Primary Care Flashcards
Hemoglobin A
two alpha chains
two beta chains
Hemoglobin F
two alpha chains
two gamma chains
Corrected Reticulocyte Count
Reticulocyte count X pt hct/normal hct
should be more than 2%
Target Cells
thalassemia or liver disease
Teardrop Cells
myelodysplastic cause
Howell-Jolly Bodies
asplenia
Bite Cells
G6PD deficiency
DDx Hypoproliferative Microcytic Anemia
Fe Deciency Lead Toxicity Anemia of Chronic Disease Thalessemia Sideroblastic Anemia
Transferrin
glycoprotein that delivers iron to tissue
INCREASED in IDA
TIBC
Available binding sites for Fe on transferrin
INCREASED in IDA
Transferrin Saturation
Serum Fe/ TIBC
DECREASED in IDA
Ferritin
storage protein for iron, but also AFR
<100 consistent with IDA
>100 rules out IDA
Soluble transferrin receptor
increased in IDA, normal in ACD
Time phase for correction of anemia in IDA on oral iron
6 weeks
Sideroblastic anemia causes
zinc, lead, alcohol
copper or pyroxidine deficiency
MDS
Differential for normocytic anemia
H A R M
- ACD
- RF
- Hypothyroidism
- MM, myeloplastic, aplastic anemia, etc
Aplastic Anemia =
pancytopenia w/ hypoproliferative normocytic anemia congenital cause (Fanconi) versus acquired
Pernicious anemia
antibody to parietal cells > ab to intrinsic factor
Homocysteine and MMA
both elevated in B12 def
only homocysteine = folate def
but MMA unreliable in CKD
Extravascular Hemolysis
RBCs removed prematurely by liver and spleen
spherocytes on smear, negative hemoglobin and hemosiderin in urine
Intravascular Hemolysis
RBCs lysed within circualation
positive hemologbin and hemosiderin in urine
Tests for hemolysis
- reticulocyte count >2%
- LDH, haptoglobin
- Direct bili
- urine hemoglobin, hemosiderin
Spherocytes on smear
either hereditary spherocytosis of AIHA
DAT+ means AIHA
Treatment of Osteopenia
hip fracture risk of 3%
any fracture risk of 20%
Daily Calcium Requirement``
1200mg
Daily Vitamin D Requirement
800-1000 IU
DEXA re-assessment following treatment
1-2 years later
Interval screening for osteoporosis
every 2 years
Risk Factors for Osteoporosis
alcohol use, tobacco use
thin body habitus, Caucasian
FRAX score for those on chronic steroids for treatment
10%
denosumab
mab that targets osteoclast activator
teriparatide
recombinant PTH
Patellar Reflex
L3-L4
Ankle Reflex
L5-S1
Spondylosis
degenerative changes of the spine
Spondylolisthesis
anterior displacement of vertebrae
Spondylolysis
Non union or fracture or pars intermedia
meds that delay progression of proteinuria
Lisinopril
losartan
non-dihydropyridine CCB (verapamil, dilt)
resistant HTN diagnosis
uncontrolled BP on three medications (one being a diuretic)
SPRINT trial
reduction in major adverse CV events if SBP less than 120
but… more hypotension, AKI, electrolyetes, etc
did not include DM
MMR- who not to vaccinate
adults before 1957
pregnant women
cancer pts
high doses of steroids (20mg+ prednisone)
When to treat subclinical hyperthyroidism
over 65
under 65 w heart disease, osteoporosis, symptoms
Risk of subclinical hyperthyroidism
A fib
bone loss
When to treat subclinical hypothyroidism
TSH 10+
positive TPO
symptoms, HF, risk factors for CVD (chol 240+)
Hep B exposure - how it is spread
serum
semen
saliva
Quick Start of birth control- how long to use backup method
for at least 7 days
Example of DPP4 Inhibitors (names of medications)
oral medications!
- gliptins
ex: sitagliptin, saxagliptin, etc
Januvia
sitagliptin
DPP-4 Inhibitors MOA
enzymes produces incretin which will increase insulin secretion
DPP-4 Inhibitors AE
can potentially cause pancreatitis
adjust dosage for CKD
LMWH After Orthopedic Surgery
Total of 35 days preferred
Triptan MOA
inhibit vasoactive peptides
–> vasoconstriction
Triptan Contraindications
Avoid in hemiplegic or basilar migraine
Avoid in ischemic heart disease, stroke, uncontrolled HTN
Avoid in pregnancy
Dose of levothyroxine
1.6mcg/kg
decrease in elderly, cardiac disease
TSH/T4 Recheck
4-6 weeks
