5 Heme Onc Immuno

Question 1

Anemic child:

Milk related Fe deficiency

-what is this, what are the mechs

Answer 1

Anemia from too much cow’s milk, OR only breastfeeding

Babies have Fe stores from birth for 6 mo. After that, need Fe supplementation from formula or diet.

1. cow’s milk does not have much Fe
2. Cow’s milk cause microscopic GI bleed
3. Cow’s milk has inhibitors for Fe uptake

Question 2

Anemic child:

Milk related Fe deficiency

• what do you expect to see on labs MCV and retic count
• what is tx
• what recommendations to avoid this

Answer 2

• low MCV, low retic count, hgb can be as low as 2
• Tx with Fe supplementation, limit cow’s milk
  recs: No cow’s milk until age 1, then limit to <24oz/day. give diverse diet (for Fe)

If breastfed, must have Fe supplemented formula starting around 4-6mo

Question 3

Transient erythroblastopenia of childhood

what is this

Answer 3

Probably parvovirus b19 infection

transient anemia with low retic count

dx around age 2, viral sxs, resolves 1-2 mo

Question 4

Hemophila A and B

How much factor dose to replace for each?

• what if factor inhibitor?
• what if don’t know what kind of hemophilia?

Answer 4

You want to increase factors up to 100% for severe bleeds such as CNS, GIB

Hemophilia A: give factor 8 (up to 50U/kg)

-each factor 8 unit raises 2%

Hemophilia B: give factor 9 (up to 100U/kg)

• each factor 9 unit raises 1%
• if factor inhibitor: use recombinant factor 7, talk to heme
• if unknown type, can give FFP (contains both factor 8 and 9)

Question 5

peds brain tumors

how sensitive is CT?

Answer 5

CT can easily miss infratentorial masses

get MRI

Question 6

Raccoon eyes sign on child, but no trauma hx

think what

Answer 6

Mets to skull/eye from neuroblastoma

Question 7

opsoclonus myoclonus

what is this, importance?

Answer 7

jumping eye movements, and myoclonic jerks

Paraneoplastic syndrome of neuroblastoma

Question 8

neutropenic fever, peds

• what is the fever definition?
• what abx

Answer 8

38. 3 once, or >38 two times 4h apart
    - give cefepime or ceftazitime, +/- others

Question 9

Tumor lysis syndrome

• what are the electrolyte abnormalities (4)
• what txs

Answer 9

hyperK–arrythmias, standard tx

hyperUricemia–can cause AKI. hydrate and can give rasburicase

hyperPhos– can cause AKI, hydrate and give phosphate binder, (eg Renagel)

HypoCa (because of high phos)–think long QT. replete if tetany

Question 10

Sickle cell:

dactylitis

-admit these?

Answer 10

treat as VOC
-can dc home with analgesics, not necesarily admit

Question 11

SIckle cell, fever presentation

management by age:

Answer 11

0-1: ceftriaxone, admit all

1-5: can give ceftriaxone and dc with 24h f/u if certain lab criteria met

>5: most stable pts can be dc home

Question 12

HSP mnemonic

Answer 12

ARENA

abdominal pain

rash

edema

nephritis

arthritis

Question 13

kawasaki’s criteria:

tell me more about each

Answer 13

CRASH and burn

Conjunctivitis–limbic sparing classic. HOWEVER can have additional uveitis which would be ciliary flush

Rash– can be anything really

Adenopathy– unilateral 1.5cm, large nontender

Strawberry tongue– includes mucositis, cracked lips

Hands/feet– erythema, eventually skin sloughing in week 2

Question 14

kawasaki’s incomplete form

-in whom to worry about

Answer 14

Infants with fever x1 week and even a few criteria, get labs, low threshold to admit!

(3-6mo have highest risk for complications, and more often incomplete)

Question 15

kawasaki

-consider what ddx

Answer 15

• strep/scarlet fever– can have strawberry tongue, body rash, LAD, fever,
• adenovirus– conjunctivitis, LAD, fever

Question 16

kawasaki’s

• what labs to get, what do you expect to see
• what is special about urine

Answer 16

BMP, LFT, CBC, ESR/CRP, UA

hypoNa

low albumin, elevated ALT

leukocytosis, anemia, thrombocytosis

ESR/CRP elevated

“sterile pyuria” from WBCs with no bacteria. comes from sloughing of cells in urethra, so cathed specimen will not show this