Pediactric Bullshit Flashcards
5 day old, rash, mother from central america, UTI pregnancy complication, erythematous rash at birth on face, periorbital swelling, to trunk and diaper area, hepatosplenomegaly, WBC elevated, 52% blast forms, elevated platelets, LDH high
DDx - syphilis, chlamydia, herpes, neuroblastoma, letterer siwe, MPD
erythema toxicum neonatorum
rash on face
not too much worse
neutrophil stages
promyelocyte myelocyte metamyelocyte band segmented PMN
herpes infection
can cause lots of problems so test for this in babies
tzanck test
for herpes
lymphocytosis in infant
viral - EBV - mirror cells
-or upper resp infection - cough, whoops - pertussis
letterer-siwe disease
langerhans cell histiocytosis
accumulation of dendritic cells
no known cause
peak age - 2 yo
skin rash lesions - vesicular
leukamoid rxn
> 50,000 leukocytes in blood
must distinguish from CML
basophilic leukocytosis
MPD - chronic myeloid leukemia
leukemic hiatus
majority of blasts
-not progressing to mature cells as they should
also elevated LDH - suggest rapid proliferation - neoplastic disorder
thrombocytosis in newborn
acute inflammation blood loss nutrition conditions asplenia MPD neuroblastoma mother substance abuse
transient myelproliferative disorder
trisomy 21 - possible mosaicism
only distinguishing factor - resolves by 12 weeks of age**
clinically identical to acute myeloid or megakaryocytic leukemia
MUST be followed by pediatric oncology physician
rash of true infant leukemia
nodular
FISH probe for chromosome 21q22
trisomy 21
3yo boy pallor, bruising, intermittent fever 3 weeks, low WBC, low platelets, BM shows myeloblasts, pancytopenia
ALL or AML
aplastic anemia BM
nothing there
13yo F malaise fever 1 week, bilateral nontender cervical nodes, splenomegaly, EBV titers high, WBC 135,000, low platelets, LDH high, uric acid high, 95% WBC blasts, mediastinal widening, BM lymphoblasts - T cells (CD2/7)
presumptive mono dx
-not mono when see high WBC blasts and marrow
high risk ALL - rapid onset - high tumor burden - WBC > 50,000
5yo F, bilateral leg and wrist pain, fever 103 three weeks, MCV 77, ESR 35 (sed rate), dx rheumatoid arthritis, but gets worse, elevated LDH, BM pre-B lymphocytes
bone pain - cytokine from lymphoblasts and marrow expansion
ALL
most common pediatric cancer - 25%
peak 2-5yo males
AML
4% of all childhood cancers
-predisposition with chemo and radiation - in older children
CML
can happen in kids, rare
myeloproliferative disorder
syndromes with acute leukemias
down syndrome
fanconi
klinefelter
shwachman diamond
WBC > 200,000
microemboli in brain or lungs in children
stroke or PE
more commonly in AML
resp distress, cough, facial edema
suggest SVC syncrome
-mediastinal compression in ALL
life threatening bleeding
secondary to DIC
in AML
evan syndrome
anemic and low platelets
DDx of leukemia malignancies
neuroblastoma
retinoblastoma
rhabdomyosarcoma
confirm Dx of leukemoa
BM studies
flow cytometry
cytogenics
CSF
must rule out CNS leukemia
need to be done under optimal conditions to prevent traumatic tap that introduces leukemic cells to CNS
80-90% ALL
cured in children
50% AML
cured in children
lower risk fx
age 1-9 and low to normal WBC at diagnosis
high risk fx
age > 10yo, infants with high WBC and those with mature B cell leukemia
hyperdiploidy
better prognosis
t9:22
higher risk
ALL therapy
aggressive first 6-12 months
CNS prophylactics - intrathecal chemotherapy
therapy extends 2-3 years
AML therapy
intensive chem for about 1 year
bone marrow transplant if possible
risk with Tx
greatest risk - infection
manage fever critical
live virus vaccines - CONTRAINDICATED**
avascular necrosis of joints
with corticosteroids
tumor lysis
hyperuricemia hyperkalemia renal failure fatal arrhythmia P/Ca metabolism messed up
to tx this - diuretics and lots of fluids**
pallor, jaundice, splenomegaly
hemolytic process
cold Abs
IgM - require complement
warm Abs
IgG - no complement
differentiate AHA from other causes of anemia
direct coombs
tx of autoimmune hemolytic anemias
corticosteroids
increase in Hg within few days of therapy with prednisone
RBC transfusions - if anemia serious
donath landsteiner Ab
cause of hemolysis
uncommon IgG cold hemolysin after viral infection and syphilis
tx of sickle cell
hydroxyurea - enhances production of HgF
ABE
acute bilirubin encephalopathy
BIND
bilirubin induced neuro dysfunction
kernicterus
blueberry muffin baby
purpura as result of EMH
