Ped Hem/Onc/Allergies Flashcards

1
Q

Low MCV
Normal RDW
High serum iron

A

Thalassemia

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2
Q

MCV of microcytic, normocytic, and macrocytic

A

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

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3
Q

Microcytic anemias

A

iron deficiency
thalassemia
Lead toxicity

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4
Q

Normocytic anemias

A

Sickle cell

ITP

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5
Q

signs/sx’s of iron deficiency

A

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

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6
Q

Peripheral blood smears with basophilic stippling

A

Lead toxicity

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7
Q

How are types of thalassemias differentiated?

A

Ethnicity: Asian (alpha); Mediterranean (beta)

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

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8
Q

What lab values can differentiate iron def anemia from thalassemia?

A
serum iron (high in thalassemia and low in IDA)
Mentzer index (< 13 in thalassemia and > 13 in IDA)
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9
Q

Iron deficiency management in pediatric patients?

A

iron supplement x 3-6 mon and f/u

if no response then get Hgb electrophoresis

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10
Q

Diagnostic labs of Sickle cell

A

peripheral smear with “sickled” cells

Hgb S on electrophoresis

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11
Q

When should routine lead screen be done?

A

at 12 months

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12
Q

Blood smear results of thalassemia

A

microcytic, hypochromic
targets
acanthocytes

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13
Q

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

A

CBC

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14
Q

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

A
3 = silent carrier; asx
2 = Alpha trait; mild anemia
1 = Hb H; pallor, splenomegaly
0 = Hydrops fetalis: stillborn
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15
Q

How can mild thalassemia be treated?

A

folate

NO iron

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16
Q

Anemia common in African Americans

A

Sickle Cell

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17
Q

How do sickle cell carriers present?

A

symptomatic only under severe hypoxia

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18
Q

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

A

1 yo

2 yo

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19
Q

Treatment of Sickle Cell

A
  • Daily folate
  • Hydroxyurea (Hb F)
  • Abx if immunocomp’d to prevent infxtn
  • Vaccinate prior to spleen loss
  • Regular eye exams (prevent retinopathy)
20
Q

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?

21
Q

ITP treatment

A

Based on platelet count; self-limiting

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

22
Q

What meds should be avoided as supportive care for ITP?

A

aspirin or ibuprofen

23
Q

DDX of petechial rash

A

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

24
Q

Pathophysiology of ITP

A

immune mediated destruction of platelets

IgG or IgM mediated antibodies cross-react

25
5 yo child with bone pain, fever, bruising, and pancytopenia on blood smear. Likely dx?
ALL
26
Likely leukemia in 65 yo
CLL
27
Philadelphia chromosome hallmark of _______.
CML
28
Auer rods hallmark of ______.
AML
29
Signs of intracranial tumors
change in mentation, HA, vomiting, gait change, papilledema, torticollis, increased head circumference
30
How to differentiate neuroblastoma and Wilms tumor?
Both have solid abd mass, but neuroblastoma is painful and Wilms is painless
31
Child comes to clinic saying he feels fine, but mother is concerned with hemihypertrophy and abdominal mass. Next best step? Likely dx?
abd U/S to eval kidneys suspect Wilms tumor
32
What is a Type 1 hypersensitivity reaction?
IgE mediated; binds to mast cells which release histamines, cytokines, interleukins
33
How can allergies get worse over time?
with repeated exposures for allergen, body produces more memory cells until a threshold is reached
34
Signs of allergic rhinitis in children on PE
allergic shiners Dennie-Morgan lines (fold under lower eyelid) Nasal salute or crease Nasal mucosa pale and boggy
35
Lab findings of allergic rhinitis
eosinophils on nasal smear elevated IgE serology markers +/- skin testing (gold std)
36
Treatment of allergic rhinitis in children
intranasal steroids anti-histamines prn decongestants if over 6 yo (Afrin) avoid triggers
37
What are common allergies in infants and children?
``` milk protein (most common) eggs nuts seafood legumes bees ```
38
Which food allergies are outgrown? When?
milk protein at 3 eggs at 6 nuts are lifelong!
39
How are lifelong allergies managed?
epi pen
40
Sx's of milk protein allergy
vomiting, bloody diarrhea, colic, failure to thrive
41
How should milk protein allergy be managed by parent?
Initially, no dairy for mom and baby given hypoallergenic milk (Alimentum) Reintroduce whole milk at 15 mon old Should outgrow by 3 yo
42
What is oral allergy syndrome?
local IgE reaction when eating fruit and raw veggies that causes tingling around mouth
43
What should be suspected if 1 month old baby's umbilical cord still has not fallen off?
leukocyte adhesion deficiency
44
Immunodeficiency with face abnormalities, seizures, cardiac defect, and low serum calcium.
DiGeorge syndrome
45
Sickle Cell symptoms
anemia, episodes of pain (crises), delayed growth, swelling of hands and feet, vision changes