Heme/Onc/Immuno

Question 1

milk related Fe deficiency

what is this:

how to tx

Answer 1

Too much cow’s milk, very common.

all children born with Fe stores for 6 months. Sxs of Fe deficiency may not develop until 10 months, usu dx is 1-2y

>24-32oz cow’s milk with no other foods (OR exclusive breast feeding)can cause microscopic bleeding from GI tract, with inhibition of Fe absorption

Labs: Hgb as low as 2

Tx: elemental Fe 3-6mg/day, limit cows milk

Question 2

Transient erythroblastopenia of childhood

what is this

Answer 2

possible parvovirus onfection

red cell aplasia, with hgb 5-7, low retic count, normal MCV

dx around age 2

no tx, resolves in 1-2 mo

Question 3

von willibrands disease

what labs

Answer 3

elevated PTT, decreased factor 8 level

reduced VWF

Question 4

hemophilia

PT/PTT shows what?

how to tx:

Answer 4

PTT elevated, normal PT

CNS bleed: correct to 100% factor level

joint/muscle: correct to 50% except psoas muscle

Oral: one dose of factor (30-50%), and amicar

Question 5

hemophilia

what factor level % indicates severe?

Answer 5

>1% is severe

1-5% is moderate, can have spontaenous bleed

Question 6

leukemia:

sanctuary sites

Answer 6

CNS and testes

pts with known leukemia can have recurrence in these sites

Question 7

child with neck pain/torticollis

what to think of

Answer 7

herniation of cerebellar tonsil from high ICP, eg tumor

Question 8

Peds brain tumor

how sensitive is CT

Answer 8

65-100%?

can miss glioma, esp in infratentorial locations

Question 9

opsoclonus myoclonus

what is this and what is significance

Answer 9

asymmetric jumping mvments of eyes, with myoclonic jerks

think of neuroblastoma (paraneoplastic syndrome)

Question 10

Pt with raccoon eyes, but no hx of trauma and not abuse

think what

Answer 10

mets to skull/eye of neuroblastoma

looks like abuse

Question 11

osteosarcoma vs ewings

radiologic classic findings

Answer 11

osteosarcoma “sunburst”

ewings “onion peel”

Question 12

neutropenic fever strict definition:

1. neutropenia count
2. fever
   - what empiric abx?

Answer 12

1. ANC <1000
2. fever >38.3, OR 2 separate temps 4h apart of >38.0
   - 3rd gen ceph (eg cefepime), gent, vanc

Question 13

tumor lysis electrolytes:

• what 4 to know, high/low
• tx

Answer 13

K high

Phos high –danger to renal, use phosphate binder, ivf

Ca low (binds phos)– replete if necessary (eg tetany)

Uric acid high–danger to renal, tx with rasburicase, ivf, prevent with allopurinol

Tx based on electrolytes above

Question 14

sickle cell pain crisis

how to hydrate

Answer 14

be careful about pulm edema

hydrate 1.5x maintenance, don’t bolus

Question 15

sickle cell dactylitis

-how to tx

Answer 15

treat as pain crisis, can dc home with analgesia

lasts days-week

Question 16

sickle cell RUQ pain

think what things?

Answer 16

1. gallstones
2. hepatic sequestration
3. intrahepatic cholestasis: sudden pain, jaundice, anorexia, tender hepatomegaly, fever, high bili

Question 17

splenic sequestration:

what age?

Answer 17

age <5 years in HbSS. usu by 6 months

However, HbSC may have splenic infarcts later in life

Question 18

Fever in sickle cell:

management, discharge home?

Answer 18

Age <1y: ceftriaxone, admit

Age 1-5: ceftriaxone, dc with 24h f/u if low risk criteria:

temp<40, wbc 5-30, plt>100, hgb >5, cxr normal, well appearing, no hx of pneumococcal sepsis

age 5+: most stable pts can go home

Question 19

HSP

what to check in urine

Answer 19

linked to IGA nephropathy

check for: hematuria, protein, casts

check Cr

90% of patients that develop renal dz do so within 2 months. f/u very important

Question 20

kawasaki criteria

-classic def, vs incomplete

Answer 20

Fever >38.5 x5d and 4/5 criteria

CRASH and burn

conjunctivitis (limbic sparing), rash (can be any type), adenopathy (nontender), strawberry tongue (mucositis), hands/soles skin sloughing

incomplete form: fewer criteria or <5d

Question 21

Kawasaki’s, incomplete form

how to manage/dispo

Answer 21

Do labwork. if 3 abnormal labs, continue further testing and admit

labs: WBC, crp, esr, platelets, ALT
- admit: get echo, consult ID