Peds Final Flashcards
which conditions need IVIG?
why?
immune thrombocytopenia
Kawasaki’s (high dose)
SCID
Wiskott-Aldrich Syndrome
it provides immunoglobulins and cells needed to replenish WBCs and platelets.
- 1 to 4 weeks after a viral illness with children younger than 10 years old
hint: given prednisone, anti-D antibody, and IVIG.
immune thrombocytopenic purpura
lack of response to antigens, lymphopenia, absence of plasma cells in the bone marrow. History of recurrent, severe infections from early infancy.
what am I?
how am I treated?
Severe combined immunodeficiency syndrome
HSCT can cure this if given by 3 months
If not, IVIG is also given.
X-linked
eczema
thrombocytopenia
immunodeficiency of T and B cells
prognosis?
-what are two conditions this child is more at risk for?
treatment?
cure? (no time frame here)
what is a special component here not seen anywhere else?
Wiskott-Aldrich Syndrome
fatal if not cured with HSCT as soon as possible.
cancer and auto-immunity
IVIG, platelet transfusion, splenectomy, aggressive eczema treatment, prophylactic antibiotics, G-CSF.
the inclusion of G-CSF for neutropenia correction
bone marrow failure (Anemia)
and nutritional deficiency
–decreased RBC production for both
increased RBC loss
increased RBC destruction
aplastic anemia
epistaxis, hemophilia, DIC, Idiopathic Thrombocytopenic purpura.
SCD and thalassemia + isoimmunization, chemo, irradiation, infection.
despite hemodilution, decreased peripheral resistance, increased circulation and turbulence within the heart causing a murmur, possibly leading to cardiac failure, growth retardation, anorexia, delayed sexual maturation.
there is not what?
cyanosis
Which age group is most susceptible to Iron deficiency anemia?
why?
treatment?
when can you expect improvement?
12–36-month-olds
they can now have milk, and the parents give them this to the exclusion of other foods, and plus they can’t chew a lot of things that have an excess of iron.
give iron tablets and orange juice
in 1 month
breast fed infants need iron during which periods?
4-12 months
aplastic
hyperhemolytic
acute splenic sequestration
acute chest syndrome
what are these?
SCA
diminished production of RBCs causing a crisis.
increased RBC destruction.
pooling of blood, spleen swells dropping hgb levels, the spleen gets blocked, and it can no longer filter blood cells.
RBCs congregate and block an area in the lungs, usually combined with infection.
precautions to take with SCA pts?
penicillin prophylaxis from 2m-5y
get all the pneumococcal vaccinations (+hib and meningococcal), starting at 2 months.
give blood, fluid, and electrolyte replacement
under 5 is at the most risk, so it’s ideal to get HSCT before then.
stroke prevention
special treatment that aplastic anemia pts get?
antilymphocyte globulin (immunosuppressive) which is ALG and ATG
Tumor lysis syndrome
high phosphate, high potassium, low calcium, high uric acid.
superior vena cava syndrome
caused by Hodgkin’s or NHL or thrombotic complications of implantable IV devices.
hemorrhagic cystitis
what med is given?
to stop this irritation from chemo, increase fluid intake and void frequently and start chemo earlier in the day giving time to of this and flush the drug out of the system.
mesna (inactivates metabolite that causes damage to the bladder)
After a HSCT, what should you not do?
get a live attenuated vaccine like MMR or varicella.
wound left open to close naturally
secondary intention
thelarche
adrenarche
menarche
puberty “delay”
first two, 8-13 years.
breast buds
pubic hair growth
two years after thelarche, menstruation begins.
delay if no thelarche by 13 years.
a) penile growth, first ejaculation, axillary, groin, and facial hair, final voice change.
b) penile enlargements, voice changes, early facial hair, gynecomastia.
c) testicular enlargement and sparse pubic hair.
d) no enlargement of testes or scrotal changes by 14 years
stage 1 (9.5-14 years)
stage 3
stage 5
pubertal delay
stage 1: c
stage 3: b
stage 5: a
delay: d
Erikson’s (3-6)
(6-12)
(>12)
initiative v. guilt
industry v. inferiority
identity v. role confusion
enlarged testicular veins, resulting in pain or growth arrest of affected testicle, may impair fertility; requires surgery or embolization.
varicocele
gynecomastia is related to which condition?
varicocele
phototherapy and a radian warmer does what was fluid requirements?
what about mechanical ventilation?
increases the need
decreases the need
rapid fluid replacement is contraindicated in which type of dehydration?
hypertonic
defect in the ability to concentrate urine.
s/s?
diet?
meds?
nephrogenic diabetes insipidus
unexplained fever, hypernatremia, copious amounts of dilute urine.
low sodium/low solute diet
hydrochlorothiazide + potassium supplementation.
___albuminemia
____proteinuria
hyper________
edema
give which two meds?
cause?
hypoalbuminemia
massive proteinuria
hyperlipidemia
edema
loop diuretics (d/t hypoalbuminemia)
steroids (need immunosuppressants b/c helps with inflammation and reduces additional damage)
varied, not d/t immune complexes, that is glomerulonephritis
leukemias
most common childhood form?
s/s?
r/t condition?
diagnostics?
prognosis?
ALL
bone pain, lymphadenopathy, hepatosplenomegaly, fever, bleeding.
aplastic anemia
blood smear, low blood counts, bone marrow aspiration/biopsy, then LP to determine CNS involvement.
80-90%
all that goes into clinical staging and prognosis of Acute Leukemias
name the basics:
immunophenotyping of the T and B lineage, myeloid antigens.
–they decide who is most at risk and assign them into risk-based groups where they can receive specialized treatment.
dx based on WBC count, CNS involvement found at LP, testicular involvement, Down syndrome (compromised immune system), sex, race, ethnicity, nutritional status, leukemic cell characteristics.
of course, the response to treatment which determines the prognosis.
3 phases of chemotherapy
remission induction, consolidation/intensification, maintenance (continuation–so they keep levels low)
HL or NHL, which is more common in children? Which is caused by the Epstein-Barr Virus?
NHL
HL
what has improved the dx of lymphomas?
risk group stratification, systemic staging (Ann-Arbor), and improved treatment protocols.
lymphomas
s/s?
dx?
anorexia, wt loss, night sweats, pruritus, low-grade fever, cough (tendency to move to the mediastinal area), and abdominal pain (mesenteric area).
total body imaging (to hit all the lymphatic drop off areas)
H&P (for risk group stratification)
+bone marrow aspiration and LP (d/t lymphoma relation to hemopoietic cells)
use immunophenotyping, cytogenics, and FISH.
use risk adapted chemo (b/c survival is not 80%)
surgery is applicable for NHL
brain tumors
s/s?
no LP if___?
dx?
tx?
most clinical manifestations are related to their anatomical location, tumor size, rate of growth, child’s age/developmental stage.
mostly: bulging fontanel, increased head circumference, headache, vomiting, nystagmus, ataxia, dysarthria, dysmetria (inability to control distance, speed, ROM)
increased ICP
MRI is gold standard
will use surgery, chemo, radiation (before surgery) to lessen this solid tumor and ultimately remove it in surgery. (note: this can have serious long-term consequences)
brain tumor post op complications
watch out for meningitis, testing reflexes, hand grip, cranial nerves, pupils, LOC, response to stimuli, dressing (drainage)
-for the dressing, avoid putting pressure against it.
-reduce ICP
-avoid aspiration.
-regulate fluids because cerebral edema and increased ICP fucks it up.
comfort with: low stim environment, eye drops, prevent strain (stool softener and antiemetics), suction, ice compress for facial edema.
from neural crest cells in adrenal medulla.
firm, nontender, irregular mass in the abdomen that crosses the midline; pain, vomiting, anorexia, urinary frequency or retention (compression of kidneys and ureters by tumor)
tumors excrete catecholamines.
“silent rumor”–70% detected after metastasis.
HSCT and myloablative therapy (during consolidation phase, in high-risk patients)
recognize poor prognosis
neuroblastoma
mass in abdomen combined to one side?
how about at midline?
Wilm’s tumor
neuroblastoma
bone tumors
bone marrow biopsy is used with which of the tumor types?
radiation is more common with which tumor type?
surgery? which type is more likely to get it?
ES (Ewing sarcoma)–bone marrow spaces can be targeted with biopsy and radiation.
surgery resulting in amputation is more often in Osteosarcoma due to it often affecting osseous tissue and infecting long bones.
nephroblastoma or?
age group most affected? times they are screened?
s/s?
CT and Chest XR is looking for what?
what condition is associated with this?
mechanisms of treatment?
Wilm’s tumor
<5, 3m-8y
HTN, hematuria–anemia, wt loss, fever, swelling or mass in the abdomen, firm, nontender, confined to one side and deep in the flank.
lung metastasis
von Willebrand disease
surgery immediately, postop chemo, radiation for advanced stages.
tumor arising from mesenchymal cells, which normally develop into muscles, but go to other sites like orbit, nasopharynx, paranasal sinuses, middle ear, retroperitoneal area, perineum.
ages 1-9 with the best prognosis
rhabdomyosarcoma
what’s the survival rate of retinoblastoma?
10 year survival rate of 90%
encephalitis
etiology
s/s (think of the mnemonic chatgpt made)
implications of condition
either direct invasion (by enterovirus) or postinfectious involvement after a viral disease.
malaise, headache, dizziness, apathy, nuchal rigidity, n/v, ataxia, tremors, hyperactivity, speech difficulties
apathy..but hyperactivity
Monitor for ICP, especially if a LP is used.
long-term complications: learning difficulties, epilepsy.
details of rabies
tx?
virus multiples in muscles, incubates for 1-3m, but can be as short as 5 days or as long as 6m.
inactivated rabies vaccine, 4 doses over 2 weeks.
globulins added with the first dose of rabies vaccine (1/4 help)
toxic encephalopathy
-preceded usually by varicella, influenza.
fever
profuse vomiting
neurologic impairment
disordered hepatic function
aggressive supportive therapy.
what should parents know?
Reye syndrome
don’t give salicylates to children every time they have flu-like symptoms.
two or more unprovoked seizures more than 24 hours apart.
epilepsy
what is the initial manifestation for generalized seizures?
a loss of consciousness
