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CPNP AC flash cards > Hem/Onc > Flashcards

Hem/Onc Flashcards

1
Q

At how many weeks of life does physiologic anemia occur?

A

6-9 weeks of life

*Hgb will naturally drop at this time

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2
Q

Premature infants are more prone to the development of anemia because their RBCs have a?

A

shorter life span

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3
Q

What anemia is associated with jaundice and hyperbilirubinemia in an infant?

A

hemolytic anemia

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4
Q

At what age does anemia associated with hemoglobinopathies develop?

A

3-6 months of age

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5
Q

Low MCV =

A

microcytic anemia

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6
Q

Examples of microcytic anemias include ____ and _____

A

IDA and Thalessemia

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7
Q

What etiologies will show anemia with a normal MCV?
*H___ ___
*B___ ____
*i_____
*m_____

A

hemolytic anemia
blood loss
infection
medication

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8
Q

high MCV =

A

macrocytic anemias

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9
Q

Etiologies for macrocytic anemias include?
*___ deficiency
*____ deficiency
*h______

A

B12 deficiency
folate deficiency
hyperthyroidism

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10
Q

A high reticulocyte count is indicative of
*H____
*B____
*H_______

A

hemolysis
bleeding
hemoglobinopathies

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11
Q

A low reticulocyte count indicates the bone marrow is?

A low reticulocyte count may also be due to ____ poisoning.

A

No working well
Lead poisoning

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12
Q

Evidence of hemolysis include
*J____
*U____ ____ changes
*S___ I______

A

jaundice
urine color changes
scleral icterus

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13
Q

High retic + Low MCV =
H____

A

hemoglobinopathy

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14
Q

high retic + normal MCV =
D
I
B___ ____

A

DIC, Infection, Blood loss

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15
Q

Low MCV =
I___
L____
T_____

A

IDA
Lead toxicity
thalessemia

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16
Q

High MCV =
A_____ ____
I___ ____

A

aplastic anemia/crisis
immune disorder

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17
Q

In what type of anemia is there hematopoiesis failure secondary to immune-mediated destruction?

A

Aplastic anemia

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18
Q

Aplastic anemia occurs in what age groups?

A

10-20 YOA

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19
Q

Aplastic anemia CBC findings will show?

A

pancytopenia without blasts
+
low or absent retic

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20
Q

Blood products for children with aplastic anemia should be?

A

CMV -, irradiated, and leukocyte reduced

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21
Q

Is BMT a possibility for children with aplastic anemia?

A

Yes

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22
Q

What anemia presents with decreased or absent Hb beta-globin and increased alpha?

A

Beta thalassemia

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23
Q

beta thalassemia is characterized as a _____ ____ anemia

A

chronic hemolytic anemia

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24
Q

Children with beta thalassemia are at increased risk for?

A

iron overload

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25
Q

Beta thalassemia has what type of inheritance pattern?
Often seen in what cultural groups?

A

autosomal recessive
mediterranean, asian, african

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26
Q

Beta thalassemia is often diagnosed by what year of age?

A

1 year of age

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27
Q

What beta-thalassemia has a severe presentation?

A

thalassemia major
*inherited from both parents

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28
Q

This Hgb electrophoresis is diagnostic for what?

elevated Hgb A2 and F

A

beta thalassemia

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29
Q

Beta thalassemia presentation includes
*F___
*H____
*J_____
*B___ D_____

A

FTT
Hepatosplenomegaly
Jaundice
Bone Deformities

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30
Q

Beta thalassemia will cause a
m____ h_____ anemia, in which RBC’s will be ____ and MCV/MCH will be _____

A

microcytic hypochromic
elevated
low

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31
Q

Children with beta thalassemia will require supplementation with what?

A

folate

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32
Q

At what age are children with beta-thalassemia at most risk for iron overload?

A

children older than 10 YOA

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33
Q

What type of inheritance pattern is G6PD?

A

X-linked recessive

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34
Q

Newborns with G6PD may present with J____ and K_____

A

jaundice and kernicterus

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35
Q

G6PD can be triggered by
F___ B____
I_____
The following medications may also trigger G6PD
S____
Q_____
C______
N_____
Anti-______

A

fava beans
infection

sulfa’s
quinolones
cipro
nitroglycerin
antimalarials

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36
Q

Sickle cell is inherited from ___ parents

A

both

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37
Q

In sickle cell, the RBC lifespan is how many days?

A

10-20

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38
Q

The 3 most common clinical manifestations of sickle cell anemia include H____, p____, and i_____.

A

hemolysis
pain
infection

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39
Q

What is the gold standard diagnostic test for sickle cell anemia?

A

Hgb electropheresis

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40
Q

Vaso-occlusive management includes
h____
p_____

A

hydration and pain management

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41
Q

Encourage ventilation of sickle cell patients via?

A

incentive spirometry

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42
Q

When a child with sickle cell has a fever, ensure to cover for _____ organisms.

A

encapsulated

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43
Q

The most common organism in a child with sickle cell anemia is?

A

Pneumococcas

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44
Q

Children with sickle cell anemia, require infection prophylaxis with?

A

penicillin

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45
Q

The chest x-ray of a child with acute chest syndrome will show new _____ and possible lung _____

A

infiltrates
infarct

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46
Q

Treatment for a child with acute chest syndrome includes
A____
P____
and
R____ support

A

antibiotics
PRBC’s
respiratory support

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47
Q

Children with sickle cell anemia should have annual screening for what?

A

stroke

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48
Q

Stroke screening for a child with sickle cell anemia should begin at what age?

A

2 YOA

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49
Q

Prevention of sickling crisis and its complications is achieved with
* _____ ______ and
* keeping HgbS levels less than ___%

A

exchange transfusions
30%

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50
Q

Once a child with sickle cell anemia has had a stroke, they are at increased risk for needing a?

A

transplant

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51
Q

What sickle cell complication occurs when there is pooling of blood into the spleen?

A

splenic sequestration?

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52
Q

Splenic sequestration can lead to h____ s___ and d_____

A

hypovolemic shock and death

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53
Q

What age groups are at the highest risk for splenic sequestration?
____ months- ____ YOA

A

3 months - 5 YOA

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54
Q

Management of splenic sequestration includes slow?

A

PRBC retransfusion

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55
Q

DIC is described as a coagulation disturbance leading to both t___ and h____

A

thrombosis and hemorrhage

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56
Q

In DIC
* plts will be _____
* PT/INR will be _____
*D. Dimer will be ____

A

low
high
high

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57
Q

The key to managing DIC begins with treating the?

A

underlying cause

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58
Q

What syndrome is considered a thrombotic microangiopathy?

A

hemolytic uremic syndrome

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59
Q

Hemolytic uremic syndrome is characterized by
*T_____
*h____ a____
and
*r____ organ damage

A

thrombocytopenia
hemolytic anemia
renal organ damage

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60
Q

Hemolytic uremic syndrome is often induced by what infection?

A

E. Coli, shiga toxin

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61
Q

Hemolytic uremic syndrome is more common in children less than ___ YOA

A

4

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62
Q

Hemolytic uremic syndrome clinical manifestations include
*a___ pain
*w____/b___ d____
*f_____

A

abdominal pain
watery/bloody diarrhea
fever

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63
Q

Hemolytic uremic syndrome physical examination findings include
*p___
*p____
*h____
*o____ and
*H______

A

pallor
petechiae
hematuria
oliguria
hypertension

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64
Q

The initial treatment for hemolytic uremic syndrome is to correct _____ and _____.

A

hypovolemia
rehydrate

*early fluid resuscitation reduces the risk for dialysis need

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65
Q

If the child with hemolytic uremic syndrome presents with volume overload and oliguria, initial treatment should begin with correction of ___ ____ via the administration of intravenous ______

A

volume overload
furosemide

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66
Q

Dialysis in a child with hemolytic uremic syndrome is indicated in patients with
*_____/_____ abnormalities
*h____ not resolved by medical therapies

A

electrolytes/acid-base abnormalities
hypertension

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67
Q

Strep pneumoniae-associated HUS should be treated with?

A

amoxicillin

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68
Q

atypical HUS is ____ mediated

A

complement

*treated with MAB

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69
Q

Children with ITP include a history of a recent?

A

viral illness

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70
Q

ITP is immune-mediated, plts counts will often below?

A

1000

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71
Q

ITP treatment includes the administration of ___ and _____

A

IVIG and steroids

72
Q

What medication is indicated for ITP patients with severe bleeds?

A

WinRHo

73
Q

Children with ITP are at the greatest risk for a ____ bleed

A

brain

74
Q

What immune-mediated condition is described as a vasculitis of small vessels?

A

HSP

75
Q

HSP often develops s/p?

A

respiratory tract infection

76
Q

HSP is most often caused by what organism?

A

Group A strep

77
Q

S/S of HSP include
P____
R____
S_____
R____ dysfunction
H_____
P_____
H______

A

pain
rash
swelling
renal dysfuction
hematuria
proteinuria
hypertension

78
Q

HSP can progress to ____ failure

A

renal failure

79
Q

Children with HSP will often have ____ purpura, acute ____, and ___ pain

A

palpable purpura
acute athralgias
abdominal pain

80
Q

HSP diagnostic criteria include the findings of ___ deposition

A

IgA

81
Q

What is the hereditary pattern for hemophilia?

A

x-linked recessive

82
Q

The key to managing hemophilia is through the replacement of ____

A

factor

83
Q

Along with factor replacement, what other medication can be used as an adjunct to treat mild-moderate bleeds in a hemophiliac?

A

DDAVP

84
Q

What condition presents with a defect or decrease in Von Willibrand protein?

A

Von Willebrand disease

85
Q

Von Willibrand Disease is often diagnosed in what age group?

A

later in life, teens

86
Q

S/S of Von Willibrand Diseases include
e___
m_____
easy _____
excessive _____ s/p surgical and/or dental procedures

A

epistaxis
menorrhagia
easy bruising
excessive bleeding

87
Q

Bleeds for patients with Von Willibrand disease are treated with what two medications?

A

amicar and DDAVP

88
Q

What is the gold standard diagnostic test to r/o a DVT, P.E, renal thrombosis, and cerebral sinus thrombosis?

A

CT angiography

89
Q

Management for heparin-induced thrombocytopenia includes discontinuing ____ and administration of ______

A

heparin
vitamin k

90
Q

Methemoglobinemia s/s include
c____ and
_____ appearing blood

A

cyanosis
chocolate

91
Q

Methemoglobinemia can occur after the administration of what drugs?
D____
n______
b______
p_____

A

Dapsone
Nitropusside
benzocaine
prirlocaine

92
Q

What is the treatment for Methemoglobinemia?

A

methylene blue IV

93
Q

What time of stroke occurs s/p clot or obstruction?

A

ischemic stroke

94
Q

What time of stroke occurs s/p bleed?

A

hemorrhagic stroke

95
Q

S/S of a pediatric stroke includes the development of acute h___ and s____

A

headaches and seizures

96
Q

What is the gold standard diagnostic test to detect a pediatric stroke?

A

brain MRI

97
Q

What is the pediatric dosing for blood, platelet, and FFP transfusion?

A

10-15 ml/kg

98
Q

What blood product replaces coagulation factors?

A

FFP

99
Q

1 unit of cryoprecipitate is indicated for children weight __-__ kg

A

5-10

99
Q

The administration of cryoprecipitate is indicated when fibrinogen levels fall below.

A

100

100
Q

During a blood transfusion, what causes an acute hemolytic reaction?

A

ABO incompatability

101
Q

What is your child experiencing when he c/o back pain, hypotension, and hemoglobinuria during or s/p blood transfusion?

A

An acute hemolytic reaction

102
Q

During a blood transfusion, nonhemolytic reactions present with?

A

allergy like s/s

103
Q

Nonhemolytic reactions during or s/p blood transfusion are the result of an ____ reaction to l___ or p____

A

antibody reaction to leukocytes or plasma

104
Q

TACO, during or s/p blood transfusion is characterized by c____ collapse and p____ e_____

A

circulatory collapse
pulmonary edema

105
Q

TRALI will occur within ___ hours of a blood transfusion

A

6

106
Q

TRALI presents with acute ____

A

hypoxemia

107
Q

The administration of cryoprecipitate is indicated when fibrinogen levels fall below.

A

100

108
Q

Leukemic cell tumors are known as what?

A

chloromas

109
Q

What is the gold standard diagnostic test for ALL?

A

a bone marrow aspiration

110
Q

Upon initial workup and once confirmed, a patient with ALL will get periodic LP’s to rule out?

A

CNS disease

111
Q

The clinical presentation of a child with non-hodgkin’s lymphoma is rapid. What two oncologic emergencies are patient’s with Non-hodgkin’s lymphoma most at risk for?

A

Acute tumor lysis syndrome and
superior vena cava syndrome

112
Q

A child with non-Hodgkins lymphoma presenting with SVCS and chest pain, should be worked up for the presence of a?

A

mediastinal mass

113
Q

In an emergency situation, what is the initial diagnostic tests for the presence of a mediastinal mass?

A

a chest x-ray

114
Q

What other radiologic exams can assess for the presence of a mediastinal mass?

A

PET and CT

115
Q

Superior vena cava s/s include c___ and s___

A

cough and shortness of breath

116
Q

Children with hodgkin’s lymphoma often present with c/o l______, f_____, and a______

A

lymphadenopathy
fatigue
anorexia

117
Q

In Hodgkin’s lymphoma, B s/s are correlated with?

A

poor outcomes

118
Q

B symptoms include
f____
w_____ _____
n____ ______

A

fever
weight loss
drenching night sweats

119
Q

What are the characteristics of lymph nodes associated with malignancy?
p_____
e_______
f_______
r_______

A

painless
enlarged
firm
rubery

120
Q

Wilm’s tumor is a ____ tumor which most often presents in children ___-___ years of age

A

renal
2-3

121
Q

Wilm’s tumor s/s include
abdominal ____
and _____

A

abdominal distension
hypertension

122
Q

Initial Wilms tumor treatment includes
a?

A

nephrectomy

123
Q

A young child with leukocoria (white eye) and strabismus most likely has?

A

retinoblastoma

124
Q

Retinoblastoma is often a _____ condition

A

genetic

125
Q

What is a sympathetic nervous system neoplasm, that is often an extracranial solid tumor?

A

neuroblastoma

126
Q

The most common finding in a child with neuroblastoma is?

A

opsoclonus myoclonus

127
Q

Neuroblastoma tumors most often occur in the c_____, a____, and p_____

A

chest, abdomen, and pelvis

128
Q

At diagnosis, children with neuroblastoma will often present with ______ because initial disease s/s are vague

A

metastasis

129
Q

What diagnostic tests are good to obtain in a child being worked up for neuroblastoma?

A

CT, MRI, MIBG

130
Q

What urine diagnostic tests are good to obtain in a child being worked up for neuroblastoma?

A

Urine HMA + Urine VMA

-assess for catecholamines

131
Q

Second to ALL, what is the most common pediatric cancer diagnosis?

A

CNS tumors

132
Q

What are the classic presenting s/s of a child with a CNS tumor?
h____ with ____ _____
and n_____ changes

A

headaches with morning vomiting
neurological changes

133
Q

CNS tumors are best diagnosed with an?

A

MRI

134
Q

Common s/s of a child presenting with an osteosarcoma or Ewings sarcoma include?

A

Pain over affected area
and an
elevated ESR

135
Q

When working up a child with osteosarcoma or Ewings sarcoma, what is the initial diagnostic test?

A

plain film x-ray

136
Q

After a plain film x-ray confirms a bone tumor, obtain both a?

A

CT and MRI

137
Q

Children with a mediastinal mass will present with
S____
h_____
d______
c_____
d_____
J____ and a
s____ face

A

SVCS
hypoxemia
dysphagia
cough
dyspnea
JVD
swollen face

138
Q

Management of a child with a mediastinal mass includes placing them in a ____ position

A

prone

139
Q

Children with a mediastinal mass are difficult to ventilate with anesthesia, if ventilation is required what vent settings are needed?

A

positive pressure vent

140
Q

What children are at greatest risk for tumor lysis syndrome?
Children with a high ___ ____ or who are ______

A

tumor burden
dehydrated

141
Q

What is the only lab that will be low in a child presenting with tumor lysis syndrome?

A

calcium

142
Q

In tumor lysis syndrome uric acid, phosphate, potassium, and LDH will be?

A

elevated

143
Q

Hyperleukocytosis is characterized by a WBC count > _____

A

100,000

144
Q

Hyperleukocytosis increases blood ______

A

viscosity

145
Q

The goal in a child with hyperleukocytosis is to _____

A

hyperhydrate

146
Q

What treatment is indicated for a child with pulmonary leukostasis?

A

dexamethasone

147
Q

Typhlitis is characterized by _____ inflammation, caused by _____ ______

A

cecum
bacterial translocation

148
Q

Typhlitis s/s include
f____
m____ and
____ ____

A

fever
mucositis
RLQ pain

149
Q

Examples of mass syndromes include ____ or _____ compression

A

abdominal or spinal compressoin

150
Q

S/S of mass syndromes include
altered ____ _______
______ and
______ syndrome

A

mental status
pain
compartment

151
Q

Mass syndrome treatment includes ______ to decrease mass effect and ____ _____

A

radiation
surgical debulking

152
Q

Should febrile neutropenic patients be catheterized for a urine sample?

A

no

153
Q

Antibiotics in a febrile neutropenic patient can be discontinued if there is no fever in ____ hours and cultures remain negative for ____ hours

A

23
48

154
Q

What type of transplant is indicated for solid tumors?

A

autologous transplant

155
Q

In autologous transplants, the patient’s cells are collected when?

A

in advance, preferably prior to chemotherapy is started

156
Q

What type of transplant is indicated for patients with bone marrow failures?

A

allogenic

157
Q

sinusoidal obstructive syndrome or VOD is characterized by _____ damage and ____ deposition

A

hepatocyte damage and
fibrin deposition

158
Q

Clinical manifestations of sinusoidal obstructive syndrome/VOD include
partial ______
hepatocyte ______
impaired ______

A

hypertension
hepatocyte necrosis
impaired coagulation

159
Q

Physical examination findings of sinusoidal obstructive syndrome/VOD include
______ overload
elevated ______
w____ _____
tender ______

A

fluid overload
elevated bilirubin
weight gain
tender hepatomegaly

160
Q

sinusoidal obstructive syndrome/VOD management includes d____ and ____ restriction

A

defibrotide
sodium restriction

161
Q

Graft failure is more common in patients who have had ____ ____ transplants

A

solid organ

162
Q

Graft vs. host disease is due to ____ __ cell activation

A

donor T-cell activation

163
Q

Graft v.s host disease occurs ____ s/p transplant

A

early

164
Q

What three body systems need to be monitored when assessing for and managing graft vs. host?

A

liver, skin, and gut

165
Q

What is the best preventative measure for graft vs. host disease?

A

immunosuppressing host before transplant

166
Q

Management for graft vs. host includes the addition of _____ at a dose of ____ mg/kg

A

corticosteroids
2mg/kg

167
Q

chronic graft v.s host presents ____ s/p transplant. Chronic graft vs. host presents with _____ features

A

later
autoimmune

168
Q

What body systems should be assessed in chronic graft vs. host?

A

skin
liver
GI
oral
occular

169
Q

In any child with a life-threatening illness, palliative care is recommended when?

A

early integration

170
Q

Palliative care is recommended for children with high ___ ___ and ____ care

A

s/s burden and complex care

171
Q

What is the cornerstone of palliative care pain management?

A

opiods

172
Q

What is recommended for children in palliative care experiencing neuro pain?

A

gabapentin

173
Q

What is recommended for children in palliative care experiencing agitation?

A

benzos or neuroleptics

174
Q

What is recommended for children in palliative care needing respiratory support?

A

oxygen

CPNP AC flash cards (10 decks)

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