GU/ surg/GI/Allergy/immunology/ et al Flashcards
- Baby with petechiae. Plt 12. After transfusion, Plt are 16. Mom’s CBC normal. What is best management?
A. PLA1 negative platelets B. IVIG
C. Pooled donor platelets
Consensus: A (but if washed maternal platelets, that would be gold standard)
Answer: … unsure… I think A but practically it may be B
- Given this haemoglobin electrophoresis, what is the most likely diagnosis?
A. Sickle cell trait
B. Sickle cell disease C. Beta thalassemia D. Alpha thalassemia
Consensus: B
Consensus: D
Haemoglobin A none Haemoglobin A2 2% Haemoglobin F 75% Haemoglobin S 25%
b
- What med can`t a G6PD kid take?
Consensus: B
Please note that this naswe was changed to B from D as the SickKids Hematology lecturer stated that blood given to babies is typically leukoreduced which significantly decreases the risk of CMV, making Hep B more likely.
Blood given to babies is irradiated but not CMV negative
- 15 year old girl has cervical lymphadenopathy which has been waxing and waning over the last 8 months. She had a CXR which showed a widened mediastinum. Which of the following is the most appropriate next test?
a. Cervical node excision b. TST
c. CT chest
d. Bartonella serology
Consensus: C
Biopsy seems like a good next step but wouldn’t you CT before laying flat?
1) A 4-year-old girl is seen in the emergency department after a motor vehicle collision. She is diagnosed with splenic rupture, and receives a large volume transfusion of packed red blood cells. Which is the most likely to occur as a result?
) Peaked T waves on ECG b) Decreased urine output c) Hypotension
d) Seizure
Consensus: A
Allergic (hypotension) more likely than hemolytic (hyperkalemia)?
A young boy presents with a normochromic, normocytic anemia. He is stable. What is your next course of action?
a) Start iron supplementation (hypochromic, microcytic anemia) b) Refer to heme for BMA
c) Follow up in 2 weeks *
Consensus: C
18mo with periorbital edema and pallor on exam. Her albumin 26 and her urine is negative for protein. Labs also show anemia. What test is most likely to reveal the diagnosis?
- Serum trypsin
- Stool alpha-1-antitrypsin
- 24-hour urine creatinine clearance
- ECHO
Consensus: B stool alpha 1
Answer: 2
Old question from GI as well. At the time, answer was stool A1AT.
Protein-Losing Enteropathy
• Severe protein loss from the GI tract resulting in hypoalbuminemia and often fat-soluble vitamin deficiencies.
• Assess with fecal alpha-1-antitrypsin. (MayoClinicLabs: Alpha-1-antitrypsin (A1A) is resistant to degradation by digestive enzymes and is, therefore, used as an endogenous marker for the presence of blood proteins in the intestinal tract. A1A clearance is reliable for measuring protein loss distal to the pylorus. Correlate with serum A1A.)
Vs. serum trypsin as answer because it measures pancreatic function, ? Schwachman Diamond Syndrome (SDS). However no neutropenia with recurrent pyogenic infections, with 60% of patients presenting with pancytopenia, and also has pancreatic insufficiency/protein losing enteropathy. Thrombocytopenia in 70% and anemia in 50% per Nelsons. Not enough hints that point towards SDS.
4 yo girl with fever, splenomegaly, diffuse lymphadenopathy, purpuric rash on legs. Ulcerated pharynx. WBC 24, HB 80, Plts 20. Likely diagnosis?
a) leukemia
b) lymphoma
c) Mononucleosis d)?
Consensus: A
- 2015, question “7”/8: A child’s newborn screen was positive, with the following pattern:
HbA – None HbF – 70% HbA2 – 10% HbS – 20%
What is your diagnosis regarding above info? a. Alpha thalassemia
b. Sickle cell trait
c. Beta thalassemia
d. Sickle cell disease (?) - no HbA (no normal Betaglobin)
d. Sickle cell disease (?) - no HbA (no normal Betaglobin)
- 2014, question 13: A 12 year-old boy presents with an X-ray (described, no picture given) of mottled(?) bone on right rib with new bone forming on top. What is the most likely diagnosis?
a. Ewings → “less common features: thickened bone, expansion of cortex, pathologic #”
b. Osteosarcoma
c. Osteochondroma
