D2 Answers

Images:

Sickle

Auto Infarction of the spleen

extramedullary hematopoesis of the skull

3 is the medulla

Aplastic Anemia

Parvo virus B19

D3 Sickle Cell Anemia

A 25 yo African American man is admitted to your service, who initially presented to the ER complaining of abdominal and bilateral lower extremity pain. He’s been admitted 6 times before for the same pain that has occured in the same locations. When you examine him, you note he is febrile to 101 F, respiratory rate of 25 breaths per minute, normal bp, and slight tachycardia of 100bpm. Lung examination revels bronchial breath sounds and egophony in the right lung base. His O2 sat on 2L/min nasal cannula is 92%. Besides the usual abdominal and leg pain, he is now complaining of chest pain, which is worse on inspiration. Although he is tender on palpation of his extremities, the remainder of his examination is normal.

Lab results revealed elevated white blood cell and reticulocyte counts, and a hemoglobin and hematocrit that are slightly lower than baseline.

These are seen on the peripheral smear:

Why do you think he was admitted 6 times prior to this hospitalization? Sickle Cell Disease
What do you think is the reason he needed to be admitted to the hospital? Acute Chest Syndrome

Name the abnormality in this image? What does it indicate?
D3 Sickle Cell Anemia

A 25 yo African American man is admitted to your service, who initially presented to the ER complaining of abdominal and bilateral lower extremity pain. He’s been admitted 6 times before for the same pain that has occured in the same locations. When you examine him, you note he is febrile to 101 F, respiratory rate of 25 breaths per minute, normal bp, and slight tachycardia of 100bpm. Lung examination revels bronchial breath sounds and egophony in the right lung base. His O2 sat on 2L/min nasal cannula is 92%. Besides the usual abdominal and leg pain, he is now complaining of chest pain, which is worse on inspiration. Although he is tender on palpation of his extremities, the remainder of his examination is normal.

Lab results revealed elevated white blood cell and reticulocyte counts, and a hemoglobin and hematocrit that are slightly lower than baseline.

These are seen on the peripheral smear:

Why do you think he was admitted 6 times prior to this hospitalization? Sickle Cell Disease
What do you think is the reason he needed to be admitted to the hospital? Acute Chest Syndrome

Name the abnormality in this image? What does it indicate?

Extramedullary hematopoesis in the skull

What three things promote sickling? Hypoxia, acidosis, dehydration, or variations in body temperature?

People with sickle cell trait do you exhibit the same severity of symptoms. Using the picture of a kidney below, determine the number/name of the site that is most susceptible to sickling for people with sickle cell trait. Tell me why? 3/Medulla of the Kidney due to

Renal papillary necrosis.

What prevents sickling at birth and for how long?

HbF for up to 6 months

Using the history of the patient, describe what is happening to the organ below and how patient must be protected after this process? (provide specific medical treatment and for what organisms) Autoinfarction of the spleen. Need to protect against encapsulated organisms such as Strep pneumo and H. influenza.

The patient starts to get better, but then after he was visited by his nephew, who likes the image below, he begin to get worse.





You notice  pallor, weakness, and lethargy secondary to something severe you notice on his daily labs. The image below is what comes up in your mind:

What is happening? Describe the image and how it relates to what is normal. How will you treat it?

The patient was exposed to Parvovirus B19 and is now experiencing aplastic anemia.
Extramedullary hematopoesis in the skull

What three things promote sickling? Hypoxia, acidosis, dehydration, or variations in body temperature?

People with sickle cell trait do you exhibit the same severity of symptoms. Using the picture of a kidney below, determine the number/name of the site that is most susceptible to sickling for people with sickle cell trait. Tell me why? 3/Medulla of the Kidney due to

Renal papillary necrosis.

What prevents sickling at birth and for how long?

HbF for up to 6 months

Using the history of the patient, describe what is happening to the organ below and how patient must be protected after this process? (provide specific medical treatment and for what organisms) Autoinfarction of the spleen. Need to protect against encapsulated organisms such as Strep pneumo and H. influenza.

The patient starts to get better, but then after he was visited by his nephew, who likes the image below, he begin to get worse.





You notice  pallor, weakness, and lethargy secondary to something severe you notice on his daily labs. The image below is what comes up in your mind:

What is happening? Describe the image and how it relates to what is normal. How will you treat it?

The patient was exposed to Parvovirus B19 and is now experiencing aplastic anemia.

(Clinical Vignette Adapted from CaseFiles Internal Medicine)