Test 2 Flashcards
1
Q
causes of microcytic anemia
A
iron deficiency anemia, anemia of chronic disease, thalassemia, sideroblastic anemia
2
Q
causes of normocytic anemia
A
anemia of chronic disease, acute blood loss, hemolytic anemia, aplastic anemia
3
Q
causes of macrocytic anemia
A
folate deficiency, vitamin B12
4
Q
this affects the formation of hemoglobin
A
iron
5
Q
Iron supplement or replacements are contraindicated for anemia associated with
A
thalassemia
6
Q
patients with excessive iron are encouraged to
A
drink tea
7
Q
anemia of chronic disease is though to be a
A
reduction in RBC production and shorter RBC lifespan
8
Q
pica for ice is a common symptom of
A
iron deficiency anemia
9
Q
Rheumatoid arthritis relation to anemia
A
meds for it can cause bone marrow suppression
10
Q
patients who have mononucleosis can develop a rash if given
A
amoxicillin
11
Q
difference in prognosis in children and adults with idiopathic thrombocytic purpura
A
develops after a viral infection or allergic reaction in children is has a spontaneous recovery
12
Q
causes of thrombocytopenia
A
mono, H.pylori, liver disease, alcohol, vitamin B12 and folate deficiency, RA, SLE, pregnancy
13
Q
atbx that can cause thrombocytopenia
A
PCN, sulfa, fluconazole
14
Q
CV drugs that can cause thrombocytopenia
A
digoxin, HCTZ, statins
15
Q
GI drugs that can cause thrombocytopenia
A
pepcid, ranitidine (Zantac), cimetidine (Tagamet)
16
Q
neuro drugs that can cause thrombocytopenia
A
anticonvulsants
17
Q
Drug that decreases effect of Plavix
A
PPI
18
Q
the action of aspirin and NSAIDs
A
inhibit COX enzyme from releasing prostaglandins
19
Q
aspirin and NSAIDs can cause GI irritation as it affects
A
COX1 that protects gastric mucosa
20
Q
why ASA is preferred over iburpofen for heart attack prevention
A
aspirin irreversibly inactivates COX and thromboxane for the life of the platelet, while ibuprofen only inactivities it for the drug’s halflife.
21
Q
blood smear in leukemia
A
high blast cells and decreased neutrophils and platelets
22
Q
presence of this on a blood smear is abnormal and should be referred to a heme-onc
A
blast cells
23
Q
cause of neonatal jaundic
A
increased turnover of RBCs produces more bilirubin
24
Q
breast milk jaundice occurs
A
first 3-5 days of life and peaks within 2 weeks
25
breast milk jaundice
infant is normal, and breastfeeding should not be stopped.
26
s/s of lead poisoning
behavioral and developmental issues, hemolytic anemia, abd pain
27
lead poisoning effect on vitamin D
inversely related; high lead can cause effects in bone and tooth development in kids
28
high levels of this is associated with heart disease
homocysteine
29
folic acid deficiency may cause
heart disease
30
folic acid reduces the amount of
homocysteine
31
ACD is common in those with
RA
32
ACD is marked by low ____ but normal or elevated ____
serum iron; total iron stores
33
iron stores in IDA and ACD
low in IDA and normal in ACD
34
life threatening condition resulting from bone marrow stem cell failure
aplastic anemia
35
meds associated with aplastic anemia
PCN, cephalosporin, sulfa, antidepressants, NSAIDs, anticonvulsants
36
diagnostic for aplastic anemia
low WBC, platelets, RBCs
37
treatment for children and younger patients with aplastic anemia
bone marrow transplant
38
treatment for adults > 40 with aplastic anemia
immunosuppresion therapy
39
toxins associated with aplastic anemia
insecticides, benzene
40
G6PD is usually precipitated by
infection or drug
41
G6PD is a
X-linked recessive disorder
42
meds that can precipitate G6PD deficiency
sulfa, aspirin, nitrofurantoin, Bactrim, fava beans
43
screening test for G6PD in an acute hemolytic event
may be negative for several weeks
44
factor VIII deficiency
hemophilia A
45
factor IX deficiency
hemophilia B
46
inheritance of hemophilia
x-linked recessive and only affects males
47
treatment for von willebrand disease
desmopressin
48
diagnostics of von willebrand disease
normal PT and aPTT, decreased vWF antigen
49
diagnostics for hemophilia
normal PT & thrombin, prolonged pTT
50
trx for hemophilia
desmopressin
51
most common gene mutation leading to VTE
factor V leiden
52
treatment for DVT
heparin & LMWH, then Warfarin for 3 months
53
marker of hemoglobin catabolism
bilirubin
54
direct cellular injury results in
high serum LDH
55
conditions that increase reticulocyte counts
hemolytic anemia, acute blood loss, hypersplenism, after trx of iron, folic acid, or vitamin B12
56
conditions that decrease reticulocyte counts
iron deficiency anemia, aplastic anemia, megaloblastic anemia
57
reflects total body iron stores
serum ferritin
58
first lab value to become abnormal when iron stores are becoming depleted
serum ferritin
59
Serum ferritin levels are ____ in iron deficiency anemia and ______ in anemia of chronic disease.
low; normal or elevated
60
reflects the amount of iron bound to transferrin
serum iron concentration
61
variation in RBC size
Anisocytosis
62
variation in RBC shape
Poikilocytosis
63
chief cause of anemia in children less than 1
iron deficiency anemia
64
iron studies in iron deficiency anemia
low iron, low ferritin, low transferrin, high TIBC, low reticulocyte count
65
s/s of anemia
fatigue, conjunctival pallor, brittle nails, tachycardia, cold intolerance
66
measure of the variability of the RBC size
RDW
67
education about iron supplementaion
take 1-2 hours before meal on empty stomach,
Don't take with antacid or dairy
Keep out of reach of children- toxic
68
causes an overproduction of specific chains in the Hgb molecule causing hemolysis
thalassemia
69
very severe form of thalassemia and rarely live into adulthood
Cooley's (Major) anemia
70
thalassemia is
autosomal recessive
71
labs for thalassemia
microcytic, hypochromic anemia with normal ferritin
72
trx for thalassemia
prevent iron overload
73
common sign of lead poisoning in adults
peripheral neuritis
74
diagnostic of lead poisoning
lead level > 10, anemia, high creatinine
75
connects muscle to bone
tendon
76
connects bone to bone
ligament
77
presence of howell-jolly bodies in
sickle cell
78
important for those with sickle cell to recieve
folic acid supplementation
79
common complications of sickle cell
stroke, heart disease, renal failure, skin ulcers
80
vitamin B12 absorption cannot occur without
intrinsic factor
81
s/s of pernicous anemia
disorientation, N/T, abnormal reflexes
82
those with vitamin B12 deficiency will also have these elevated
homocysteine and MMA
83
dietary changes for vitamin B12 deficiency
increase protein
84
Trx for vitamin B12 deficiency
vit B12 1000 mcg IM once a day for a week, then weekly for a month, then monthly for life.
85
those with pernicious anemia should also have
endoscopy every 5 years
86
atrophic glossitis is present in
vitamin B12 and folic acid deficiency
87
vitamin B12 and folic acid deficiency has ___ Hgb, ___ Hct in, and ___ MCV in
normal; low; high
88
food high in folic acid
green leafy veggies
89
in neonatal hyperbilirubinemia, there is an accumulation of
unconjugated bilirubin
90
risk factors for neonatal hyperbilirubinemia
prematurity, Rh and ABO incompatibility
91
s/s of neonatal jaundice
appears on head first then progresses down, resolve in opposite direction
92
elevated bilirubin can be
neurotoxic
93
trx for neonatal jaundice
increase breastfeeding, phototherapy
94
Rh incompatibility occurs with a
Rh- negative mom and Rh- positive fetus
95
s/s of Rh incompatibility
jaundice, anemia, hydrops fetalis
96
In Rh incompatibility, the ___ Coombs is positive in the mom and the ____ Coombs is positive in the infant
indirect; direct
97
RhoGAM is given to Rh-negative mothers at
28 weeks, 72 hours after delivery of Rh+ infant, after ectopic pregnancy
98
does not eliminate the possibility but decreases likelihood
RhoGAM for Rh incompatibility
99
when all other causes of thrombocytopenia must be r/o
ITP
100
acute ITP occurs in
children 2-9
101
chronic ITP occurs in
those more than 50 y/o
102
in ITP the peripheral smear shows
megathrombocytes
103
a marked abnormality and uncontrolled production of the immature leukocytes.
acute lymphocytic leukemia (ALL)
104
common symptoms of leukemia
lymphadenopathy, hepatosplenomegaly, joint and bone pain/swelling, bleeding
105
common in lab results for CML
high eosinophils and basophils
106
hallmark in diagnosis of CML
philadelphia chromosome
107
cardinal sign of patients with CML
splenomegaly
108
presence of Reed-Sternberg cells
Hodgkin lymphoma
109
manifested as painless lymphadenopathy
hodgkin lymphoma
110
peak incidence of hodgkin lymphoma
in 20s and then again in 60s
111
peak incidence of nonhogkin lymphoma
60s
112
trx for breastfeeding jaundice
stop for 12-24 hours then resume
113
Progressive degenerative joint process of the articular cartilage and subchondral bone
osteoarthritis
114
most common joints affected in OA
hands, fingers, cervical and lumbar spine, hip, knee
115
symptoms of OA
stiffness/pain in morning and after activity for
116
When OA involves the cervical and lumbar spine, this can develop
neuropathy and radiculopathy
117
OA in the hands are characterized by
Heberdens (DIP) and Bouchards (PIP)
118
diagnostic for OA
r/o RA (ESR, RF, CCP), xray
119
trx for OA
Tylenol
120
risks for COX2 NSAIDS
increase in cardiovascular risk and SJS
121
Patients treated with NSAIDs should be monitored for changes in
renal and liver function
122
example of COX2 selective NSAIDS
Mobic and Celebrex
123
How often to given intra-articular corticosteroid injections for arthritis
no often than every 3-4 months
124
autoimmune disorder characterized by inflammation and thickening of synovial membrane
RA
125
these must be present for at least 6 weeks to diagnose RA
morning stiffness > 1 hour, swelling or 3 or more joints, swelling of at least 1 joint in wrist or hand
126
s/s of RA
weakness, weight loss, painful/tender joints, morning stiffness > 1 hour
127
In RA, joint swelling is
symmetric
128
also commonly diagnosed with RA
Sjogren's syndrome (dry eyes and mouth)
129
A good measure or RA's activity
ESR
130
a synovial fluid in RA will reveal
high WBC count with poor viscosity
131
Give this with DMARDs to reduce liver toxicity
folate
132
high risk of this with RA
cardiovascular disease
133
when passive and active ROM are limited with gradual onset of shoulder pain
adhesive capsulitis (frozen shoulder)
134
Severe acute shoulder pain with restricted movement in an active athlete or laborer is likely
calcific tendinitis
135
patients with rotator cuff tear with show marked weakness in
abduction and internal rotation
136
Clinical test to help dx for rotator cuff tear
drop arm test and empty can test
137
erythema and fever with shoulder pain suggest
septic arthritis
138
rotator cuff tear is common in
those older than 40
139
Shoulder arthritis is characterized by gradual onset and progression of
pain at rest, aggravated by movement, and loss of motion
140
Stenosing tenosynovitis
trigger finger
141
a nodule or thickened tendon that impedes tendon movement
trigger finger
142
diagnostic for trigger finger
have patient try to extend finger, a pop should be felt and should be painful
143
trx for trigger finger
splinting, NSAIDs, steroid injection, surgery
144
seen in new parents who frequently lift their child using wrist strength alone.
deQuervain's tenosynovitis
145
Finkelstein test helps to diagnose for
deQuervain's tenosynovitis
146
deQuervain's tenosynovitis trx
splinting and NSAIDs
147
palmar fibrosis
Dupuytren's contracture
148
Any contracture of more than ____ degrees should be referred to a hand specialist
30
149
carpal tunnel syndrome is best described as
medial nerve entrapment
150
risk factors for CTS
pregnancy, menopause, arthritis, diabetes, HTN, hypothyroidism
151
In CTS, the patient reports N/T to the
thumb, index, middle, and medial part of ring finger
152
When the patient may describe an inability to hold objects or tendency to drop things, suspect
CTS
153
clinical test for CTS
Tinel (tap on median nerve), Phalen (press hands together)
154
cubital tunnel syndrome is nerve entrapment to the
ulnar nerve
155
In cubital tunnel syndrome, there is N/T to the
ring and pinky finger
156
Lateral epicondylitis
tennis elbow
157
medial epicondylitis
golfer's elbow
158
clinical test for tennis elbow
apply pressure to force wrist into flexion while patient extends wrist
159
clinical test for elbow sprain
applying valgus stretch to forearm with elbow flexed
160
s/s of ulnar neuritis
sensory loss of pinky, diminished motor and grip strength
161
loss of blood supply and subsequent death of subchondral bone tissue; it is often r/t trauma, alcohol intoxication, sickle cell anemia, or corticosteroids.
avascular necrosis
162
diagnostic for avascular necrosis
MRI
163
can cause rapid onset hip pain and fever
infection or septic arthritis
164
s/s of hip fracture
inability to bear weight, extremity externally rotated
165
Lachman test
flex knee, push down on femur while pulling on tibia
166
Lachman tests for
ACL tear
167
important teaching for ACL tears
strength quad muscle
168
McMurray tests for
meniscal tear
169
McMurray test
Place hand on heel and other on knee. Rotate the heel and apply valgus stress to knee. + if click is heard
170
Apley tests for
meniscal tear
171
Refers to knee pain that is localized to the anterior portion of the knee.
patellofemoral pain syndrome (runner's knee)
172
trx for runner's knee
exercises that doesn't stress quad (bicycling, swimming)
173
treat for LBP
ice for 48 hours then heat for several days, increase functional movements for rapid recovery
174
result from a tearing of the ligaments that bind the joint.
sprains
175
result from an overstretching or overuse of muscles.
strains
176
risk factors for osteoporosis
estrogen deficiency, hypothyroidism, steroids, sedentary lifestyle
177
how to test for knee effusion
ballottement test: apply firm pressure to patella, if a click is heard, and effusion is present
178
meds that can cause gout
ASA, nicotinic acid, diuretics, cyclosporine
179
diagnostic for acute gout
ESR and WBC, uric acid not helpful
180
used to increase excretion of uric acid
colchicine and probenecid acid
181
decreases production of uric acid
allopurinol
182
Avascular necrosis of the femoral head found in 4-8 year old boys.
Legg Calve Perthes disease
183
s/s of legg calve perthes disease
progressive groin pain with limp
184
Slipped capital femoral epiphysis is common in
11-14 year old obese boys
185
Severe hip, thigh, or knee pain associated with a limp in obese boys
Slipped capital femoral epiphysiS
186
s/s of fibromyalgia
widespread MS pain, nonrestorative sleep, depression, IBS
187
pain on this number of trigger points is needed to dx fibromyalgia
11 out of 18
188
trx for fibromyalgia
tricyclic, SSRIs, gabapentin, lyrica
189
education regarding biphosphonates
avoid lying for 30-60 min after taking
190
there is no evidence that supports taking biphosphonates for more than
5 years
191
patellar tendinosis and traction apophysitis
Osgood-Schlatter disease
192
Osgood-Schlatter disease is common in
adolescent boys and girls who play sports
193
important teaching for Osgood-Schlatter disease
quad strengthening and stretching
194
repetitive overhead activities are a risk factor for
rotator cuff tear
195
in rotator cuff tear there is ____ active ROM and ____ passive ROM
decreased; normal
196
labs in ALL
low platelets, anemia, low neutrophils, high lymphocytes, high LDH, high uric acid
197
different b/t ALL and CLL
ALL has accumulation of immature lymphocytes where CLL has accumulation of mature but incompetent lymphocytes
198
blood smear in CLL shows
ruptured lymphocytes "smudge" cells
199
blood smear in ALL shows
blast lymphocytes
200
which form of lymphoma is more treatable?
Hodgkin's lymphoma
201
in a patient with neonatal jaundice, it would be appropriate to screen for this
G6PD deficiency
202
meds that can cause hemolytic anemia
macrobid, urocid, and pyridium
203
most common cause of microcytic anemia is
bleeding
204
NSAID effect on kidney
inhibits prostaglandin which prohibits vasodilation, thus decreasing blood flow to kidneys
205
regular NSAID use should be avoided in patients taking
baby ASA for CV disease
206
intoeing is self-limited and usually resolves by age
5
207
most common cause of intoeing
metatarsus abdcutus
208
intoeing causing by internal rotation of the tibia
tibial torsion
209
exercises used to stretch and strengthen the lumbar
williams flexion exercises
210
Gower's sign indicates that there is
weakness to proximal muscles and seen in DMD
211
used only as a preventative medication but not as a treatment during acute attacks of gout
allopurinol
212
allopurinol is excreted through the
kidneys
213
febuxostat is excreted through the
liver
214
when should uric acid lowering meds be started
4-8 weeks after acute gout attack
215
HRT has been approved for...
prevention of osteoporosis but not for trx
216
major cause of kyphosis is
low bone density
217
compression of the interdigital plantar nerves
morton's neuroma
218
Mulder's sign
tests for morton's neuroma. compress foot and applying pressure b/t 3rd and 4th toe. a click heard is positive.
219
trx for morton's neuroma
wearing wider shoes, using pads to separate toes, NSAIDS
220
labs for DMD
high CK
221
vaccine that can cause thrombocytopenia
MMR
222
imaging should be done if there has been LBP for more than
6 weeks
223
The RDW is ____ in iron deficiency anemia and ____ in thalassemia
high; normal
224
In trendelenberg test, the affected leg is
raised higher and the unaffected leg sags
225
transient synovitis of the hip occurs in
children 3-8 years old
226
cause of transient synovitis of the hip is
viral illness
227
when the patient has obligatory external rotation of the hip during flexion
SFCE
228
In SFCE, the pain is often referred to
the knee
229
diagnosing SFCE
it will appear normal on a AP view, but appear abnormal on an AP frog-leg lateral view
230
when knees point toward the midline
genu valgum
231
when knees point outward
genu varum
232
radial head sublaxation
nursemaid's elbow
233
cause of nursemaid's elbow
parents pulling kids by wrist
