Iron overload/protoporphyrin synthesis Etoh, lead poisoning (basophilic stippling), vitB6 deficiency, myelodysplasia RINGED SIDEROBLASTS Inc Fe, ferritin, saturation - dec TIBC Tx underlying dz, EPO doesn't help
Hallmark of aplastic anemIa
Pancytopenia; hypo cellular bone marrow
Anemia of chronic disease 2 most commons Labs Tx
a/w chronic inflammation, organ failure, cancer 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
Folic acid deficiency anemias
MC c/b poor intake -alcoholics, prego, low veggies, old, anorexic Green leafy, absorbed in jejunum Glossitis, GI sx, NO neuro sx *howell-jolly bodies, hypersegmented neutrophils, macroovalocytes* Tx: folic acid PO
B12 deficiency anemia
MC c/b pernicious anemia -> inc gastric CA risk 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
If bleeding c/b platelet problems, (3) Coag problem, (2)
Mucosa and skin (epistaxis, gum bleeding, menorrhagia) Skin and muscle
Petechiae almost exclusively for
Acquired disorders that cause bleeding (5) Drugs
Neoplasia, infection, malabsorption, shock, OB complications NSAIDS, aspirin, AB
ITP-like reaction in hospitalized pts - this drug
Mc acquired coagulopathies
Vitamin K dependent Think postoperative pt not eating on broad AB that suppress colonic bacteria. Tx with vitaminK, FFP if hemmorhagic
MC congenital coagulopathy
Von Willebrands: #2 is hemophilia A
Most common skin cancer
Basal cell carcinoma
BCC is more common in Presentation is
Males, blue-eyed blonds. >40, sun exposed Pearly elevated nodules, rolled up pearly edges. Telangiectasias, pigmentation. Morphea or sclerosing carcinoma is flat and whitish or waxy and firm.
Treatment of BCC
Curettage and electrodesiccation (small) 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.)
Most common skin cancer in dark skinned individuals and second most common in Whites
Squamous cell carcinoma
Squamous cell carcinoma is most commonly found If found in a burn scar it is called
ears cheeks lower lip backs of hands Marjolin ulcer
Squamous cell carcinoma is often preceded by Generally they are slow or fast growing? Presentation
Actinic keratoses; slow Firm erythematous plaque or nodule w indistinct margins. As it grows it becomes raised and fixed. Ulceration may occur
Mainstay of treatment for squamous cell carcinoma
Surgery. Radiation can be used in some circumstances. SCC is more aggressive than BCC, so total eradication is imperative. No LN removal usually needed.
Most common precancerous skin lesion
Actinic keratoses Treat with curette and electrodesiccation or chemicals- 5FU is great.
Leading cause of death due to skin cancer Most important prognostic factor is tumor thickness. 2/3 are superficial spreading malignant melanoma Acral-lentiginous melanoma- palm solws and nailbeds
ABC DE rule and sign
Asymmetry, border irregularity, color variation, diameter greater than 6 mm, evolution. Evolution is the most important historical reason for evaluation The ugly duckling sign
Treatment of melanoma
Excision; margins of .5 to 1 cm for melanoma in situ and 1 cm for lesions <1 mm thick. LN biopsy for intermediate risk patients and lesions greater than 1 mm thick or with high risk histology
Charcot's triad, Reynold's Pentad
RUQ pain, jaundice, fever Hypotension, confusion
Treatment of nephrolithiasis
Stones less than 5 mm will pass spontaneously. Supportive treatment with fluid analgesics Alpha or calcium channel blocker 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 good drugs for kidney stones Three specific drugs for calcium, uric acid, or citrate stones
Morphine, meperidine, Ketorlac. hydrochlorothiazide for calcium, allopurinol for uric acid, alkali for citrate.
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