Final FINAL-Table 1 Flashcards
What are 2 important diagnostic tests for anemia?
Reticulocyte count, Hgb
What does a high retic count with high bilirubin indicate?
Bone marrow is working!
Most likely d/t destruction or loss of RBCs (hemolytic)
(acute/chronic) anemias are well tolerated in children
Chronic
Anemic disorder characterized by bone marrow aplasia
Diamond Blackfan anemia
Diamond Blackfan anemia responds to ____treatment, and is cured by ____
Steroids
Bone Marrow Transplant (BMT)
3 yo pt with cc of lethargy x3 days. Pt is pale, jaundiced, w/ palpable spleen. CBC shows low Hb, High retic count, and increased LDH. What do you suspect?
Hemolytic anemia
In the case above, which findings were indicative of hemolysis?
Jaundice
Splenomegaly
___ hemolysis can be due to Hereditary spherocytosis, G6PD deficiency, and hemoglobinopaties
Intrinsic
____ hemolysis can be due to AIHA, DIC, or IV hemolysis
Extrinsic
What common virus can produce a low retic count and red cell aplasia?
Parvovirus B19
Your patient presents with anemia + Petechiae. You suspect:
Leukemia or HUS
Which lab would show you the presence of spherocytes?
Peripheral blood smear
When does Fe deficiency anemia first appear?
After the first 4-5 mo of life
What should you check if a pt presents with neutropenia or thrombocytopenia?
Bone marrow fxn
Name the iron studies for Fe Deficient anemia
Serum ferritin (low) Serum iron (low) Total Fe binding capacity (inc) Transferrin saturation (low)
Children who drink cow’s milk are at risk for developing__ deficiency
Iron
Kids who drink goat’s milk are at risk for developing__ deficiency
Folate
Age range for kids with Diamond Black-fan anemia
Birth-1 year
B-12 deficiency is a common finding in this GI disorder
Crohn’s
Smooth beefy red tongue may indicate
B-12 deficiency
Fanconi and Diamond-Blackfan anemias are ____ forms of normocytic anemia
Congenital
Age range for Fanconi anemia
2-10 years
What is TAR and what condition is it found in?
Thrombocytopenia with absent radius. Fanconi anemia
____anemias are characterized by Anemia, Jaundice, Splenomegaly
Hemolytic
Longstanding spherocytosis and sickle cell disease can cause _____
Gallstones
What is the most common inherited enzyme defect?
G6PD deficiency (2nd is Pyruvate Kinase Deficiency)
G6PD manifests as _____ cells on peripheral blood smear
Blister cells
G6PD commonly presents with this finding
Hyperbilirubinemia
B12/folate deficiency presents as _____ RBCs on peripheral blood smear
Macrocytic
This hemoglobinopathy is found in carriers only
Thalassemia trait
Hemophilias, vitamin K deficiency, and DIC are all disorders of _____
Coagulation
Intrinsic clotting pathway is measured by a
PTT
Extrinsic pathway measured with a
PT
A pt who is bleeding into their joints should be worked up for
Hemophilia
More common mechanism of thrombocytopenia
Increased consumption/ breakdown of RBCs
Kasabach-merritt syndrome is associated with sepsis and ____
Thrombocytopenia
DIC, Liver disease, and HSP are all _____ types of bleeding disorder
Acquired
____ is a type of thrombocytopenia associated with severe illness or shock
DIC
Most common bleeding disorder of CHILDhood
ITP (idiopathic thrombocytopenia purpura)
ITP usually shows up after____
A viral infection
Treatment for ITP includes
Steroids IV Ig (in severe cases)
Factor ___- and Von Willebrand work together
VIII
Hemophilia B, aka _____, is x-linked and are assoc w/ factor IX deficiency
Christmas Disease
_____ is the most common INHERITED bleeding disorder among Caucasians (though it can be acquired…)
Von Willebrand disease
VW disease can be treated with _________, which releases vWF from endothelial stores
Desmopressin
FFP contains____
All coag factors
If you have abnormal PT/PTT, you would give
FFP
If you have normal PT/PTT values, you would give
Cryoprecipitate
In ___ syndrome, bilirubin is elevated in times of stress, causing jaundice
Gilbert’s Syndrome
Most common death by disease in children
Cancer
___ has inc. incidence of Trisomy 21, NF type 1, and fanconi’s anemia
ALL
First labs for a CA workup
CBC w/ diff
Peripheral blood smear
ALL occurs most commonly in kids aged _____-______
2-10 (peak at 4)
Most common CA treatment for kids
Chemo
Philadelphia chromosome is associated with ____
CML (Chronic Myelogenous Leukemia)
Pt presents with firm, non-tender lymph node and hx cough. What do you order?
CBC
CXR
Lymph biopsy
What are you looking for on x-ray for a kid with suspected ALL?
Mediastinal widening/ mass
This type of lymphoma peaks in adolescence and again after age 50
Hodgkins Disease
Biopsy for suspected hodgkin’s disease would show this type of cell:
Reed-Sternberg cells
Hodgkin’s is characterized by ______ adenopathy
Painless cervical
Mediastinal lymphadenopathy or mass can present with: __ or ___
Cough, dyspnea
Most common type of solid tumor in kids:
Brain tumor
Classic triad of brain tumors
Papilledema
Morning headache
Vomiting (w/o nausea)
Most common tumor of childhood
Astrocytoma
Young children most often get ______ brain tumors
Infratentorial
Older children more often get ____ brain tumors (which are WORSE)
Supratentorial
Abdominal mass that crosses midline
Neuroblastoma
Painless abdominal mass that does NOT cross the midline
Wilms Tumor (nephroblastoma)
Most common solid neoplasm OUTSIDE the CNS
Neuroblastoma
This type of tumor is common in Beckwith-Widemann syndrome
Wilms tumor
Most common sign of a retinoblastoma
White pupillary reflex
How do you diagnose retinoblastoma
MRI
Most common soft tissue sarcoma in childhood
Rhabdomyosarcoma
3 types of Rhabdomyosarcoma
Orbital, nasal, bladder
____ is a definitive test for osteosarcomas
Tissue biopsy
____ present with a painful, palpable mass and lytic lesions with calcifications on x-ray
Osteosarcoma
___ commonly presents with femur and pelvic pain, fever, and wt loss.
Ewing sarcoma
Most important diagnostic tools in ortho
PE and Radiographic imaging
Hip dysplasia (is/is not) a disease of dislocation
Is NOT
____ is the abnormal relationship between the prox femur & acetabulum
Hip Dysplasia
Hip dysplasia can be diagnosed using these techniques
Barlow’s and Ortolani’s
______ are indicative (not diagnostic) of hip dysplasia, occurring in up to 40% of cases
Asymmetric Skin folds
If diagnosed in the first 4-6 mo of life, hip dysplasia can be treated with __
Pavlik harness
You find a palpable mass in your patient’s neck, and note that their head is twisted to the side. X-ray reveals no cervical deformities. What is your ddx?
Torticollis
Children with this congenital connective tissue disorder can have subluxed ocular lenses, thoracic aortic aneurysms.
Marfan syndrome
This disorder is characterized by in-utero fractures and blue sclera
Osteogenesis imperfecta
_____ show promise for decreasing incidence of fractures in OI
Bisphosphonates
The most common form of short-limbed dwarfism:
Achondroplasia
Patients with achondroplasia have a greater risk for ___
Scoliosis
Your patient has a 20˚ scoliosis curvature. Your next step is:
No tx required
Name 4 types of congenital vertebrae abnormalities
Wedge vertebra
Hemivertibra
Congenital bar
Block vertebra
Most common cause of limping and hip pain for kids in the US:
Transient Synovitis
Most common organism implicated in septic arthritis of the hip
Staph aureus
Treatment course for septic arthritis
ABX then surgery if needed
Your 7 year old male patient presents with an atraumatic painless limp and decreased internal rotation. You suspect:
Legg-Calve-Perthes Dz
Treatment for Perths disease includes
Protecting the joint w/o limiting mobility
3 x-ray views for diagnosing Perths disease
AP, Lateral, Frog-leg
____ is an orthopedic emergency, characterized by pain in hip, medial knee, and anterior thigh.
SCFE
Radial head subluxation is also known as
Nursemaid’s Elbow
Typical posture associated with radial head subluxation
“my arm” posture
SCFE is most common in this age group
Adolescents 10-16
Genu ____ is normal between infancy and 2 years
Varum
Genu ____ is normal between 2-8 years
Valgum
___ is the abnormal growth of the medial aspect of the proximal tibial epiphysis, resulting in a progressive varus deformity
Blout’s
Most common cause of in-toeing in kids under the age of 2
Tibial torsion
The recommended treatment for W-sitters
Bicycle/skating
Patellofemoral Pain Syndrome presents with _______pain, worse with activity, stairs, prolonged sitting
Anterior knee pain
___ can cause microfractures to the tibial tuberosity bone overgrowth
Osgood-Schlatter Disease
_______ is a MSS problem of intrauterine positioning and will resolve spontaneously
Calcaneovalgus
What should you look for on physical exam if the patient also presents with metatarsus varus?
Check for hip dysplasia
Most ___ is caused by congenital hypoplastic tarsal bones (esp the Talus)
Talipes Equinovarus
Torus fractures are also known as
Buckle fracture
Torus fractures affect these bones
Radius/ulnar
___ is an oblique fracture of the distal tibia without a fibula fracture
Toddler’s Fracture
Salter Harris classification describes ______ fractures
Epiphyseal
A type _____ S-H fracture through a portion of the physis and epiphysis into the joint that may result in complication because of intra-articular component and because of disruption of the growing or hypertrophic zone of the physis.
Type III
A type ____ S-H fracture presents as a crush injury to the physis with a poor functional prognosis (aka the WORST)
Type V
This type of S-H fracture has joint involvement
Type III
Types _&__ are a closed reduction and are treated with a cast
Types I & II
Osteosarcomas most commonly occur in ______ bones
Long bones
Most common bone tumor in children (benign)
Osteochondroma
Most common malignant bone tumor in children
Osteosarcoma
____ can present like an osteomyelitis with fever and leukocytosis, but shows lytic lesions on x-ray
Ewing Sarcoma
Anterior thigh and knee pain may be presentations of a ___ problem
Hip
Joint pain can be an early presentation of ___-
Crohns Disease
____ is the inflammation at the insertion of a ligament to a bone
Enthesitis
Pleuritis, pericarditis, or peritonitis are all types of _____
Serositis
Most common chronic Rheumatic Disease of children is ___
JIA/JRA
Young girls with ____ JRA and a positive ANA are at highest risk of uveitis
Pauciarticualr
You order an ANA on your patient. It comes back positive. What should be on your differential?
Lupus
Most common site of pauciarticular arthritis
Knee
___ often presents with a cyclic fever, salmon pink macular rash, and HSM
Systemic Form of JRA
The 3 P’s of systemic JRA
Polyserositis
Pleuritis
Pericarditis
____ in kids usually affects males >10 yrs, and typically presents with a positive HLA-B27, elevated ESR, and CRP
Spondyloarthropathy
1st & 2nd line tx for JRA
1 – NSAIDs
2 – Methotrexate
First lab to order for suspected SLE
ANA
