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SBL Test 2 > Hubbard: Fatigue > Flashcards

Hubbard: Fatigue Flashcards

1
Q

What is fatigue?

A

Difficulty initiating or maintaining voluntary mental/physical activity.

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2
Q
  1. Its important to distinguish fatigue from what?
  2. How is this done?
A

Perform a ROS to distinguish fatigue from;

    1. True muscle weakness
    1. Excessive sleepiness
    1. DOE
    1. Exercise intolerance
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3
Q

What are common benign disorders that cause fatigue?

A
  1. Psych diseases (depression and anxiety)
  2. Neuro disease (patients may “feel weak” ; MC = MS)
  3. Sleep disorders
  4. Liver and kidney dissease
  5. like everythinggg fuck
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4
Q

What type of fatigue can occur before a migraine?

A

Episodic fatigue before the migraine

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5
Q
  1. Describe the fatigue in Obstructive sleep apnea
  2. How do we evaluate to diagnose?
A
  1. Excessive daytime sleepiness + fatigue
  2. Overnight polysomnography, esp in those snoring, obesity, other RF
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6
Q

Fatigue + true muscle weakness + hair loss + dry skin + cold intolerance

= Dx?

A

HypOthyroidism

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7
Q

Fatigue + sweating + palpitations + heat intolerance

= Dx?

A

HypERthyroidism

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8
Q

MC drugs to cause fatigue

A
  • 1. Antidepressants
  • 2. Antipsychotics
  • 3. Anxiolytics
  • 4. Opiates
  • 5. Antispasticity
  • 6. Antiseizure meds
  • 7. Beta blockers
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9
Q

Cardiopulm causes of Fatigue

A

1. CHF

2. COPD

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10
Q

Common malginant causes of fatigue

A
  • 1. Leukemia/lymphoma
  • 2. Plasma cell disorders
  • 3. Metastatic solid tumors
  • 4. Paraneoplastic disorders
  • 5. Secondary hematologic causes (anemia)
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11
Q

1st step in diagnosing fatigue

A
  1. History and context of onset: OOOLDCAAARTS
    1. Demographics/ethnicity
    2. Menstrual status
    3. Diet
    4. Social status/living conditons
  2. PE
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12
Q

If fatigue + bleeding (GI/GU/mucocutaneous), what are DDx?

A
  • GI/GU = Defective clotting factors
  • Mucocutaneous = platelet disorders
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13
Q

Fatigue + dyspnea.

What is the DDx?

A
  • 1. Pleural effusion
  • 2. Pericaridal effusion
  • 3. Anemia
  • 4. LAD
  • 5. Constrictive pericardial disease
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14
Q

Fatigue + petachiae and purpura on PE.

DDX?

A

Thrombocytopenia: TTP, HUS, DIC

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15
Q

Fatigue + hemarthrosis

= Dx?

A

Severe hemophilia

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16
Q

Fatigue + telangiectasias

= DDx

A

CT disease or Hereditary Hemorrhagic Telangiectasias

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17
Q

Disorders that cause

↓ reticulocyte count

A

Non-hemolytic processes

  1. Iron-deficiency anemia
  2. Anemia of Chronic Disease
  3. Aplastic Anemia
  4. Chronic Kidney Disease (renal failure)
  5. Chronic diseases and marrow infiltration
  6. Megaloblastic Anemia (Vit B12/folate deficiency)
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18
Q

Disorders that cause

↑ reticulocyte count

A

Hemolysis (↑ destruction)

  1. PNH
  2. PK
  3. Hereditary Spherocytosis
  4. G6PD
  5. Spherocytosis
  6. Sickle Cell Anemia/HbC
  7. AIHA/MAHA
  8. Infection: Malaria, Babesia, Bartonella
  9. March Hemoglobinuria/Sports & Cardiac Anemia
  10. Lead/copper poisoning
  11. Portal HTN
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19
Q

If a patient presents with anemia, what is the most important work-up you should perfom?

If you were on a deserted island and could perform 1 test, what test would you perform?

Benefits/drawback?

A

Reticulocyte count:

  • Benefit = tells you how well BM is working/responding
  • Drawback = only a snapshot of what the BM is doing at that time; have to make sure if patient is on any medications to tx anemia
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20
Q

What are reticulocyte counts in the following disorders?

  1. Iron deficiency anemia
A
  1. low
    2.
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21
Q

Patient has

  1. ↓ reticulocyte count
  2. Problems with proliferation/distribution of stem cells

DDx?

A

Aplastic anemia

22
Q

Patient has

  1. ↓ reticulocyte count
  2. Problems with the proliferation/distribution of erythroid progenitor cells

DDx?

A

Chronic kidney disease (decreased EPO production)

23
Q

Patient has

  1. ↓ reticulocyte count
  2. Problem with DNA synthesis

DDx?

A

Megaloblastic anemia (B12/folate deficiency)

24
Q

Patient has

  1. ↓ reticulocyte count
  2. Problem with Hb synthesis

DDx?

A

Iron-deficiency

25
Q

____ reticulocyte count in chronic disease and diseases with marrow infiltration

A
  1. decreased
26
Q

Iron-deficiency Anemia

  1. Clinical Presentation
  2. Labs
A
  1. Microcytic, hypochromic anemia
  2. Labs
    1. ↓ iron
    2. ↓ ferritan
    3. ↑ TIBC (transferrin is less saturated with iron & ↑ capacity for transporting iron exists)
    4. ↓ percent saturation
27
Q

Anemia of Chronic Disease

  1. Therapy?
A
  1. Iron suppliments = NOT effective
  2. Mild anemia (Hb 10-12) = supportive care only
  3. Severe anemia = transfusions to keep Hb >9gm
28
Q

Patient has

  1. ↑ reticulocyte count (↑ production of RBC)

Problem:

  1. Membrane defects or
  2. Enzyme deficiency

DDx?

A
  1. Membrane defects = heriditary spherocytosis
  2. Enzyme deficiency = G6PD deficiency
29
Q

Patient has

  • ↑ reticulocyte count (↑ production of RBC)

Problem:

  • Mechanical
  • Chemical/physical

DDx?

A
  1. Mechanical = March hemoglobinuria/ sports & cardiac anemia
  2. Chemical/physical = lead/copper poisoning
30
Q

Patient has

  • ↑ reticulocyte count (↑ production of RBC)

Problem:

  • Infection
  • Ab-acquired

DDx?

A

Infection

  1. Malaria
  2. Babesia
  3. Bartonella

Ab-acquired

  1. AIHA
31
Q

Patient has

  • ↑ reticulocyte count (↑ production of RBC)

Problem:

  • Hypersplenism

DDx?

A

Portal HTN

32
Q

What is March hemoglobinuria?

AKA?

Treatment?

A
  1. Damage/lysis to RBCs in capillaries on plantar feet due to striking ur feet (marathon runners)
  2. AKA: Sports anemia/foostrike hemolysis
  3. Treat: well-padded footwear and reassurance
33
Q

What is Cardiac Anemia?

A

Ongoing lysis of RBC in patients with severe aortic stenosis (valve gradient > 50mmHg) and prosthetic valves

34
Q

Refer to SBL Test 1 Brainscape/SG for:

A
  1. G6PD deficiency
  2. AIHA
  3. Polycythemia vera
  4. Paraxysmal nocturnal hemoglobinuria
35
Q

Lead poisoning causes what?

A

Interferes with cation pump, causing shortened RBC survival time and slows production of RBC in marrow.

36
Q

MCC of hemolytic anemia in the world?

What does it cause?

Treatment?

A

Malaria

  1. Causes
    1. Severe hemolysis
    2. Blackwater fever = dark urine d/t alot of Hb.
  2. Treatment
    1. Antimalarial agents
37
Q

Treatment of Immune-Mediated Hemolytic Anemia (warm AB hemolysis)

A
  1. Most patients not in sudden danger
  2. Treatment = high dose steroids (mainstay tx); remissions last long
    1. Cyclophosphamide and Azathioprine
    2. If chronic steroid use is required = splenectomy
38
Q

Symptoms/signs of Polycythemia Vera

A
  1. Facial rubor
  2. Hyperviscosity signs (HA, dizziness, blurred vision, heavy arms/legs)
  3. Itchy after hot shower
  4. Splenomegaly
  5. Budd-Chiari syndrome
  6. NL EPO
39
Q

No treatment in PV causes what?

MCC of death?

A
  1. 50% mortality at 18months
    1. Cause of death = pancytopenia due to progressive marrow fibrosis (“spent phase”).
40
Q

What are other causes of elevated RBC counts that can be a DDx in PV?

A
  1. COPD
  2. EPO producing tumors = RCC, Neuroendocrine tumors
  3. Hemoglobinopathy with high affinity Hb (holds O2 more tightly => ischemia to tissues => increased RBC mass)
  4. Living at high altitude => hypoxia d/t decrease FiO2.
41
Q

W/U for Polycythemia Vera

A
  1. CBC/biochemical profile
  2. Exclude other caues of hemoconcentration: is pt dehydrated/ BUN/Cr = NL?
  3. Exclude ABNL EPO levels
  4. Excluse ABNL lung function (Pulse ox with ABG if ABNL; high carboxyhemoglpbin); PFT with DLCO (tests lung function and performance)
42
Q

When both found, what is indicative of Polycythemia Vera?

A

JAK2 kinase muation (V617F) + NL EPO level

43
Q

Treatment of Polycythemia Vera

A

Lower RBC mass to avoid hyperviscoity

    1. Phlebotomy of 250-500cc whole blood q 1-2 weeks as long as Hct >50%. Do this q 6-12 weeks.
    1. 500-1500 mg/d of Hydroxyurea
  • Do not use alkylating agents (busulfan/chlorambucil) d/t risk of therapy related leukemia)
44
Q
  1. NL reticulocyte count
  2. NL Hb for women
  3. NL LDH
A
  1. 1%
  2. 11-13
  3. 180-250
45
Q

What weird feature do you see in iron-deficiency anemia?

A

Craving for crunchy shit/ice cravings = pagophagia

46
Q

What is erythromalagia?

A

Pain in digits, MC due to essential thrombocytopenia

47
Q

What causes fatigue in hematology malignancies?

A

Anemia + cytokine release

48
Q

What test is done to estrablish semiquantitavely the degree of debility in someone with a malignancy?

Why is it done?

A

Performance status (PS) = determine the tolerance to cytotoxic therapy and evaluating the effects of therapy.

49
Q

Performance status Grades 0-5

A
  • 0 = Full active, can carry on all pre-disease performance without restriction
  • 1 = restricted in physically strenous activity, but can walk and do light work (office work/light housework)
  • 2 = ambulatory and capable of self, but cant to any work activities; up and about >50% of waking hours
  • 3 = Only self-limited care; confined to bed or chair more than 50% of waking hours
  • 4= completely disabled; cannto carry on any self-care; totally confined to bed/chair
  • 5 = dead
50
Q

If patient has “fever of unknown origin”, think _____

A

NHL

SBL Test 2 (11 decks)

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