What anemias are microcytic?
iron deficiency, the thalassemias, and anemia of chronic diseases
What tests should be included in a lab panel when hemoglobin is below 10.0 g/dL?
CBC, serum folate, serum iron, ferritin, total iron binding capacity, hemoglobin electrophoresis
How long does it take for iron stores to be replenished after hemoglobin levels are WNL?
3 months with supplementation
What is the formula for Mentzer's index?
MCV/RBC < 13
What does Mentzer's index help in identifying?
traits for Beta thalassemia
Will iron supplementation resolve Beta thalassemia?
No
What percentage of African Americans have sickle cell anemia?
8%
What is the primary complication for pregnant women with sickle cell anemia?
increase in UTIs, hematuria
What does G6PD stand for?
Glucose-6-phosphate dehydrogenase deficiency
What groups are most likely to have G6PD?
Mediterranean and African American
What situations cause hemolysis in individuals with G6PD?
infections, oxidative drugs, surgery
What is a leading cause of menorrhagia in teenagers?
Von Willebrand's disease
What symptoms indicate a bleeding disorder?
history of heavy menstrual bleeding in association with increased bruising & nosebleeds, or a family history of bleeding problems
What labs should be done for suspected bleeding issues?
platelet count, bleeding time & coagulation studies
What medication should be avoided if a diagnosis of Von Willebrand's is made?
aspirin
What is dyslipidemia?
elevated cholesterol
What is a URI?
Upper Respiratory Infection
What is the most common bacterial respiratory infection?
Streptococcus pneumoniae
What are symptoms more of a flu than a cold?
high fever, dry cough
What simple technique can prevent URIs?
hand washing
What is the term for infections of the lower respiratory tract that are limited to the trachea and bronchi?
bronchitis
What two symptoms are suggestive of pneumonia?
worsening chest pain with shortness of breath or pain
What are symptoms of a bacterial bronchitis infection?
worsening cough with productive discolored sputum, chronic or recurring bronchitis with underlying respiratory disease
What are the symptoms of pneumonia?
fever, cough, chest pain, shortness of breath, sweats and chills, generalized aches, headache, and fatige
What is the difference between bacterial and viral pneumonia?
bacterial: high fever, productive cough
viral: more general malaise
What are the marks of true diarrhea?
...
What bacterium is the most common cause of traveler's diarrhea?
E. coli
What should be included in the initial questioning during assessment for constipation?
assessment of their "usual" bowel habits
What are common causes in healthy women for constipation?
inadequate dietary fiber, possibly decreased fluid intake, iron therapy for anemia, medications
What are the symptoms if Irritable Bowel Syndrome (IBS)?
lower gastrointestinal tract complaints of increased bloating, diarrhea, and/or constipation in the absence of any structural or biochemical cause
Further comfirmations of IBS diagnosis
increased/decreased stool frequency, abnormal stool formation (either hard or water), bloating, difficulty in the passage of stool (straining, urgency, or failure to completely empty the bowel), and mucus in the stool
Symptom relief related to having a bowel movement is strongly suggestive of what?
IBS
What do most food allergies present as?
acute upset not chronic bowel changes
What does GERD stand for?
Gastroesophageal Reflux Disease
What are the symptoms of GERD?
heartburn that worsens with meals, bending over, or lying down
What are theraputic ways to alleviate GERD?
weight reduction, maintaining a diet high in protein/low in fat, avoidance of triggers such as caffeine, tobacco, and spicy/acidic foods, at night, elevate the head
What are peptic ulcers?
open lesions of the stomach or duodenum, penetrating through the mucosa into muscle
What are common causes of peptic ulcers?
excessive use of nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or aspirin, and H. pylori infection
What is cholecystitis?
inflammation of the gallbladder
What are the symptoms of cholecystitis?
diffuse discomfort to sharp epigastric pain after meals, often associated with nausea and vomiting; persistent right-upper quadrant pain, often radiating to the right shoulder blade or central back; occasionally palpable mass at the gallbladder
What are common laboratory findings for Cholecystitis?
leukocytosis, elevated liver function tests, and elevated bilirubin
What are the classic descriptive symptoms for appendicitis during pregnancy?
anorexia, generalized abdominal pain resolving into acute right-lower quadrant pain, vomiting, fever, and the appearance of leukocytosis on CBC, Rovsing's sign
What is an early sign of acute appendicitis?
Deep tenderness over McBurney's point in the lower right abdomen
What is Rovsing's sign?
rebound pain with release of pressure from the left lower abdomen
Asymptomatic bacteruria is associated with what?
increased risk of preterm labor
What are symptoms of acute cystitis?
pain on urination, increased voiding frequency
What category of healthy young women are at higher risk for cystitis?
those who are sexually active, primarily associated with delayed voiding after genital sex and the use of spermicides and diaphragms
What single sign is enough to initiate therapy if cystitis is suspected?
identification of positive leukocyte esterase on a urinalysis
What is the time frame for antibiotic regimens generally adequate for uncomplicated bladder infections?
three days
Single-day antibiotic regimens for bladder infections are associated with what?
higher rate of recurrent infection
What is acute pyelonephritis?
inflammation of the kidneys
what is the characteristic presentation of acute pyelonephritis?
sever flank pain, fever associated with nausea
How is an acute pyelonephritis diagnosis confirmed?
urinalysis positive for white cells or pyuria, or by culture
Is hospitalization usually required for initial stages of treatment of acute pyelonephritis?
yes...for intravenous antibiotics
What is the time frame for a course of IV/oral therapy antibiotics for acute pyelonephritis?
10 to 14 days
Which type of diabetes is almost always mediated by the immune system causing pancreatic B cell destruction?
Type I
Which type of diabetes is the result of resistance to insulina dn the inability of the pancreas to increase insulin production to compensate?
Type II
What are presenting symptoms of Type I diabetes?
polyuria, increased thirst, hunger with associated weight loss, and weakness or fatigue
What are presenting symptoms of Type II diabetes?
thirst, frequent voiding, weakness, recurrent vaginal yeast infections, itching, skin infections, blurred vision, or peripheral neuropathy
Diagnosis should always be made with what?
laboratory screening
What must two consecutive fasting values be above to be used as diagnostic?
125 mg/dL
What blood test can be used to asses background level of blood sugar in newly diagnosed diabetics and maintenance of glycemic control?
Hemoglobin A1C
What does a Hemoglobin A1C express results as?
percentage of total hemoglobin
What are the normal nondiabetic results of a Hemoglobin A1C?
4.0 to 7.0 percent
When choosing hormonal contraceptives with diabetic women, what kind of drug should be given preference?
a drug with minimal effect on the lipid profile
What are the first tests performed in diagnosing thyroid diseases?
TSH and free T4