UA Hematology Leukemia Erythrocytosis Seropositive together Flashcards by Chris Ness

SSx of erythromelagia and spontaneous brusing
What is the most likely DX

Polycythemia vera

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CBC shows:
Erythrocytosis
Normal WBC and platelets
Increased EPO
What is the most likely DX

Secondary Erythrocytosis

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What would you expect with EPO in Relative Erythrocytosis?

Normal

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What is the charachteristic cell of Lymphoma?

Reed Sternberg cell

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Alcohol induced pain is a classic symptom of?

Lymphoma

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What is the Dx Triad for Lymphoma?

Pel ebstein fever
Pruitis
Lymphadenopathy

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CBC shows:
Slight anemia
Leukocytosis
Neutrophilia
Lymphocytopenia
And small amounts of Eosinophilia
What is the most likely DX

Lymphoma

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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

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CBC shows:
Anemia
Leukocytosis 15k-50k
Thrombocytopenia
Lymphoblasts >25%
What is the most likely DX

ALL

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CBC shows:
Anemia
Leukocytosis
Thrombocytopenia
Myeloblasts with auer rods
What is the most likely DX

AML

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CBC shows:
Anemia
Leukocytosis >15000
Lymphocytosis >50%
Thrombocytopenia
Smudge cell
Absolute monotonous lymphocytosis
What is the most likely DX

CLL

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What follow up test would you use on someone suspect to have CLL? And what would you expect to find?

Chem panel
Hypogammaglobulinemia

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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

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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

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Dx triad for Ebstein-Barr?

High fever (101-104)
sore throat
lymphadenopathy (ANT cervical chain)

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CBC shows:
WNL RBC
Leukocytosis
Lymphocytosis >50%
Reactive lymphocytes >10%
Abnormal monocytes
Thrombocytopenia
What is the most likely DX

Mononucleosis/Ebstein Barr virus

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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

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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

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SSx: subcutaneous nodules, heart murmur, erythema marginatum, chest pain.
What is the most likely DX

Acute rheumatic fever

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CBC shows:
Leukocytosis
Neutrophilia
What is the most likely DDx?

bacterial infection
acute rheumatic fever

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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

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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

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What are the Jones criteria?

Carditis
arthritis
chorea
erythema marginatum
subcutaneous nodules

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CBC shows:
Anemia (hypochromatic microcytic)
Leukopenia
Lymphopenia
Thrombocytopenia
What is the most likely DX

Systemic Lupus Erythematosus/ SLE

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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?

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