Newman, VG

Question 1

Clinical features seen when Hb falls below 7-8

Answer 1

pallor, sleepiness, irritability, decreased exercise tolerance, flow murmur (grade 2-3, systolic ejection, crescendo-decrescendo, between LLSB and apex).

Question 2

MCV and RDW in IDA vs. Lead-Poisoning

Answer 2

IDA: slight decrease in MCV, slight increases in RDW
Lead: slight decrease in MCV, HUGE INCREASE in RDW

Question 3

Anemia caused by decreased RBC production caused by ineffective/incomplete or complete failure of erythropiesis results in: ____ # of reticulocytes

Answer 3

low or normal number of reticulocytes (inadequate marrow response to anemia)

Question 4

Anemia caused by increased destruction or loss of RBC due to hemolysis, sequestration, or bleeding results in _____ # of reticulocytes

Answer 4

normal number (normal marrow response to anemia)

Question 5

Three most common causes of microcytic anemias in kids:

Answer 5

IDA, Lead poisoning, thalassemia

Question 6

Physical findings for fanconi anemia

Answer 6

Microcornea, hyperpigementation of the skin

Question 7

Physical findings for Vit B12 deficiency

Answer 7

glossitis, mouth sores

Question 8

Physical findings for Diamond-Blackfan Syndrome

Answer 8

Shield chest

Question 9

Physiologic nadir of Hct/Hb occurs when?

Answer 9

6-8 weeks

Question 10

Define Diamond-Blackfan Syndrome, avg age of dx, and lab findings

Answer 10

• Perfect example of a PURE red cell aplasia due to increased apoptosis in erythroid precursors.
• Avg dx is at 3mo (neonatal pallor progressing to sx anemia)
• MACROcytic with low retic count

Question 11

Define Fanconi Anemia, avg age of dx, and lab findings

Answer 11

A pancytopenia due to increased apoptosis of marrow progenitor cells.

• 8yo (cafe-au-lait, low briht wt, thumb/renal/eye abnormalities)
• MICROcytic

Question 12

IDA, avg age of dx, and lab findings

Answer 12

Highest risk from 6-36mo

• MICROcytic with elevated RDW, possible target cells
• increased transferritin, low iron/ferritin

Question 13

Sickle cell inheritance pattern and lab findings.

Answer 13

AR

basophilic stippling, reticulocytosis, hemolysis, HgbS on electrophoresis

Question 14

What is often associated with birth trauma - can cause mental status changes, jaundice, tachycardia, tachypnea, increased HC, normal retic, low Hgb (~9) in a newborn

Answer 14

subgleal hemorrhage brith trauma (vacuum/forceps)

Question 15

Mentzer Index

Answer 15

Used to differentiate between iron deficiency and thalassemia.
MCV/RBC. greater than 13 suggests iron deficiency (decreased RBC#); less than 13 suggests thalassemia (normal RBC#)

Question 16

Normocytic anemia in older child with a low retic count = ?

Answer 16

Marrow hypofunction –> ddx: leukemia

Question 17

Most common cause of thrombocytopenia in kids - ISOLATED THROMBOCP in the absence of any obvious initiating or underlying cause

Answer 17

Acute ITP

Question 18

Clinical manifestations of ITP

Answer 18

petechiae, purpura, ecchymoses, gingival bleed, epitaxis, menorrhagia, GI bleed, hematuria, CNS hemorrhage

Question 19

Platelet:
Normal count, Primary hemostasis impaired when below___, spontaneous bleeding below ___, clinically significant bleeding below___, life threatening hemorrhage below____.

Answer 19

• Normal count - 150,000 to 450,000
• Primary hemostasis impaired when below 75,000
• Spontaneous bleeding below 50,000
• Clinically significant bleeding below 20,000
• Life threatening hemorrhage below 10,000

Question 20

Four main causes of thrombocytopenia

Answer 20

Decreased platelet production, decreased platelet survival, sequestration, dilution

Question 21

Anemia and leukopenia, then consider what?

Answer 21

Marrow failure/infiltration

Question 22

Most common viral infection caused by marrow suppression

Answer 22

Parvo, CMV, HIV, EBV, varicella

Question 23

Causes of decreased platelet production (5)

Answer 23

1. Marrow failure or infiltration
2. Infection
3. Cyanotic heart disease
4. nutritional deficiencies
5. genetic defects

Question 24

Sudden onset of bruising/petechiae or mucocutaneous bleeding in an otherwise healthy child (with NO SYSTEMIC SYMPTOMS), think what?

Answer 24

Acute ITP (1/2 follow 1-2wks after viral illness)

Question 25

What labs in Acute ITP

Answer 25

ONLY ISOLATED THROMBOCYTOPENIA

Question 26

Tx of Acute ITP

Answer 26

None that alter natural history, but use IVIG/prednisone/anti-D Ig to temporarily increase platelets

Question 27

Plt range ofr chronic ITP. QOF? Tx?

Answer 27

30,000-80,000
Normal, just no contact sports
Tx - splenectomy

Question 28

Worry about what?

1. All cell lines decreased + LAD + constitutional symptoms
2. All cell lines decreased only

Answer 28

1. leukemia

2. aplastic anemia

Question 29

Plt low, H/H low, WBC normal, child presents with rash, fatigue, bloody diarrhea, bleeding gums.

Answer 29

microangiopathic process