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Pediatrics Exam 2 > Peds. Heme > Flashcards

Peds. Heme Flashcards

1
Q

The two reasons why physiologic jaundice occurs:

A
  1. Increased destruction of RBC - lifespan of RBC is 70-90 d

2. Hepatic uptake is lower (decreased glucuronyl transferase) - this conjugates bilirubin

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2
Q

When does physiologic jaundice appear and pattern?

A

Days 3-5; cephalopods –> caudal

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3
Q

Breastfeeding jaundice is when:

A

The mom is not producing enough milk - their jaundice is MORE EXAGGERATED because they are dehydrated and nutrient deprived

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4
Q

Breast Milk jaundice is when:

A

There is a LATER onset of physiologic jaundice with peak bilirubin levels 2-3 weeks after birth (slower progression)

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5
Q

What is the normal level of diapers for elimination?

A
  • 6 wet

- 3-4 dirty

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6
Q

Bilirubin levels and regions of the body:

A 
Safe (II): Head and to the nipple line = 12
Dangerous (III): Lower abdomen and legs = 8-16
More dangerous (IV): Arms and lower legs: 11-18
BAD (V): Palms and soles (15)
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7
Q

What do you order and treatment level for bilirubin assessment?

A

TSB; treat after 12

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8
Q

What is Kernicterus:

A

Acute bilirubin encephalopathy - stains the basal ganglia, pons or cerebellum

Bilirubin >20
Symptoms when bilirubin >25

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9
Q

Major risk factors for hyperbilirubinemia

A 
Jaundice within 24 hours of birth
A sibling with jaundice as a neonate
Unrecognized hemolysis
Nonoptimal sucking/nursing
Def. in glucose-6-phosphate
Infection 
Cephalohematoma (extra blood)
East Asian or mediterranean
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10
Q

When do you treat a baby with phototherapy? Day 3 and day 5 levels:

A

Day 3: At 16/17

Day 5: Over 20

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11
Q

Kernicterus has not been documented to show:

A

A relationship with Breast milk jaundice

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12
Q

What are the therapies for breast milk jaundice (2)?

A
  • 1-2 days of formula (keep pumping) and breast feed later

- Phototherapy

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13
Q

What is the therapy for breastfeeding failure jaundice?

A
  • 1-2 days of formula and then re-begin breast feeding 5 days later (jaundice usually does not return)
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14
Q

If you see jaundice in the first 24 hours of life, think of:

A

Hemolytic anemia

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15
Q

What are the two causes of hemolytic anemia?

A
  • Mom is rh - and baby is rh +

- Mom is O and baby is A or B

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16
Q

Hemolytic disease of the newborn is from:

A

Mom is Rh- and formed AB against previous Rh + baby - now her Ab are attacking baby #2 RBC = lysis

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17
Q

To prevent AB formation to an Rh+ baby, mom is given shots when?

A

28 weeks and within 72 hours of birth

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18
Q

To test if the baby is a different blood type than mom, you can perform the:

A

Direct Coomb’s test - Looking for AB on the baby RBC

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19
Q

If the direct coomb’s test is positive, you should:

A

Switch the infant to formula

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20
Q

What do you do for a baby with Hemolytic anemia of the newborn?

A
  • hospitalize

- exchange transfusion

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21
Q

Anemia is diagnosed when:

A

It is two SD below the normal

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22
Q

Pattern of H and H in newborns:

A

Newborn: HIGH: 18.5 and 56%
1 mo - 2 yr: Decreases to 13 and 36%
12: Adult levels

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23
Q

What is the most common cause of anemia in kids?

A

Iron def. during times of rapid growth - toddlers and adolescents

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24
Q

When does a normal term and a premature infant run out of its iron stores?

A

Normal: 4-6 months
Premature: 3-4 months

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25
Q

What three things would make a child vulnerable to anemia?

A
  • Low SES (mex. Americans)
  • Lead exposure
  • Exclusively breast feeding beyond 4 months
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26
Q

IDA is more common where?

A

Inner city (8%)

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27
Q

When is routine Fe screening and when should it be done early?

A

Routine: at 12 months
Early:
- 9-12: Low SES, immigrated to USA
- 6 months: Pre-term/low birth weight

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28
Q

How should you treat IDA? Recovery?

A
  • 3-6 mg of iron/kg/day TID or BID
    Response: 1g/dL/week
    Recovery: 6-8 weeks
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29
Q

What are two PE findings of sickle cell?

A
  • Maxillary hyperplasia

- Dactylysis

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30
Q

What is the most common reason for early mortality in sickle cell patients?

A

Acute Chest Syndrome

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31
Q

What are the three symptoms of pediatric acute chest syndrome?

A
  • Fever
  • Cough
  • Upper lobe
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32
Q

What are the three symptoms of adult acute chest syndrome?

A
  • Afebrile
  • Pain
  • Lower lobe
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33
Q

What are lab findings for Sickle cell?

A

Increased: MCV, WBC, Platelets
Decreased: H & H

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34
Q

An aplastic crisis can result from:

A

A parvovirus infection - slapped cheek rash

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35
Q

What is hereditary spherocytosis and treatment?

A

The RBC membrane is rigid and gets clogged in the spleen - treatment is to remove the spleen

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36
Q

When should you perform a splenectomy on someone with hereditary spherocytosis?

A

Age 5/6 or unless they are being hospitalized for crisis before then

37
Q

You are susceptible to parvovirus causing problems with what two illnesses?

A
  • Hereditary spherocytosis

- Sickle cell

38
Q

Primary hemostasis involes what two things:

A

Platelets and endothelial cells

39
Q

What does secondary hemostasis involve?

A

Coagulation factors

40
Q

ITP only affects the ___ in the body and is most common in ____ YO (time of year?)

A

Platelets; 2-5 - Summer and spring

41
Q

Progression of ITP in kids:

A

Follows a viral illness from 1 month ago and resolves within 6 months

42
Q

What are some symptoms of a primary bleeding disorder?

A
  • Bleeding from mucous membranes
  • Epistaxis
  • Eccymosis
  • Petechiae
  • Prolonged bleeding from wound
43
Q

What are some symptoms of a secondary bleeding disorder?

A
  • Palpable SC/IM hematomas

- Hemarthroses

44
Q

What should you avoid with ITP?

A

IM injections and NSAIDS

45
Q

Under a platelet count of 30,000 for ITP you should treat with:

A
  • Tranfusion
  • Corticosteroids
  • IVIG
  • Anti-D immune globulin
  • Recover in 3-6 months
46
Q

Grade I - Minor ITP findings:

A

Few petechiae <100, and <5 bruises <3 cm diameter

47
Q

Grade II - Mild ITP findings:

A

Many petechia >100 and or >5 large bruises >3 cm in diameter

48
Q

Grade III - Moderate ITP findings

A

Mucosal bleeding

49
Q

What is Henoch-Schonlein Purpura NOT

A

a platelet disorder

50
Q

What are 5 PE findings of Henoch-Schonlein Purpura?

A
  • Nonthrombocytopenic purpura
  • Arthritis
  • Arthralgias
  • GI sx
  • Renal findings
51
Q

What age are people normally with Henoch-Schonlein Purpura?

A

6-7 (older than ITP)

52
Q

What are two features of the clinical presentation for Henoch-Schonlein Purpura?

A
  • Previously well child with a history of illness or immunization
  • Rashon hands, legs and feet + abdominal pain and arthralgia
53
Q

Rash is ___% present in cases of Henoch-Schonlein Purpura but:

A

100% present; but not always the first thing to develop

54
Q

The rash in Henoch-Schonlein Purpura becomes:

A

Confluent over time

55
Q

What two sites are the most common for arthralgia pain in Henoch-Schonlein Purpura?

A

Knees and ankles

56
Q

Antibody in Henoch-Schonlein Purpura?

A

IgA

57
Q

What are the three problematic systems in someone with Henoch-Schonlein Purpura?

A
  • Renal
  • GI
  • Arthralgia
58
Q

What tests should you order in someone with Henoch-Schonlein Purpura?

A
  • CBC - rule out ITP

- Renal function tests **Renal damage is permanent if not treated

59
Q

When should someone be hospitalized for Henoch-Schonlein Purpura?

A
  • Cannot orally drink
  • Significant abdominal pain
  • Change in mental status
  • Renal insufficiency
  • Mental problems
  • Self care issues (cannot walk d/t pain)
60
Q

What are the two issues with von Willebrand disease?

A
  • Platelets cannot adhere

- VWf is a carrier for factor VIII (results in deficiency)

61
Q

VWf affects:

A

Men and women - many different levels of severity

62
Q

Presentation of VWF?

A

Bleeding from mucous membranes - nose, vaginal, GI

63
Q

What are the labs for VWF?

A

Prolonged PT and bleeding time

64
Q

What is the management for VWF (2)?

A
  • Supportive

- DDAVP - releases VWF from platelets

65
Q

What is a huge sign for Hemophilia A?

A

Bleeding in male circumcision

66
Q

What are the labs for Hemophilia A?

A

ONLY PROLONGED PTT

67
Q

What are the two therapies for Hemophilia A?

A
  • Replacement therapy and DDAVP for VIII replacement
68
Q

When is lymphadenopathy concerning in kids?

A

Under 12: over 1 cm

Over 12: Over 0.5 cm

69
Q

What kills kids most under the age of 15?

A
  • Accidents (44%)

- Cancer 10% of kid deaths under 15

70
Q

75% of all childhood leukemia:

A

ALL

71
Q

__ is rare in kids and ____ is very rare

A

CML is rare

CLL is very rare

72
Q

What two things are commonly associated with having leukemia?

A

Down syndrome

Having a sibling with leukemia

73
Q

What are three odd signs of leukemia?

A
  • Gingival hyperplasia
  • Rashes
  • CN palsy
74
Q

What will you see on a CBC for someone with leukemia?

A

High WBC, low RBC

75
Q

What confirms a diagnosis of leukemia?

A

Bone marrow biopsy

76
Q

Brain tumors are the __ most common cancer in kids

A

Second

77
Q

What three things indicate a kid may have a brain tumor?

A
  • Loss of dev. milestones
  • Poor performance in school
  • Increased head circumference or expanded fontanelles
78
Q

What are two signs of a BT in kid regarding their eye:

A

Marcus Gunn pupil, CN 6 palsy

79
Q

Lymphoma in kids presents like:

A

2-3 months of painless growing cervical/supraclavicular lymph nodes

80
Q

How does Non-Hodgkin Lymphoma present?

A

SOB, cough, SVC, hepatosplenomegaly, mediastinal mass, abdominal mass/tenderness

81
Q

What is a wilms tumor?

A

Nephro tymor

82
Q

Wilm’s tumor is __ most common cancer in kids:

A

Second

83
Q

What age is most common for a Wilm’s tumor and what is the peak age?

A

Most common in 6mo - 10 yr; peak age is 2-3

84
Q

Most are asymptomatic with a Wilm’s tumor but 30% can have:

A

Abdominal pain, malaise, gross hematuria, hypertension

85
Q

To diagnose a Wilm’s tumor…

A

US and CT

86
Q

Osteosarcomas are common where and with what sign?

A

Metaphysic; Sun burst

87
Q

Ewing sarcoma is common where and with what sign?

A

Flat bones, diaphysis (hip); Onion peel

88
Q

What tests do you order if you suspect osteosarcoma or Ewing’s?

A

Xray then CT or MRI - Chest X-ray to look for mets

Pediatrics Exam 2 (7 decks)

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