HEME-ONC

Question 1

At what point do screen babies for iron deficiency (MICROcytic) anemia? What do you see on labs?

Answer 1

12 months

Elevated TIBC, low MCV, low serum ferritin

Question 2

What would you notice on PE with anemia?

Answer 2

Glossitis, angular stomatitis, koilonychia

Question 3

What does basophilic stippling indicate?

Answer 3

Lead poisoning

Question 4

How do you treat lead poisoning?

Answer 4

Chelating therapy

Question 5

If labs show macro-ovalocytes, hypersegmented polymorphonuclear cells, and Howell-jolly bodies or elevated homocysteine – what diagnosis?

Answer 5

Folate deficiency (MACROcytic anemia >100 MCV)

Question 6

Do children often have neuro sxs with folate deficiency? What about B12 deficiency?

Answer 6

No Neuro sxs or folate

B12 deficiency will have neuro sxs

Question 7

If a child has facial swelling (chipmunk face) and on PE you note cardiac, hepatic, and endocrine abnormalities – what diagnosis? What lab finding?

Answer 7

Beta thalassemia Major

See Target Cells

Question 8

What diagnosis presents with painful swelling in the hand and feet, and significant bone pain? What would you see on labs?

Answer 8

Sickle cell

See peripheral smear with sickle-shaped RBC’s

Question 9

If a child has acute, severe, and debilitating pain – what diagnosis and what is occurring?

Answer 9

Sickle cell crisis

avascular necrosis → bone marrow infection

Question 10

If a child is very easily bruised, and you noted significant swelling into the knee – that when aspirated is blood. What diagnosis?

Answer 10

Hemophilia A or B

Question 11

If a young child has reccurent bleeding gums or epistaxis – or a young girl with significant menorrhagia – what diagnosis should you keep on your differentials?

Answer 11

Von Willebrand or Idiopathic thrombocytopenia purpura

Question 12

How do you differentiate Von Willebran vs. Idiopathic thrombocytopenia purpura? Treatment?

Answer 12

Von Will = Normal platelet with vWF antigen. Tx = Desmopressin

ITP = ISOLATED decreased platelets without cause. Tx = Steroids or Rituximab

Question 13

If you have 7 year old with frequent nose bleeds, bone pain, and frequent infections, what test do you get and what do you see?

Answer 13

CBC and you will see mildly elevated leukocytosis

Blood smear – you will see the younger/small nucleus with BLASTS

Question 14

In AML, how would the patient appear?

Answer 14

Acute picture – Adults who have been exposed to chemo/radiation or has previously had CML

Question 15

We know that in AML, we will see mainly lymphocytes, but what else might we see?

Answer 15

Auer Rods! Would indicate treatment with vitamin A

Question 16

A 4 year-old boy is coming in for leg pain while walking. He has pallor of the conjunctiva, purpura, petechiae, and a palpable spleen. His lab results show a low WBC count, low hemoglobin, and low platelets. What is your differential Dx?

Answer 16

ALL

Question 17

How do you treat ALL & AML?

Answer 17

Chemo

Question 18

If WBC are VERY elevated, you order a smear that comes back negative, and you decide to order a Karyotype and it shows Philadelphia chromosome – what diagnosis?

Answer 18

Chronic myelogenous leukemia (CML)

Question 19

A patient presents with PAINLESS lymphadenopathy (a supraclavicular node is visible). Their CBC comes back normal, but you want to biopsy the lymph node – it comes back with Reed Sternberg cells which are pathognomonic for?

Answer 19

Hodgkin’s lymphoma

Question 20

What lymphoma typically presents with B symptoms?

Answer 20

Hodgkins

Question 21

What lymphoma has the better prognosis?

Answer 21

Hodgkins

Question 22

What else is associated with Hodgkins lymphoma?

Answer 22

Pel-Epstein fevers (cyclical fevers)

Their swollen lymph node that is non-tender, becomes tender when they drink alcohol

Question 23

What else is associated with Non-Hodgkins lymphoma?

Answer 23

Burkitt’s lymphoma = has a “starry sky” pattern

Question 24

What is the most common malignancy is infancy? What lab finding is present?

Answer 24

Neuroblastoma

Catecholamine secretion*

Question 25

If an infant has a unilateral abdominal mass – what diagnosis and how do you treat?

Answer 25

Wilms tumor

Diagnose via CT NEVER biopsy

Treat with surgery & chemo

Question 26

What is the most common bone cancer that appears as a sunburst?

Answer 26

osteosarcoma

Question 27

What form of bone cancer is present in the long bones (leg pain), ribs, and flat bones (back pain)?What form of bone cancer is present in the long bones (leg pain), ribs, and flat bones (back pain)?

Answer 27

Ewing sarcoma

Question 28

What is a rhabdomyosarcoma?

Answer 28

Soft tissue sarcoma; that will cause disturbance of normal body function

Question 29

If a child does not have a red reflex, but instead has leukocoria (white papillary reflex) – what diagnosis?

Answer 29

Retinoblastoma