (from someone else) stem cell transplant

31
Q

what is chronic myelogenous leukemia

A

myeloproliferative disorder of uncontrolled production of mature and maturing granulocytes (predominantly neutrophils)

32
Q

pathophysiology of chronic myelogenous leukemia

A

BCR (on chromosome 22) and ABL1 (on chromosomes 9) –> BCR-ABL1 fusion –> Philadelphia chromosome

33
Q

sx chronic myelogenous leukemia

A

70% asx
pruritus after hot shower/bath
splenomegaly

34
Q

dx chronic myelogenous leukemia

A

CBC - leukocytosis with granulocytic cells (basophilia, neutrophilic, eosinophilia)

leukocyte alkaline phosphatase score - decreased LAP score due to dysfunctions WBC

bone marrow bx - granulocytic hyperplasia with elevated basophils and eosinophils; chronic < 5% blasts, acceletered 10-19% blasts, acute blast crisis > 20% blasts

genetic testing - fluorescence in situ hybridization (FISH) most accurate genetic test for Philadelphia chromosome

35
Q

tx chronic myelogenous leukemia

A

tyrosine kinase inhibitors (Imatinib, Dasatinib, Nilotinib, Bosutinib) - they inhibit Philadelphia chromosome

if refractory - omacetaxine

36
Q

what is Hodgkin lymphoma

A

B cell malignancy originating in the lymphatic system

37
Q

ages affected by Hodgkin Lymphoma

A

bimodal - 15-34 and > 50

38
Q

RF for Hodgkin Lymphoma

A

EBV
immunosuppression
smoking
caucasian

39
Q

MC type of Hodgkin Lymphoma

A

nodular sclerosing - female predominance

40
Q

4 main types of Hodgkin Lymphoma

A

nodular sclerosing
mixed cellularity
lymphocyte rich/predominance - best prognosis
lymphocyte depleted - worst prognosis

41
Q

sx Hodgkin Lymphoma

A

asx painless lymphadenopathy - ETOH ingestion may induce lymph node pain
upper body lymph nodes - neck MC
hepatomegaly
splenomegaly
systemic B sx - fever, night sweats, weight loss; cyclical fever

42
Q

dx Hodgkin Lymphoma

A

excision whole lymph node bx - Reed-Sternberg cell pathognomonic - large cells with Bi or multilobed nuclei (owl eye appearance) and inclusions in the nucleoli

43
Q

tx Hodgkin Lymphoma

A

stage 1 and 2 - ABVD chemo followed by radiation

stage 3 and 4 - ABVD chemo

44
Q

which lymphoma has a better prognosis

A

Hodgkin Lymphoma

45
Q

major subtypes of non-hodgkin lymphoma

A

Diffuse large B cell - MC - fast growing and aggressive

Follicular - slow growing but hard to cure

Mantle cell

Marginal zone

Burkitt lymphoma - MC in peds and HIV patients ; involves the jaw

small lymphocytic

46
Q

RF non-hodgkin lymphoma

A

age
immunosuppression - HIV
infections - EBV, HHV-8, H pylori associated with gastric lymphoma

47
Q

sx non-hodgkin lymphoma

A

painless lymphadenopathy
GI tract MC site of extra nodal involvement
systemic B sx are rare in non-hodgkin lymphoma

48
Q

dx non-hodgkin lymphoma

A

lymph node and/or tissue bx

for staging - CT/PET scan of chest, abdomen, pelvis

49
Q

tx non-hodgkin lymphoma

A

stage 1 and 2 - radiation alone

R-CHOP chemotherapy

50
Q
A

ER EOR (28 decks)

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