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Osteoarthritis (DJD)
Definition Degenerative Joint Disease Chronic Articular cartilage loss No inflammation Etiology Age Trauma Contact sports Obesity Presentation Weight-bearing joints → Knee, Hip, Ankle DIP > PIP > MCP Pain Worsens with use Crepitation No effusion Stiffness <15 min Heberden nodes → DIP enlargement Bouchard nodes → PIP enlargement Diagnosis Labs ALL normal...
Read moreAplastic Anemia
Etiology BM invasion Infection Cancer Myelofibrosis Myelophthisic anemia Etiology BM fibrosis Extramedullary hematopoiesis Spleen Liver Presentation Pancytopenia symptoms Diagnosis Pancytopenia Blood smear Tear-drop cells Nucleated RBC Treatment TNF inhibitors Thalidomide Lenalidomide <50y → BM transplant Ruxolitinib → JAK2 inhibitor → Suppress myelofibrosis Disease SLE PNH B12/Folate deficiency Renal failure (↓EPO) Thymic...
Read moreHemolytic Anemia
Seen in all hemolytic anemias Sudden ↓HCT ↑LDH ↑Indirect bilirubin → Bilirubin gallstones (in chronic hemolysis) ↑Retic → ↑MCV ↓Haptoglobin ↑K ↓Folate Sickle Cell Disease Etiology AR Beta globin chain 6th position → Point mutation → Valine replaces Glutamic acid Presentation African American First presentation → Dactylitis in children Acute crisis Billirubin gallstones...
Read moreMacrocytic Anemia
Etiology ↓B12 Pernicious anemia Parietal cell atrophy → No intrinsic factor ↑ Risk of gastric cancer Pancreatic insufficiency → B12 not freed from R-protein Dietary (vegan) Terminal illeum Crohn Celiac → Also causes Iron deficiency Tropical sprue Radiation Blind loop syndrome Diphyllobotrium latum HIV Alcoholism ↓Folate Dietary (goat milk) Alcoholism...
Read moreMicrocytic Anemia
MCV <80 fL Etiology Iron deficiency Blood loss Menstruation GI bleeding Iron need Normal → 1-2 mg/day Menstruating → 2-3 mg/day Pregnancy → 5-6 mg/day Duodenum absorption → 4 mg/day Chronic disease Iron locked in cells, macrophages and ferritin Renal failure → ↓Erythropoietin ⬆︎Hepcidin Sideroblastic Iron cannot incorporate into heme Alcohol Lead poisoning Isoniazid...
Read moreHypercoagulable States
Factor V Leiden mutation Etiology Factor 5 resistant to inactivation by protein C Presentation Young caucasian with family history of thrombosis DVT PE MI Stroke Treatment First event → Heparin to Warfarin until INR 2-3 for 6m Second event → Heparin to Warfarin until INR 2-3 for 12m Third event...
Read moreBleeding Disorders
Hemophilia Etiology XR Factor 8 → A (80%) Factor 9 → B Factor 11 → C Presentation Male child with delayed joint/muscle bleeding Normal BT Normal PT ↑aPTT Diagnosis Best initial → Mixing study → Corrects aPTT Most accurate → Factor assays for 7, 8, 9, 11, 12 Treatment...
Read morePlasma Cell Disorders
Multiple Myeloma Etiology Plasma cell monoclonal proliferation Osteoclast activating factor (OAF) ⇒ Lytic lesions Presentation CRAB C → ↑Ca R → Renal failure A → Anemia B → Bone pain Most common → Bone pain → Pathologic fracture ↑Ca Infection ↑ Uric acid → Nuclear material turnover Anemia Renal failure Immunoglobulin accumulation...
Read moreLymphoma
Non-Hodgkin Lymphoma Etiology Proliferation of lymphocytes inside lymph nodes and spleen Similar to CLL → NHL is solid, CLL is liquid Stages 1 → 1 lymph node group 2 → ≥2 lymph node groups on one side of diaphragm 3 → Both sides of diaphragm 4 → Widespread Pathologic classification B-Cell Follicular Middle-aged Indolent,...
Read moreLeukemia
Leukemoid Reaction ↑ WBC after infection Acute inflammatory response Neutrophils Left shift Distinguish from leukemia → LAP (Lymphocyte alkaline phosphatase) ↑LAP → Leukemoid reaction ↓LAP → CML or another leukemia AML/ALL Etiology ALL Children 85% cured Poor prognosis Age <1y, >10y WBC >50k t(9;22) CNS involvement ↑ incidence in Down syndrome...
Read morePolycythemias
Polycythemia Vera Etiology JAK2 protein mutation All cells rise → RBC most prominent Hyperviscosity Presentation Older patient with Hyperviscosity Syndrome Headache Blurred vision Tinnitus Pruritus → After warm shower → ↑Basophils Hypertension Fatigue Splenomegaly Bleeding → From engorged vessels Easy bruising Thrombosis CHF Diagnosis Best initial → CBC ↑Hematocrit >60% ↑PLT ↑WBC Normal...
Read moreAnemia (General)
Anemia Etiology Microcytic Iron deficiency Thalassemia Sideroblastic Anemia of chronic disease Macrocytic B12 deficiency Folate deficiency Sideroblastic Alcoholism Liver disease Hypothyroidism Myelodysplastic syndrome Drugs Azathioprine 6-MP Hydroxyurea Methotrexate Zidovudine Phenytoin Cold agglutinins → cell clumping → False ↑MCV Normocytic Rapid blood loss Eventually iron deficiency → Microcytic Rapid hemolysis Eventually ↑Retic → Macrocytic...
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