Hemo_Onco

Question 1

What type of anemia do iron deficient children have?

Answer 1

microcytic hypochromic anemia

Question 2

What is the best approach for acute resuscitation in newborns with mod-severe dehydration?

Answer 2

bolus NS 20 ml/kg until stable

Question 3

What are 2 major differences between immune thrombocytopenic purpura and acute lymphoblastic leukemia?

Answer 3

• ITP patients look well; ALL patients look sick

- ITP has normal WBC; ALL has neutropenia + 1

Question 4

What is the classic sign of raised ICP?

Answer 4

Cushing’s triad

Question 5

Because patients with SCA are at risk of stroke what yearly test should you perform?

Answer 5

transcranial doppler

Question 6

How do you calculate the lower limit of MCV?

Answer 6

70 + age in years from 1-10 years old

Question 7

Which of the following statements regarding acute lymphoblastic leukemia is NOT true?

a. treatment is risk-based
b. treatment consists of 3+ years of chemotherapy
c. CNS prophylaxis is necessary to prevent CNS relapse
d. Stem cell transplant is recommended in all children

Answer 7

d. Stem cell transplant is recommended in all children

Question 8

How is iron deficiency anemia diagnosed and treated?

Answer 8

• dx: low ferritin

- tx: elemental Fe + Vit C

Question 9

Raised ICP is most commonly caused by what?

Answer 9

hydrocephalus from tumor blockage

Question 10

What is the diagnostic test of choice for acute lymphoblastic leukemia?

Answer 10

-Bone marrow aspirate

Question 11

What are the common causes of high MCV, normocytic, or low MCV anemia?

Answer 11

high MCV = folate/Vit B12 deficiency
normocytic = ACD, acute blood loss
low MCV = iron deficiency anemia

Question 12

What is the risk of correcting hyponatremia too fast?

Answer 12

central pontine myelonosis

Question 13

What is the recommended dietary intervention for lead poisoning patients?

Answer 13

increase iron and calcium

Question 14

What are the 3 major causes of mortality in infants?

Which of the 3 is the major cause of death in first year of life?

Which of the 3 is the major cause of death in teenagers/young adults?

Answer 14

• Septicemia = first year of life
• Acute Chest Syndrome = teens/young adults
• Stroke

Question 15

If a patient presents with a headache over the occipital region that wakes him up at night and ataxia what are you concerned about?

Answer 15

CNS tumor

Question 16

Which of the following should be corrected slower?

hyponatremia or hypernatremia

Answer 16

hypernatremia

Question 17

What is the maintenance fluid of choice if child is >1 year old/10kg vs infant?

Answer 17

• > 1 yo/10kg = D5 NS + 20 mEq/L KCI

- infant = D5 1/2 NS + 20 mEq/L KCI

Question 18

What is the classic sign of immune thrombocytopenic purpura?

Answer 18

petechiae

Question 19

What is the most common complication of SCA?

Answer 19

Pain crisis

Question 20

What is the risk of correcting hypernatremia too fast?

Answer 20

cerebral edema

Question 21

You should define anemia based on what?

Answer 21

MCV

NOT reticulocyte count

Question 22

How do you calculate the deficit volume for mod-severe dehydration?

Answer 22

• First 8 hrs = 50% deficit

- Next 16 hrs = 50% deficit

Question 23

To prevent septicemia from occurring in patients with SCA what prophylaxis treatment is recommended and for how long?

Answer 23

Penicillin until 5 yo

Question 24

What does Cushing’s triad consist of?

Answer 24

• Bradycardia
• HTN
• Respiratory irregularity

Question 25

Calculate the fluid maintenance in a 24 kg child

Answer 25

4ml/kg/hr x 10kg)+(2ml/kg/hr x 10kg)+(1ml/kg/hr x 4kg) = 64ml/hr

Question 26

T/F: IV maintenance fluids can sustain growth or recovery.

Answer 26

False

Question 27

What % of water loss classifies dehydration as mild, moderate or severe in infants?

Answer 27

• mild = 5%
• moderate = 5-10%
• severe = 10-15%

Question 28

What is the cause of aplastic crisis?

Answer 28

wipeout of RBC production d/t parovirus B12 infection

Question 29

Which of the following treatment options is NOT recommended for immune thrombocytopenic purpura?

a. steroids
b IVIg
c. platelet transfusion
d. Anti-D globulin

Answer 29

c. platelet transfusion

Question 30

Which of the following treatment options is the best for immune thrombocytopenic purpura IF the patient has the Rh + factor?

a. steroids
b IVIg
c. splenectomy
d. Anti-D globulin

Answer 30

d. Anti-D globulin

Question 31

What medication can be given for recurrent severe pain crisis in SCA?

Answer 31

hydroxyurea

Question 32

Not including acute resuscitation, what are the 3 components of rehydration for a patient with mod-severe dehydration?

Answer 32

• deficit replacement
• maintenance fluids
• replace ongoing losses

Question 33

What % of water loss classifies dehydration as mild, moderate or severe in older children?

Answer 33

mild = 3 %
moderate = 6 %
severe = 9%

Question 34

What classic symptom do you see in iron deficiency anemia in children?

Answer 34

Pica

Question 35

How do you calculate fluid maintenance?

Answer 35

• First 10 kg = 4 ml/kg/hr
• Second 10 kg = 2 ml/kg/hr
• each additional kg = 1 ml/kg/hr

Question 36

In a patient with SCA if he presents with fingers/toes of unequal length in adulthood what condition do you suspect he had as a child?

Answer 36

Dactylitis (Hand-foot syndrome)

Question 37

What is the best approach to mild-mod dehydration correction?

Answer 37

oral rehydration with pedialyte

Question 38

What lab values is a classic sign of acute lymphoblastic leukemia?

Answer 38

ANC will be rock bottom + 1 other CBC line will be down

Question 39

What lab finding would have you concerned for aplastic crisis in a patient with SCA?

Answer 39

Reticulocyte index of 0 (or low)

It should be high

Question 40

Hypernatremia should be corrected over how many hours?

Answer 40

48-72 hrs