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Heme/Onc > Heme/Onco > Flashcards

Heme/Onco Flashcards

1
Q

Reed Sternberg Cells?

A

Hodgkins Lymphoma

Also, night sweats

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2
Q

Treatment for splenic sequestration??

A

Serial Abd exam
IVF/fluid resuscitation
RBC transfusion
In severe cases, exchange transfusion

Transfusion w/ caution, autotransfusion may occur

High retic, low Hgb

Enlarged spleen

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3
Q

Treatment for acute chest syndrome?

A 
IVF
Infiltrates on X-ray
O2
Incentrive spirometry, bronchodilators
IV abx (cephalosporin and macrolide)
Analgesics
Blood transfusion
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4
Q

Patient with sickle cell is having fever, is hypoxic and has chest pain. You are suspicious that he has what?

A

Acute chest

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5
Q

Patient w/ splenic sequestration has a high or low retic and a high or low Hgb?

A

High retic

Low Hgb

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6
Q

Your 1yo pts CBC shows hypochromic microcytitic anemia w/ an elevated RDW and a low retic. What do you suspect? and how do you treat?

A

Iron deficiency anemia

Treat w/ iron supplements for 3 months

Limit cows milk

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7
Q

If you see target cells on a smear, your patient has …

A

Thalassemia

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8
Q

Your patient has hypochromic microcytic anemia on CBC. Decreased MCV and basophilic stippling, you are suspicious that he has….

A

Thalassemia

Basophilic stippling also seen in Lead Poisioning :)

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9
Q

What is the treatment for Thalassemia?

A

Blood transfusion
Folate

This is serious, they can have CHF and early death

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10
Q

A normal WBC count Hgb level peripheral smear with a decrease in platelets is suggestive of….

A

ITP

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11
Q

A normal healthy 3 year old p/w bleeding gums and a normal hemoglobin and normal labs. She just recovered from a URI. She has petechiae. You notice mego-thrombocytes on peripheral smear. How do you treat?

A

IVIG
Corticosteroids
Rituximab
Platelets (for severe bleeding)

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12
Q

PCN doses for sickle cell prophylaxis

A

2months-3 years: 125mg PO BID
3-5 years: 250mg PO BID

Start once diagnosed

Stop at age 5 if no spleenectomy or no pneumococcal infection

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13
Q

Folic acid supplementation for sickle cell patient?

A

Start at age 1

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14
Q

Frequency of trans cranial Doppler evaluation for sickle cell

A

2 years-16 years. annually

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15
Q

Geoff is a 7 year old male with sickle cell disease. He p/w R hand numbness and weakness. His speech is slurred. He has had a stroke confirmed by an MRI. How do we treat his CVA?

A

Exchange transfusion

NO ANTICOAG

Prevention: Chronic/monthly PRBCs to keep Hgb SS down less than 30%

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16
Q

How does hydroxyurea work??

A

Increases fetal hemoglobin. Hgb F!

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17
Q

What are examples of causes of an ischemic stroke?

A 
Clot
Cardiac
Sickle cell
Lipid abnormalities
Metabolic abnormalities
Dehydration
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18
Q

What is the treatment for Von Willebrand disease?

A

DDAVP
Prevention of bleeding, avoid contact sports
Joint strengthening exercises

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19
Q

Treatment for hemophilia?

A

GIVE THE FACTOR first

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20
Q

Where does osteosarcoma usually arise?

A

Distal femur, proximal tibia
Long bones (also scan lung fields, look for mets on CXR)
Age: teenagers

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21
Q

What is HSP?

A

Hendrich Schonlein Purpura

Bleeding in small vessels in intestines, kidneys, joints

Abdominal pain, blood in urine

Treatment: corticosteroids.

22
Q

In DIC, the following lab values…

D-dimer, PT/PTT, INR, Fibrinogen, and platelets.

A

D-dimer- high

PT/PTT - high

INR- high

Fibrinogen- low

Platelets- low

Treatment: Give FFP (10-15ml/kg), platelets, cryo, Vit K, treat underlying cause

23
Q

HIT

A

Heparin induced thrombocytopenia
Stop all Heparin
Red flag: low platelet on heparin therapy
Patient will have CLOTTING, NOT BLEEDING. Will have DVT and PE

24
Q

Patient comes in with bloody diarrhea, abdominal pain and fever. He recently ate a hamburger at a picnic. BUN=30, Cr=2. Also c/o hematuria. What do we think he has and how do we treat?

A

HUS

Treatment: supportive, diuretics, fluids/electrolyte management, maybe dialysis

Caused by E COLI

25
Q

Children w/ Trisomy 21 are at risk for what anemia and what cancer?

A

ALL

Macrocytic anemia w/ a low Retic

26
Q

Patients who need folate….

A

Sickle cell

Thalassemia

27
Q

Leukocoria is associated w/ what kind of cancer?

A

Retinoblastoma

28
Q

True or False: it is better to have acute ALL when you are younger.

A

True. Under 10 years

29
Q

Chloromas are associated with

A

AML

Blueberry muffins

30
Q

Fever, bone pain and limp are associated with…..

A

ALL

31
Q

Night sweats and a swollen lymph node are associated with…

A

Hodgkins lymphoma

32
Q

Typhlitis treatment includes….

A

Antibiotics (cover for gram negatives)
IVF
Surgical consult

Associated with mucocitis

33
Q

Treatment for tumor lysis syndrome:

A

Allopurinol (lowers uric acid)
Rasburicase and Ampha Gel (lowers your Phos)
Aggressive fluid hydration (no K in fluids)

34
Q

When do you start hydroxyurea w/ Sickle Cell

A

Consider w/ frequent crisis or severe disease

35
Q

Vaccine PEARL

A

Pneumococcal vaccine- vaccine w/ 13 valant conjugate vaccine as per routine childhood schedule.

23 valant polysaccharide @ age 2 and booster at age 5 for all sickle cell/other high risk croups

Meningococcal vaccine- give at age 2years and Q5 years after that

Normal meningococcal vaccine given at age 11-12 and booster at age 16-18

Influenza vaccine— yearly beginning at 6 months (get 2 for 1st dose)

36
Q

ALL pt on chemotherapy is due for MMR vaccine, should he get it?

A

MMR is a live vaccine. Do not give for 1 year post chemotherapy

37
Q

Live vaccines

A 
MMR
Rota
Nasal flu
Varicella
BCG/OPV/Typhoid
38
Q

When do you vaccinate w/ bone marrow transplant

A

1 year post BMT, re-vaccinate ALL vaccines

Do not give any vaccines, live or dead, w/ BMT until 1 year out

39
Q

Vaccines and chemo

A

Can give dead vaccines during chemo :)

But nothing live for 1 year

40
Q

How long do you have to wait to give live vaccine after IVIG????

A

11 months

41
Q

How do we tx neutropenic patient w/ a fever w/ a line

A

VANC
GENT
CEFEPIME

42
Q

Mother brings in a 2 year old w/ hematuria and large distended abdomen. What should you not do?

A

Do not palpate abdomen
Suspect Wilms tumor
Often caught by parents

43
Q

3 y/o w/ periorbital ecchymosis, what oncologic process do you suspect?

A

Neuroblastoma

44
Q

Clinically significant bleeding is not probably not happening if platelets are above what?

A

> 20,000

45
Q 
What is not a macrocytic anemia??
A. Fanconi
B. Diamond blackfan
C. Aplastic
D. Iron Deficiency
A

D. Iron deficiency

A, B, and C are all Macrocytic

46
Q

When is the physiologic nadir of hgb for infants

A

8-12 weeks for full term

3-6 weeks for pre-term

47
Q

G6PD

A

Cause of hemolytic anemia

Avoid certain drugs (NSAIDS) and foods (fava beans)

x-linked disorder

48
Q

An example of a hypercoagulable condition

A

Protein C and Protein S deficiency and Anti thrombin 3 and Factor V Leiden

Increased risk for venous thrombosis

49
Q

When is Warfarin indicated?

A

Long term anticoagulation

Heparin or low weight heparin when initiating Warfarin therapy

50
Q

How do you dx Sickle Cell

A

Sickledex
Newborn screen
MCV
**Hemoglobin electrophoresis*

Heme/Onc (1 decks)

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