L10 - Lab Medicine Presentations Flashcards
How does unstable angina present?
Chest pain, radiating pain, dyspnea, nausea, diaphoresis, syncope, signs of heart failure, indigestion or epigastric abd pain
How is unstable angina treated?
Aspirin (chew 162-325mg) Nitroglycerin Beta blockers P2Y12 inhibitor (e.g. clopidogrel) IV glycoprotein IIb/IIIa inhibitor Anticoagulation (unfractionated heparin) Percutaneous intervention
What is the presentation of CHF?
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
What is the treatment for CHF?
Potassium sparing diuretics Loop diuretics Thiazide diuretics ACE inhibitors ARBs Direct acting vasodilator Inotropic drugs
What is the clinical presentation of hypothyroidism?
Fatigue, goiter, oligomenorrhea and amenorrhea, depression, hyponatremia, macroglossia, constipation, reflexes delayed relaxation, hypothermia and weight gain
What is the treatment for hypothyroidism?
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
What is the clinical presentation for Afib?
Heart palpitations, tachyarrythmia, dyspnea, fatigue, anxiety, chest discomfort, dizziness
How is Afib treated?
Cardioversion (electrical or chemical)
Rate control with beta blockers or Ca channel blockers
Anticoagulation
Cardiac ablation
If the PT/PTT/INR are normal what should be considered?
GI bleed from a coagulopathy or liver disease
What may be an indication of non GI malignancies such as leukemias or lymphoma?
Weight loss, LAD, and coagulopathy
What is the classification fo anemia according to WHO?
<12 for women
<14 for men
Describe the epidemiology for anemia
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
What is the clinical presentation for anemia?
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)
What are common findings in profound iron deficiency anemia?
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)
What can cause microcytic anemia?
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
What can cause macrocytic anemia?
Megaloblastic anemia Drug effects (antiretrovirals) Hypothyroidism Reticulocytosis Alcoholism/liver disease (target cells) Myelodysplastic syndrome
What are causes of normocytic anemia?
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
All anemias presenting with hemodynamic instability can improve with what?
RBC transfusions
How is IDA treated?
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)
How is B12 deficiency treated?
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
How is folate deficiency treated?
Oral therapy of 1mg/day orally until corrected
How is anemia of chronic inflammation treated?
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
What is the MCC of IDA in both female and male geriatric patients?
GI bleeding
Mandates a GI work up in this pt population
What is important in a pt with a history of healthy also how intake/abuse?
Investigation for vitamin B12 and folate deficiency
What is the clinical presentation for polycythemia?
Plethora, splenomegaly, HA, lethargy, coagulation and bleeding abnormalities
How is polycythemia treated?
Correct the underlying condition
Therapeutic phlebotomy
Maintenance of iron sufficiency
What is the presentation for altered hematopoietic cell lines?
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
How are altered HSC lines treated?
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
What is the presentation for metabolic disease?
Based upon the diagnose Congenital abnormalities common Atypical anatomy and physiology MSK abnormalities Dermatological abnormalities Delayed intellectual development Impaired neuro and sensory function
How are metabolic diseases treated?
Based upon etiology
Dietary modification
Treatment of underlying condition
Symptomatic care
