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CPNP EXAM PREP > HEME/ONC > Flashcards

HEME/ONC Flashcards

1
Q

Mother’s is blood type O And baby is a, B, or AB

A

ABO incompatibility Is the incompatibility between the ABO blood group of the fetus and the mother

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2
Q

Symptoms of ABO incompatibility

A

Mild cases asymptomatic
Can have jaundice of the skin, sclera, gums or mouth

Janice usually occurring within the first 24 hours a wife up to one week; may have Hepatosplenomegaly

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3
Q

Diagnostic test for ABO incompatibility

A

Coombes test this is a direct anti-globulin test or DAT
-Positive and 13% of cases

Hemoglobin moderately low
Elevated indirect Bili level
Presence of antibodies an infant and maternal serum

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4
Q

Management of ABO incompatibility

A

Monitor indirect bilirubin levels
Phototherapy if indicated
If anemia severe may require exchange transfusion

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5
Q

Mother’s is RH negative and baby is Rh positive

A

Rh incompatibility the incompatibility between Rh boy group of the mother in the fetus

Relatively uncommon; becomes more severe with each pregnancy if untreated

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6
Q

Causes hemolysis, resulting in anemia and high bilirubinemia; severe cases causes fetal death, jaundice, hepatosplenomegaly

A

Signs and symptoms of RH incompatibility

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7
Q

Diagnostic test for RH Incompatibility

A

Blood type Mom RH negative, baby Rh positive

direct Coombes test—-positive

Hemoglobin low, hemodialysis often continues up to three months

Serum indirect BiliRubin —-Elevated

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8
Q

When should administration of Rh immunoglobulin be given?

A

After any invasive procedure during pregnancy, after termination of each pregnancy (including miscarriage/or abortion)

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9
Q

When is an RH Isoimmunization screen performed?

A

First prenatal visit

If mom is RH negative, test father; if father is Rh positive, pregnancy is at risk

Risk for problems increase with each pregnancy as antibody levels rise

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10
Q

Treatment for Rh incompatibility

A

Anti-natal treatment once diagnosis has been established, transfusion a fetus with Rh negative blood

Postpartum treatment

Photo therapy with exchange transfusion if needed
Transfusion of PRBC‘s if indicated by hemoglobin
Studies show efficacy of gamma globulin but no recommendation at this time

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11
Q

Microcytic, normocytic, macrocytic so what type of RBC indices ? And what are their values?

A

Mean corpuscular volume MCV “CYTIC”

Determine size of the RBC

Microcytic: ~<80
Normocytic:~ 80 to 100
Macrocytic: ~100

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12
Q

Determine the size of the RBC

A

Mean corpuscular volume

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13
Q

Determines color of the RBC

A

Mean corpuscular hemoglobin concentration MCHC

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14
Q

Determines weight of the RBC

A

MCH

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15
Q

What is the normal MCH of an RBC ? What does MCH measure?

A

Measures weight

Normal 26 to 34

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16
Q

Hypochromic

A

Less than 32

MCHC color

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17
Q

Normochromic

A

32 to 36 MCHC color

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18
Q

RDW Is helpful how

A

Red cell distribution with

Differentiates between IDA, thalassemia, ACD

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19
Q

RDW in IDA is _____.

A

Increased

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20
Q

RDW in ACD is ____.

A

Normal

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21
Q

RDW and thalassemia is _____.

A

Normal or slightly increased

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22
Q

What is the reticulocyte count

A

Number of new, young RBCs in circulation

Index of bone marrow health in response to anemia
Bone marrow failure send new baby RBCs increases retic count

Increase in hemorrhage or hemo- lysis

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23
Q

Normal reticulocyte count is ____ to ___%.

A

1 to 2%

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24
Q

Microcytic/hypochromic anemia’s are?

A

IDA, thalassemia, PB poisoning

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25
Q

Normocytic/normochromic anemia‘s include

A

ACD, acute blood loss, early IDA

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26
Q

Microcytic, hypo chromatic anemia due to an overall deficiency of iron

A

Iron deficiency anemia IDA

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27
Q

Anemia caused by decreased iron intake, increase needs, or slow gastrointestinal blood loss

A

Iron deficiency anemia

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28
Q

In infancy a micro hemorrhage from the gut due to an early Intake of whole milk before the age of nine months can cause what

A

Iron deficiency anemia

Because does not have the proteins a breakdown cows milk

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29
Q

In toddlers iron deficiency is often due to what

A

Increase reliance on whole milk at the expense of solid foods

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30
Q

And adolescents Iron deficiency is due to what?

A

Diet practice is contributing to an adequate intake of iron, specially in girls after monarchy

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31
Q

Easily fatigued, palpitations, lethargy, headaches, pica, delayed motor development, pale dry skin, brittle hair, tachypnea, tachycardia, flat brittle or spoon shaped nails

A

IDA symptoms

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32
Q

In IDA hemoglobin and hematocrit are_____. MCV is ____. MCHC is ____.
RDW is _____. RBCs are _____.
Serum ferritin is _____ ug/L, because it is the iron tagged for storage.

A

In IDA hemoglobin and hematocrit are low.

MCV is low, size of RBCs.

MCHC color of RBCs is low.

RBCs are low.

Increased red cell width >17.

Increased total arm binding capacity (TIPC) I can take all the iron you can give me.

Low serum ferritin <30 , iron that is tag for storage, FIRST VALUE TO FALL

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33
Q

What increases the absorption of iron

A

Orange juice

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34
Q

How long do RBCs live

A

120 days (three months)

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35
Q

Management of iron deficiency anemia

A

Maintain breast-feeding for the six months use supplemental iron drops or iron fortified cereal by 4 to 5 months

Use iron fortified formula until one year if NOT BF

Elemental iron 3 to 6 mg/KG/day in 1 to 3 doses until hemoglobin normalizes
Then,
Replace iron stores: 2 to 3 mg/kg/day x 4 months Time until RBCs can replace stores

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36
Q

What is the relationship of iron and hemoglobin

A

Hemoglobin binds to 4 02— transporter to all the tissues in the body
Iron binds to O2 helps carry oxygen to the tissues

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37
Q

Autosomal recessive genetic disorder the second most common microcytic anemia

A

Thalassemia

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38
Q

Group of hereditary disorders characterized by abnormal synthesis of alpha and beta genes globulin chains

A

Thalassemia
Alpha 4 genes and beta 2 genes

One or more of each gene can be missing; type is determined by which ones are missing alpha versus beta; severity depends on Number of genes affected

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39
Q 
Pale or bronze color to skin, tachycardia, tachypnea, Weakness,Hepatosplenomegaly
Characteristic faces (expose your frontal teeth, frontal bossing)
A

Symptoms of thalassemia

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40
Q

Thalassemia diagnostics

A

CBC shows low hemoglobin/low MCV/hypochromic RBCs/increased reticulocyte count
Increased total Bilirubin
Increase ferritin

Refer to hematologist

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41
Q

At what age do children be screened for anemia

A

Nine and 12 months, additionally if a child is at risk

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42
Q

Awesome recessive genetic disorder characterized by hemoglobin S variant

A

Sickle cell disease
Hemoglobin S and a single base pair of the beta globular gene; resulting in distorting RBCs into classic crescent shape when deoxygenated

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43
Q

Sickle cell pain crisis symptoms

A

Vasoinclusive acute event
Most often bones but can occur in any part of the body; children less than two years usually in hands or feet dactylitis

Swelling sometimes seen outside of pain, low-grade fever

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44
Q

Symptoms of sickle cell infection

A

Fever, malaise, anorexia, poor feeding

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45
Q

Symptoms of sickle cell splenic sequestration

A

Weakness, irritability, unusual sleepiness, Pilnäs, in large spleen, fast heart rate, pain in left side of abdomen

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46
Q

A plastic crisis is associated with what

A

Parvovirus B 19

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47
Q

Prenatal diagnosis of sickle cell disease

A

DNA through chorionic villus sampling
9-11 weeks
Or amniocentesis 11-17 weeks

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48
Q

Diagnostics for sickle cell

A

Hemoglobin electrophoresis and hematologist results, evidence of splenic sequestration (hemoglobin low, platelets low);A plastic crisis (hemoglobin below baseline, reticulocyte count <1.0%)

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49
Q

Management of sickle cell disease, should be directed towards_____\of complications again preventing ____.

A

Management focuses on prevention of complications in crisis precipitating factors:
administering all immunizations, additional pneumococcal vaccine every 5 to 10 years,

Prophylactic penicillin from 2 months to 5years of age

Increased risk for infection with encapsulated bacteria due to functional asplenia, therefore any fever greater than 101.5°F needs eval!!! Blood culture, broad abx

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50
Q

Cumulation of toxic amounts of lead blood in the body

A

Lead poisoning; a whole blood lead level (BLL) >5ug/Dallas

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51
Q

Sources of lead exposure

A

Lead based paint an older homes built prior to 1978 and those especially built before 1950

Lead contaminated soil and dust from automobile emission of gasoline
Lead contaminated drinking water related to pipes

Lead-based paint on important items like toys, certain folk remedies(Asian/Hispanic) cosmetics and other items

52
Q

Children between what ages are at highest risk for lead poisoning

A

One to three years

53
Q

Symptoms of lead poisoning

A

Low exposure may be asymptomatic

Mild—— gastroenteritis (anorexia, N/V), constipation, diarrhea, abdominal pain, sleep disturbance, metallic taste in mouse, limp pain, headache

Severe—-lethargy, difficulty walking, cognitive impairment, personality change

90% children will have pica
Bradycardia, papilledema, ataxia, neuropathy

54
Q

Burtonian lines

A

Blueish discoloration of the gingival border scene in lead poisoning

55
Q

Screening for lead poisoning is done when

A

Those deemed at risk living homes built before 1978; universal screening for Medicaid
Poor
Living in innner city

56
Q

A lead level of____ is considered lead poisoning

A

> 5 ug/dL ; <5 is not blood poisoning per CDC

57
Q

Lead level of ____ is a medical emergency

A

> 70 ug/dL
CLASS 5!

Hospitalization

58
Q

Lead level of _____will require Chelation therapy

A

> 45 ug/dL-69

Class 4

Requires chelation therapy

59
Q

Lead level class

A 
class I: <10 —— f/u 6 months-1 year
Class IIA: 10-14 —— f/u 3 month
Class IIB: 15-19 ——f/u 2 month
Class III: 20-44 —— f/u 1 month 
Class IV: >45
Class V: >70
60
Q

X-linked recessive bleeding disorder

A

Hemophilia A

Pleading disorder caused by congenital deficiency or absence of the Connie factor V I I I or IX

61
Q

How does hemophilia affect males versus females

A

Only females are carriers; occurs in 1:7000 males
Male disorder

FEMALE CARRIER:
25% risk of having an infected son with each pregnancy

25% risk of having a carrier daughter

25% chance of having a non-carrier daughter or healthy son

62
Q

Signs and symptoms of hemophilia

A

Easy bruising injection sites
Prolonged bleeding following circumcision
Mucosal bleeding
Prolonged bleeding in any part of the body
Bleeding in joint spaces
Swelling
Pain in joints

63
Q

Diagnostics for hemophilia

A

Prenatal diagnosis can be done by Fetal blood sampling through the Periumbilical blood PUBS
@18-20 weeks gestation
Via fetoscopy; chorionic villus sample 9-11 weeks; amniocentesis 11-17weeks

Direct assay of plasma factor activity level for hemophilia a and B

Screening includes :

  1. activated partial thromboplastin time (APTT)—-prolonged
  2. PT ——normal
  3. Bleeding time ——normal
64
Q

Management and treatment of hemophilia

A

Interdisciplinary approach

Hemophilia treatment center will receive factor replacement therapy:

Hemophilia A—— Factor VIII concentrate intravenously; B—-Factor IX

Regular prophylaxis of infusions given to prevent joint hemorrhage and bleeding episodes, desmopressin, PT, surgery

65
Q

Glucose six phosphate Dehydrogenase (G-6-PD) deficiency

A

X linked or autosomal recessive genetic disorder in which activity of the reD cell enzyme G6PD is decreased or absent causing a hemolytic anemia

Babies May Experience hyperbilirubinemia —-neonatal jaundice

***Inability to deal with stress causing hemolysis!

66
Q

Signs and symptoms of G6PD deficiency

A

Weakness, pale appearance, severe cases may have blood in urine/yellow discoloration of skin

67
Q

Management of G6PD

A

Identification of appointments of food and drugs that caused hemolysis :

  1. Drugs: aspirin, sulfonamides, antimalarial‘s, nitrofurans
  2. Food: fava beans,
  3. Infection

Transfusion if needed

68
Q

Diagnostics for G6PD

A

Fluorescence screen

RBC indices: Heinz bodies present, fragmented cells, Reticulocytosis, hemoglobin normal

69
Q

Inherited hemorrhagic disorder characterized by a defective due to the quantitative or qualitative abnormalities Of VWF which helps form blood clots

A

Von Willebrand’s disease

70
Q

Nose bleeds, bleeding gums, heavy menstrual cycles, prolonged losing from cuts, increased bleeding after trauma or surgery, bruising

A

Signs and symptoms of von Willebrand’s disease

71
Q

Treatment of von Willebrand’s disease

A

Desmopressin as a Tate used to treat bleeding complications or as a preop

Anti-fibrinolytic agents —— helps continuous bleeding usually amicus membranes (nose, mouth, throat)

72
Q

Autoimmune condition where the body produces its own antibodies to destroy its own thrombocytes and platelets—— resulting in small bleeding spots against the skin “purpura”

A

ITP idiopathic thrombocytopenia Purpura

Immune mediated disorder characterized by production of antiplatelet antibodies

Sometimes related to sensitization by viral infection

73
Q

Primary ITP

A

Platelet count of 100,000/MM3 in the absence of other causes

74
Q

Chronic ITP

A

Disease lasting for more than 12 months; approximately 10% of children with ITP

common in children >7 years; prevalent in females

75
Q

Persistent ITP

A

Disease that continues between three and 12 months from diagnosis

76
Q

Secondary ITP

A

All other forms of immune mediated thrombocytopenia except for primary ITP

77
Q

Diagnostics for ITP

A

CBC generally they only require test
Hemoglobin normal or slightly reduced with prior bleeding

Platelet counts

  1. less than 20,000/mm3 DX acute ITP
  2. <100,000/mm3 for <12 months Dx chronic ITP

WBC normal

Bleeding time Test (unnecessary) always have normal if platelets < 50,000

78
Q

Management and treatment of ITP

A

Controversial

  1. Acute ITP:
    Treatment unnecessary platelet count >50,000
    TX if <20,000/ bleeding / can’t have protective enviro

Pharm:
A.high dose corticosteroids/ prednisone 2-5 mg/kg/day 1-3 week

B.IVIG 1g/kg/day

C. Anti-D immunoglobulin 50 MCG/KG

  1. Chronic ITP—-refer to hematologist
    Splenectomy, rituximab( monoclonal therapy) , low dose maintenance steroid, pharm
79
Q

Patient and family education for ITP

A

Avoid all competitive contacts for second result in trauma or ruptured spleen

Avoid aspirin & NSAIDS

Monitor for signs of a occult bleeds

Seek medical care if signs of bleeding are noticed

80
Q

Acute lymphocytic leukemia (a LL) has a peak incidence of ____years

A

4 years of age

81
Q

Acute myelogenous leukemia (AML) occurs primarily in what age group?

A

Malignant hematological cancer occurs primarily an older children

82
Q

Leukemia signs and symptoms

A

Anemia, Pale, listless, Irritable, chronically tired, frequent infections, bleeding, lymphadenopathy, hepatosplenomegaly, bone and joint pain

83
Q

Leukemia diagnostics

A

CBC with differential—-presence of The blast cells peripheral blood smear highly suggestive

WBC, platelet, and reticulocyte count

Bone marrow aspiration/biopsy =required confirmed diagnosis

84
Q

Leukemia management

A

Chemo 1 to 3 years
CNS prophylaxis (radiation, combine intrathecal chemo)
Patient family education
Relapse = bone marrow transplant recommendation

Hold all immunizations until 6 to 12 months after therapy

Any fever requires hospitalization for neutropenia

85
Q

Fever in leukemia patient requires what

A

Hospitalization for neutropenia

86
Q

How long do you hold immunizations for a child diagnosed with leukemia

A

6 to 12 months after therapy

87
Q

Neuroblastoma

A

Neoplasm of the permanent cells from the sympathetic nervous system

Possible familial pre-deposition
Most common malignancy in infancy; 10:1mill births

88
Q

Neuroblastoma symptoms

A

Poor feeding, pale, weight loss, abdominal pain, weakness, irritability, listlessness, lymph node enlargement, hepatomegaly, proptosis (raccoon eyes), scalp nodules

abdominal/flank mass

89
Q

Diagnostics for neuroblastoma

A

CT
Or MRI to determine location and suspected mass

Tissue biopsy to confirm

Serum or urine catecholamine levels—increased

90
Q

Mangement of Neuroblastoma

A

Surgery
Radiation therapy/chemo
Bone marrow transplant for high-risk
Immune mediated therapy/monoclonal antibody

Immunizations held while on therapy for 6 to 12 months after completion of therapy

91
Q

Congenital malignant intraocular tumor

A

Retinoblastoma

Hereditary (germinal mutation in 40%); acquired somatic mutations

92
Q

What are age range for children with retinoblastoma?

A

Dx usually before 5 years

93
Q

Leukocoria

A

Yellow white pupillary reflex most common presentation of retinoblastoma

94
Q

Diagnostics for retinoblastoma

A

Fundoscopic examination: creamy pink mask, white avascular tumor mass

CT to evaluate extent of tumor and optic nerve or bony structure involvement; MRI for optic nerve invasion; ultrasound

95
Q

Treatment of retinoblastoma

A

Refer for surgery, radiation therapy/laser therapy, chemo

96
Q

Anticipatory guidance for parents with children with cancer

A

Anticipatory guidance on developmental issues such as sleep, toileting, discipline, and childcare

97
Q

Lymphomas

A

Malignant proliferation of cells; includes Hodgkins and non-Hodgkin’s lymphoma

Related to genetic predisposition, environment, Epstein bar virus

98
Q

Peak Age for Hodgkin’s lymphoma

A

15 to 35 years; greater than 50 years

99
Q

Peak Age for non-Hodgkin’s lymphoma

A

5-15 years

100
Q

Hodgkin’s lymphoma symptoms

A

Painless, firm swelling of lymph nodes

Fatigue

Decreased appetite and attention weight loss 10%

Unexplained fever

Drenching night sweats

101
Q

Non-Hodgkin’s lymphoma symptoms

A

Asymptomatic if not disseminated
Difficulty swallowing, breathing, or cough
Swelling in neck, face, upper extremity
Abdominal pain

Distended neck pain/respiratory stress due to superior vena cava syndrome

102
Q

Which nodes in Lymphoma are often affected and how do they present?

A

Affected nodes ——often fixed, firm, nontender, discrete CERVICAL/Supraclavicular

103
Q

Diagnostics for lymphoma

A

Chest radiograph examine airway patency

Pet scan

Biopsy—-Reed Sternberg cells

CBC with red cell indices; certain ferritin; ESR— increased

104
Q

Primary malignant renal tumor

A

Wilms tumor (nephroblastoma)

105
Q

Peak incidence for Wilms tumor

A

1 to 5 years

106
Q

Abdominal mass usually non-painful, firm/confined to one side

malaise, fever, loss of appetite, vomiting, blood in urine

The symptoms are suspected of what?

A

Wilms tumor

107
Q

Diagnostic test for Wilms tumor

A

CBC, urinalysis, CT of abdomen,
Don’t palpate ***ABD/pelvic US

Chest radiograph to determine meta-status to lung

Surgical removal, chemo, radiation treatments

108
Q

Wilms tumor occurs 3x more in ____. It is more frequent in what gender____?

A

African Americans; males

109
Q

Solid tumor in the bone which is malignant

A

Osteosarcoma

Peak age 15-19 with growth spurt

110
Q

Localized pain, swelling, mass at the end of a long bone in decreased range of motion in affected extremity

Are signs and symptoms indicative of what?

A

Osteosarcoma

111
Q

Osteosarcoma diagnostics

A

Radiograph of affected bone, MRI, biopsy, CT

112
Q

Absence of T/B cell function leading to susceptibility to infection from any type of pathogen

A

Severe combined immuno deficiency (SCID)

Opportunistic infections and infections from any pathogen

Profound lymphopenia is always SCID until proven otherwise

Bone marrow transplant is a standard of care

113
Q

One day Old child is evaluated in the newborn nursery for fever. A CBC reveals a white blood cell count of 18 with a differential of 82% PMNs, 4% lymphs 9% monos 3% do’s , and 2% with bands.

Which of the following will be the highest on your list for differential diagnosis?

Necrotizing enterocolitis
Maternally transmitted bacterial infection
SCID
TORCH infection

A

SCID related to profound lymphopenia (low b/t cells) he should be treated as though he has SCID until it is proven not

114
Q

What test is required to diagnose leukemia?

CBC with diff
Bone aspiration/biopsy
CT
Biopsy of an enlarge lymph node

A

Bone marrow aspiration/biopsy

115
Q

Which of the following is not include as a part of initial therapy for ALL?

Chemotherapy
Radiation
Bone marrow transplant
Intrathecal chemotherapy

A

Bone marrow transplant

Chemotherapy oral, IV, and intrathecal is first line with addition of radiation
Bone marrow transplant is rarely use because most people are cured with chemo alone

116
Q

Which malignancy is associated with GU abnormalities?

Acute lymphocytic leukemia
Osteosarcoma
Chronic myelogenous leukemia
Wilms tumor

A

Wilms tumor

117
Q

Live virus immunization may be resumed after____ months once chemotherapy is completed

A

12 months

Non-live virus musicians may be resumed @6months

118
Q

Peak incidence of osteosarcoma age?

4-7 years

8-11 years

12-14 years

15-19 years

A

15-19 years of age

During growth spurt

119
Q

Management of a patient with a splenectomy

A

Pneumococcal vaccine‘s at least two weeks prior to surgery

Prophylactic penicillin

Blood culture and paraenteral anabiotic’s for febrile illness is

Rocephin should be given if a patient appears toxic; febrile illnesses need to be immediately evaluated

120
Q

Product of RBC breakdown by macrophages — turns to heme and globulin —goes to liver —-excreted via intestines

A

Bilirubin

121
Q

Why NB higher risk for hyperbilirubinemia ?

A
  1. HCT is increased and RBC breakdown faster
  2. Liver not fully mature —- doesn’t make enzyme in uterus to turn unconjugated bili to conjugated to be excreted in intestines
122
Q

Indirect bili

A

Unconjugated

123
Q

Direct bili

A

Conjugated

124
Q

Hyperbili peaks day 5-7

A

Physiologic jaundice

Resolves within 10 days
Risk: preterm

125
Q

Day 7 hyperbilirubinemia , increased sleepiness, fussiness, feeding difficulty

A

Breast milk jaundice

CPNP EXAM PREP (17 decks)

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