Heme/Onc & Infxns Flashcards
1
Q
Sickle cell disease MC in ___ and ___ ethnicities
A
AA; mediterranean
2
Q
SCD–pt w/ swollen, painful hands/feet
A
Dactylitis. 2/2 necrosis of small bones
3
Q
SCD–Excruciating pain in the extremities, ulcers, hip pain
A
Pain crises. Ischemic damage 2/2 sickling
4
Q
SCD–Point tenderness on femur, fever, and malaise
A
Osteomyelitis; MCC salmonella
5
Q
SCD–seen on blood smear
A
inc retics, nl MCV sickles, targets, HJ bodies
6
Q
SCD–acute drop in HCT w/ dec retics
A
aplastic crisis due to Parvo B19
7
Q
SCD–recurrent RUQ pain after meals; tx
A
pigment gallstones; do cholecystectomy
8
Q
SCD–resp distress & emergent tonsilectomy
A
Waldyer Ring hyperplasia
9
Q
SCD–proteinuria and inc creatinine and recurrent UTIs
A
kidney infarcts due to sickled RBCs
10
Q
SCD–MCC sepsis
A
strep pneumo
11
Q
SCD–pt w/ fever, cough, chest
pain, chills, and SOB; tx
A
Acute Chest syndrome (pulm infarction = MCC DEATH); O2, abx and exchange transfusion
12
Q
SCD–MCC death
A
pulmonary infarction (Acute chest syndrome)
13
Q
SCD–acute confusion and focal neuro deficits; tx
A
stroke; EXCHANGE TRANSFUSION (not tPA)
14
Q
SCD–stroke assessment
A
transcranial doppler, keep HbS
15
Q
SCD–vaccination and prophylaxis
A
2yo–23valent pneumo vaccine, H. flu, N. mening; 2mo to 6yrs–PCN prophylaxis
16
Q
SCD–pt w/ fatigue and megaloblastic anemia (MC)
A
folate deficiency 2/2 inc retics
17
Q
SCD–tx
A
Hydroxyurea incr prod HbF, tx infx aggressively, manage pain, BMT cures
18
Q
SCD–BMT cures but has a ___ post-op mortality rate
A
10%
19
Q
When is anemia benign?
A
for first 2-3months of life; physiologic drop in H&H
20
Q
Anemia–transient erythroblastopenia 3mo-6yrs means that there is ___ after viral infxn (not B19)
A
immune suppression
21
Q
Anemia–18 mo, picky eater, drinks lots of cow’s milk.
↓H&H, MCV 75, ↓ferritin, ↑TIBC
A
Iron deficiency [tx PO iron]
22
Q
Anemia–18 mo, eats a varied diet. Mom is Italian.
↓H&H, MCV 60, ↓RDW
A
Thalessemia
23
Q
Thalessemia tx
A
transfusion & deferoxamine
24
Q
Anemia–8 mo is irritable, has glossitis & FTT. Picky eater, drinks lots of goat’s milk
A
folate deficiency (see low serum RBC folate), tx w/ daily folate PO
25
Dx--4mo pale baby, normal plts, WBCs but hemaglobin is 4. Incr RBC ADA and low retics. Triphalangeal thumbs
Blackfan-Diamond anemia
26
Blackfan-Diamond anemia tx
corticosteroids, transfusions, stem cell transplant
27
Dx--18mo baby presents w/ low plts, low WBCs and profound anemia. He has café-au-lait spots, microcephaly, and absent thumbs
Fanconi anemia
28
Fanconi anemia--dx
Bone marrow shows hypoplasia, Cytogenetic studies for chr breaks
29
Fanconi anemia--tx
Corticosteroids, androgens, bone marrow transplant
30
Fanconi anemia complications
Incr risk for AML and other cancers
31
Dx--2 y/o baby presents w/ hyperactivity, impaired growth, abdominal pain and constipation
Lead poisoning (basophilic stippling)
32
Lead poisoning--dx
venous blood sample, ck lead level
33
Lead poisoning--tx
Pb>45 = tx w/ succimer; Pb>70 = admit and tx w/ EDTA + dimercaprol
34
Lead poisoning--screening
Test blood lead levels btwn 12-24 mo if low SES, live in old house (
35
Thrombocytopenia--15 y/o F recurrent epistaxis, heavy menses & petechiae. ↓plts only
ITP
36
Idiopathic thrombocytopenic purpura--tx
IVIG for 1-2 days, then prednisone, then splenectomy. NO plts!!
37
Thrombocytopenia--15 y/o F recurrent epistaxis, heavy menses, petechiae, normal plts, ↑ bleeding time and PTT
vonWilebrand Dz
38
VWD--tx
DDAVP for bleeding or pre-op. Replace factor VIII (contains vWF) if bleeding continues
39
Thrombocytopenia--7 y/o M recurrent bruising, hematuria & hemarthroses, ↑ PTT that corrected w/ mixing studies
Hemophilia; if mild, replace w/ DDAVP, otherwise replace w/ factors
40
Thrombocytopenia--1wk old newborn, born at home, comes in with bleeding from the umbilical stump & bleeding diathesis
vit K def (↓ II, VII, IX and X)
41
Vit K def--tx
FFP acutely + vit K shot
42
Vit K def--what other pathology can cause this besides low vit K supplement?
CF kid w/ malabsorbtion
43
Thrombocytopenia--9 y/o F with Wilson’s disease developed fulminant liver disease, what is first factor depleted?
VII (PT increases first, then PTT)
44
Thrombocytopenia--9 y/o F with Wilson’s disease developed fulminant liver disease, what factors are NOT depleted?
VIII and vWF b/c they are made by ENDOTHELIAL CELLS
45
Dx--3 y/o w/ petechiae, abd pain, vomiting and lethargy. Had bloody diarrhea 5 d ago after eating hamburgers. +Thrombocytopenia and ↑creatinine
Hemolytic uremic syndrome
46
MCC HUS
E. Coli O157H7 [Shigella, Salmonella, Campylobacter]
47
Tx HUS
Tx w/ aggressive nutrition (TPN) and early peritoneal dialysis. NO abx for bloody diarrhea (↑ risk of HUS), NO platelets!
48
Dx--5 y/o w/ purpura on legs and buttocks, abd pain, joint pain, current jelly stool. Blood smear nl, coag studies nl and electrolytes nl. IgA and C3 are deposited in the skin.
Henoch Schonlein Purpura
49
Henoch Schonlein Purpura--MCC; tx
following URI; symptomatic tx, can use steroids for GI/renal dz
50
Dx--New onset seizure, ataxia and HA worse in the AM with vomiting for a month
brain tumor, most likely infratentorial
51
MC brain tumor in kids; tx; px
Pilocytic astrocytoma of cerebellum. Resect. ~90% survive.
52
Dx--Adolescent with height in 5th %, w/ bitemporal hemianopsia. See calcifications in sella turcica
Craniopharyngioma. Suprasellar; remnant of Rathke’s pouch
53
Dx--2 year old hypertensive child with asymptomatic abdominal mass
Wilm's tumor
54
Wilm's tumor--associations (4)
Aniridia, GU anoms, Hemihypertrophy, Beckwith-Weidemann
55
Wilm's tumor--best test; tx
abd CT + CXR to see lung involvement; sx, chemo, rads
56
Dx--4 year old with jerking movements of eyes and legs, bluish skin nodules and an tender abdominal mass
neuroblastoma
57
Neuroblastoma--dx
↑urine homovanillic or vanillylmandelic acid
58
Dx--3 year old girl w/ a limp & left leg pain, T = 99.9, HSM, petechiae, & pallor. Cells TdT+
ALL
59
ALL--best dx
bone marrow bx w/ >30% lymphoblasts
60
ALL--tx
VDP + CNS tx w/ intrathecal methotrexate
61
ALL--poor px factors
10yo, >100K WBC
62
Dx--14 y/o boy w/ enlarged, painless, rubbery
| nodes, drenching fevers, and 10% weight loss
Hodgkin Lymphoma
63
Hodgkin Lymphoma--best test
excisional bx
64
Hodgkin Lymphoma--next steps s/p bx
staging CT or laparoscopy
65
Hodgkin Lymphoma--tx
chemo + rads; 90% cure if stage I or II
66
Dx--7 year old girl with non-productive cough and large anterior mediastinal mass on CXR
Non-Hodgkin Lymphoma
67
Non-Hodgkin Lymphoma--best test
bx of mass, bone marrow bx for staging
68
Non-Hodgkin Lymphoma--tx
Surgical excision if abdominal tumor. Can use anti-CD20 [ritixumab] if B-cell tumor. Rads for some.
69
Dx--2y/o w/ a fever to 105, 3 days later gets a pink, mac-pap rash on trunk arms and legs
Roseola-HHV6
70
Dx--2y/o w/ a low grade fever, lacy reticular rash on cheeks and upper body (spares the palms/soles)
5th Disease/Erythema Infectiosum- Parvovirus B19
71
Parvovirus B19 is BAD for _____ (3)
pregnant pts, SCD, thalessemia
72
Dx--Fine, mac-pap desquamating
| rash begins on chest and spreads to neck, trunk, & extremities+ strawberry tongue. Sore throat 1-2wks prior
Scarlett fever (GAS)
73
Scarlet fever--tx
GAS--> PCN prevents rheumatic fever [cannot help risk post-strep GN]
74
Dx--Cough, runny nose, fever;
macular rash begins behind
ears & spreads down. Gray
spots on the buccal mucosa.
Measles--paramyxovirus
75
Measles--tx
Vitamin A + supportive care
76
Dx--Sore throat, joint pain, fever; pinpoint rash on the face and spreads down. Rose spots
on the palate.
Rubella (paramyxovirus)
77
Rubella--triad of congenital rubella syndrome
deafness, eye problems (retinopathy, cataracts, micropthalmima), cardiac issues (PDA, pulm artery stenosis)
78
Dx--Baby w/ poor feeding. Vesicles in moth on palms/soles and rash on buttocks
Hand-Foot-and-Mouth Dz (Coxsackie virus A16)
79
Dx--16yo M w/ swollen parotid glands, fever and HA
Mumps (paramyxovirus)
80
Mumps--complications for boys
orchidis and sterility
81
Dx--6yo from central PA went camping; fever + bullseye
Lyme disease (B. burgdorferi)
82
Lyme Dz--complications
arthritis, 3rd degree HB, meningitis, Bells palsy
83
Lyme Dz--tx
if 8 give doxycycline
84
Dx--6yo from coastal NC went camping. Had fever, myalgias and abdominal pain. Now has papular erythematous rash over body
Rocky Mountain Spotted Fever (Rickettsia rickettsii)
85
RMSF--complications
vasculitis and gangrene
86
RMSF--tx
doxycycline
87
Dx--8yo w/ multiple excoriations on arms. Itchy at night
Scabies
88
Scabies--tx
5% permetrin; tx WHOLE FAMILY
89
Dx--Honey-colored crusted plaque on face
Impetigo (MC bug is staph if bullae)
90
Impetigo--tx
topical muciprocin
91
Dx--inflamed conjunctiva and multiple blisters. Nikolsky +
SSSS (exfoliative staph toxin)
92
SSSS--tx
IV oxacillin/nafcillin
93
Meningitis--MC bugs in neonates; tx?
GBS, E. Coli, Listeria; amp + gentamicin
94
Meningitis--MC bugs overall; tx?
S. pneumo, N. meningiditis, H. influenza; vancomycin + ceftriaxone
95
Meningitis--young and immunosuppresed
Listeria (tx ampicillin)
96
Meningitis--pple w/ brain tumor
Staph (tx vanco)
97
Meningitis--TB tx
RIPE + 'roids
98
Meningitis--Lyme tx
IV ceftriaxone
99
Meningitis--how to tx roommate of kid in dorm who has bacterial meningitis and petichial rash?
rifampin
100
Dx--2 y/o w/ fever to 102, tugging on his right ear. Patient’s tympanic membrane is red and bulging.
OM
101
OM--most sensitive dx test
Limited mobility on insufflation or air-fluid level
102
OM--RFs
↓SES, Native Americans, formula fed, tobacco smoke, around kids
103
OM--tx
Amox or azithromycin for 10days. If no improvement in 2-3
| days, switch to amox-clav
104
OM--complications
Effusion-place tubes if bilat effusion >3mo or if bilateral hearing loss
105
Dx--12y/o in summer swim league has pain when adjusting his goggle straps behind his ear. Thick exudates coming from
– Complications?
the ear and tender posterior auricular nodes.
Otitis Externa (OE)
106
Otitis externa--tx
topical ciprofloxacin
107
Otitis externa--complications
malignant OE can invade into temporal bone, causing facial paralysis and vertigo; need CT/IV abx +/- sx
108
Dx--7y/o w/ exudative pharyngitis w/ tender cervical lymph nodes and 102 fever
most likely GAS (beta-hemolytic) pharyngitis
109
Strep throat--best 1st test; if negative?
rapid strep antigen; if high clinical suspicion, do culture
110
Strep throat--tx?
PCN or erythromycin
111
Dx--A child presents w/ “muffled voice”, stridor and refuses to
turn her head to the left.
Retropharyngeal abscess
112
Retropharyngeal abscess--tx
I&D for C&S. GAS + anaerobes. 3rd gen ceph + amp or clinda
113
Dx--A child presents w/ “hot potato voice” and upon throat
| exam her uvula is deviated to the right 2/2 a bulge.
Peri-tonsillar abscess
114
Peri-tonsillar abscess--tx?
Aspiration or I&D + abx, tonsillectomy if recurrent.
115
Indications for tonsilectomy
>5 episodes of strep/year for 2 years or >3 episodes/year for 3 years
116
Dx--teenager with fever, fatigue, generalized adenopathy and splenomegaly (anterior and posterior cervical nodes)
EBV
117
EBV--what happens if give ampicillin/amoxicillin
Maculopapular Rash (immune mediated vasculitic)
118
EBV--dx
Blood smear shows lymphocytosis w/ atypical lymphs +Heterophile antibody (Monospot) test.
119
EBV--tx
self-limited; no contact sports until splenomegaly resolves
120
Dx--1 y/o w/ fever to 100.5 & “barking” cough and loud noises on inspiration.
Croup (MC parainfluenza virus)
121
Croup--Xray shows ___; tx
steeple sign; mist, racemic epi and steroids
122
Dx--2 y/o w/ fever to 104 & drooling w/ intercostal retractions and tripod position.
epiglottitis (MC HiB in unimmunized; MC S. pyogenes, S. pneumo and staph in immunized)
123
Epiglottitis--Xray shows ___; next best step??? tx??
thumbprint sign; OR to intubate!!; anti-staph abx + cetriaxone
124
Dx--Kid w/ cough productive of yellow-green sputum, runny nose and T = 100.8. Lung exam only reveals some coarse rhonchi.
Acute bronchitis
125
Acute bronchitis--next best step
Supportive tx w/ anti-pyretic, tussives, histamines.
126
Dx--Kid w/ cough productive of yellow-green sputum, runny nose and T = 100.8. Decrease breath sounds and crackles in the LLL and WBC = 16K.
Pneumonia
127
Pneumonia--next best step?
CXR
128
Pneumonia--MCC 5yo?
GBS/E. coli/Listeria; C. trachomatis/RSV/parainfluenza/S. pnuemo; VIRAL (RSV) then S. pneumo; Mycoplasma/S. pneumo
129
Pneumonia--specific findings for chlamydia pneumonia
Staccato cough, eosinophilia
130
Dx--9mo infant w/ runny nose, wheezy cough, T = 101.5, and RR = 60. Retractions are visible and pulse ox is 91%
Bronchiolitis (MCC RSV, swab to confirm)
131
Bronchiolitis--CXR shows ___; tx? vaccinate _____
hyperinflation w/ patchy atelectasis; hosp if resp distress + albuterol nebs (NO STEROIDS); palivizumab for premies/CHD/lung/immune dz
132
Dx--9mo infant with severe coughing spells with loud inspiratory whoops and vomiting afterwards. 2 weeks ago she had runny nose and dry cough.
Pertussis
133
Pertussis--labs show ___; tx?
lymphocytosis; erythromycin x14d AND family members/daycare contacts
134
Dx--neonate w/ fever, dehydration and fussiness. Always check for ___.
UTI (if fever, then pyelo)
135
UTI--before ____, boys > girls
1yo
136
UTI--anatomic RF
viscoureteral reflux (prophylax w/ TMP-SMX or nitrofurantoin)
137
UTI--dx
clean catch or cath sample, UA and culture (>10k); US if febrile or mass
138
UTI-tx
PO TMP-SMX or nitrofurantoin
139
Pyelonephritis--tx
IV ceftriaxone or amp/gent x14d
140
Who needs VCUG?
all males w/ suspected UTI, females 5 w/ 2nd UTI
141
Role of Tc-labeled DMSA scan in UTI
It is most sensitive and accurate study of scarring and renal size, but is not first line.
