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ECOS III Midterm > L10 - Lab Medicine Presentations > Flashcards

L10 - Lab Medicine Presentations Flashcards

1
Q

How does unstable angina present?

A

Chest pain, radiating pain, dyspnea, nausea, diaphoresis, syncope, signs of heart failure, indigestion or epigastric abd pain

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2
Q

How is unstable angina treated?

A 
Aspirin (chew 162-325mg)
Nitroglycerin
Beta blockers 
P2Y12 inhibitor (e.g. clopidogrel)
IV glycoprotein IIb/IIIa inhibitor 
Anticoagulation (unfractionated heparin)
Percutaneous intervention
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3
Q

What is the presentation of CHF?

A

Lower extremity edema, jugular venous distention, S3 Gallop, dyspnea, lung crackles/rales, orthopnea or nocturnal dyspnea, acute cough, SOB, acute pulmonary edema, cough, chest pain, fatigue and weight gain

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4
Q

What is the treatment for CHF?

A 
Potassium sparing diuretics 
Loop diuretics 
Thiazide diuretics 
ACE inhibitors 
ARBs 
Direct acting vasodilator 
Inotropic drugs
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5
Q

What is the clinical presentation of hypothyroidism?

A

Fatigue, goiter, oligomenorrhea and amenorrhea, depression, hyponatremia, macroglossia, constipation, reflexes delayed relaxation, hypothermia and weight gain

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6
Q

What is the treatment for hypothyroidism?

A

Thyroid hormone replacement for primary hypothyroidism
Determine underlying cause and treat
Evaluate pituitary function if secondary hypothyroidism
Monitor serum TSH levels to guide therapy
Test for positive anti thyroid peroxidase Abs as cause

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7
Q

What is the clinical presentation for Afib?

A

Heart palpitations, tachyarrythmia, dyspnea, fatigue, anxiety, chest discomfort, dizziness

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8
Q

How is Afib treated?

A

Cardioversion (electrical or chemical)
Rate control with beta blockers or Ca channel blockers
Anticoagulation
Cardiac ablation

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9
Q

If the PT/PTT/INR are normal what should be considered?

A

GI bleed from a coagulopathy or liver disease

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10
Q

What may be an indication of non GI malignancies such as leukemias or lymphoma?

A

Weight loss, LAD, and coagulopathy

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11
Q

What is the classification fo anemia according to WHO?

A

<12 for women

<14 for men

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12
Q

Describe the epidemiology for anemia

A

The prevalence of anemia in Americans older than 65 years is estimated at 9-45%
Wide variation based upon ethnic and racial designation
Most studies show anemia increased in men over women

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13
Q

What is the clinical presentation for anemia?

A

Fatigue, weakness, dyspnea, palpitations and tachypnea on exertion
Can exacerbate sx of underlying conditions
Folate deficiency
Other signs include decreased vibratory and positional senses, ataxia, paresthesia, confusion, dementia, and pearly gray hear at an early age (suggestive of B12 deficiency)

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14
Q

What are common findings in profound iron deficiency anemia?

A

Skin and mucosal changes such as koilonychias (spoon nails), smooth tongue or glossitis, dysphagia (esophageal webs, Plummer-Vinson syndrome)
Pica behavior is also common (craving specific foods such as ice, lettuce, foods not rich in iron)

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15
Q

What can cause microcytic anemia?

A

Mostly IDA
Thalassemias, sideroblastic anemia, anemia of chronic disease, chronic GI blood loss, poor nutritional intake, lead poisoning, bleeding disorder, initial presentation of a GI malignancy

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16
Q

What can cause macrocytic anemia?

A 
Megaloblastic anemia 
Drug effects (antiretrovirals) 
Hypothyroidism 
Reticulocytosis 
Alcoholism/liver disease (target cells) 
Myelodysplastic syndrome
17
Q

What are causes of normocytic anemia?

A

Anemia of chronic inflammation in the elderly
Blood loss
Hemolysis
Renal insufficiency
Reticulocytopenia (low reticulocyte count)
Primary bone marrow disorder
Differentiated by normal serum ferritin levels but body is unable to use it

18
Q

All anemias presenting with hemodynamic instability can improve with what?

A

RBC transfusions

19
Q

How is IDA treated?

A

Supplemental iron (ferrous sulfate 325mg) TID
Only in uncomplicated anemia
Compliance limited by side effects
May require parenteral (IV) infusions for certain conditions (malabsorptive conditions, malignancy, CKD, HF, significant chronic blood loss administered by a trained clinician only due to a high risk of side effects)

20
Q

How is B12 deficiency treated?

A

IM B12 shots
1000mcg IM daily for 7 days then weekly for 4 weeks then monthly for life
New studies show equal effectiveness with oral B12 (1000-2000mcg) in a similar regimen

21
Q

How is folate deficiency treated?

A

Oral therapy of 1mg/day orally until corrected

22
Q

How is anemia of chronic inflammation treated?

A

Treatment of underling condition to decrease inflammation/BM suppression
Severe anemia (Hb <10g/dL)
-blood transfusion + erythropoiesis-stimulating agents can be effective
-dialysis patients, goal is Hb level between 10-12g/dL

23
Q

What is the MCC of IDA in both female and male geriatric patients?

A

GI bleeding

Mandates a GI work up in this pt population

24
Q

What is important in a pt with a history of healthy also how intake/abuse?

A

Investigation for vitamin B12 and folate deficiency

25
Q

What is the clinical presentation for polycythemia?

A

Plethora, splenomegaly, HA, lethargy, coagulation and bleeding abnormalities

26
Q

How is polycythemia treated?

A

Correct the underlying condition
Therapeutic phlebotomy
Maintenance of iron sufficiency

27
Q

What is the presentation for altered hematopoietic cell lines?

A

Weakness and pallor, petechiae, purpura, bleeding, frequent or severe infections, unexplained fever, hepatosplenomegaly, significant LAD
Congenital anomalies such as abnormal pigmentation, short stature, skeletal malformations, renal anomalies, microcephaly, hypogenitalism

28
Q

How are altered HSC lines treated?

A

Evaluation to ID underlying cause
Comprehensive supportive care
ID and treat any source of infection
Irradiated leukocyte depleted RBC transfusion
Irradiated leukocyte depleted platelet transfusions
Immunomodulation (anti thymocyte globulin and cyclosporine)
HSC transplant

29
Q

What is the presentation for metabolic disease?

A 
Based upon the diagnose 
Congenital abnormalities common 
Atypical anatomy and physiology 
MSK abnormalities 
Dermatological abnormalities 
Delayed intellectual development 
Impaired neuro and sensory function
30
Q

How are metabolic diseases treated?

A

Based upon etiology
Dietary modification
Treatment of underlying condition
Symptomatic care

ECOS III Midterm (15 decks)

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