Module 1 Flashcards
most common skin condition in USA
acne vulgaris
Acne vulgaris has the highest incidence among individuals aged
12 to 25 years, with incidence peaking at 15 years of age.
closed comedones
(“whiteheads”
open comedones
blackheads
Although androgen excess may lead to acne formation
, most individuals with acne do not overproduce androgens. However, their pilosebaceous glands are likely hypersensitive to these hormones and more prone to retention hyperkeratosis
mild acne
, lesions are primarily noninflammatory comedones with occasional small papules.
face, chest, neck
moderate acne
, lesions are mainly inflammatory lesions such as papules and pustules. The papules range in size from a few millimeters to one-half centimeter. The color of the acne papules in light-skinned patients ranges from light pink to bright red.
Scarring is more likely with
larger and deeper pustules
severe acne
severe acne, or nodulocystic acne, lesions are mainly nodules and cysts. This form of acne always results in scar formation
more common in males
acne conglobat
a is severe cystic acne in which nodules, cysts, and abscesses develop; lesions are predominantly located on the trunk area instead of the face. Females with acne conglobata should be evaluated for polycystic ovary syndrome (PCOS)
acne fulminan
s is rare and is seen in young adolescent males. This condition is characterized by acute onset of multiple painful, ulcerated acne lesions, along with systemic symptoms such as fever, chills, malaise, and generalized joint and muscle aches.
rosacea
Rosacea, previously termed “acne rosacea,” should be ruled out. Rosacea is more common in adults and older patients and is located more centrally on the face, cheeks, chin, and nose. Comedones are never found in rosacea. There is a tendency for easy flushing in response to alcohol or heat. Telangiectasias (dilations of small groups of superficial blood vessels) may be present at the skin surface. Rosacea can be accompanied by eye complaints such as excessive dryness and irritation, and it is more common in patients of Irish, Scottish, or English descent.
hot tub folliculitis
“hot tub folliculitis” (folliculitis lesions caused by Staphylococci), which appears within 1 to 4 days after hot tub use, due to insufficient temperature and inadequate chlorination of the water. Patients will complain of small red pustules that are occasionally pruritic. Folliculitis is located on the areas of the body that were immersed in the water, such as the lower torso, buttocks, and legs.
primary goal of acne treatment
is to prevent and/or minimize scarring and permanent pigmentation changes
topical tx for comedonal acne
topical retinoids (Retin-A)
dryness, erythema, scaling
topical tx inflammatory acne
topical abx
applied once-twice daily, refrigerate when stored
Systemic Antibiotic and Hormonal Treatment of Moderate to Severe Acne
if have not responded to topical meds x2-3 months
moderate-severe
doxycycline, minocycline
doxycycline
take with full glass of water
se: photosensitive, GI upset
do not take with antacids, dairy product, iron vitamins
severe acne tx
derm referral
tretinoin tx
0.5mg/kg daily in two divided doses, increase gradually
SE: dry skin, hypertriglyceridemia
acne f/u
every 4-6 weeks to evalaute response
Rosacea is characterized by flare-ups that include three cutaneous components
the first component is vascular in nature, with persistent erythema that primarily involves the central face
he second component is cutaneous and involves the development of recurrent acneiform, erythematous papules and pustules around the central face. The third component consists of connective tissue hyperplasia around the central face with discrete sebaceous gland hyperplasia, consisting of persistent yellow papules particularly around the nose
rosacea tx
metronidazole cream, may take 6-8 weeks to work
ABX if flare (tetracycline, minocycline, doxycycline)
Seborrheic keratosis
is one of the most common noncancerous skin growths seen in older adults. It is characterized by benign, warty-appearing growths that are usually found on the trunk, but they may also be seen on the hands and face. They develop in both sun-exposed and sun-protected areas
Seborrheic keratosis tx
does not require tx
removal if symptomatic
ABCDEs of malignant melanoma.
A = asymmetry
B = border irregularity
C = color change
D = diameter larger than a pencil eraser (greater than 6 mm)
E = an evolving lesion (changing over time); may also be used for elevated, as in a raised lesion
Actinic keratosis (AK
), also called solar keratosis and senile keratosis, is the most common precancerous skin lesion found in lighter-skinned (white) patients. They are found on sun-exposed areas of skin that have been damaged by cumulative sun exposure
rough or scaly rash
removal indicated
All melanomas should be tested for mutations in
BRAF, a gene involved in cell growth signaling,
Basal cell carcinoma
(BCC) is a malignant tumor of the skin that originates in the basal cells of the epidermis. It is a slow-growing and locally invasive tumor that rarely metastasizes. It represents the beginning of a continuum of skin cancers in both severity and mortality.
Squamous cell carcinoma
(SCC), a malignant tumor originating from keratinocytes, can invade the dermis and occasionally metastasize to distant sites.
more common of the two nonmelanomatous skin cancers and the most common type of skin cancer overall
basal cell
The most important risk factor for both BCC and SCC is
chronic accumulated sun exposure
A typical patient with nonmelanomatous skin carcinoma is an adult or elderly patient who presents with
complaints of a spot or a bump that is getting larger or a sore that is not healing. Often the lesion appears as a thick, rough patch that may bleed if scratched or scraped.
surgery has the highest cure rate for both BCC and SCC.
Mohs microsurgery
Refractory errors include
myopia, hyperopia, astigmatism, and presbyopia
what is responsible for central visual acuity
macula of retina, most important portion of retina for distinguishing visual details
Light ray convergence in front of the retina causes
myopia, or near-sightedness
If light rays converge posterior to the retina, the patient is
hyperopic, or farsighted.
if light rays focus on two separate lines rather than a single point, the patient has .
astigmatism
refractive error presentation
change in vision, headache
gradual onset
not typically accompanied by pain
worsened visual acuity
the lens of eye cannot
shed unviable cells
3 types of cataracts
nuclear- significant near sightedness
cortical- no significant impairment to vision
posterior- haze, severe glare in bright light, associated with steroid use, faster progression
Age-related cataracts tend to be
bilateral in nature and may manifest as blurred or distorted vision, with complaints of a glare when driving at night or in bright light
Glaucoma is defined as
a group of diseases characterized by progressive damage to the optic nerve, resulting in optic nerve atrophy and blindness, most typically associated with elevated intraocular pressure
most common glaucoma
open angle, is characterized as a chronic form of the disorder that, before loss of peripheral visual fields, is asymptomatic. It has an excellent prognosis if treated early and appropriately
angle closure glaucoma
most often associated with acute episodes of significant eye pain, redness, and acute visual loss, which, if untreated, may rapidly lead to permanent blindness.
most common cause blindness in African Americans
glaucoma
open angle glaucoma presentation
asymptomatic until optic nerve damage advanced
gradual onset, slow painless bilat periph vision loss, poor night vision
angle-closure glaucoma
a rapid onset, with unilateral pain and pressure, blurred vision, seeing halos around lights, and photophobia, followed by loss of peripheral vision, subsequently followed by central vision loss
unreactive pupil
Normal intraocular pressure is
12 to 22 mm Hg.
tx goal glaucoma
prevent progression of damage
decrease intraocular pressure
1st line therapy glaucoma
beta blocker or prostaglandin
meds given during acute glaucoma attak
diamox or IV mannitol
Diabetic retinopathy
is a noninflammatory disorder of the retina that develops in patients with diabetes mellitus.
3 stages diabetic retinopathy
- background diabetic retinopathy, (2) preproliferative diabetic retinopathy, and (3) proliferative diabetic retinopathy.
leading cause of new cases of legal blindness among Americans aged 20 to 64
diabetic retinopathy
Almost all patients with diabetes will develop background diabetic retinopathy after they have had diabetes for at least .
20 years
background diabetic retinopathy fundoscopic exam
, microaneurysms, intraretinal hemorrhage, macular edema, and lipid deposits may be apparent.
The only pharmacologic agent that has been found to slow the progression of diabetic retinopathy is
lisinopril, an angiotensin-converting enzyme inhibitor.
the leading cause of blindness in patients older than 60 years
macular degeneration
dry macular degeneration
characterized by slow, progressive atrophy and degeneration of the retina
wet macular degeneration
new blood vessels develop under the retina in the macula, causing a sudden distortion or loss of central vision
Vision that corrects with the pinhole test implies an
uncorrected refractive error.
hyperthyroidism
includes a heterogeneous group of conditions characterized by the excessive secretion and synthesis of one or both of the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
hyperthyroidism more common in
women than men (8:1)
20-40 yr olds
Graves’ dx
by far the most common cause of spontaneous hyperthyroidism in the United States. An autoimmune disorder characterized by autoreactive, agonistic antibodies to the thyroid-stimulating hormone (TSH) receptor,
most common hyperthyroid during pregnancy
Subacute thyroiditis
most common cause of thyrotoxicosis
Characterized by glandular inflammation and follicular cell destruction, it is thought to be of viral etiology, frequently occurring following an acute viral infection.
hyperthyroid clinical presentation
anxiety, nervousness, diaphoresis, fatigue, heat intolerance, palpitations, weight loss, and insomnia. In situations in which the thyroid tissue has become enlarged, the patient may complain of fullness or pressure in the neck. Additional symptoms include weakness, exercise intolerance, tremors, lower extremity edema, weight loss in the presence of an increased appetite, menstrual irregularities, frequent bowel movements or diarrhea, and exertional dyspnea.
thyroid acropachy
Patients with long-standing hyperthyroidism may also have clubbing of the digits and signs of new bone growth in the hands, termed
thyroid storm
fever
n/v, abdominal pain
agitation, severe
elevated ft4
TX: PTU
hyperthyroid labs
TSH less than 0.35
FT4 >12.5
tx of choice for hyperthyroidism
radioactive iodine
tx of subacute thyroiditis
beta adrenergic blocking meds, NSAIDs
if unresponsive to above, steroids
most common worldwide cause of thyroid disorders is
iodine deficiency,
most common cause hypothyroidism USA
Hashimotos thyroiditis
hypothyroidism clinical presentation
fatigue, dry skin, slight weight gain, cold intolerance, constipation, and heavy menses. Myalgia, muscle cramps, headaches, and weakness
diagnostic test for Hashimotos thyroiditis
high (1;400) anti TPO antibody titer
hypothyroidism tx
levothyroxine, 1.6 mcg/kg per day for full replacement
take in morning on empty stomach, avoid nighttime insomnia
lab for hypothyroidism after starting tx
TSH in 4-8 weeks
myxedema coma
—a life-threatening state of multiorgan failure, characterized by progressive respiratory depression, decreased cardiac output, and fluid and electrolyte abnormalities (including hyponatremia)—or even death, result from untreated hypothyroidism x10-15 yrs
target TSH level
0.3-2.4
major risk factor for thyroid cancer
exposure to ionizing radiation
major symptom of thyroid cancer
lump/nodule in neck, typically painless
Cushing’s syndrome
persistent inappropriate hypercortisolemia.
pituitary adenomas secrete excessive amounts of ACTH. The hypersecretion is random, episodic, and does not follow the usual circadian rhythm of ACTH secretion in terms of amplitude and duration
most frequent cause of Cushing’s syndrome,
however, is prolonged administration of exogenous glucocorticoid hormones—an iatrogenic etiology that is ACTH-independent
cushing dx clinical presentation
weight gain, back pain, headaches, skin changes, and muscle weakness. Women may complain of menstrual irregularities and hirsutism, and men often report decreased libido and impotence.
“moon face”
cushing dx diagnostic tests
urine free cortisol (at least two measurements), late-night salivary cortisol (two measurements), 1-mg overnight dexamethasone suppression test (DST), or a longer low-dose DST (2 mg/day for 48 hours).
Addison’s dx
primary adrenal insufficiency, failure of adrenale glands to produce hormones b/c of problem in bland
autoimmune destruction of adrenal cortex
addison dx clinical presentation
fatigue, weakness, anorexia, weight loss, nausea, abdominal pain, diarrhea, hypoglycemia, and hypotension (particularly orthostatic hypotension
most common endocrine disorder
diabetes
DM type I
a metabolic disorder characterized by severe insulin deficiency resulting from beta cell destruction, which produces hyperglycemia due to the altered metabolism of lipids, carbohydrates, and proteins.
immune mediated DM (type 1A)
caused by autoimmune destruction of insulin-producing pancreatic beta islet cells. The triggering factor in the development of type 1 DM is thought to be an infection or toxic insult in persons with a genetic predisposition. The most commonly identified infectious agents are congenital rubella
90% of cases
The classic symptoms of type 1 DM are
polyuria (increased urination), polydipsia (increased fluid intake due to excessive thirst), nocturnal enuresis, polyphagia with paradoxical weight loss (due to reduced glucose metabolism, despite increased consumption), visual changes (especially blurred vision), and eventual fatigue, weakness, and anorexia
repeated or complicated infections
diagnosis of DM
- Glycosylated hemoglobin (A1C) of 6.5% or higher
- Symptoms of diabetes (e.g., polyuria, polydipsia, weight loss) plus a random plasma glucose level of 200 mg/dL or higher
- Fasting plasma glucose level of 126 mg/dL or higher (following 8 hours of no caloric intake)
- Two-hour plasma glucose level of 200 mg/dL or higher during an oral glucose tolerance test (OGTT) with a 75-g glucose load
first 3- confirm with repeat testing
glucose level goal for DM before meals
80-130
glucose level goal for DM 2h after meal
180 or less
Optimal SMBG for patients with type 1 DM is
three to four times a day—before each meal and before bedtime
hypoglycemia symptoms
diaphoresis, tachycardia, hunger, shakiness, altered mentation (ranging from an inability to concentrate to frank coma), slurred speech, and seizure
<70 BS
appropriate foods for hypoglycemia tx
1/2 cup of fruit juice
6 oz regular soda
1 cup milk
glucose tabs
check blood sugar 15m after tx
Somogyi effect
, for example, is a unique combination in which a diabetic patient develops hypoglycemia during the night with rebound hyperglycemia in the morning
type 1 DM exercise guidelines
- Check blood glucose before, every 30 to 60 minutes during, and after exercise.
- Avoid exercise if fasting glucose is more than 250 mg/dL and ketosis is present or if the glucose level is more than 300 mg/dL, regardless of whether ketosis is present.
- Consume additional carbohydrate if the glucose level is less than 100 mg/dL and as needed to avoid hypoglycemia.
- Identify when changes in insulin dose or food intake are necessary.
type 2 DM
abnormal secretion of insulin, resistance to the action of insulin in the target tissues, and/or an inadequate response at the level of the insulin receptor. Type 2 DM reduces life expectancy because of complications that are affected by the duration of DM, the degree of blood glucose control, and other cardiovascular risk factors such as smoking and hypertension.
Type 2 DM is associated with two physiological abnormalities:
insulin resistance and impaired insulin secretion by the beta islet cells of the pancrea
If weight loss is indicated for type II DM
, a moderate caloric restriction of 500 to 750 calories less than the patient’s average daily intake, as calculated from a detailed food history (which can be tracked with a food diary), can be instituted.
DM exercise recommendations
150 min/week of moderate-intense physical exercise
at least 3 days/week
biguanide
metformin
works by suppressing excessive hepatic glucose production and by increasing glucose utilization in peripheral tissues
contra: kidney dx
500mg/day with meal x1 week, then bid
Sulfonylureas
glucotrol
work by stimulating pancreatic insulin secretion; thus, pancreatic beta cells must still be producing insulin in order for sulfonylureas to be effective, as they do not reduce insulin resistance
higher risk of hypoglycemia
lowest possible dose with once daily at breakfast
thiazolidinediones
actos
work by sensitizing peripheral tissues to insulin by activating the nuclear glitazone receptor (also known as peroxisome proliferator-activated receptor-γ), which lowers serum glucose levels without increasing pancreatic insulin secretion
caution if risk for fracture
DPP4-I
Januvia
prolong and enhance the activity of incretins, which suppresses glucagon secretion and modestly reduces A1C by 0.5% to 0.8
nasopharyngitis, abdominal pain
GLP1 analogues
Victoza
enhance insulin secretion in a glucose-dependent manner in response to food intake. GLP1 analogues also improve insulin sensitivity, increase beta cell mass, and decrease glucagon secretion.
SGLT2
Invokana
block the activity of SGLT proteins in the renal proximal tubule, thereby reducing glucose reuptake and increasing the secretion of glucose in the urine. The medication is given once daily. Patients often lose weight due to the loss of sugar through the kidney
increase risk of UTI
adult hypoglycemia
<55
Anemia
- can mean any of several problems that involve suboptimal red blood cell (RBC) number or function
- World Health Organization (WHO) identifies anemia as a hemoglobin of less than 13.0 g/dL (less than 42% Hct) in men and less than 12.0 g/dL (less than 36% Hct) in women
microcytic anemia
- Linked to nutritional deficiencies
- MCV value of less than 80 fL
- incidence is high among women of childbearing age, with up to one-third of pregnant women developing anemia in the third trimester
microcytic anemia causes
inadequate oral intake or GI uptake of dietary iron
anemia of chronic disease
thalassemia
sideroblastic anemia
o Inadequate oral intake or GI uptake of dietary iron
microcytic anemia
Most common cause
Monitor especially with vegans/vegetarians
Dx- Iron deficiency- ferritin
Tx- increase dietary iron (animal protein, legumes, dark green leafy veggies) , supplement if needed
If supplement, 325mg iron tid
Recheck level 2-4 weeks later
Parental iron only if failed oral iron supplements
F/u- CBC
anemia of chronic disease
microcytic anemia
Caution for malignancy
Tx- underlying disease. Recommend parental iron
Monitor hgb twice weekly for 2-6 weeks after increase in dose
Consider epogen or Procrit if needed
Chronic use of NSAIDs
thalassemia
microcytic anemia
Depletion or mutation in genes that code for subunits of the protein component in hgb
DX- CBC, Hgb electrophoresis
“vigilance” concerning hematological markers
sideroblastic anemia
microcytic anemia
Host of molecular defects that affect biosynthesis of heme moiety of hgb. Iron delivered appropriately, but not incorporated into uptake
DX- Prussian blue stain of a bone marrow aspirate
RBC transfusion may be required
subjective anemia presentation
o Tachycardia, fatigue, SOB, palpitations, poor concentrations, dizziness
objective anemia presentation
o Hgb below 10- fatigue, sallow colored skin, pale mucous membranes, tachycardia, tachypnea
anemia screening recommendations
if pregnant
children at 1 yr
if fatigue, generalized weakness, SOB with exertion, pallor, dizziness, fainting, chest pain, HA, evidence of GI bleed
Hct is __x value of Hgb
3
Norocytic Anemia
- MCV = 81–99 fL
- presumed mechanism for this is through increased phagocytosis by macrophages, which results in increased clearance of erythrocytes from the circulation
- increase in plasma volume
- increased blood volume loss
- recent history of trauma
- DX: CBC, absolute retic count, periph smear
- Retic count higher in proliferative normocytic anemia
- TX: focus on cause of disorder
- Symptomatic first
- Correct, stabilize, prevent underlying cause (ACD, AIHA, heart valve abnormalities, vasculitis, HTN, HELLP syndrome, DIC)
AIHA tx
oral or IV steroid tx- 1-2 mg/kg in divided dose, then decreased. Supplement with vitamin D, calcium, folic acid, bisphosphonates for prophylaxis against osteoporosis
o Possible splenectomy if steroids ineffective
o DX- Coombs test positive
Vasculitis tx
o Tx- high dose prednisone
o Additional immunosuppressive therapy (Cytoxan) may be needed
DIC tx
o Tx- heparin and plt transfusion- admission to hospital
Macrocytic Anemia
- anemia with an MCV equal to or greater than 100 fL
- greatest among people of northern European and Caucasian descent. Incidence increases past 60 years of age
causes of macrocytic anemia
b12 def
folate def
antimetabolite meds
misc drugs- etoh, liver disease
vitamin b12 def anemia
macrocytic anemia
Pernicious anemia is a macrocytic anemia caused by a hereditary autoimmune disorder in which destructive antibodies are directed against intrinsic factor
Caution with vegan/vegetarian
Tx- oral supplementation- 1,000mcg/day until b12 levels achieved
If needed, parenteral B12 IM daily x7 days, then weekly x1 month
folate def anemia
macrocytic anemia
presents with a low serum folate level and a normal level of vitamin B12. It is almost always related to inadequate dietary intake
Adequate dietary intake is 50 to 100 mcg/day, except in pregnant women who need 800 mcg/day to prevent neural tube defects during fetal development.
tx- 1mg/day of supplemental folic acid
macrocytic anemia subjective presentation
o stomatitis, glossitis, nausea, anorexia, diarrhea, peripheral neuropathies, and malaise
macrocytic anemia objective presentation
o pale or icteric mucosa, a dry and cracked oropharynx, a thickened and smooth-surfaced tongue, tachycardia, a systolic ejection murmur, tachypnea, and diffuse abdominal tenderness
Sickle cell anemia
- Autosomal recessive disorder
- Dx with sickled cells on peripheral blood smear, positive family hx, recurrent painful episode of vaso occlusive pain, pattern of mutated hgb S on electrophoresis
- inherited conditions that occur most commonly in people of West African descent
- initial symptoms typically occur within 1 year of life
sickle cell anemia patho
o Sickled cells become lodged in microvasculature as small thrombi
o If against vascular membrane, they create occlusion to blood flow
o Ischemic injuries/infarcts cause pain as ischemia continues
o Rate of sickling increases as tissues become hypoxic and acidotic
o Body attempts to compensate with expansion and upregulation of bone marrow
o Microthrombi occurs in many parts of bodies- chest, vertebrae, long bones of legs, leg ulcers
o Organs affected- heart, liver, penis, kidneys, retinopathy, spleen
watch if sickle cell anemia
splenic sequestration
acute chest syndrome
CVA
sickle cell anemia subjective presentation
o Severity of anemia, pain. Pain is sudden, characterized as excruciating, lasts several hours- day, unrelieved by rest
o nausea, anorexia, light-headedness, significant anxiety or panic, heart palpitations, and shortness of breath, depression, anxiety
sickle cell anemia objective presentation
o Low grade fever, point tenderness, guarding, pinpoint pupils, inability to follow command
sickle cell anemia DX
o CBC with periph blood smear
o Sickle cells will constitutee 5-10% of peripheral blood smear
o Presence of Howell-Jolly bodies
o Indirect bili level
sickle cell anemia tx
o Folic acid supplementation- 1mg/day, diet rich in vitamin b and C
o Rehydration
o Prophylactic PCN from children 2month- 5years
o UTD on all vaccines
o Packed RBC transfusion in children
- If sickle cell crisis-
hospitalization, symptom control of pain, rehydration, O2 supplementation
* Only cure- transplant of stem cells
sickle cell anemia f/u
every 3 m if stable, seen twice annually by hematologist
polycythemia
- Hct greater than 51% in women and 54% in men is characteristic of the condition
- More prevalent in men older than 70 years of age
- Causes of relative polycythemia include decreased fluid intake, increased fluid loss from the body, and extravasation (redistribution) of vascular fluid into the tissues
Relative polycythemia
- is a condition in which there is a decrease in plasma volume while the total number of circulating erythrocytes remains constant.
o Almost always dehydration (vomiting, burns, fevers)
absolute polycythemia
is a condition in which the actual numbers of circulating erythrocytes are increased with a corresponding increase in measured RBC mass
o Primary- polycythemia vera, which is a chronic myeloproliferative disorder caused by an abnormally dividing pluripotential stem cell that leads to a clonal erythrocytosis that is erythropoietin independent, as well as a variable leukocytosis (increased myelocytes) and thrombocytosis
o Secondary- chronic hypoxia, carboxyhemoglobinemia, Cushing’s syndrome, chronic corticosteroid use, erythropoietin-secreting tumors, and cardiopulmonary diseases
subjective polycythemia presentation
o Chronic cough, cyanosis, hypersomnolence, SOB, headache, blurred vision, weakness, fatigue, irritability, dizziness, and, on occasion, tinnitus
objective polycythemia presentation
o Erythromelalgia, tendency for thrombosis, hemmorhage
o Dark flushed face
tx polycythemia
o Relative- rehydrate
o Absolute- progressive phlebotomies
leukemia
- neoplastic disease of malignant hematopoietic stem cells that differentiate and proliferate according to specific lineage trajectories that distinguish the types of leukemia as either acute or chronic
AML
more prominent over age 40
ALL
o 2-15 years
o B-cell lymphoblasts increase
o Philadelphia chromosome poor prognostic indicator
CML
o More prominent over 60, median age: 42
o Philadelphia chromosome
CLL
o > 60 years
o most common leukemia in Western (developed) countries
o increased number of small B lymphocytes
acute leukemia subjective presentation
o bone and joint pain, as well as fevers, chills, palpitations, shortness of breath, and signs of infection
o skin eruptions, easy bruising, or prolonged bleeding from simple wounds form a significant part of the subjective history.
objective presentation acute leukemia
o High fever, tachycardia, tachypnea, pale, confusion
subjective presentation chronic leukemia
o fatigue, night sweats, and low-grade fevers.
objective presentation chronic leukemia
splenomegaly
tx for acute leukemia
chemo
tx for chronic leukemia
“watchful vigilance”
