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EOR - Pediatrics > Hematology > Flashcards

Hematology Flashcards

1
Q

microcytic anemias (4)

A

IDA
sideroblastic
thalassemias
anemia of chronic dz
lead poisoning

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2
Q

normocytic anemias are divided into (2)

A

hemolytic
non hemolytic

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3
Q

intrinsic hemolytic anemias (5)

A

hereditary spherocytosis
g6pd
puruvate kinase deficiency
ssa
hbc dz

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4
Q

extrinsic hemolytic anemia

A

autoimmune hemolytic anemia

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5
Q

macrocytic anemias are divided in to

A

megaloblastic
non megaloblastic

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6
Q

megaloblastic macrocytic anemias (4)

A

folate deficiency
b12 deficiency
copper deficiency
drugs

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7
Q

non megaloblastic macrocytic anemias

A

etoh
liver dz

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8
Q

work up for microcytic anemia (3)

A

ferritin
iron
TIBC

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9
Q

work up for normocytic anemias (3)

A

coombs
iron
bilirubin

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10
Q

work up for macrocytic anemias (2)

A

RBC folate
B12

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11
Q

only anemia with elevated TIBC

A

IDA

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12
Q

what does “basophilic stippling” make you think of

A

lead poisoning

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13
Q

4 infxns associated w. anemia

A
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14
Q

4 infxns associated w. extrinsic hemolysis

A

osteolmyelitis
HIV
mycoplasma
EBV

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15
Q

type of anemia associated w. bone marrow malignancy

A

normocytic

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16
Q

lab findings associated w. intrinsic hemolytic anemia (4)

A

increased reticulocytes
positive coombs
spherocytosis
decreased haptoglobin

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17
Q

labs associated w. extrinsic hemolytic anemias (3)

A

cold agglutinins
increased: LDH, K+, bilirubin
decreased haptoglobin

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18
Q

what does spherocytosis make you think of

A

g6pd deficiency

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19
Q

3 causes of extrinsic hemolysis

A

cold agglutinins
autoimmune
mechanical destruction

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20
Q

3 causes of mechanical destruction extrinsic hemolytic anemia (microangiopathic hemolysis)

A

TTP
HUS
DIC

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21
Q

hemostatic problems are divided into (2)

A

primary
seconday

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22
Q

describe primary hemostatic problems

A

weak platelet plug -> mucocutaneous bleeding

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23
Q

describe secondary hemostatic problems

A

problems w. coagulation factors -> deep tissue bleeding

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24
Q

sx of primary hemostatic problems (4)

A

-petechiae
-anterior epistaxis
-immediate post op bleeding (ex tooth extraction)
-mucosal, gingival, GI, vaginal bleeding

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25
Q

sx of secondary hemostasis (5)

A

-large bruises
-deep tissue hematomas
-hemarthrosis
-posterior epistaxis
-persistant bleedig post op (ex ICH)

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26
Q

problems w. hemostasis are caused by decreased (3)

A

PLT number
PLT fxn
clotting factors

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27
Q

primary hemostasis disorders (5)

A

von willebrand
bernard-soulier
glanzmann thrombasthenia
uremic PLT dysfxn (CKD)
meds: NSAIDs, clopidogrel

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28
Q

secondary hemostasis disorders (5)

A

anticoagulant use
hemophilia
cirrhosis
vit K deficiency
DIC

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29
Q

labs associated w. primary hemostatic problems

A

prolonged PT
prolonged PTT

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30
Q

_ is elevated in bleeding from warfarin
_ is elevated in bleeding from heparin

A

warfarin: PT
heparin: PTT

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31
Q

what factors are decreased in von willebrand dz

A

von willebrand
VIII

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32
Q

hemophilia is classified in to

A

A: VII
B: IX (christmas)

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33
Q

lab findings associated w. hemophilia

A

prolonged aPTT
normal PTT
normal PLT

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34
Q

three presentations of hemophilia in peds

A

-excessive bleeding from circumcision
-cephalohematoma during delivery
-hemearthrosis when walking starts

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35
Q

3 conditions where you see prolonged PT and PTT

A

liver cirrhosis
vitamin K deficiency
DIC

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36
Q

lab findings of DIC

A

everything out of whack:

-elevated PT, PTT
-decreased PLT
-(+) schistocytes
-smear: microangiopathic hemolytic anemia

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37
Q

pediatric brain tumors to know mc -> lc (4)

A

astrocytoma
medulloblastoma
ependymoma
retinoblastoma

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38
Q

5 yo w. occipital HA, ataxic gait, nystagmus, papilledema

A

astrocytoma

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39
Q

mc primary childhood CNS tumor

A

astrocytoma

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40
Q

sx of brain tumors are mc related to

A

increased ICP:
morning HA
vomiting
lethargy

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41
Q

t/f astrocytomas are often benign

A

t!

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42
Q

sx of astrocytoma based on location

A

cerebellum: weakness, tremor, ataxia
visual pathway: vision loss, proptosis, nystagmus
spinal cord: pain, weakness, gait disturbance

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43
Q

dx for brain tumors

A

MRI
bx

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44
Q

which type of astrocytoma has the best prognosis

A

posterior fossa

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45
Q

5 yo w. 1 month of AM HA, nausea, vomiting, mild f/c - PE shows wide based gait, impaired heel to toe walking, bilat papilledema

A

medulloblastoma

46
Q

MRI findings of medulloblastoma

A

heterogenous midline lesion w. hydrocephalus

47
Q

mc malignant posterior fossa tumor in peds

A

posterior fossa tumor

48
Q

4 mc sx of medulloblastoma

A

n.v
HA
visual changes
unsteady walking/clumsy

49
Q

pediatric brain tumor that is sometimes associated w. sz, balance/gait disturbance, or sx of spinal cord compression

A

ependymoma

50
Q

tx for ependymoma

A

surgery
+/- chemo

51
Q

3 yo w. strabismus - in pics, one eye is white, other is red

A

retinoblastoma

52
Q

mc age for retinoblastoma

A

< 3 yo

53
Q

medical term for absent red reflex

A

leukocoria

54
Q

tx for retinoblastoma

A

surgical enucleation of the eye
chemo

55
Q

hemophilia is _ linked

A

X, recessive

56
Q

presentation of hemophilia (both types)

A

bleeding
bruising
hemarthrosis

57
Q

grading of hemophilia

A

mild (5-25% nl): bleeding after surgery/dental extractions/injury, usually non fatal
moderate (1-5% of nl): little unprovoked bleeding, bleeding after surgery/injury may be fatal
severe (< 1% nl): unprovoked bleeding,

58
Q

when is severe hemophilia often diagnosed

A

bleeding immediately after delivery -> ex cephalohematoma

59
Q

mod/severe hemophilia is commonly diagnosed at what age

A

< 18 mo

60
Q

lab findings of hemophilia

A

increased: PTT
normal: PT, bleeding time
decreased: factor VIII vs IX

61
Q

hallmark lab findings of hemophilia (2)

A

increased PTT
normal PLT

62
Q

most specific test for hemophilia

A

functional assay for factor VIII vs IX

63
Q

tx for hemophilia

A

replace deficient factor

64
Q

4 yo M presents w. abd pain, constipation x 2 days - has also been lethargic, irritable x 2 weeks and has stopped talking - PMH includes failing to meet developmental milestones x 1 year

A

lead poisoning

65
Q

mc environmental illness of children in the US

A

lead poisoning

66
Q

most significant source of lead for peds

A

environmental: lead-based paint, food, water, soil

67
Q

big HPI clue for lead poisoning

A

old house w. paint chips

68
Q

sx of lead poisoning (lots!)

A

anemia
behavior changes
temperamental lability
irritability
hyper/hypoactivity
developmental delays
abd pain
vomiting
constipation
lethargy
HA
ataxia
sz

69
Q

what blood level of lead is considered positive

A

> /= 10

70
Q

lab findings of lead poisoning

A

-basophilic stippling
-low vs nl MCV
-low MCH
-hemolysis: elevated indirect bili, LDH; low haptoglobin

71
Q

tx for lead poisoning

A

> 45: chelation
80: hospitalization
-diet

72
Q

when do you have to contact health department w. lead poisoning (2)

A

> 20
elevation > 3 mos

73
Q

3 chelation meds used in lead poisoning

A

dimercaprol
CaNaEDTA
pencill

74
Q

pediatric leukemias to know (2)

A

ALL
AML

75
Q

mc childhood malignancy

A

leukemia

76
Q

2 mc childhood leukemia

A

ALL
AML

77
Q

child + LAD + bone pain + bleeding + fever

A

ALL

78
Q

hallmark finding of ALL (2)

A

20% blasts in bone marrow
ANC < 1,000

79
Q

mc childood malignancy

A

ALL

80
Q

tx for ALL

A

chemo

81
Q

t/f: AML is much more common in males

A

t!

82
Q

pt’s w. AML may develop a greenish soft tissue tumor called a _

which is located in the _ (2)

A

chloroma
spinal cord, skin

83
Q

hallmark finding of AML

A

auer rods on smear

+/- blast cells

84
Q

sx of AML (5)

A

pallor
ecchymoses
petechiae
fever
bone pain

85
Q

_ are present at dx w. 90% of AML cases (2)

A

-anemia (normochromic, normocytic)
-thrombocytopenia

low reticulocytes also common

86
Q

tx for ALL vs AML

A

ALL: chemo
AML: combo chemo/bone marrow transplant

87
Q

lethal s.e of chemo

A

tumor lysis syndrome

88
Q

tx for tumor lysis syndrome

A

allopurinol

89
Q

pediatric lymphomas to know (2)

A

hodgkin
non-hodgkin

90
Q

hodgkin lymphoma is derived from _ cells in lymph nodes

A

B

91
Q

LAD associated w. hodgkin lymphoma

A

painless LAD: cervical vs supraclavicular vs upper body

92
Q

what are B symptoms associated w. lymphoma (3)

A

wt loss > 10%
T > 38
night sweats

93
Q

hodgkin lymphoma is assocated w. what virus

A

EBV

94
Q

t/f: hodgkin lymphoma rarely has extranodal spread

A

t!

95
Q

2 types of hodgkin lymphoma

A

classical
nodular

96
Q

4 types of classical hodgkin lymphoma

A

nodular sclerosis
mixed cellularity
lymphocyte-rich
lymphocyte depleted

97
Q

if you suspect hodgkin lymphoma, order a _

A

CXR -> look for mediastinal LAD

98
Q

hallmark finding of hodgkin lymphoma

A

reed-sternberg cells: B cells fused together to form “owl eye”

99
Q

tx for hodgkin lymphoma

A

chemo/xrt: highly effective

100
Q

non hodgkin lymphoma is derived from _ cells (2)

A

B
T

101
Q

sx of non hodgkin lymphoma (5)

A

constitutional
painless LAD
bowel obstruction
fatigue/bruising/infxns
loss of sensation

102
Q

2 types of non hodgkin lymphoma

A

B cell
T cell

103
Q

types of non hodgkins B cell lymphoma

A

diffuse large B cell -> mc/aggressive
follicular
burkitt
mantle cell
marginal zone
nodal marginal
splenic marginal
lymphoplasmacytic

104
Q

starry sky appearance

A

burkitt lymphoma

105
Q

2 types of non hodgkin T cell lymphoma

A

adult t-cell -> leukemia
mycosis fungoides -> skin

106
Q

typical presentation of T cell hodgkin lymphoma (3)

A

immunocompromised
painless peripheral LAD
extranodal spread (skin/GI/brain)

107
Q

t/f: non hodgkin lymphoma has a worse prognosis than hodgkin

A

t!

108
Q

neutropenia definition

A

ANC < 1,000

109
Q

earliest sign of neutropenia

A

fever

110
Q

tx for neutropenia

A

outpt/low risk: cipro PLUS augmentin, +/- moxifloxacin
monotherapy/pseudomonas: cefepime vs imipenem vs augmentin
dual therapy/unstable: monotherapy + vanc vs flagyl

EOR - Pediatrics (15 decks)

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