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Pediatrics Exam 5 > Hem/Onc > Flashcards

Hem/Onc Flashcards

1
Q

Normal pediatrics CBC levels vary based on ____ and _____

A

Age
Gender

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2
Q

Hgb starts ___ at birth, and _____ ending at about _____ by 18 years.

A

High (16.5)
Downtrends
14-15

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3
Q

Reticulocytosis can elevate and MCV. If you have an elevated MCV without a high retic - could indicate a primary bone marrow disorder.

A
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4
Q

thalassemias have a ____ RDW which means the RBCs are standard size.

A

Normal

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5
Q

IDA will have a _____ RDW. Why?

A

High.
Much variation in the sizes of the cells, because there’s not a dependable source of iron for their creation.

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6
Q

What are reticulocytes?

A

Youngest RBCs in circulation.

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7
Q

If you have anemia with HIGH reticulocyte count, then the bone marrow response is ______
Anemia with low retic - ____ bone marrow response/

A

Good
Poor

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8
Q

What could cause a poor bone marrow response (low reticulocyte count)?

A

Marrow aphasia
Infiltration with malignant cells
Depression from infection
Nutritional deficiency

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9
Q

What is the most reliable morphology indicator of the classification of anemia?
Most reliable physiologic indicator?

A

MCV (big, small or normal)
Reticulocyte count - what is the source of the anemia?

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10
Q

Decreased RBC production would have a ____ retic
Increased blood loss (hemorrhage) or increased destruction (hemolytic anemia) would have a ____ retic

A

Low
High

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11
Q

4 labs to draw in a basic anemia workup (and 1 secondary test)

A

CBC w/ Diff with smear
Reticulocyte count
Total/direct bili (asses for hemolysis)
DAT (assess for autoimmune hemolysis)

Secondary: iron panel.

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12
Q

If you have a negative DAT, it could indicate a physiologic process (SCD, G6PD). If you have a positive DAT, it could indicate ______

A

Hemolysis related to autoimmune/immune mediated.

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13
Q

Differentials for macrocytic anemia

A

Folic acid or B12 deficiency
Malabsorption
Surgical resection (of bowel)
Primary bone marrow disease

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14
Q

Differential for normocytic anemia

A

Aplastic anemia (anemia secondary to bone marrow infiltration)
Anemia secondary to Hypothyroidism, renal disease or chronic illness
Transient erythroblastopenia of childhood (TEC)

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15
Q

Differential microcytic anemia

A

IDA, thalassemias, sideroblastic anemia (mitochondrial disorder or lead/isoniazid Tox)
Anemia of chronic disease
Hgb E

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16
Q

how will the CBC differ between IDA and thalassemia?

A

IDA has an increased RDW and a low reticulocyte count
Thalassemia has a low RDW and normal reticulocyte

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17
Q

Why might you not want to measure ferritin during an acute illness?

A

It’s an acute phase reactor, so it will be falsely high.

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18
Q

What is the overall best screen for total body iron on the iron panel?

A

Ferritin - fluctuates the least over time.

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19
Q

MVC in kids should be _____ + age.

A

70

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20
Q

How do you prescribe iron?
Dose?

A

With vit C - either OJ or gummies.
NOT with milk - this will prevent absorption.
4-6mg/kg
You absorb about 3mg/kg so if you’re on the upper end of 6, split BID doseing.

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21
Q

Thalassemia is a ______ hbg disorder and SCD is a ______ Hgb disorder.

A

Quantitative
Qualitative.

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22
Q

Beta thalassemia is most prevalent in ______ and alpha is most in _____

A

Mediterranean
Southeast Asian

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23
Q

When do children with major thalassemias start to show s/s?

A

6-12mo when cross over in Hgb happens.

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24
Q

High reticulocyte count in G6PD

A
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25
Q

Class III is the most common class of G6PD

A
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26
Q

Meds than can trigger hemolysis in G6PD

A

Aspirin in high doses, Macrobid, Antimalarial, primaquine, nitrate, sulfonamides, quinine.

27
Q

ITP most often happens ______

A

After a viral infection

28
Q

If patient with ITP has platelet count <10, need treatment. Treatment?

A

IVIG, Oral prednisone, IV anti-D (WinRho)

29
Q

Abnormal aPTT

A

Factor VIII (vWD)
IX, XI, heparin

30
Q

Abnormal PT

A

Factor VII
Coumadin
Occ liver disease
Occ DIC rVIIa effect

31
Q

Abnormal PT and aPTT

A

Common pathway factors (II, V, X)
Fibrinogen
Liver disease
vit K deficient
Coumadin
DIC

32
Q

Doing a mixing study. if an inhibitor is present (such as lupus anticoagulant), then the result after the mix will be the same (long) as it was before the mix.
If a factor deficiency is present, then the result will be normal after the mix.

A
33
Q

How are Ehler-Danilo’s and clotting related?

A

ED is a lack of collagen. Exposed collagen is what starts the clotting cascade. If it’s not there, then there might not be a clot.

34
Q

Hemophilia A is factor ____ deficiency
Hemophilia B is _____ deficiency

A

VIII eight (Ay -> Ayte)
IX nine

35
Q

VWD has a ______ bleeding pattern whereas hemophilias tend to have a _____ bleeding pattern.

A

Mucosal (nose, oral, gums, easy bruising)
Soft tissue (welts large hematomas))

36
Q

Most common type of vWD - type 1 - a quantitative deficiency of vWF.

A
37
Q

SCD - clinically presents with anemia (normochromic, normocytic), high retic, high neutrophilia, high throbocytosis.

A
38
Q

Children with SCD get prophylactic _____ until age ____ and only after they’ve had all vaccines and have not had any significant infections.

A

Penicillin
5

39
Q

Other meds for SCD?

A

Folic acid supplementation
Hydroxyurea (start at 9mo)

40
Q

What should the PCM do with a SCD (newborn screen)?

A

Start penicillin therapy (VK 125mg bid) and refer to heme.

41
Q

SCDpateints get a CXR every other year, a EKG/Echo every 1-2 years, PFTs every 1-2 years, eye exams every 1-2 years and an MRI/MRA and RUQUS prn

A
42
Q

Patients with sickle cell trait are more at risk for:

30 fold increase in risk of sudden death in black army recruits with SCT.

A

Heat stroke, heat exhaustion and rhabdo.
VTE
Renal medullary carcinoma
ESRD
Hematuria
Impaired urinary concentration.

43
Q

Parents of a child with SCD or sickle cell trait are concerned that their child is going to the bathroom more than their peers. This is?

A

Normal. They don’t have as much ability to concentrate urine so they go more frequently.

44
Q

Most common cancer in children <15 is leukemia (ALL)

A
45
Q

Compared with adults, child cancer treatment often lacks _____

A

Radiation. Chemo alone is more common.

46
Q

Neutropenic precautions are initiated for ANC <1000. <500 is an automatic ______

A

Admission with broad spectrum IV abx (Ceftriaxone).

47
Q

What are the most common infectious pathogens in neutropenic cancer patients?

A

Those that come from elsewhere on the child’s body:
Staph epideritis and aureus (MRSA), E. coli, enterococcus, Psuedomonas , fungus (aspergillosis, candida)

48
Q

Varicella, PJP, HSV can be serious in immunocompromised kids.

A
49
Q

Administration of neurogenic or neulasta for neutropenia _______ duration but does not _____

A

Shortens duration
Eliminate it.

50
Q

At what point with weight loss would you get a nutritionist involved? How about appetite stimulant?
TPN is last resort.

A

> 5% = nutritionist, increase calories, PO supplements, antiemetics
10% = appetite stimulants, supplemental feeds (NG or Gtube).

51
Q

Enlarged ______ and ______ are always abnormal.

A

Epitrochlear and supraclavicular

52
Q

Warning signs with enlarged lymph nodes:

A

Firm,/hard,rubbery, non mobile ,non tender.

53
Q

Mediastinal masses could present with the following s/s:

A

Cough, dyspnea, orthopnea, strior, SVC syndrome (SOB on lying down)

54
Q

Concerning symptoms in pediatric headaches:

A

AM headache wakes them from sleep
Incapacitating, vomiting, changing pattern of HA
Abnormal Neuro exam
Vision loss/change
Head tilt
Ataxia (gait/coordination abnormality)
<3yo.
Think brain tumor.

55
Q

At what point is the WBC high enough that it’s almost always leukemia?

A

> 100,000

56
Q

What is the pathophys of tumor lysis syndrome and what 3 electrolyte abnormalities will result?

A

When the malignant cells of the tumor are lysed with chemo/radiation, their intracellular contents spill out:
Hyperuricemia -> renal failure
Hyperkalemia -> arrhythmias
Hyperphosphatemia -> hypocalcemia

57
Q

Tx for ALL leukemia
AML leukemia

A

Chemo
Chemo and stem cell transplant

58
Q

If ALL is diagnosed between age 1 and 10 with WBC < 50,000, then prognosis is better.

A
59
Q

Back pain in a child - never normal! Do not miss. Could be a sign of cancer. Get MRI.

A
60
Q

How does a Wilms tumor usually present?

A

Asymptomatic abdominal mass in flank in well appearing child.

61
Q

Biggest difference in presentation between wilms tumor and Neuroblastoma tumor?

A

Wilms - asymptomatic, healthy happy kid
Nueroblastoma? Sick kid.

62
Q

Most common presentation of rhabdomyosarcoma?

A

(Soft tissue malignancy that can involve ANY skeletal muscle including eye muscles)
Painless, enlarging mass, symptoms related to mass, head, neck, orbit, extremities, GU, trunk.

63
Q

Osteosarcoma is resistant to radiation. Distal has better prognosis as well as stage.

A

Pediatrics Exam 5 (2 decks)

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