UA Hematology Leukemia Erythrocytosis Seropositive together Flashcards
SSx of erythromelagia and spontaneous brusing
What is the most likely DX
Polycythemia vera
CBC shows:
Erythrocytosis
Normal WBC and platelets
Increased EPO
What is the most likely DX
Secondary Erythrocytosis
What would you expect with EPO in Relative Erythrocytosis?
Normal
What is the charachteristic cell of Lymphoma?
Reed Sternberg cell
Alcohol induced pain is a classic symptom of?
Lymphoma
What is the Dx Triad for Lymphoma?
Pel ebstein fever
Pruitis
Lymphadenopathy
CBC shows:
Slight anemia
Leukocytosis
Neutrophilia
Lymphocytopenia
And small amounts of Eosinophilia
What is the most likely DX
Lymphoma
For someone with suspected Leukemia, What follow up test would you do and what are you likely to see?
Comprehensive blood panel
Increased LDH and uric acid
ESR noticable increase
CBC shows:
Anemia
Leukocytosis 15k-50k
Thrombocytopenia
Lymphoblasts >25%
What is the most likely DX
ALL
CBC shows:
Anemia
Leukocytosis
Thrombocytopenia
Myeloblasts with auer rods
What is the most likely DX
AML
CBC shows:
Anemia
Leukocytosis >15000
Lymphocytosis >50%
Thrombocytopenia
Smudge cell
Absolute monotonous lymphocytosis
What is the most likely DX
CLL
What follow up test would you use on someone suspect to have CLL? And what would you expect to find?
Chem panel
Hypogammaglobulinemia
CBC shows:
Anemia
Leukocytosis 200k-1 million
Thrombocytosis
Eosinophilia
Basophilia
Variety of myeloid cells in periphery of all stages of development.
What is the most likely DX
CML
What follow up test would you use if someone is suspect to have CML? And what would you expect to find?
Special test for Philadelphia chromosome
Abnormal
Dx triad for Ebstein-Barr?
High fever (101-104)
sore throat
lymphadenopathy (ANT cervical chain)
CBC shows:
WNL RBC
Leukocytosis
Lymphocytosis >50%
Reactive lymphocytes >10%
Abnormal monocytes
Thrombocytopenia
What is the most likely DX
Mononucleosis/Ebstein Barr virus
What follow up tests would you use when suspecting Mono? And what would they show if the patient indeed did have mono?
Chem panel- Elevated Liver Fx tests
Heterophile antibody test/Monospot
Epstein Barr virus titers:
Anti VCA antibody- IgM early and IgG post 2-4 weeks
Anti EBNA antibody- elevated post 2-4 months
If a patient was sick with Mono, but it has been 2 months since onset of symptoms, and you did an Epstein Barr titer. What would you expect to see?
Anti VCA antibody positive with IgG and Anti EBNA antibody positive
SSx: subcutaneous nodules, heart murmur, erythema marginatum, chest pain.
What is the most likely DX
Acute rheumatic fever
CBC shows:
Leukocytosis
Neutrophilia
What is the most likely DDx?
bacterial infection
acute rheumatic fever
If you suspect bacterial infection of ARF given CBC results, what follow up tests can be done? And what would you expect to see?
GABHS cultures (although often negative by the time ARF develops)
ASO titer/Anti Streptolysien O- Elevated
DNAse B/ Anti-Deoxyribonuclease- elevated after one week
EKG
What is the Tx plan for someone with ARF?
Moniter symptoms for 5 years or till age 21 (whichever is longer) or 10 years if carditis symptoms are present
What are the Jones criteria?
Carditis
arthritis
chorea
erythema marginatum
subcutaneous nodules
CBC shows:
Anemia (hypochromatic microcytic)
Leukopenia
Lymphopenia
Thrombocytopenia
What is the most likely DX
Systemic Lupus Erythematosus/ SLE
What would you see on a chem panel with someone suspect to have SLE?
Elevated BUN and creatinine /Kidney Fx tests
What special tests would you do for someone you suspect to have SLE?
ANA/Anti Nuclear antibody test
Anti-dsDNA
UA- Proteinuria MC and hematuria
What SLE special test is more used for Dx due to decreased sensitivity but increased specificty?
Anti-dsDNA
What is the sensitive but not specific screening test for SLE?
ANA
How many symptoms out of the list of 11 must someone have to be Dx with SLE?
4
SSx:
Fatigue
HA
Joint pain in hands and wrist (although it appears non-erosive with imaging)
photosensitivity
alopecia
Many miscarriages
What is the most likely DX
SLE
How might SLE effect:
Vascular
GI
Reproductive
Vascular- Raynauds
GI- Ulcers
Reproductive- increased risk of miscarriages
What disorders will cause Macrocytosis?
Folate/B12 deficiency anemia
Liver disease
Myxedema
Reticulocytosis
Alcoholism
Complications of strep infections can lead to what conditions?
Rheumatic fever
AGN
BL hand and wrist pain.
Xrays are negative
What is the most likely DDX?
and what are follow up tests to determain between?
RA - RF
other autoimmune disorders- HLA B 27
ARF- Anti-dsDNA or ANA
Leukocytosis with Lymphocytosis should ring bells for what condition?
Infectious Mono
Heterophile antibody test is for what condition?
What is the pros and cons of this test?
Infectious mono
Pro- inexpensive and rapid
Con- Not specific or sensitive, unreliable within the first week and under age 5
what is a flat painless rash MC on trunk or proximal extremities?
Erythema Marginatum
What is a late finding for SLE?
Sydenham chorea
Normal rages for Hct?
women: 37-47
men: 40-54
DDX for Microcytosis?
<80FL
Iron deficiency anemia
Thalassemia
Sideroblastic anemia
Anemia of chronic disease
DDX for Macrocytosis?
>100FL
B12/Folate deficiency
Liver disease
Alcoholism
Myxedema
Reticulocytosis
What is the earliest identification of anemia?
RDW 11-15 %
** Will never decrease
Hyper-segmented neutrophils can indicate?
B12/Folate deficiency
Basophilia is bad until proven otherwise.
What could potential causes be?
Hypersensitivity Rx
Myxedema
Myeloproliferative condition
What are complications to watch out for when someone has PV?
Stroke
DVT
Heart attack
Pulmonary emboli
Hypochromic microcytic will lead you to what two conditions?
SLE
Hodgkins lymphoma
Pepsi color urine is a sign of?
AGN
post strep infection
Red/smoky brown urine is a sign of?
Hemtauria
Yellow foam in urine indicates?
Bile
never normal
White foam in urine indicates?
Albumin
Small amounts ok
Stale water smell in urine indicates?
Advanced kidney disease
Low specific gravity could indicate?
Whereas High SG indicates?
Low- Diabetes Insipidus
High- Diabetes Malidus
High protein diets would show what in a UA?
Possible white foam
acidosis (<4.5pH)
Cystitis would show what in UA?
Hematuria
Alkalosis (>8pH)
What type of bacteria produce nitrites causing Nitrituria?
Gram Negative
Bilirubinuria indicates?
Cholelithiasis
Liver disease
What form of bilirubin is found in urine?
Conjugated
Unconjugated is not water soluble so it will not show up.
DDX for hematuria?
Nephrolithiasis
AGN
GU malignancy
benign prostatic hyperplasia
Cystitis
Pyelonephritis
Contamination
Waxy casts indicate?
Advanced renal failure
RBC casts indicate?
AGN
WBC casts indicate?
Acute pyelonephritis
Fatty casts indicate?
Advanced renal disease/Nephrotic syndrome
Pseudocasts indicate?
Fibers or dust
Hyaline casts indicate?
little concern
What are reasons one may have proteinuria that is not pathonemonic?
Muscle break down due to extreme exercise
Orthostatic
Pregnancy
High protein diet
Explain UA findings for DM and DI.
DM Type 1= Glucosuria and Ketonuria
DM Type 2= Glucosuria
DI= Low SG
Glucose >180 if shows up on UA