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Pediatrics 2 > Hematology/Oncology > Flashcards

Hematology/Oncology Flashcards

1
Q

Which malignancy is associated with Bence-Jones proteins in 75% of patients, an M-spike and bone pain?

A

multiple myeloma

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2
Q

Which malignancy is associated with enlarged nodes 90% of the time and the unique presence of Reed-Sternberg cells?

A

Hodgkin’s lymphoma

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3
Q

Which malignancy is associated with B-symptoms and follicular and diffuse large B cell subtypes?

A

Non-Hodgkin’s lymphoma

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4
Q

Which malignancy has a 13q deletion, 90% of patients are over age 50 years old and a hallmark is the clonal expansion of cells expressing CD5+ B cells?

A

Chronic lymphocytic leukemia

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5
Q

Which malignancy has patients with the Philadelphia chromosome in 85-95% of the time?

A

Chronic Myelogenous Leukemia (Cheesesteaks Me Likey)

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6
Q

Which malignancy features > 30% peripheral blasts (5% is normal) that stain myeloperoxidase + and the median age of onset is 68 years of age?

A

Acute Myelogenous (Myeloid) Leukemia

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7
Q

What are some common findings with anemia?

A

pallor, jaundice, petechiae, and purpura

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8
Q

What will MCV look like in iron-deficiency anemia or Thalassemia?

A

Hypochromic, microcytic

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9
Q

What will MCV look like in anemia of chronic disease?

A

Normocytic, normochromic

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10
Q

What will MCV look like in Vitamin B12 or folate deficiency?

A

Macrocytic anemia

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11
Q

What should a be the ddx for fatigue?

A

anemia, CA

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12
Q

How does congenital aplastic anemia (Fanconi’s Anemia) appear in blood work?

A

First as thrombocytopenia OR neutropenia THEN progresses to pancytopenia

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13
Q

What are some physical signs of congenital aplastic anemia?

A

short stature, Cafe au lait spots, mental retardation

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14
Q

Are most anemias acquired or congenital?

A

Acquired

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15
Q

What is the ddx for congenital aplastic anemia?

A

Idiopathic thrombocytopenic purpura

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16
Q

What is the treatment for congenital aplastic anemia?

A

Bone marrow transplant

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17
Q

How does acquired aplastic anemia appear in blood work?

A

Peripheral pancytopenia with hypocellular bone marrow

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18
Q

What are the primary causes of acquired aplastic anemia?

A

50% idiopathic, some drugs, others viral (mostly hepatitis)

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19
Q

What will labs show in AAA?

A

Low reticulocyte (bone marrow isn’t producing new cells)

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20
Q

What is acquired aplastic anemia often seen to be comorbid with?

A

complications of overwhelming infection (low WBC) and severe hemorrhage (decreased platelets)

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21
Q

What is the treatment for acquired aplastic anemia?

A

Treatment of underlying cause (abx), blood transfusion, and bone marrow trans

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22
Q

What is the most common cause of anemia in children?

A

Iron deficiency anemia

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23
Q

What is the clinical presentation of iron deficiency anemia?

A

glossitis, angular stomatitis, fatigue

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24
Q

What will labs show in IDA?

A

microcytic, hypochromic RBCs, low serum iron, elevated TIBC

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25
Q

What is the treatment for IDA?

A

Fe supplement

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26
Q

What is the ddx for IDA?

A

Thalassemia in African, Mediterranean, or Asian children

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27
Q

How do you diagnose thalassemia?

A

Hemoglobin electrophoresis

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28
Q

What are the primary causes of megaloblastic anemia?

A

Vitamin B12, folic acid deficiency (or both)

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29
Q

What will labs for megaloblastic anemia show?

A

elevated MCV and MCH

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30
Q

What is the treatment for megaloblastic anemia? What treatment should be done first? Why?

A

Vitamin B12 or folate replacement therapy; Vitamin B12 should be done first to prevent irreversible peripheral neuropathy

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31
Q

What is hereditary spherocytosis?

A

inherited hemolytic anemia

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32
Q

What are findings of hereditary spherocytosis?

A

post-hepatic jaundice and splenomegaly

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33
Q

What will labs show in hereditary spherocytosis?

A

increased reticulocyte count

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34
Q

what is the treatment of hereditary spherocytosis?

A

splenectomy to prevent RBC destruction

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35
Q

What will labs show in thalassemia?

A

Microcytic (MCV of 50) but Hb is just below normal range at 10 or 11 (out of proportion to the degree of the anemia)

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36
Q

What is the treatment for beta major thalassemia?

A

Bone marrow transplant

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37
Q

What is the treatment for beta minor and alpha thalassemia?

A

Blood transfusion

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38
Q

What is the most common red cell enzyme causing anemia?

A

G6PD

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39
Q

What will labs reveal in G6PD deficiency? infants?

A

low MCP and high reticulocyte and Heinz bodies; infants will show hyperbilirubinemia

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40
Q

Where do we see the highest incidence of sickle cell disease?

A

in people of Central African decent

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41
Q

What is the clinical presentation of sickle cell disease?

A

Some jaundice, mostly PAIN due to vasoocclusion

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42
Q

What are sickle cell patients at a much higher risk for?

A

Bacterial sepsis

43
Q

What will labs of sickle cell anemia show?

A

low Hb, high reticulocyte, abnormal Hbg on electrophoresis

44
Q

What is the treatment for sickle cell anemia?

A

Supportive, blood transfusion if it becomes acute, education

45
Q

What will labs show if you suspect lead poisoning?

A

basophilic stripping on peripheral blood smear

46
Q

What is the treatment for lead poisoning?

A

Chelation therapy with edetate calcium disodium

47
Q

What is the primary cause of polycythemia?

A

secondary hypoxemic disorder

48
Q

What is the clinical presentation for polycythemia?

A

HA due to increased blood viscosity

49
Q

What is the treatment for primary polycythemia?

A

phlebotomy

50
Q

What is the secondary cause of polycythemia? How do you treat it?

A

cyanotic congenital heart dz: Transposition of the great vessels or the tetrology of Fallot; surgical correction

51
Q

What is the most common bleeding disorder in patients age 2-5?

A

Idiopathic thrombocytopenic purpura

52
Q

What is the mechanism of action of idiopathic thrombocytopenic purpura? What does it usually follow

A

immune system attacks platelets; usually follows viral infection

53
Q

What is the treatment for idiopathic thrombocytopenic purpura?

A

prednisone for bleeding

54
Q

What are two common inherited bleeding disorders?

A

Factor VIII (hemophilia A) and Factor IX (hemophilia B)

55
Q

What are three most commonly acquired bleeding disorders?

A

DIC, Vitamin K, liver dz

56
Q

What is the cause of DIC? What happens?

A

Injury or hypoxia; causes microthrombi and a decrease in platelets as well as hemorrhaging

57
Q

What are labs like in DIC?

A

increased PT, aPTT, FDP, d-dimer, decreased platelets

58
Q

What will liver disease result in?

A

decreased clotting factors

59
Q

What will labs look like in vitamin k deficiency?

A

decreased platelet count, increased bleeding time, increased INR/PT (VII-warfarin), increased aPTT (VIII-heparin)

60
Q

What are three commonly inherited thrombotic disorders? FHX of clotting

A

Factor 5 leiden, antithrombin III, and Protein C and S

61
Q

What is the CP of thrombotic disorders?

A

DVTs of lower extremities

62
Q

What is the most common form of small vessel vasculitis in children ages 2-7? When do most cases occur?

A

Henoch-Schonlein purpura; 66% occurs following a URI

63
Q

What is the most common malignancy of childhood?

A

Acute lymphoblastic leukemia

64
Q

What is the CP of acute lymphoblastic leukemia?

A

intermittent fever, pelvic, vertebrae, and leg bone pain

65
Q

What is are PE findings on someone with ALL?

A

hepatomegaly or splenomegaly, +/- lymphadenopathy

66
Q

What do labs show in patient with ALL? Bone marrow?

A

WBC > 200,000, increased lactate dehydrogenase, bone marrow is shown with leukemic blasts

67
Q

What is the treatment for ALL?

A

chemo, anticipate tumor lysis syndrome

68
Q

What is tumor lysis syndrome?

A

Hyperkalemia, hyperuricemia, hypocalcemia, renal failure

69
Q

What disorder has most diagnoses over age 60 but is still seen in children?

A

acute myeloid leukemia

70
Q

What disease should you suspect if you see a cytogenic clonal abnormalitiy?

A

Acute myeloid leukemia

71
Q

What will labs show in acute myeloid leukemia?

A

low Hb, low platelet, low neutrophils (leukocytosis in 25%)

72
Q

What dangerous condition a/w acute myeloid leukemia can become more of a medical emergency than ALL?

A

leukocytosis

73
Q

What is the treatment for acute myeloid leukemia?

A

chemo

74
Q

Only 5% of leukemias are this, seen with what finding?

A

Chronic Myelogenous Leukemia; Philadelphia chromosome

75
Q

How do you treat chronic myelogenous leukemia?

A

interferon alpha or bone marrow transplant

76
Q

What is the most common solid tumor of childhood?

A

brain tumor

77
Q

What is the CP of brain tumor? What will older children report?

A

vomiting, lethargy, irritable, gait, head asymmetry; older children report HA and visual changes

78
Q

How do you dx a brain tumor?

A

MRI

79
Q

an astrocytoma ependymoma is what type of brain tumor?

A

Glial

80
Q

a meulloblastoma is what type of brain tumor?

A

Nonglial

81
Q

How do you treat a brain tumor?

A

surgery, radiation, and chemo

82
Q

What is the CP of Hodgkins dz?

A

anorexia, wt loss, fever, fatigue, night sweats (B cell symptoms), painless cervical/supraclavicular lymph nodes

83
Q

How do you dx Hodgkins lymphoma?

A

CXR, CT, bone marrow bx, look for REED-STERNBERG cells (owl eyes)

84
Q

What disease do you see Reed-Sternberg cells in (owl eyes)?

A

Hodkins Lymphoma

85
Q

As far as response to chemo goes, Hodgkins lymphoma has a better prognosis in

A

kids

86
Q

As far as response to chemo goes, Non-Hodgkins lymphoma has a better prognosis in

A

adults (rapidly proliferating, high-grade, diffuse malignancies in kids)

87
Q

What is the CP of Non-Hodgkin in kids?

A

cough, dyspnea, orthopnea, lymphadenopathy, abd pain, vomiting, fevers

88
Q

How do you dx Non hodgkin?

A

Biopsy

89
Q

How do you treat Non Hodgkin lymphoma?

A

chemo

90
Q

What cancer invades the sympathetic nervous system? 90% are diagnosed before 5 y.o.

A

neuroblastoma

91
Q

What is the CP of neuroblastoma?

A

fever, weight loss, ABDOMINAL MASS

92
Q

What is needed for staging of a neuroblastoma?

A

bone scan and skeletal survey

93
Q

What is the treatment for neuroblastoma?

A

Chemo, radiation, surgery

94
Q

What is the CP of nephroblastoma (Wilms Tumor)? What is the tx?

A

asymptomatic ABD mass, hematuria, HTN; surgical exploration of abd and chemo

95
Q

What is the prognosis for a patient with osteosarcoma?

A

Poor

96
Q

When is the peak incidence for osteosarcoma? Treatment?

A

adolescent growth spurt, found in long bones; surgery (70% metastasize to lungs w/o chemo) PLUS chemo

97
Q

Ewing sarcoma is cancer of what areas?

A

Long bone and soft tissue

98
Q

What is the CC of Ewing Sarcoma?

A

NIGHTTIME BONE PAIN in white males

99
Q

How do you dx Ewing Sarcoma?

A

CT, MRI

100
Q

How do you tx Ewing Sarcoma?

A

chemo, surgery

101
Q

90% of diagnoses are made in kids under age 5 in what 2 diseases?

A

neuoblastoma and retinoblastoma

102
Q

What is known as purely a “soft tissue tumor”? It is also the most common soft tissue tumor in childhood

A

Rhabdomyosarcoma (70% dx before age 10)

103
Q

Where does rhabdomyosarcoma usually affect?

A

the head and neck

104
Q

Upon palpation of the abdomen, you find a tumor that is malignant 57% of the time. What test are you going to run? How will you treat it?

A

AFP; surgery and chemo

Pediatrics 2 (3 decks)

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