Module 6 Butarro Ch 216-224 Flashcards
A patient reports recent mild fatigue and palpitations. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What other findings are likely to be present?
a. Decreased hematocrit
b. Decreased MCV, MCH, and MCHC
c. Elevated total iron-binding capacity
d. Paresthesias, koilonychia, and pica
a. Decreased hematocrit
This patient has signs of milder iron-deficiency anemia and will also have a low hematocrit level.
MCV=measure of average size of RBC aka microcytic anemia
Micro anemias: IDA, thalasemia
Macaro anemias: Vitamin B12, Folate, Pernicious anemias
The RBC indexes are the last to change as the anemia becomes more severe.
Ferritin = STORED IRON)
TIBC (Total Iron Binding Capacity) = amount of available transferrin in the body.
Transferrin= transfers iron to tissues
MCH= color of the RBC
Paresthesias, koilonychia, and pica occur with more severe anemia. Folate and Vitamine B12
A child weighing 20 kg has been diagnosed with iron-deficiency anemia and will begin taking an oral iron preparation. What will the provider teach the child’s parents about administration of this medication?
a. Iron supplements should be given with food.
b. The child must take the iron for 3 months.
c. The correct dose is 30 mg twice daily.
d. The iron is stopped when the hemoglobin increases.
c. The correct dose is 30 mg twice daily.
The dose for children is 3 mg/kg/day in divided doses.
This child should get 60 mg/day, which is 30 mg/dose twice daily.
Iron supplements are best absorbed on an empty stomach with VITAMIN C
. Iron is given for at least 4 to 6 months.
Hemoglobin levels will begin to increase in 1 to 2 weeks, but the iron is given until the serum ferritin (STORED IRON) increases sufficiently in 4 to 6 months.
A 60-year-old female patient has recently lost weight and a physical examination reveals a beefy-red, sore tongue, with no neurological findings. Based on these clinical findings, what will the provider anticipate finding in the laboratory data?
a. Decreased homocysteine levels
b. Leukopenia and thrombocytopenia
c. Low hemoglobin and elevated MCV
d. Normal methylmalonic acid level
c. Low hemoglobin and elevated MCV
Macrocytic anemia caused by vitamin B12 deficiency will have symptoms described above (beefy-red tongue, sore tongue, neurological symptoms, n/t, weakness, decreased appetite trouble walking, diminished reflexes)
B12 is an essential vitamin for the health of neurons and the brain and normal DNA production of RBCs
Although folate acid deficiency causes macrocytic anemia, there are rarely any symptoms.
Hemoglobin will be decreased and MCV will increase. Homocysteine levels will be increased.
The patient with B12 deficiency will have leukopenia and thrombocytopenia with severe deficiency, characterized by neurologic findings, which this patient does not have.
Methylmalonic acid level will decrease.
A patient is noted to have prolonged bleeding after an intravenous needle is removed. A subsequent laboratory test reveals a prolonged activated partial thromboplastin (aPTT) time with a normal prothrombin time (PT). Based on this result, the provider may suspect alteration in function of which factor?
a. Factor V
b. Factor VII
c. Factor VIII
d. Factor X
c. Factor VIII (hemophila A and vonwillebrand)
Factor VIII is part of the intrinsic system which is more sensitive to factors XII, XI, X, IX which aPTT measures.
The other factors are part of the extrinsic system (VII, X, V, II) , which is measured by PT.
A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the provider asks about a family history of bleeding disorders. The patient reports no female relatives who had excessive bleeding episodes, but states that a maternal uncle and his maternal grandfather both had postsurgical complications related to bleeding. Based on this history, which diagnosis is possible?
a. Hemophilia
b. Thrombocytopenia
c. Thrombophilia
d. Von Willebrand disease
a. Hemophilia
Hemophilia is an X-linked recessive disorder affecting only males and carried by females.
A family history of maternal males with bleeding disorders should clue the provider that this disorder is likely.
Thrombocytopenia is usually an acquired disorder.
Thrombophilia causes clots and thrombi, not bleeding.
Von Willebrand disease is an autosomal genetic disorder affecting both males and females.
A patient has type 1 Von Willebrand disease (vWD). What treatment is generally effective to prevent and treat bleeding episodes in this patient?
a. Coagulation factor
b. Desmopressin
c. Heparin
d. Vitamin K
b. Desmopressin
Desmopressin may be useful in patients with type 1 vWD. Coagulation factor is used in most patients with hemophilia. Heparin is an anticoagulant. Vitamin K is used to counter warfarin overdose.
A child has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider notes petechiae and diffuse lymphadenopathy. A complete blood count reveals a white blood cell (WBC) of 30,000 cells/mm3 and near normal red blood cell (RBC) and platelet counts. What will the provider do next to manage this patient?
a. Order coagulation studies to evaluate for coagulopathies
b. Perform biochemical studies to look for hyperuricemia
c. Refer to a specialist for a bone marrow aspirate and biopsy
d. Repeat the complete blood count in 2 weeks
Patients with acute lymphocytic leukemia (ALL) may have normal blood counts even when the marrow has been replaced with leukemic cells, so a bone marrow aspirate and biopsy is required for the definitive diagnosis.
Coagulation and biochemical studies may be performed after the diagnosis is known to evaluate for complications.
Waiting and repeating the CBC in 2 weeks is not recommended since the definitive diagnosis is made by bone marrow biopsy.
A patient is suspected of having leukemia and the provider orders biochemical studies and a bone marrow aspirate and biopsy. The results include white blood cells (WBCs) greater than 200,000 cells/mm3 normal red blood cells (RBCs), hyperplastic myeloid cells, and the absence of serum leukocyte alkaline phosphatase. Which test will the provider order to confirm a diagnosis in this patient?
a. Chest radiograph
b. Coagulation studies
c. Philadelphia chromosome test
d. Serum protein electrophoresis
c. Philadelphia chromosome test
The findings from the complete blood count (CBC) and bone marrow biopsy, along with a positive Philadelphia chromosome test, confirm the diagnosis of chronic myelogenous leukemia.
A chest radiograph and serum protein electrophoresis may be performed to evaluate for associated symptoms.
Coagulation studies are usually performed as part of the diagnostic workup for acute lymphocytic leukemia (ALL).
A patient with acute myelogenous leukemia (AML) who has a high white blood cell count and diffuse lymphadenopathy is hospitalized during the induction phase of chemotherapy. What monitoring and interventions are critical to assess for complications during this phase of care for this patient? (Select all that apply.)
a. Administration of sodium bicarbonate and allopurinol
b. Assessment for bruising and petechiae
c. Close monitoring of absolute neutrophil counts
d. Daily renal function and chemistry values
e. Meticulous assessment of hydration status
a. Administration of sodium bicarbonate and allopurinol
d. Daily renal function and chemistry values
e. Meticulous assessment of hydration status
This patient has a high WBC load and diffuse lymphadenopathy, so is at increased risk for acute tumor lysis syndrome (ATLS). Close monitoring of renal function, serum renal chemistry values, and hydration status is essential. Adding sodium bicarbonate and allopurinol help to minimize risk. Thrombocytopenia causing bruising and petechiae, along with neutropenia, are common complications of chemotherapy but these symptoms generally occur 7 to 10 days after initiation of therapy.
A patient reports a neck mass that has been present intermittently for 5 or 6 weeks which varies in size. The provider palpates a lymph node measuring 1.25 cm. Which test will provide proper histologic diagnosis for this patient?
a. Bone marrow aspirate
b. Computed tomography (CT) scan with intravenous (IV) contrast
c. Lymph node biopsy
d. Positron emission tomography (PET) scan
c. Lymph node biopsy
Lymphomas are cancers of the B, T and NK cells
typical sx are presence of lymph nodes in necks for at least 4 weeks typically >1 cm
The lymph node biopsy is used to provide proper histologic diagnosis and precise classification.
Bone marrow aspirate identifies the presence of dysplastic cells. PET and CT scans will identify the presence of other lesions.
A 30-year-old male patient is diagnosed with Hodgkin lymphoma. Initial lab work reveals a WBC of 20 109/L, hemoglobin of 10.1 gm/dL, a serum albumin of 3 g/dL, and lymphopenia of 0.5 109/L. Staging studies identify stage III disease. What is this patient’s prognostic score?
a. 2
b. 3
c. 4
d. 5
c. 4
Risk factors for lymphoma include age >45 years, male gender, serum albumin <4, Hb <10.5,
stage IV disease, WBC >15, and lymphopenia <0.6. This patient has 4 risk factors.
Which types of lymphomas typically have an aggressive presentation? (Select all that apply.)
a. Adult T cell leukemia-lymphoma
b. Burkitt lymphoma
c. Diffuse large B cell lymphoma
d. Follicular lymphoma
e. Splenic marginal zone lymphoma
a. Adult T cell leukemia-lymphoma
b. Burkitt lymphoma
c. Diffuse large B cell lymphoma
Adult T cell leukemia-lymphoma, Burkitt lymphoma, and diffuse large B cell lymphoma are all aggressive lymphomas.
Follicular lymphoma and splenic marginal zone lymphomas are indolent lymphomas.
A patient diagnosed with myelodysplastic syndrome (MDS) and presenting with severe neutropenia and anemia is given erythropoietin (EPO) with improvement in hemoglobin. Which intervention has been shown to prevent infection in patients with MDS who have severe neutropenia?
a. Anti-thymocyte globulin and cyclosporine
b. Granulocyte-macrophage colony-stimulating factor (GM-CSF)
c. Intravenous immunoglobulin infusions
d. Prophylactic treatment with fluoroquinolones
d. Prophylactic treatment with fluoroquinolones
Prophylactic antibiotic therapy with fluoroquinolones in neutropenic patients has been shown in a large meta-analysis to decrease the incidence of serious infections and reduce all-cause mortality. Anti-thymocyte globulin and cyclosporine is immune suppression treatment used to reduce the need for transfusions. GM-CSF is given when there is active infection but does not decrease the actual number of infections. IVIG is not used for these patients and is not a prophylactic measure.
A 70-year-old patient reports frequent infections, shortness of breath, fatigue, and palpitations.
An exam reveals pallor and petechiae. The provider orders a peripheral blood smear and bone marrow biopsy. Which findings are consistent with a diagnosis of myelodysplasia? (Select all that apply.)
a. Anisocytosis and poikilocytosis of erythrocytes on peripheral smear
b. Defects in cellular maturation in all cell lines in bone marrow aspirate
c. Hypercellular bone marrow with peripheral cytopenia
d. Larger than normal megakaryocytes in bone marrow
e. Smaller than normal granulocytes in the peripheral blood smear
a. Anisocytosis and poikilocytosis of erythrocytes on peripheral smear
b. Defects in cellular maturation in all cell lines in bone marrow aspirate
c. Hypercellular bone marrow with peripheral cytopenia
d. Larger than normal megakaryocytes in bone marrow
The key finding in MDS is packed, hypercellular bone marrow with peripheral cytopenia. Erythrocytes in peripheral blood will show anisocytosis, poikilocytosis, or basophilic stippling. The bone marrow will have defects in all cellular maturation. Megakaryocytes in bone marrow will be smaller than normal. Granulocytes in peripheral blood will be larger than normal.
What is the most important role of the primary care provider in cancer management?
a. Counseling about healthy practices to reduce risk factors
b. Performing regular screenings to detect cancer
c. Referring patients for genetic testing to identify those at risk
d. Teaching patients about cancer management once diagnosed
a. Counseling about healthy practices to reduce risk factors
