5 Written Questions
5 Matching Questions
- Sickle Cell Disease/Anemia
- Pernicious Anemia
- Multiple myeloma
- Non-Hodgekin's Disease/Lymphoma
- Folate Deficiency
- a GENERAL: Originates at extranodal sites and spreads to anatomically contiguous nodes. 85% of all lymphomas. Most common in USA.
CAUSE: Largely unknown. Frequent in persons infected with HIV. Impairment of the immune system and infectious agents may play a roll.
PATHOPHYSIOLOGY: Commonly originate in lymph nodes, but can arise in any lymphoid tissue. Has the potential to spread to various lymphoid tissues throughout the body, especially the Liver, Spleen, and bone marrow.
S/SX: Firm nodes, fatigue, fever that may last for 2 weeks or more. Can be anywhere in body. MANY TIMES THE AREA ABOVE THE LYMPH NODE IS RED AND ITCHY. Severe pruritis. Coughing, SOB, could have inhibited urination d/t urethral growths. Pain.
1) LOW GRADE TUMOR= painless lymphadenopathy
2) INTERMEDIATE TUMOR=all sx depending on area
3) HIGH GRADE=larger tumors (easier to treat), all sx depending on area, most common in children.
ADDITIONALLY: Uncontrolled lymph node and lymphoid tissue growth, bone marrow involvement, and constitutional symptoms (fever, fatigue, weight loss) related to the rapid growth of abnormal lymphoid cells and tissues.
LABS: biopsy and imaging, abnormal b-cells or killer t-cells
DDX: HL, infections, drug reactions
TX: Radiation for localized, chemotherapy is standard. Survivability is less than 60%
- b This is a chronic illness caused by impaired absorption of vitamin B-12 because of a lack of intrinsic factor (IF) in gastric secretions. It occurs as a relatively common adult form of anemia that is associated with gastric atrophy and a loss of IF production and as a rare congenital autosomal recessive form in which IF production is lacking without gastric atrophy.
-seen in people of N. American decent, chronic alcoholics, seen in people with gastric bypass or stomach staple surgeries.
SX: Very pronounced fatigue (feeling run down)... can be tired from hours to days to all of the time, dyspnea comes and goes regardless of exertion, glossitis, brittle nails, sudden explosive diarrhea with possible weight loss, mental fog, decreased concentration and confusion, common in people of the 60yr age range, BURNING PAIN IN FEET or anywhere in body, wtach for an unsteady gait, and think nervous system manifestations. This is the FAR END of VIT B12 deficiency.
DDX: LV disease, Alzheimer's, are they a chronic alcoholic?
LABS: Decreased hematocrit, decreased RBC, decreased MCH
- c GENERAL: Folic acid is required for DNA synthesis and red blood cell maturation. It is found in vegetables, leafy greens, fruits, cereals, and meats. Megaloblastic anemia (enlarged red blood cells).
CAUSE: Much of the vitamin is lost in cooking. Most causes are malnutrition or dietary lack, especially in the elderly or in association with alcoholism. Also common in pregnancy, as bearing women require 5-10x the normal daily amount of 50ug.
PATHOPHYSIOLOGY: Dietary lack. Malabsorption of Folic Acid may be due to syndromes such as sprue or other intesinal disorders. Some drugs used to prevent seizures also interfere with folic acid absorption.
S/SX: Similar to Vitamin B12 symptoms, only without neurologic sensations, FATIGUE, DIARRHEA, GENERAL MUSCLE WEAKNESS
DDX: Vit B12 deficiency, Iron def anemia, hypothyroidism, cancer
LABS: increased MCV and MCH, increased homocysteine, slightly increased WBC, decreased RBC, decreased folate
TX: Folic Acid intake
"this is a type of megaloblastic anemia"
- d CAUSE: An inherited disorder from both parents in which an abnormal hemoglobin leads to chronic hemolytic anemia, pain, and organ failure. Amino acids don't exchange properly within the cell.
PATHOPHYSIOLOGY: The abnormal structure of HbS results from a point in the beta chain of the hemoglobin molecule, with an abnormal substitution of a single amino acid, valine, for glutamic acid. The deoxygenated hemoglobin aggregates and polymerizes in the cytoplasm, creating a semisolid gel that changes the shape and deformability of the cell. The disc is in a deoxygenated shape.
S/SX: None unless upon exertion, i.e. difficulty breathing. Infarctions caused by sluggish blood flow may cause chronic damage to the Liver, Spleen, Heart, Kidneys, Retina and Other Organs.
DDX: Thalassemia (always seen in people of Mediterranean decent)
LABS: DECREASED HEMOGLOBIN (main), slightly elevated bilirubin, serum electrophoresis, anemia, decreased RBC
TX: Bone marrow transplant (10% morbidity), Chemotherapy (which retards bone marrow fx)
- e LABS:
-anemia, decreased hematocrit, normo/normo
-presence of BENCE JONES PROTEINURIA
-Increased IgG and IgA
-sheets of plasma cells on bone marrow
5 Multiple Choice Questions
- General timing of chronic leukemias
- CAUSE: A malignancy of plasma cells that produce monoclonal immunoglobulin and invade and destroy adjacent bone tissue.
Plasma cell tumors produce IgG in 55% of these patients and IgA in 20%....of these patients, 40% also have Bence Jones proteinuria.
Lesions are caused by bone replacement by expanding plasma cytomas or by cytokines that are secreted by malignant plasma cells that activate osteoclasts. The osteolytic lesions are usually multiple, and occasionally they are solitary intramedullary masses.
S/SX: Persistent bone pain (esp. in back or thorax), renal failure , and recurring bacterial infections are the most common presentations.
- -asymptomatic for long time
Stage 1: insidious onset, weight loss, fatigue, weakness
Stage 2: higher fevers with night sweats, a very full feeling in abdomen (splenomegaly), THE PRESENCE OF PHILADELPHIA CHROMOSOME (on comps)
-prognosis with treatment = 3-7yrs
-prognosis with no treatment = 3-6 months
-if this disease is not controlled with chemo it will convert into AML within 2 years
-this is the only leukemia that converts
- what does "CLL" stand for?
- what does "AML" and "ANLL" stand for?
5 True/False Questions
Hematocrit (HTC) → - a measurement of the percentage of packed red blood cells in a given volume of blood
- increased could be the result of water deprivation, excess use of diuretics, or gastrointestinal losses
Multiple Myeloma → LABS:
increased T and B cells (performed with lumbar puncture)
-found with blood work
-normocytic normochromic anemia (just not enough RBC's)
-increased leukocytosis (more WBC's)
-low platelets and increased bleeding times, longer to coagulate → what does "CML" stand for?
*increase of WBC's
*losing elements in blood because body is only making WBC's
*bone pain (flat & irregular bones, common in adults)
*swollen gums that look like gingivitis
*Fever (high in acute, low grade in chronic)
*hepatomegaly & splenomegaly
*petechial rash (red, spotted) → General Lab results for leukemias:
1) Acute Lymphoblastic Leukemia (aka Lymphocytic) "ALL"
2) Acute Non-Lymphoblastic Leukemia (aka myeloblastic...older term) "AML" or "ANLL"
3) Chronic Lymphocytic Leukemia "CLL"
4) Chronic Myelocytic Leukemia "CML" → 4 Major Leukemias
-these are all common leukemias