Myeloproliferative neoplasms (crash cards) Flashcards
Myeloproliferative neoplasms:
Low EPO
Normal SaO2
High RBC#
High WBC#
High Platelet #
Increased plasma volume
Increased MCV
Polycythemia Vera (primary)
A JAK2 mutation that leads to the production of too many RBCs
Signs:
- Aquagenic pruritis
- Erythromelalgia
- Thrombotic episodes
Myeloproliferative neoplasms:
Normal EPO
Normal SaO2
Normal MCV
Low Plasma volume
Relative Polycythemia
Caused by dehydration or burns
Myeloproliferative neoplasms:
High EPO
High MCV
Normal Plasma volume
Low SaO2
Secondary appropriate polycythemia
Caused by:
- Lung disease
- Congenital heart disease (Right-left shunt)
- High altitude
- Smoking
Myeloproliferative neoplasms:
Normal Plasma volume
Normal SaO2
High MCV
High EPO
Secondary Inappropriate Polycythemia
Caused by
- Exogenous EPO (blood doping)
or
- Malignancy (RCC, HCC)
Myeloproliferative neoplasms:
AV Malformations
Recurrent epistaxis
Telangiectasias (blanching lesions)
Gi bleeding
Hematuria
Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu)
AUTO DOM mutations in either ENG (Endoglin) or ALK1 which both modulate TGF-B signaling leading to uncontrolled bleeding
Shock:
High SVR (afterload)
Low PCWP (preload)
Low CO
Cold + clammy skin
Hypovolemic Shock
Caused by:
- Hemorrhages
- Dehydration
- Burns
Shock:
High/Low PCWP (preload)
High SVR (afterload)
Very Low CO
Cold + clammy skin
Cardiogenic shock
Caused by:
- Acute MI
- Valve dysfunction
- Arrythmia
Shock:
High/Low PCWP
High SVR (afterload)
Very Low CO
Cold + clammy skin
Obstructive shock
Caused by
- Cardiac tamponade
- Pulmonary embolism
- Tension pneumothorax
Shock:
Warm skin
Low PCWP (preload)
Very Low SVR (afterload)
High CO
Distributive shock
Caused by:
- Sepsis
- Anaphylaxis
- CNS injury
Shock:
Dry skin
Low PCWP (preload)
Very Low SVR (afterload)
Low CO
Distributive shock
Caused by:
- Sepsis
- Anaphylaxis
- CNS injury
Heart:
Low CO
Low QRS
High HR
Cardiac Tamponade
Heart is compressed by fluid (blood & effusions in the pericardial sac)
Signs:
- Pulsus paradox
- Becks triad (Hypotension, Distended Jugular vein, Distant heart sounds)
- Electrican alternans
Heart:
ST Elevation
Pathological Q waves
Full thickness of myocardial wall involved
Transmural infarcts
Myocardial infarction
Usually from a ruptured coronary artery atherosclerotic plaque causing acute thrombosis with elevated CKMB & Troponins
MI:
Coagulative necrosis
Delineated Myocardium
No nuclei
0-24Hr Mi caused by ventricular arrythmia, Heart failure, & Cardiogenic shock
MI:
Heavy neutrophilic infiltrates
24-48Hrs
MI:
Macrophages with granulation
&
Angiogenesis
3-5 Days
MI:
Some normal myocardium with type 1collagen
&
Macrophage-granulation
1-2 week MI
MI:
Low Cellularity
High collagen deposition
Higher risk of balloon aneurysm
Complication is Dressler syndrome
3-4 week MI
Heart:
Abnormally fast conduction from the atria to the ventricle (bypasses the AV node)
&
Shortened PR interval
Wide QRS
Delta waves
Supraventricular tachycardia
Wolf-Parkinson White syndrome
Wolf-Parkinson White syndrome
Heart:
Abnormally fast conduction from the atria to the ventricle (bypasses the AV node)
&
Shortened PR interval
Wide QRS
Delta waves
Supraventricular tachycardia
ECG:
Absent P waves
A fibrillation
ECG:
Saw tooth patterns
Atrial flutter
ECG:
No discernable rhythm
Ventricular fibrillation
Heart failure:
High EDV
Low Ejection fraction
Low Contractility
Poor perfusion
Complications:
- Ischemia
- Dilated cardiomyopathy
Systolic dysfunction
Signs:
- Congestion
- Dyspnea
- Orthopnea
- Fatigue
- Heart sounds
- JVD
- Pitting edema
Heart failure:
Normal Ejection fraction
Normal EDV
Low Compliance
High EDP
Complications:
- Myocardial hypertrophy
Diastolic dysfunction
Signs:
- Congestion
- Dyspnea
- Orthopnea
- Fatigue
- Heart sounds
- JVD
- Pitting edema
Heart failure:
- Pulmonary edema with
Hemosiderin laden-macrophages - Orthopnea
- Paroxysmal nocturnal dyspnea
Left-sided heart failure
Heart failure:
- Hepatomegaly with more central venous pressure
- Nutmeg liver
- Peripheral edema
- JVD
Right-sided Heart failure
Bleeding disorders:
- Hinge pain (arthralgias)
- Stomach pain
- Palpable purpura on butt/legs
- Fever with sudden onset
- Arthritis
- Hematuria
Henoch-Schönlein purpura (Immunoglobin A vasculitis)
A common systemic vasculitis that follows a URI. IgA’s are deposited in tissues (skin, gut, renal, & joints)
Endothelial injury
Turbulent blood flow
Hypercoagulability
Virchow’s triad
Locally invasive (doesn’t metastasize) pearly nodule with telangiectasia & rolled borders, non-healing ulcers, & palisading nuclei
Basal cell carcinoma
- A chronic non-healing ulcers of the face, lower lip & ears
- Locally invasive that can metastasize with keratin pearls
Squamous cell carcinoma
- Follows the administration of post fractioned heparin (5-14 days post admin)
- Antibodies against heparin complexes & platelet 4 factor on platelets & platelet 4 factor like proteins & heparin like molecules on endothelial cells
Heparin-Induced Thrombocytopenia
Platelets activate & aggregate (a prothrombotic state) even with heparin because the low platelet count
- Recurrent abortion
- Recurrent thrombosis
- Cardiac valve vegetations
- Thrombocytopenia
- False positive syphilis test
- Recurrent DVT
Antiphospholipid Antibody Syndrome
Usually in SLE
Ab’s target B2-glycoprotein I (B2GP1) on plasma membranes & endothelial cells
Anemia:
Short stature
Cafe-au-lait spots
Absent thumbs/radii
High tumor risk
Leukemia
Aplastic anemia
Fanconi anemia
AUTO REC, DNA repair deficiency causing bone marrow failure
Anemia:
Mutated SPECTRIN causing elliptocytes
Hereditary elliptocytosis
Anemia:
Deficient intrinsic factor
Pernicious anemia
Autoimmune destruction of parietal cells leading to B12 deficiency
