Last Modified: 2014-08-22
Px with dysphagia, anemia, beefy red tongue (atrophic glossitis)
Inc TIBC (trying to bind all it can), RDW
Dec Hgb/Hct, RBC size
Both are problem with _________
Alpha - gene deletion. 3 deletions: HbH, severe anemia. 4: fatal: HbBarts, hydrous fetalis
Beta - major (Cooley anemia) Px a few weeks after birth.
Inc iron, ferritin. Hgb 3-6. Dx w electrophoresis - alpha HgH, beta HgF, HgA2
HgH - folic acid
Beta major - transfusions + deferoxamine to avoid hemosiderosis
- prob of ________
- tx (_____doesn't work)
Etoh, lead poisoning (basophilic stippling), vitB6 deficiency, myelodysplasia
Inc Fe, ferritin, saturation - dec TIBC
Tx underlying dz, EPO doesn't help
2 most commons
MC anemia in hospitalized pts
MC cause overall is Tcell mediated autoimmune
Inc ferritin, dec TIBC, saturation
Tx ULC. EPO for renal failure, CA, inflamm d/o
Green leafy, absorbed in jejunum
Glossitis, GI sx, NO neuro sx
*howell-jolly bodies, hypersegmented neutrophils, macroovalocytes*
Tx: folic acid PO
Think vegans, gastric surgery, Crohns
***irreversible neuro dmg if not tx in 6mo***
Absorbed in terminal ileum, stored in liver
Neuro findings - propioreception, vibratory, paresthesias
Coag problem, (2)
Skin and muscle
NSAIDS, aspirin, AB
Think postoperative pt not eating on broad AB that suppress colonic bacteria. Tx with vitaminK, FFP if hemmorhagic
Pearly elevated nodules, rolled up pearly edges. Telangiectasias, pigmentation.
Morphea or sclerosing carcinoma is flat and whitish or waxy and firm.
Surgical excision (small/moderate, leave 3-5 cm margins) MOHS technique has highest cure rate and least tissue loss. Face/cosmesis.
radiation (hard to reconstruct areas-nose, eyelid; >40.)
If found in a burn scar it is called
Generally they are slow or fast growing?
Firm erythematous plaque or nodule w indistinct margins. As it grows it becomes raised and fixed. Ulceration may occur
SCC is more aggressive than BCC, so total eradication is imperative.
No LN removal usually needed.
Treat with curette and electrodesiccation or chemicals- 5FU is great.
Most important prognostic factor is tumor thickness.
2/3 are superficial spreading malignant melanoma
Acral-lentiginous melanoma- palm solws and nailbeds
Evolution is the most important historical reason for evaluation
The ugly duckling sign
LN biopsy for intermediate risk patients and lesions greater than 1 mm thick or with high risk histology
5 to 10 mm fluids analgesics, lithotripsy, basket extraction.
Greater then 10 vigorous hydration, ureter stent, percutaneous nephrostomy is the gold standard if renal function jeopardized
Extracorporeal shockwave lithotripsy.
Three specific drugs for calcium, uric acid, or citrate stones
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