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PCM > Week 3 (Test 1) > Flashcards

Week 3 (Test 1) Flashcards

1
Q

Anemia by Etiology

A

1) BLOOD LOSS
- Acute
- Chronic

2) DECREASED PRODUCTION
- B12, Folic Acid, Fe Deficiency!!!!

  • Infiltration of marrow by NEOPLASIA!!!!
  • APLASTIC ANEMIA

3) INCREASED DESTRUCTION
- Hemolytic Anemia!!!!!

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2
Q

Lab Value Classifiation

A

1) MICROCYTIC:
A) Fe Deficiency

B) Thalassemia

C) Lead Poisoning

2) NORMOCYTIC:
A) Chronic Disease

B) Renal Disease

C) Infections

D) Acute Blood Loss

3) MACROCYTIC
A) B12, Folic Acid Deficiency

B) Abnormal DNA Synthesis

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3
Q

Microcytic Anemia

A
  • Deficiency of Vitamin B12
  • Deficiency of Folic Acid
  • Drugs affecting DEOXYRIBONUCLEIC ACID (DNA) Synthesis
  • Inherited DISORDER of DNA Synthesis
  • LIVER DISEASE
  • Hypothyroidism and Hypopituitarism
  • Accelerated Erythropoiesis (Reticulocytes)
  • Hypoplastic and Aplastic Anemia
  • Acute Leukemia

****SMALL RBC that appear Hypochromic (Less Hb in the Cell) and expressed by a lower than normal MCHC

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4
Q

Normocytic Anemia

A
  • Anemia of Chronic Dx
  • Endocrine Etiology
  • Acute Blood Loss
  • RENAL FAILURE
  • Hypersplenism
  • NEONATAL ANEMIA
  • HEMOLYSIS

*****HEMATOCRIT (Packed Cell Volume) and HEMOGLOBIN is DECREASED but NORMAL RBC size!!!!!!!!

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5
Q

Anemia and Iron

A

IIRON DEFICIENCY:

1) Ferritin (Stores Iron in Cells):
- Low

2) Iron:
- Low

3) TIBC (Total Iron Binding Capacity):
- High

4) Transferrin (Carries Iron in Blood):
- High

CHRONIC Dx:

1) Ferritin:
- High

2) Iron:
- Normal/ High

3) TIBC:
- Low

4) Transferrin:
- Low

THALASSEMIA:

1) Ferritin:
- Normal or High

2) Iron:
- Normal or High

3) TIBC:
- Normal

4) Transferrin:
- Normal

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6
Q

Decreased Production of RBCs

A

1) Infiltration of Marrow
- Neoplasia, Myelofibrosis

2) Hyperplastic Marrow (Response to decrease in RBC)
- B12, Foalte, Fe Deficiency

3) Aplastic/ Hypoplastic Marrow- Pure RBC Aplasia (Bone Marrow Damaged)
- Acquired ACUTE RBS Hypoplasia

4) Aplastic/ Hypoplastic Marrow- Familial (Bone Marrow Damaged)
- Diamond/ Backfan
- Falcon
- Congenital Pancytipenia

5) Aplastic/ Hypoplastic Marrow (Drugs/ Idiopathic)
- Antibiotics, Dilatin, Viral Hepatitis

6) Aplastic/ Hypoplastic Marrow- Dose Related
- Heavy Metals, Benzene, Antimetabolites

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7
Q

Some Hemolytic Causes

A

1) Sickle Cell (Hemoglobin S)
2) Hereditary Spherocytosis ( Autosomal Dominant, mutation in genes that allow RBC to change shape)
3) G6PD
4) Pyruvate Kinase Deficiency (RBC break down too easily)

5) Microangiopathic Disorders (RBC Destruction caused by factors in Small Vessels)
A) DIC

B) Hemolytic Uremic Syndrome

C) TTP

6) Mechanical Hemolysis
7) Paroxysmal Nocturnal Hemoglobinuria (Destruction fo RBC by Complement System)

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8
Q

Intracorpuscular Defect

A

HEREDITARY:
- Hereditary Spherocytosis

  • Hereditary Elliptocytosis
  • Hemoglobinopathies
  • Thalassemias
  • Congenital Dyserythropoietic Anemias
  • Hereditary RBC Enzymatic Deficiencies
  • Rarer Hereditary Abnormalities

ACQUIED:
- Vitamin B12 and Folic Acid Deficiency

  • Paroxysmal Nocturnal Hemoglobinuria
  • Sever Iron Deficiency
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9
Q

Extra corpuscular Defects

A
  • Physical Agents: Burns, Cold Expose
  • Traumatic: Prothetic Heart Valves, March Hemoglobinuria
  • Chemicals: Drugs and Venom
  • Hepatic and Renal Disease
  • Malignancies: Particualrly Hematologic Neoplasia
  • Transfusion of Incompatible Blood
  • Hemolytic disease of Newborn
  • Cold Hemagglutinin Disease
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10
Q

Nutritional Etiologies

A
  • Iron Deficiency
  • Vitamin B12 Deficiency
  • Folate Deficiency
  • Starvation and Generalized Malnutrition
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11
Q

Physical Etiologies

A
  • Trauma
  • Burns
  • Frostbite
  • Prosthetic Valves and surfaces
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12
Q

Elements of Social History

A
  • Demographics and Occupational History
  • Nutrition and diet
  • Daily activities and exercise
  • Alcohol, Tobacco, and recreational drug use
  • Spirituality and beliefs
  • Relationships
  • Sometimes: Sexual History
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13
Q

Demographics

A
  • Age
  • Gender
  • Race or Ethnic Background
  • Religion/ Spirituality
  • Residence
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14
Q

Occupational History

A
  • Do you work outside your home?
  • What kind of work do you do?
  • Tell me what your job is like for you?
  • Ever been exposed to fumes, chemical, dust, loud noise or radiation?
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15
Q

The BIGGIE!!!

A
  • Do you think anything at work or home is AFFECTING your SYMPTOMS!!!
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16
Q

Practice Pearls

A
  • Patients often five “best case scenarios”
  • Patients respond differently to different physician regarding these questions
  • Food habits are EXTREMELY SENSITIVE topic for many patients
17
Q

Daily Activities and Exercise

A
  • CDC recommends adults get 150 minutes per week of moderate activity (brisk walking) and strength training 2 days of the week that focuses on all Major Muscle groups
18
Q

Interview Issues

A
  • Like an activity is not the same as doing it
  • Owning exercise equipment does not mean a person uses i
  • People tend to exaggerate how much they exercise
19
Q

Tobacco Use

A
  • Smoking linked to Cardiovascular events, Cancer, Lung Disease, etc
  • Most smokers know they should quit
  • A person has to WANT to quit before they will be successful
  • Most ex-smoker tried to quit 7 to 8 times before success
  • Number of packs smoked per day (times) number of years smoked = PACK YEARS
20
Q

Alcohol Use

A
  • CAGE Questions
  • Useful for screening patients who drink more than one drink daily OR who drink a lot on the weekends
    • Can open door to conversation about getting help
21
Q

NIAA Safe Drinking Limits

A

Men: 14 or fewer drinks per week, nor more than 4 drinks a day

Women and those over age 65: 7 per week, no more than 3 in a day

22
Q

Cage Questions

A

1) Has anyone every suggested you CUT BACK?
2) Are you every ANNOYED when people talk about your drinking?
3) Do you ever feel GUILTY about your drinking?
4) Do you ever need a drink in the morning to steady your nerves (An EYE OPENER)?

23
Q

Recreational Drug Use

A
  • Truth telling is an issue
  • May be tolerant of and/ or addicted to prescription pain/ anxiety meds
  • Establishing confidentiality is Important
  • Important to know resources in your communities
  • Drugs can exacerbate certain health issues
  • Ask if they have used any prescription or nonprescription or street drug to “get high” in the past 12 months
24
Q

Spirituality and Beliefs

A
  • Spiritaulity does not always mean religion, though for some they are equivalent
  • I like to think of Spirituality as “where do you get your strength.” Some get it through music, art, long walks on the beach, meditation, running, talking with friends, etc
  • Spirituality does NOT require belief in a HIGHER POWER!!!
  • Do you support any specific faith community?
  • I spirituality important to you?
25
Q

Relationships

A
  • Living environment
  • Support System
  • Domestic violence

And my addition:
- Partnering, whether marriage involved or not

26
Q

Living Environment

A
  • Who do you share a home with?
    • Friends
    • Children
    • Spouse
27
Q

Support System

A
  • Who can you count on to help you if you have a Problem?
  • Co-Workers
  • Church Family
  • Neighbors
  • Friends
28
Q

Domestic Violence

A
  • Be careful you screen for Domestic Violence
  • Remember there is Emotional Warare, too: WORDS CAN HURT
- SAFE:
S: Stress/ Safety
A: Afraid/ Abused
F: Friends/ Family
E: Emergency Plan
29
Q

Partnering

A
  • Life partners can be husbands. wives, girlfriends, boyfriends
  • Marriage is not a requirement for people to spend their lives together
  • Living together is not a REQUIREMENT for people to spend their lives together
  • Sexual intercourse is NOT a Requirement for people to Spend their lives together!
30
Q

Transitional Statements

A
  • As important when transitioning to Sexual History as anywhere in the Interview
  • “Now I’d like to move our conversation to Sexuality, which is an important aspect of your complete healthcare”
31
Q

Questions

A
  • Open ended first, then get more specific
  • Remain non judgmental in you choice of words, tone, facial expressions and body language
  • Important to make sure the patient is not having any concern about sexuality
32
Q

The Five P’s

A
  • Partners
  • Prevention of Pregnancy
  • Protection from STDs
  • Practices
  • Past History of STDs
33
Q

Partners

A
  • DO you have sex with men, women, or both?
  • In the past 2 months, how many partners have you had sex with?
  • In the past 12 month, how many partners have you had sex with?
  • Is it possible that any of your sex partners in the past 12 months had sex with someone else while were still in a Sexual Relationship with you?
34
Q

Prevention of Pregnancy

A
  • What are you doing to Prevent Pregnancy?
  • What are you doing to protect yourself from STDs and HIV?

-

35
Q

Practices

A
  • To understand your risks for STDs, i need to understand the kind of sex you have had recently
  • Have you have Vaginal Sex, Meaning “penis in Vagina Sex?” If yes, “Do you use condoms: Never, sometimes, or always?
  • Have you had Anal Sex, meaning “penis in rectum/ anus sex?” If yes, “Do you use Condoms: Never, Sometimes, or always?”
  • Have you had oral sex, meaning “mouth on penis/ Vagina?”

Condom Questions:

  • If “Never”: Why don’t you use Condoms?
  • If “Sometimes”: in what situations (or with whom) do you not use Condoms?
36
Q

LGBT

A
  • Never, ever make assumptions
  • A question that i have used is, “In the past, have you had sexual relationships with men, women, or both?” How about now?
  • Can then go into specifics that may impact Health, such as Anal Sex, Oral Sex, etc
  • Gender Identity Disorder now called Gender Dysphoria
37
Q

Past History of STDs

A
  • Have you ever had an STD?
  • Have any of your partners had an STD?
  • Additional questions to Identify HIV and VIRAL Hepatitis risk include:
    • Have you or any of your partners ever injected drugs?
38
Q

Other Random Important Facts

A
  • Not all married people have sex. Ok as long as there is mutual consent
  • Many adult men and women go their entire lives without having sex
  • One way to do a general screening is “do you have nay concerns about your sex life?”
39
Q

Final Note

A
  • Self-Disclosure is INAPPROPRIATE when discussing a patient’s Sexual History

PCM (6 decks)

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