Ped Hem/Onc/Allergies

Question 1

Low MCV
Normal RDW
High serum iron

Answer 1

Thalassemia

Question 2

MCV of microcytic, normocytic, and macrocytic

Answer 2

microcytic: MCV < 80
normocytic: MCV 80-100
macrocytic: MCV > 100

Question 3

Microcytic anemias

Answer 3

iron deficiency
thalassemia
Lead toxicity

Question 4

Normocytic anemias

Answer 4

Sickle cell

ITP

Question 5

signs/sx’s of iron deficiency

Answer 5

weakness, tachycardic, palpitations, angular cheilosis, koilonychias (nail spooning), pica, Plummer-Vinson (esophageal webs)

Question 6

Peripheral blood smears with basophilic stippling

Answer 6

Lead toxicity

Question 7

How are types of thalassemias differentiated?

Answer 7

Ethnicity: Asian (alpha); Mediterranean (beta)

Hgb electrophoresis: normal (alpha); increased Hb A2 and F (beta)

Question 8

What lab values can differentiate iron def anemia from thalassemia?

Answer 8

serum iron (high in thalassemia and low in IDA)
Mentzer index (< 13 in thalassemia and > 13 in IDA)

Question 9

Iron deficiency management in pediatric patients?

Answer 9

iron supplement x 3-6 mon and f/u

if no response then get Hgb electrophoresis

Question 10

Diagnostic labs of Sickle cell

Answer 10

peripheral smear with “sickled” cells

Hgb S on electrophoresis

Question 11

When should routine lead screen be done?

Answer 11

at 12 months

Question 12

Blood smear results of thalassemia

Answer 12

microcytic, hypochromic
targets
acanthocytes

Question 13

What labs should be ordered for anyone with unexplained petechial rash?

Answer 13

CBC

Question 14

What are four variants of alpha thalassemia and how do they present?

Answer 14

3 = silent carrier; asx
2 = Alpha trait; mild anemia
1 = Hb H; pallor, splenomegaly
0 = Hydrops fetalis: stillborn

Question 15

How can mild thalassemia be treated?

Answer 15

folate

NO iron

Question 16

Anemia common in African Americans

Answer 16

Sickle Cell

Question 17

How do sickle cell carriers present?

Answer 17

symptomatic only under severe hypoxia

Question 18

Onset of Sickle Cell by age _____ and loss of spleen by age _____.

Answer 18

1 yo

2 yo

Question 19

Treatment of Sickle Cell

Answer 19

• Daily folate
• Hydroxyurea (Hb F)
• Abx if immunocomp’d to prevent infxtn
• Vaccinate prior to spleen loss
• Regular eye exams (prevent retinopathy)

Question 20

3 yo female with petechial rash but otherwise normal PE. Recent URI that has resolved. Only finding on CBC was thrombocytopenia. What do you suspect?

Answer 20

ITP

Question 21

ITP treatment

Answer 21

Based on platelet count; self-limiting

> 50: no tx; close monitoring
10-20 or bleeding signs: IV IG
< 10: platelet transfusion

Question 22

What meds should be avoided as supportive care for ITP?

Answer 22

aspirin or ibuprofen

Question 23

DDX of petechial rash

Answer 23

meningits (fever)
HUS (E. coli infxtn)
TTP (older, HA)
ITP (young, asx)

Question 24

Pathophysiology of ITP

Answer 24

immune mediated destruction of platelets

IgG or IgM mediated antibodies cross-react

Question 25

5 yo child with bone pain, fever, bruising, and pancytopenia on blood smear. Likely dx?

Answer 25

ALL

Question 26

Likely leukemia in 65 yo

Answer 26

CLL

Question 27

Philadelphia chromosome hallmark of _______.

Answer 27

CML

Question 28

Auer rods hallmark of ______.

Answer 28

AML

Question 29

Signs of intracranial tumors

Answer 29

change in mentation, HA, vomiting, gait change, papilledema, torticollis, increased head circumference

Question 30

How to differentiate neuroblastoma and Wilms tumor?

Answer 30

Both have solid abd mass, but neuroblastoma is painful and Wilms is painless

Question 31

Child comes to clinic saying he feels fine, but mother is concerned with hemihypertrophy and abdominal mass. Next best step? Likely dx?

Answer 31

abd U/S to eval kidneys

suspect Wilms tumor

Question 32

What is a Type 1 hypersensitivity reaction?

Answer 32

IgE mediated; binds to mast cells which release histamines, cytokines, interleukins

Question 33

How can allergies get worse over time?

Answer 33

with repeated exposures for allergen, body produces more memory cells until a threshold is reached

Question 34

Signs of allergic rhinitis in children on PE

Answer 34

allergic shiners
Dennie-Morgan lines (fold under lower eyelid)
Nasal salute or crease
Nasal mucosa pale and boggy

Question 35

Lab findings of allergic rhinitis

Answer 35

eosinophils on nasal smear
elevated IgE serology markers
+/- skin testing (gold std)

Question 36

Treatment of allergic rhinitis in children

Answer 36

intranasal steroids
anti-histamines prn
decongestants if over 6 yo (Afrin)

avoid triggers

Question 37

What are common allergies in infants and children?

Answer 37

milk protein (most common)
eggs
nuts
seafood
legumes
bees

Question 38

Which food allergies are outgrown? When?

Answer 38

milk protein at 3
eggs at 6
nuts are lifelong!

Question 39

How are lifelong allergies managed?

Answer 39

epi pen

Question 40

Sx’s of milk protein allergy

Answer 40

vomiting, bloody diarrhea, colic, failure to thrive

Question 41

How should milk protein allergy be managed by parent?

Answer 41

Initially, no dairy for mom and baby given hypoallergenic milk (Alimentum)

Reintroduce whole milk at 15 mon old

Should outgrow by 3 yo

Question 42

What is oral allergy syndrome?

Answer 42

local IgE reaction when eating fruit and raw veggies that causes tingling around mouth

Question 43

What should be suspected if 1 month old baby’s umbilical cord still has not fallen off?

Answer 43

leukocyte adhesion deficiency

Question 44

Immunodeficiency with face abnormalities, seizures, cardiac defect, and low serum calcium.

Answer 44

DiGeorge syndrome

Question 45

Sickle Cell symptoms

Answer 45

anemia, episodes of pain (crises), delayed growth, swelling of hands and feet, vision changes