OSCE - Hematology
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Name some of the systemic manifestations of hematologic disease you may see
- petechiae (thrombocytopenia)
- gum hypertrophy (infiltrative process, leukemia)
- bruises, joint effusions (hemarthrosis)
- jaundice (hemolysis)
- angular cheilosis, glossitis, stomatitis, koiloncychia (anemia)
- peripheral sensory neuropathy, impaired proprioception (B12 deficiency)
- thromboembolic dz
what should a focused hematologic system hx include?
- enlarged lymph nodes (#, location, duration, tenderness, any streaking, redness, warmth)
- constitutional sx (fever, chills, night sweats, weight loss, anorexia, general weakness)
- bleeding (easy bruising, epistaxis, hematuria, menorrhagia, hemoptysis, melena, postop....)
- blood type
- previous transfusions
- hx of infection
Name the organs not to miss in a hematologic exam
describe an approach to the lymph node exam
Inspect - size, number, presence of redness
- Palpate and describe enlarged nodes and location according to Professors Teach Sick Med Students to Correctly Define NeW Lumps
- Tenderness (w palpation or constant)
- Consistency (hard, soft, firm, rubbery, compressible, fluctuant)
- Definition of margins
- Number and Nodularity
where are the active marrow sites in normal adults?
- ends of long bones
- vertebral bodies
which system does not contain lymphatics?
name the branches of the axillary lymph nodes
name the branches of the H&N lymph nodes
- post auricular
- deep cervical (deep to SM muscle)
what should your DDX of lymphadenopathy include?
- Autoimmune/Allergic: collagen vascular dz, infiltration w sarcoid/amyloid and serum sickness
- Metabolic: drug hypersensitivity
- Neoplastic: lymphoma, leukemia, metastatic dz
enlargement of a supraclavicular node suggests metastasis from....
thoracic or abdominal malignancy (esp. on left side)
malignant nodes are likely to be described as
fixed and hard
what 3 processes are needed to achieve hemostasis?
- platelet plug formation
- coagulation cascade
DDx of recent onset of easy bruising and nosebleeds
Infectious: Hypersplenism (mono), HUSAutoimmune/Allergic: ITP, TTP, Wegener's granulomatosis, Henoch-Schonlein purpuraMetabolic: DIC, Vit K deficiency, Cushing'sIdiopathic/Iatrogenic: Hypersplenism 2' to portal HTNNeoplastic: Leukemia, lymphoma
list signs of severe anemia
- hyperdynamic precordium
- bounding pulses
- aortic flow murmur
signs of superior vena cava syndrome
congestion and edema of the face and neck
2 problems commonly associated with Non-hodgkin's but rarely seen in Hodgkin's
- SVC syndrome
- renal failure (2' ureteral compression by pelvic lymph nodes)
what GI symptoms might a person with hepatosplenomegaly present with?
grossly, what are the 4 causes of anemia
- decreased production of RBCs
- increased destruction of RBCs
- loss of RBCs
- sequestration of RBCs
name 3 causes of microcytic anemia
- iron deficiency
- sideroblastic anemia
name 4 causes of normocytic anemia
- acute blood loss
- hypoproduction of RBCs
- anemia of chronic disease
name 3 causes of macrocytic anemia
- B12 deficiency
- folate deficiency
DDx for unilateral swollen, painful calf
- Vascular: DVT, thrombophlebitis, arterial insufficiency
- Infectious: cellulitis
- Traumatic: injury, ruptured Baker's cyst
- Idiopathic/Iatrogenic: neuropathic, referred pain
what hx would you expect from a Baker's cyst?
- knee effusion
- sudden onset of pain and swelling
- popliteal mass
what hx do you expect from arterial insufficiency (claudication)
calf pain w activity, resolves w rest
what are the risk factors for thromboembolic dz?
- Virchow's triad!
- 1. endothelial injury (trauma, iatrogenic)
- 2. hypercoagulability (DM, malignancy, HRT, dehydration.....)
- 3. stasis (MI, pregnancy, immobility)
- other risk factors:
- hx of thromboembolic dz
what are the 6 P's of arterial occlusion?
- polar (cool)
what are the signs of a PE
- the triad (rare)
- sudden SOB
- pleuritic CP
what are the signs of cor pulmonale
- increased JVP
- positive hepatojugular reflux
- right ventricular heave
what initial investigations would you order in an anemic pt?
- serum ferritin
- reitc count
- blood film
chronic vs. critical ischemia
- discomfort w exertion
- pain relieved w rest
- reproducible pain (claudication distance)
- night and rest pain
- ulcerations and gangrene
- pallor on elevation
- rubor on dependency
signs and symptoms of a AAA
- palpable pulsatile mass above umbilicus
- bounding femoral pulse
- pain (abdominal, flank, back)
what do tender nodes suggest?
how can you tell the difference b/w a lymph node and a muscle band or an artery
lymph nodes able to be rolled in 2 directions (up and down, side to side)
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