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Peds Boards > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

Sudden onset of fatigue, pallor, scleral icterus, and tachycardia with severe anemia and reticulocytosis in previously healthy patient would be

A

Autoimmune Hemolytic Anemia - EMERGENCY

  • normocytic anemia
  • reticulocytosis

Tx:

  • DAT to confirm
  • Steroids
  • Tranfuse
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2
Q

Neonatal Thrombocytopenia:

Mom with ITP vs. Neonatal alloimmune thrombocytopenia.

A

Maternal ITP -> Neonatal thrombocytopenia

  • bc maternal antibodies cross placenta and attack neonate’s
  • Tx: IVIG

Neonatal alloimmune thrombocytopenia

  • no maternal hx, maybe previous child with thrombocytopenia
  • maternal antibody production to an antigen expressed on fetal platelets, which is not expressed on maternal platelets.
  • Tx: If severe, it is treated with a transfusion of maternal platelets, because these do not express the offending antigen.
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3
Q

Signs of a posterior fossa brain tumor

A

Early morning vomiting
Headache
Gait imbalance

New head tilt or torticollis can also be seen!

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4
Q

Platelet function disorders

A 
Glasmann Thrombasthenia (d/o platelet aggregation)
Bernard Soulier (d/o platelet adhesion)

Normal platelet number but not function.

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5
Q

When is lymphadenopathy worrisome?

A

Persistent lymphadenopathy more than 1 cm in diameter, despite appropriate antimicrobial therapy for bacterial adenitis, should warrant an evaluation by a pediatric oncologist.

The presence of “B” symptoms (fever, weight loss > 5% body weight, night sweats) in the context of adenopathy should trigger a referral to a pediatric oncologist.

Evaluation by an oncologist should occur before a biopsy of enlarged lymph nodes.

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6
Q

Cancer associated with greatest risk of Breast cancer

A

Hodgkin’s Lymphoma
- chest irradiation to fields that include breast tissue

Risk of breast cancer is high and mortality is substantial.

Annual screening with mammogram, breast MRI, or both is recommended after age 25 or 8 years after completing treatment.

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7
Q

Diamond-Blackfan Anemia

A

Due to defect in maturation of RBCS

Babies - 2-6 months

Macrocytic anemia, low reticulocytes

Abnormal facies - light-colored hair, a small “snubbed” nose, hypertelorism, and a thick upper lip
Short, webbed neck

Limb abnl - thumbs (bifid, triphalangeal, subluxed, or hypoplastic), a flat, hypoplastic thenar eminence, and weak or absent radial pulses

cardiac, ophthalmologic, and urogenital anomalies

Tx:
- RBC transfusions, steroids, chronic transfusions, stem cell transplant

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8
Q

Iron deficient RBCS look like

A

small red blood cells
marked central pallor
small ring of hemoglobin on peripheral blood smear

Note: basophilic stippling is nonspecific - usually with Pb tox, thalassemia, or sideroblastic anemia

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9
Q

Fanconi Anemia

A

APLASTIC anemia - so you get hypocellular bone marrow with fatty infiltration

  • hyperpigmentation of skin, cafe au lait
  • growth retardation
  • absent/hypoplastic thumb or radii
  • RENAL abnormalities
  • at risk for malignancy
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10
Q

Hemolytic anemia after a URI

A

Autoimmune Hemolytic Anemia - Direct Coombs test

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11
Q

Cyclic neutropenia would present with

A

Regular intervals of neutropenia (~21 +/- 3 days)
ANC < 1500 with BM hypoplastic with myelocyte arrest

You would get:
aphthous ulcers, stomatitis, pharyngitis, LAD
and then more serious infections like cellulitis, PNA, etc

At risk for sepsis caused by Clostridium

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12
Q

Cranial Radiation risk

A

For Children < 3 years old, cranial radiation will have profound neurocognitive effects and they will likely be incapable of independent living

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13
Q

Bleeding after circumcision is most likely due to? And what test would you order?

A

Hemophilia.
A = 8 B = 9 C = 11
A/B are X-linked. C is much less common and AR.

Sx: postcircumcision bleeding, epistaxis, soft-tissue bleeding, muscle hematoma, hemarthrosis, posttraumatic/surgical bleeding, or intracranial bleeding

Dx: Prolonged PTT and low factor levels.
Tx: Factor replacement, education

NOT vwD. That usually presents with mucosal bleeding from gums or nose

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14
Q

How to distinguish HbS/beta-thal vs. HbSS on labs?

A

HbSS

  • not microcytic
  • would not have increased A2 only F and S
  • if on hydroxyurea, would increase F and cause macrocytosis

HbS/Beta-thal

  • would have decreased or no A: no production of HbA (i.e. HbS/β0-thalassemia) or a reduced amount of HbA (i.e., HbS/β+-thalassemia).
  • increased F, A2, S
  • microcytic anemia
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15
Q

Most common presenting complications of sickle cell trait

A

Renal papillary necrosis with gross hematuria or hyposthenuria (inability to concentrate the urine)

Note: HbF is there until about 6months. Then electrophoresis pattern becomes A,S.

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16
Q

“Basophilic Stippling” is associated with?

A

Basophilic Stippling = blue granules (ribosomal precipitates ) of various sizes dispersed throughout the cytoplasm of the red blood cell

Associated with Lead Poisoning.
Which is associated with INCREASED Zinc protoporphyrin and Erythrocyte Protoporphyrin bc it disrupts pathway that incorporates iron into heme

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17
Q

Chronic benign neutropenia

A

Caused by autoantibodies to granulocytes
Usually 8-11 months, until 2 years
Benign condition
Persistently low as opposed to cyclic neutropenia

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18
Q

Factor 5 Leiden

A

Point mutation of Factor 5 = prevent cleavage of Factor 5 by activated protein C. ==> Thombosis!

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19
Q

G6PD Deficiency

A
  • X-linked, Mediterranean origin
  • reduced glutathione so rbcs cannot detoxify free oxygen radicals generated by drugs (dapsone, primaquine), foods (fava), or illness.
  • hemoglobin precipitates into heinz bodies and rbc membrane is damaged leading to hemolysis and rbc destruction
20
Q

Neuroblastoma - cutaneous findings

A

Neuroblastoma
- most common malig in infancy; usually dx’ed around 22 mo
- can arise at any site of the sympathetic nervous system but most common adrenal medulla or retroperitoneal sympathetic ganglion
- Bony mets are common and lead to significant pain and irritability
- SKIN: subcutaneous bluish nodules and periorbital ecchymoses associated with proptosis “raccoon eyes”
due to periorbital metastasis
- sometimes secrete VIP which causes diarrhea
- tumor makers: HVA and VMA are high
- CT shows calcifications (Unlike Wilms)

21
Q

Langerhans cell histiocytosis

A

Langerhans Cell: antigen presenting cell of the skin

  • Micro: Tennis racket–shaped Birbeck granules throughout the cytoplasm of the Langerhans cell
  • BONE Lesions - osteolytic lesions, esp in SKULL, femur, humerus, vertebrae.
  • EAR - Chronic ear drainage or chronic Mastoiditis
  • Cutaneous - persistent SCALP or DIAPER seborrheic dermatitis
  • EXCESSIVE URINE/DECREASED URINE OSMOLARITY - due to pituitary dysfunction and diabetes insipidus
22
Q

Paroxysmal Nocturnal Hemoglobinuria

A

destruction of red blood cells by the complement system,

  • hemolytic anemia
  • pancytopenia
  • arterial and venous thromboses

Gene: acquired (rather than inherited) intrinsic defect in the cell membrane (deficiency of glycophosphatidylinositol leading to the absence of protective proteins on the membrane).

PIG-A gene on the X chromosome is messed up - enzyme that makes GPI

23
Q

Liver tumor with high AFP

A

Hepatoblastoma

24
Q

Osteosarcoma

A

Codman’s triangle

Sunburst pattern

25
Q

Functional Platelet Disorders

A

Glanzmann thrombasthenia
- abnormality in the gene encoding the αIIb-β3 integrin fibrinogen receptor.
- platelets cant bind fibrinogen and aggregate
- mucocutaneous bleeding
- normal plt count*
Dx:
- poor aggregation to ADP, epinephrine, and collagen.
- do aggregate to ristocetin

Bernard-Soulier syndrome
- deficiency of glycoprotein Ib in the platelet membrane
- thrombocytopenia* giant platelets
Dx: opposite
- do aggregate in response to ADP, epinephrine, or collagen.
- do not aggregate in response to ristocetin

26
Q

Osteoid Osteoma

A
  • small radiolucent center with a sclerotic margin.
  • PAINFUL as they secrete high levels of prostaglandin, and the pain is typically relieved by treatment with aspirin or other nonsteroidal antiinflammatory agents.

Surgical removal is generally recommended; minimally painful lesions may be followed and treated symptomatically because some lesions resolve with skeletal maturity.

27
Q

B symptoms of Lymphoma

A

Weight Loss > 10%, Night Sweats, Fever

NOT bone pain or rash

28
Q

Prolonged bleeding during 1st menstruation is usually due to

A

VWF disease. NOT hemophilia as it is in a girl and severe bleeding would have presented earlier age.

29
Q

How does 6MP cause neutropenia?

A

Pts who have an underlying deficiency in thiopurine methyletransferase (TPMT)

30
Q

TTP

A

FAT RN + elevated LDH/hyperbili

F is for fever, A is for anemia, and T is for thrombocytopenia. The R in RN is for renal dysfunction, while the N is for neurologic abnormalities.

thrombotic microangiopathic hemolytic anemia typically caused by antibodies against ADAMTS13, a protease that breaks down ultralarge von Willebrand Factor (vWF) multimers.

Characteristic lab findings include an elevated LDH, hyperbilirubinemia, and azotemia.

The condition is life-threatening because of the risk of thrombosis in small central nervous system or cardiac arteries. The treatment of TTP includes emergent plasmapheresis and corticosteroids.

31
Q

HLH

A

Hemophagocytic Lymphohistiocytosis: 5 of the following

  • fever
  • splenomegaly
  • cytopenias (at least 2 of the 3)
  • hypofibrinogen
  • hyperTAG, elevated ferritin, elevated IL2
  • Low NK activity
  • tissue showing HEMOPHAGOCYTOSIS (phagocytosis of rbcs or wbcs) wihtout evidence of malignancy

Can be inherited or secondary (due to infection)

=> immune dysregulation and life threatening illness

32
Q

Ewing Sarcoma

A
  • small, round, blue cell tumor of neural crest origin
  • more common in caucasians
  • may have fever, weight loss/systemic symptoms
  • pain, swelling, and ONION skin appearance of lesion
  • more commonly in DIAPHYSIS
33
Q

Hodgkin’s Lymphoma

A
  • can present as asymptomatic lymphadenopathy, usually cervical or supraclavicular
  • 1/2 have “B” symptoms

Dx: lymph node biopsy/excision

34
Q

Juvenile Xanthogranuloma

A
  • benign, self limited form of non-langerhans cell histiocytosis -> spontaneous resolution is expected
  • SKIN: solitary, erythematous, dome-shaped, nonumbilicated papules or plaques (often with mild surface scaling), older lesions take on a more intense yellowish-orange color
  • HISTO: dense dermal infiltrates of histiocytes; giant cells with a central wreath of nuclei and peripheral rim of eosinophilic cytoplasm (“Touton giant cells”) are pathognomonic for the disorder.

MONITOR FOR CANCER

  • increased risk fo juvenile myelomonocytic leukemia
  • especially in those with café-au-lait macules or a family history of neurofibromatosis 1.
35
Q

Retinoblastoma Genetic Inheritance

A

Requires inactivation of both copies of RB1.
And can be

Heritable = Autosomal dominant with 90% penetrance

  • usually BOTH eyes affected
  • if mom has it = one wildtype, one mutated then risk of child having it is 0.5 (allele) x 0.9 (penetrance) = 0.45% and reasonable to assume that father doesn’t carry germline mutation bc almost 80% of heritable cases arise from de novo mutations

Non-heritable
- usually unilateral

(If parent had it in only 1 eye = then risk of child affected is 1/20 or 5%)

36
Q

Normal MCV calculation

A

MCV = 72 + age in years or 70-90

37
Q

TEC vs. DBA

A

Both are anemias with LOW RETIC

TEC:

  • Toddler
  • transient
  • NORMOCYTIC

DBA

  • Dysmorphic facies
  • Babies
  • Anemia that is MACROCYTIC
  • thumb abnormalities.
38
Q

Neutropenia, Anemia, Pancreatic insufficiency, FTT, recurrent infections = what disease and what other features

A

Schwamann Diamond

Skeletal Abnormalities.

39
Q

vWF vs. Hemophilia

A

vWD

  • needed for plt aggregation and F8 fxn
  • dental procedure or tonsillectomy
  • epistaxis
  • girl with menorrhagia
  • abnormal PTT but can be normal too (with normal PT)
  • vWF activity is low

Hemophila

  • BOYS
  • prolonged PTT
  • deep joint bleeds, intracranial bleeding, bleeding after circ
40
Q

ITP treatment

A

Treatment if

  • active bleeding
  • plt count < 10 even without bleeding (bc risk of spontaneous intracranial bleed is higher when plt < 10)

Tx: IVIG (or steroids or anti-Rh immune globulin)

NOT PLATELET TRANSFUSION - because transfused platelets will present antigens that continue to drive the autoimmune process.** THIS IS CONTRAINDICATED

ITP + headache = intracranial bleed!

Most pt with ITP will have resolution by 6 months.

41
Q

Primary Ciliary Dyskinesia

A

Chronic sinusitis
Bronchiectasis
Heterotaxy
Male infertility

BUT MOST LIKELY to support diagnosis is homozygous mutation of DNAH11 mutation!

42
Q

How to treat Priaprism in SCD

A

Aspiration of blood from the corpus cavernosum followed by irrigation with saline or adrenergic agonists alleviates the condition.

43
Q

PREP Review

A

2017: 2. 3, 4, 10

44
Q

Splenic Sequestration

A

Anemia, thrombocytopenia, palpable spleen

Tx: pRBC

45
Q

Neuroblastoma in the chest

A

Posterior Thoracic Mass

46
Q

Beckwith-Wiedemann screening

A

AFP q3mo until age 4 for hepatoblastoma

abd US q3mo until age 7-8 for nephroblastoma

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