OSCE - Hematology

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  1. 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
  2. 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)
    • anemia
    • bleeding (easy bruising, epistaxis, hematuria, menorrhagia, hemoptysis, melena, postop....)
    • blood type
    • previous transfusions
    • hx of infection
  3. Name the organs not to miss in a hematologic exam
    • lymph nodes
    • spleen
    • liver
  4. 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
    • Pulsatility
    • Tenderness (w palpation or constant)
    • Shape
    • Mobility
    • Size
    • Consistency (hard, soft, firm, rubbery, compressible, fluctuant)
    • Definition of margins
    • Number and Nodularity
    • Warmth
    • Location
  5. where are the active marrow sites in normal adults?
    • ends of long bones
    • pelvis
    • ribs
    • vertebral bodies
  6. which system does not contain lymphatics?
  7. name the branches of the axillary lymph nodes
    • lateral
    • medial
    • infraclavicular
    • supraclavicular
    • pectoral
  8. name the branches of the H&N lymph nodes
    • preauricular
    • post auricular
    • occipital
    • tonsillar
    • cervical
    • deep cervical (deep to SM muscle)
    • supraclavicular
    • submaxillary
    • submental
  9. what should your DDX of lymphadenopathy include?
    • Infection
    • Autoimmune/Allergic: collagen vascular dz, infiltration w sarcoid/amyloid and serum sickness
    • Metabolic: drug hypersensitivity
    • Neoplastic: lymphoma, leukemia, metastatic dz
  10. enlargement of a supraclavicular node suggests metastasis from....
    thoracic or abdominal malignancy (esp. on left side)
  11. malignant nodes are likely to be described as
    fixed and hard
  12. what 3 processes are needed to achieve hemostasis?
    • vasoconstriction
    • platelet plug formation
    • coagulation cascade
  13. 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
  14. list signs of severe anemia
    • hyperdynamic precordium
    • bounding pulses
    • aortic flow murmur
  15. signs of superior vena cava syndrome
    congestion and edema of the face and neck
  16. 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)
  17. what GI symptoms might a person with hepatosplenomegaly present with?
    • early satiety
    • n/v
  18. grossly, what are the 4 causes of anemia
    • decreased production of RBCs
    • increased destruction of RBCs
    • loss of RBCs
    • sequestration of RBCs
  19. name 3 causes of microcytic anemia
    • iron deficiency
    • thalassemia
    • sideroblastic anemia
  20. name 4 causes of normocytic anemia
    • acute blood loss
    • hemolysis
    • hypoproduction of RBCs
    • anemia of chronic disease
  21. name 3 causes of macrocytic anemia
    • B12 deficiency
    • folate deficiency
    • alcohol
  22. DDx for unilateral swollen, painful calf
    • Vascular: DVT, thrombophlebitis, arterial insufficiency
    • Infectious: cellulitis
    • Traumatic: injury, ruptured Baker's cyst
    • Idiopathic/Iatrogenic: neuropathic, referred pain
  23. what hx would you expect from a Baker's cyst?
    • knee effusion
    • sudden onset of pain and swelling
    • popliteal mass
  24. what hx do you expect from arterial insufficiency (claudication)
    calf pain w activity, resolves w rest
  25. 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:
    • smoking
    • age>60
    • hx of thromboembolic dz
    • obesity
    • dm
  26. what are the 6 P's of arterial occlusion?
    • pain
    • pulselessness
    • pallor
    • polar (cool)
    • parasthersia
    • paralysis
  27. what are the signs of a PE
    • fever
    • palpitations/syncope

    • the triad (rare)
    • sudden SOB
    • hemoptysis
    • pleuritic CP
  28. what are the signs of cor pulmonale
    • increased JVP
    • positive hepatojugular reflux
    • right ventricular heave
  29. what initial investigations would you order in an anemic pt?
    • cbc
    • serum ferritin
    • reitc count
    • blood film
  30. chronic vs. critical ischemia
    • chronic:
    • discomfort w exertion
    • pain relieved w rest
    • reproducible pain (claudication distance)

    • critical:
    • night and rest pain
    • ulcerations and gangrene
    • bruits
    • pallor on elevation
    • rubor on dependency
  31. signs and symptoms of a AAA
    • hypotension
    • palpable pulsatile mass above umbilicus
    • bounding femoral pulse
    • pain (abdominal, flank, back)
    • syncope
  32. what do tender nodes suggest?
  33. 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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OSCE - Hematology
2011-01-07 08:24:56
OSCE medical school hematology

from OSCE and clinical skills handbook
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