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Pediatric Clerkship > Heme/Onc & Infxns > Flashcards

Heme/Onc & Infxns Flashcards

1
Q

Sickle cell disease MC in ___ and ___ ethnicities

A

AA; mediterranean

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2
Q

SCD–pt w/ swollen, painful hands/feet

A

Dactylitis. 2/2 necrosis of small bones

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3
Q

SCD–Excruciating pain in the extremities, ulcers, hip pain

A

Pain crises. Ischemic damage 2/2 sickling

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4
Q

SCD–Point tenderness on femur, fever, and malaise

A

Osteomyelitis; MCC salmonella

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5
Q

SCD–seen on blood smear

A

inc retics, nl MCV sickles, targets, HJ bodies

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6
Q

SCD–acute drop in HCT w/ dec retics

A

aplastic crisis due to Parvo B19

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7
Q

SCD–recurrent RUQ pain after meals; tx

A

pigment gallstones; do cholecystectomy

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8
Q

SCD–resp distress & emergent tonsilectomy

A

Waldyer Ring hyperplasia

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9
Q

SCD–proteinuria and inc creatinine and recurrent UTIs

A

kidney infarcts due to sickled RBCs

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10
Q

SCD–MCC sepsis

A

strep pneumo

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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

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12
Q

SCD–MCC death

A

pulmonary infarction (Acute chest syndrome)

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13
Q

SCD–acute confusion and focal neuro deficits; tx

A

stroke; EXCHANGE TRANSFUSION (not tPA)

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14
Q

SCD–stroke assessment

A

transcranial doppler, keep HbS

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15
Q

SCD–vaccination and prophylaxis

A

2yo–23valent pneumo vaccine, H. flu, N. mening; 2mo to 6yrs–PCN prophylaxis

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16
Q

SCD–pt w/ fatigue and megaloblastic anemia (MC)

A

folate deficiency 2/2 inc retics

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17
Q

SCD–tx

A

Hydroxyurea incr prod HbF, tx infx aggressively, manage pain, BMT cures

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18
Q

SCD–BMT cures but has a ___ post-op mortality rate

A

10%

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19
Q

When is anemia benign?

A

for first 2-3months of life; physiologic drop in H&H

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20
Q

Anemia–transient erythroblastopenia 3mo-6yrs means that there is ___ after viral infxn (not B19)

A

immune suppression

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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]

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22
Q

Anemia–18 mo, eats a varied diet. Mom is Italian.

↓H&H, MCV 60, ↓RDW

A

Thalessemia

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23
Q

Thalessemia tx

A

transfusion & deferoxamine

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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

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25
Q

Dx–4mo pale baby, normal plts, WBCs but hemaglobin is 4. Incr RBC ADA and low retics. Triphalangeal thumbs

A

Blackfan-Diamond anemia

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26
Q

Blackfan-Diamond anemia tx

A

corticosteroids, transfusions, stem cell transplant

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27
Q

Dx–18mo baby presents w/ low plts, low WBCs and profound anemia. He has café-au-lait spots, microcephaly, and absent thumbs

A

Fanconi anemia

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28
Q

Fanconi anemia–dx

A

Bone marrow shows hypoplasia, Cytogenetic studies for chr breaks

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29
Q

Fanconi anemia–tx

A

Corticosteroids, androgens, bone marrow transplant

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30
Q

Fanconi anemia complications

A

Incr risk for AML and other cancers

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31
Q

Dx–2 y/o baby presents w/ hyperactivity, impaired growth, abdominal pain and constipation

A

Lead poisoning (basophilic stippling)

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32
Q

Lead poisoning–dx

A

venous blood sample, ck lead level

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33
Q

Lead poisoning–tx

A

Pb>45 = tx w/ succimer; Pb>70 = admit and tx w/ EDTA + dimercaprol

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34
Q

Lead poisoning–screening

A

Test blood lead levels btwn 12-24 mo if low SES, live in old house (

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35
Q

Thrombocytopenia–15 y/o F recurrent epistaxis, heavy menses & petechiae. ↓plts only

A

ITP

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36
Q

Idiopathic thrombocytopenic purpura–tx

A

IVIG for 1-2 days, then prednisone, then splenectomy. NO plts!!

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37
Q

Thrombocytopenia–15 y/o F recurrent epistaxis, heavy menses, petechiae, normal plts, ↑ bleeding time and PTT

A

vonWilebrand Dz

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38
Q

VWD–tx

A

DDAVP for bleeding or pre-op. Replace factor VIII (contains vWF) if bleeding continues

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39
Q

Thrombocytopenia–7 y/o M recurrent bruising, hematuria & hemarthroses, ↑ PTT that corrected w/ mixing studies

A

Hemophilia; if mild, replace w/ DDAVP, otherwise replace w/ factors

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40
Q

Thrombocytopenia–1wk old newborn, born at home, comes in with bleeding from the umbilical stump & bleeding diathesis

A

vit K def (↓ II, VII, IX and X)

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41
Q

Vit K def–tx

A

FFP acutely + vit K shot

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42
Q

Vit K def–what other pathology can cause this besides low vit K supplement?

A

CF kid w/ malabsorbtion

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43
Q

Thrombocytopenia–9 y/o F with Wilson’s disease developed fulminant liver disease, what is first factor depleted?

A

VII (PT increases first, then PTT)

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44
Q

Thrombocytopenia–9 y/o F with Wilson’s disease developed fulminant liver disease, what factors are NOT depleted?

A

VIII and vWF b/c they are made by ENDOTHELIAL CELLS

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45
Q

Dx–3 y/o w/ petechiae, abd pain, vomiting and lethargy. Had bloody diarrhea 5 d ago after eating hamburgers. +Thrombocytopenia and ↑creatinine

A

Hemolytic uremic syndrome

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46
Q

MCC HUS

A

E. Coli O157H7 [Shigella, Salmonella, Campylobacter]

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47
Q

Tx HUS

A

Tx w/ aggressive nutrition (TPN) and early peritoneal dialysis. NO abx for bloody diarrhea (↑ risk of HUS), NO platelets!

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48
Q

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.

A

Henoch Schonlein Purpura

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49
Q

Henoch Schonlein Purpura–MCC; tx

A

following URI; symptomatic tx, can use steroids for GI/renal dz

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50
Q

Dx–New onset seizure, ataxia and HA worse in the AM with vomiting for a month

A

brain tumor, most likely infratentorial

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51
Q

MC brain tumor in kids; tx; px

A

Pilocytic astrocytoma of cerebellum. Resect. ~90% survive.

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52
Q

Dx–Adolescent with height in 5th %, w/ bitemporal hemianopsia. See calcifications in sella turcica

A

Craniopharyngioma. Suprasellar; remnant of Rathke’s pouch

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53
Q

Dx–2 year old hypertensive child with asymptomatic abdominal mass

A

Wilm’s tumor

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54
Q

Wilm’s tumor–associations (4)

A

Aniridia, GU anoms, Hemihypertrophy, Beckwith-Weidemann

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55
Q

Wilm’s tumor–best test; tx

A

abd CT + CXR to see lung involvement; sx, chemo, rads

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56
Q

Dx–4 year old with jerking movements of eyes and legs, bluish skin nodules and an tender abdominal mass

A

neuroblastoma

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57
Q

Neuroblastoma–dx

A

↑urine homovanillic or vanillylmandelic acid

58
Q

Dx–3 year old girl w/ a limp & left leg pain, T = 99.9, HSM, petechiae, & pallor. Cells TdT+

A

ALL

59
Q

ALL–best dx

A

bone marrow bx w/ >30% lymphoblasts

60
Q

ALL–tx

A

VDP + CNS tx w/ intrathecal methotrexate

61
Q

ALL–poor px factors

A

10yo, >100K WBC

62
Q

Dx–14 y/o boy w/ enlarged, painless, rubbery

nodes, drenching fevers, and 10% weight loss

A

Hodgkin Lymphoma

63
Q

Hodgkin Lymphoma–best test

A

excisional bx

64
Q

Hodgkin Lymphoma–next steps s/p bx

A

staging CT or laparoscopy

65
Q

Hodgkin Lymphoma–tx

A

chemo + rads; 90% cure if stage I or II

66
Q

Dx–7 year old girl with non-productive cough and large anterior mediastinal mass on CXR

A

Non-Hodgkin Lymphoma

67
Q

Non-Hodgkin Lymphoma–best test

A

bx of mass, bone marrow bx for staging

68
Q

Non-Hodgkin Lymphoma–tx

A

Surgical excision if abdominal tumor. Can use anti-CD20 [ritixumab] if B-cell tumor. Rads for some.

69
Q

Dx–2y/o w/ a fever to 105, 3 days later gets a pink, mac-pap rash on trunk arms and legs

A

Roseola-HHV6

70
Q

Dx–2y/o w/ a low grade fever, lacy reticular rash on cheeks and upper body (spares the palms/soles)

A

5th Disease/Erythema Infectiosum- Parvovirus B19

71
Q

Parvovirus B19 is BAD for _____ (3)

A

pregnant pts, SCD, thalessemia

72
Q

Dx–Fine, mac-pap desquamating

rash begins on chest and spreads to neck, trunk, & extremities+ strawberry tongue. Sore throat 1-2wks prior

A

Scarlett fever (GAS)

73
Q

Scarlet fever–tx

A

GAS–> PCN prevents rheumatic fever [cannot help risk post-strep GN]

74
Q

Dx–Cough, runny nose, fever;
macular rash begins behind
ears & spreads down. Gray
spots on the buccal mucosa.

A

Measles–paramyxovirus

75
Q

Measles–tx

A

Vitamin A + supportive care

76
Q

Dx–Sore throat, joint pain, fever; pinpoint rash on the face and spreads down. Rose spots
on the palate.

A

Rubella (paramyxovirus)

77
Q

Rubella–triad of congenital rubella syndrome

A

deafness, eye problems (retinopathy, cataracts, micropthalmima), cardiac issues (PDA, pulm artery stenosis)

78
Q

Dx–Baby w/ poor feeding. Vesicles in moth on palms/soles and rash on buttocks

A

Hand-Foot-and-Mouth Dz (Coxsackie virus A16)

79
Q

Dx–16yo M w/ swollen parotid glands, fever and HA

A

Mumps (paramyxovirus)

80
Q

Mumps–complications for boys

A

orchidis and sterility

81
Q

Dx–6yo from central PA went camping; fever + bullseye

A

Lyme disease (B. burgdorferi)

82
Q

Lyme Dz–complications

A

arthritis, 3rd degree HB, meningitis, Bells palsy

83
Q

Lyme Dz–tx

A

if 8 give doxycycline

84
Q

Dx–6yo from coastal NC went camping. Had fever, myalgias and abdominal pain. Now has papular erythematous rash over body

A

Rocky Mountain Spotted Fever (Rickettsia rickettsii)

85
Q

RMSF–complications

A

vasculitis and gangrene

86
Q

RMSF–tx

A

doxycycline

87
Q

Dx–8yo w/ multiple excoriations on arms. Itchy at night

A

Scabies

88
Q

Scabies–tx

A

5% permetrin; tx WHOLE FAMILY

89
Q

Dx–Honey-colored crusted plaque on face

A

Impetigo (MC bug is staph if bullae)

90
Q

Impetigo–tx

A

topical muciprocin

91
Q

Dx–inflamed conjunctiva and multiple blisters. Nikolsky +

A

SSSS (exfoliative staph toxin)

92
Q

SSSS–tx

A

IV oxacillin/nafcillin

93
Q

Meningitis–MC bugs in neonates; tx?

A

GBS, E. Coli, Listeria; amp + gentamicin

94
Q

Meningitis–MC bugs overall; tx?

A

S. pneumo, N. meningiditis, H. influenza; vancomycin + ceftriaxone

95
Q

Meningitis–young and immunosuppresed

A

Listeria (tx ampicillin)

96
Q

Meningitis–pple w/ brain tumor

A

Staph (tx vanco)

97
Q

Meningitis–TB tx

A

RIPE + ‘roids

98
Q

Meningitis–Lyme tx

A

IV ceftriaxone

99
Q

Meningitis–how to tx roommate of kid in dorm who has bacterial meningitis and petichial rash?

A

rifampin

100
Q

Dx–2 y/o w/ fever to 102, tugging on his right ear. Patient’s tympanic membrane is red and bulging.

A

OM

101
Q

OM–most sensitive dx test

A

Limited mobility on insufflation or air-fluid level

102
Q

OM–RFs

A

↓SES, Native Americans, formula fed, tobacco smoke, around kids

103
Q

OM–tx

A

Amox or azithromycin for 10days. If no improvement in 2-3

days, switch to amox-clav

104
Q

OM–complications

A

Effusion-place tubes if bilat effusion >3mo or if bilateral hearing loss

105
Q

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.

A

Otitis Externa (OE)

106
Q

Otitis externa–tx

A

topical ciprofloxacin

107
Q

Otitis externa–complications

A

malignant OE can invade into temporal bone, causing facial paralysis and vertigo; need CT/IV abx +/- sx

108
Q

Dx–7y/o w/ exudative pharyngitis w/ tender cervical lymph nodes and 102 fever

A

most likely GAS (beta-hemolytic) pharyngitis

109
Q

Strep throat–best 1st test; if negative?

A

rapid strep antigen; if high clinical suspicion, do culture

110
Q

Strep throat–tx?

A

PCN or erythromycin

111
Q

Dx–A child presents w/ “muffled voice”, stridor and refuses to
turn her head to the left.

A

Retropharyngeal abscess

112
Q

Retropharyngeal abscess–tx

A

I&D for C&S. GAS + anaerobes. 3rd gen ceph + amp or clinda

113
Q

Dx–A child presents w/ “hot potato voice” and upon throat

exam her uvula is deviated to the right 2/2 a bulge.

A

Peri-tonsillar abscess

114
Q

Peri-tonsillar abscess–tx?

A

Aspiration or I&D + abx, tonsillectomy if recurrent.

115
Q

Indications for tonsilectomy

A

> 5 episodes of strep/year for 2 years or >3 episodes/year for 3 years

116
Q

Dx–teenager with fever, fatigue, generalized adenopathy and splenomegaly (anterior and posterior cervical nodes)

A

EBV

117
Q

EBV–what happens if give ampicillin/amoxicillin

A

Maculopapular Rash (immune mediated vasculitic)

118
Q

EBV–dx

A

Blood smear shows lymphocytosis w/ atypical lymphs +Heterophile antibody (Monospot) test.

119
Q

EBV–tx

A

self-limited; no contact sports until splenomegaly resolves

120
Q

Dx–1 y/o w/ fever to 100.5 & “barking” cough and loud noises on inspiration.

A

Croup (MC parainfluenza virus)

121
Q

Croup–Xray shows ___; tx

A

steeple sign; mist, racemic epi and steroids

122
Q

Dx–2 y/o w/ fever to 104 & drooling w/ intercostal retractions and tripod position.

A

epiglottitis (MC HiB in unimmunized; MC S. pyogenes, S. pneumo and staph in immunized)

123
Q

Epiglottitis–Xray shows ___; next best step??? tx??

A

thumbprint sign; OR to intubate!!; anti-staph abx + cetriaxone

124
Q

Dx–Kid w/ cough productive of yellow-green sputum, runny nose and T = 100.8. Lung exam only reveals some coarse rhonchi.

A

Acute bronchitis

125
Q

Acute bronchitis–next best step

A

Supportive tx w/ anti-pyretic, tussives, histamines.

126
Q

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.

A

Pneumonia

127
Q

Pneumonia–next best step?

A

CXR

128
Q

Pneumonia–MCC 5yo?

A

GBS/E. coli/Listeria; C. trachomatis/RSV/parainfluenza/S. pnuemo; VIRAL (RSV) then S. pneumo; Mycoplasma/S. pneumo

129
Q

Pneumonia–specific findings for chlamydia pneumonia

A

Staccato cough, eosinophilia

130
Q

Dx–9mo infant w/ runny nose, wheezy cough, T = 101.5, and RR = 60. Retractions are visible and pulse ox is 91%

A

Bronchiolitis (MCC RSV, swab to confirm)

131
Q

Bronchiolitis–CXR shows ___; tx? vaccinate _____

A

hyperinflation w/ patchy atelectasis; hosp if resp distress + albuterol nebs (NO STEROIDS); palivizumab for premies/CHD/lung/immune dz

132
Q

Dx–9mo infant with severe coughing spells with loud inspiratory whoops and vomiting afterwards. 2 weeks ago she had runny nose and dry cough.

A

Pertussis

133
Q

Pertussis–labs show ___; tx?

A

lymphocytosis; erythromycin x14d AND family members/daycare contacts

134
Q

Dx–neonate w/ fever, dehydration and fussiness. Always check for ___.

A

UTI (if fever, then pyelo)

135
Q

UTI–before ____, boys > girls

A

1yo

136
Q

UTI–anatomic RF

A

viscoureteral reflux (prophylax w/ TMP-SMX or nitrofurantoin)

137
Q

UTI–dx

A

clean catch or cath sample, UA and culture (>10k); US if febrile or mass

138
Q

UTI-tx

A

PO TMP-SMX or nitrofurantoin

139
Q

Pyelonephritis–tx

A

IV ceftriaxone or amp/gent x14d

140
Q

Who needs VCUG?

A

all males w/ suspected UTI, females 5 w/ 2nd UTI

141
Q

Role of Tc-labeled DMSA scan in UTI

A

It is most sensitive and accurate study of scarring and renal size, but is not first line.

Pediatric Clerkship (5 decks)

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