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Quarter 3 > Peds II- Exam 1 > Flashcards

Peds II- Exam 1 Flashcards

1
Q

Abdominal mass that CROSSES midline

A

Neuroblastoma

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2
Q

Most common solid tumor of childhood

A

Brain tumor

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3
Q

ALL/LBL

Acute Lymphoblastic Leukemia

A

Most common CA of childhood

circulating lymphoblasts

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4
Q

AML

A

Auer rods with circulating myeloblasts

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5
Q

CML

A

Philadelphia chromo

rare in childhood

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6
Q

Hodkin lymphoma

A

painless cervial and supraclavicular lymphadenopathy

Reed sternberg cells

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7
Q

Ewing Sarcoma

A

2nd most common primary bone tumor

Affecting children and young adults

Nighttime bone pain

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8
Q

Retinoblastoma

A

Most common intraocular tumor in kids

White pupillary reflex

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9
Q

Rhabdomyosarcoma

A

Painless, progressive, enlarging mass

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10
Q

Most common nutritional deficiency in kids

A

Iron deficiency

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11
Q

Most common bleeding disorder of kids

A

Acute ITP

Idiopathic Thrombocytopenic Purpura

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12
Q

Anemia

A

2 SD below normal for age and sex

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13
Q

Anemia in age 6 mo- 5 YO

A

Hgb <11

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14
Q

Normocytic and Normochromic anemia

A

anemia of chronic dz

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15
Q

Microcytic, Hypochromic Anemias

A

Iron def
Thalassemia
Lead intox

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16
Q

Macrocytic

A

B12 and Folate def

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17
Q

Fanconi Anemia

A

Inherited
Progressive pancytopenia- all cell lines
Skin pigment, short stature, skeletal malform

Inc incidence of CA

often misdx as ITP

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18
Q

Tx for Fanconi

A

Supportive

Stem Cell transplant

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19
Q

Fanconi prognosis

A

Succumb to infection, bleeding, or CA in teen or early adult

Pt at high risk of developing MDS or AML

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20
Q

Acquired Aplastic Anemia

A

any age
Peripheral pancytopenia

Low WBC with marked Neutropenia

Thrombocytopenia

Low reticulocytes

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21
Q

Acquired Aplastic Anemia

A

Complications: overwhelming infection and severe hemorrhage: leading causes of death

foot picture with lost of bleeding- petechaie, purpura

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22
Q

Tx for Acquired Aplastic Anemia

A

Supportive, refer, stop offender, Abx, Transfusion, platelet transfusion (sparingly), Immunosuppressive agent, Stem Cell *** tx of choice

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23
Q

Iron Def Anemia

A

most common nutritional def in kids

Afirican Amer, Hispanic, poor communities

1-2 YO and mothers of childbearing age

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24
Q

Iron Def Anemia

A

hx of Pica
delayed motor development
fatigue, irritable

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25
Q

Screen for Iron Def Anemia

A

@ 12 months!!

determine hg concentration and risk factors

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26
Q

Labs for Iron Def Anemia

A

Microcytic (Small)
Hypochromic
Ferritin <12

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27
Q

Tx for Iron Def Anemia

A

Hgb 10-11 at 12 month checkup- just watch closely or empirically treat

check again in 1 month

if replace: Iron 6 mg TID

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28
Q

B12

A

malabsorption!!

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29
Q

Folic acid

A

increased requirements, malabsorption, dietary (rare), meds

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30
Q

B12

A

NEURO sx

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31
Q

Megaloblastic sx (B12 and folate)

A

Pallor

Glossitis

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32
Q

Labs of B12 and Folate

A

Neutrophils are large and hypersegmented

Macro-ovalcytes; large, oval RBC

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33
Q

B12 only

A

Neuro and

MMA elevated lab

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34
Q

Homo lab elevated in

A

both Folic Acid and B12 def

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35
Q

Hereditary Spherocytosis HS

A

Red cells lyste and burst open

Jaundice, splenomeg, gallstones

Spherocytes o nlab
Increased osmotic fragility

supportive care and maybe transfusion

SPLENECTOMY maybe

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36
Q

Thalassemia

A

beta or alpha

Microcytic, hypochromic

RDW is normal

Hgb electrophoresis*

Suporrtive care maybe transfusion, iron chelation, splenectomy

severe beta- stem cell transplant

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37
Q

Sickle cell

A

vaso occlusive pain most common sign

chronic hemolysis

splenic infarcts -> functional splenia

Hgb electrophoresis needed

Tx: avoid triggers
med: Hydroxyurea
stem cell transplant

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38
Q

G6PD

A

enzyme defect that -> hemolytic anemia

African, Mediteranea, Asian

Episodic hemolyis

Signs: jaundice
HEINZ BODIES (bite cells)

Supportive and avoid triggers

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39
Q

Lead poisoning

A

Basophillic stippling on labs (little black dots)

tx: chelation

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40
Q

Primary polycythemia

A 
familial
only RBC affected
Hgb can be as high as 27
Plethora and splenomegaly
HA and lethargy
Tx: phlebotom
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41
Q

Secondary polycythemia

A

in response to hypoxemia (Cyanotic heart condition or CF)
Tx: correct underlying
phlebotomy prn

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42
Q

Normal platelet count

A

150-400K

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43
Q

Risk of spontaneous bleeding occurs when platelet levels are

A

<20K

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44
Q

PT

A

extrinsic factor

7

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45
Q

PTT/aPTT

A

intrinsic

8, 11, 12

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46
Q

INR

A

more accurate reflection of PT

Warfarin monitoring

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47
Q

Bleeding time

A

test platelet fx

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48
Q

ITP

A

most common bleeding disorder of childhood

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49
Q

ITP

A

follows VIRAL infection
2-5 YO
immune mediated

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50
Q

ITP

A

Immune mediated attack on platelets- they are phagocytozed by splenic macrophages

SPLEEN eats the PLATELETS

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51
Q

Sx of ITP

A

multiple petechiae
bruising
nosebleeds

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52
Q

Lab ITP

A

Thrombocytopenia

normal everything else

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53
Q

Tx for ITP

A 
Observe is Asx
Avoid ASA, NSAIDs
Bleeding precautions
Maybe Prednisone
IVIG
Splenectomy
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54
Q

Von Wille

A

most common inherited bleeding disorder

decrease or impairment of VWF

can’t clot correctly

VWF binds to factor 8!!!

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55
Q

Von Wille clinical

A

Prolonged bleeding from mucosal surface

easy bruisin

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56
Q

What lab is abnormal with Von Wille?

factor 8

A

aPTT because this is intrinsic and measures factor 8

Also, prolonged bleeding time

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57
Q

Tx of Von Wille

A

Desmopressin

VWF replacement therapy

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58
Q

Hemophilia A

A

factor 8 def

most common

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59
Q

Hemophilia B

A

factor 9

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60
Q

Hemophilia sx

A

varies w severity-
mild: bleed in response to trauma, may not be apparent til later in life

severe: severe and spontaneous bleeding, earlier age of first bleeding episode

onset of bleeding may be days

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61
Q

Hemophilia bleeding sx

A

can occur anywhere, but most commonly into JOINTS and MUSCLES

Spontaneous hemarthrosis- severe dz, if recurrent can lead to destruction

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62
Q

Hemophilia labs

A

Everything normal except MAY have prolonged aPTT

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63
Q

Hemophilia tx

A

Desmopressin for type A

Factor replacement for both

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64
Q

DIC

A

acquired

bleeding, clotting, bleeding, clotting

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65
Q

DIC

A

triggered by an event- sepsis, trauma, CA

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66
Q

Signs of DIC

A

Shock- end organ dysfx

Diffuse bleeding tendency- hematuria, melena, purpura, petechiae, oozing

Evidence of thrombotic lesions- major vessel clots, p”purpura fulminans”

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67
Q

Labs of DIC

A

decreased platelet count

prolonged aPTT AND PT

decreased fibrinogen level

Elevated D-Dimer and FDP!!!

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68
Q

Liver makes:

A

prothrombin, fibrinogen

factors 5,7,9,10,13

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69
Q

Vitamin K dependent factors

A

2,7,9,10

Newborn period: physiologically depressed activity of the vitamin K dependent factors

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70
Q

Platelet count with Liver dz

A

normal or low

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71
Q

Liver dz or Kidney dz

A

prolonged PT and aPTT

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72
Q

Protein C def

A

normal activated protein C turns off factors 5 and 8

These pts may develop “Warfarin induced Skin Necrosis”

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73
Q

Protein S def

A

S is a cofactor for protein C

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74
Q

Factor 5 Leiden

A

increased risk of CLOT bc resistant to inactivation by protein C

35 fold heterozygous and taking birth control

80 fold homozygous for factor 5

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75
Q

Antithrombin def

A

CLOT

efficiency of Heparin may be diminished if they have this def

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76
Q

Hypercoag disorders

A

increased risk of CLOT

Tx proph with anticoags
UFH, LMWH, Warfarin

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77
Q

Vasculitis- HSP

A

most common type of small vessel vasculitis

boys 2-7 YO

URI often precedes dx

deposition of IgA immune complexes

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78
Q

HSP affects

A

small vessels of skin, GI tract, kidneys

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79
Q

Clinical presentation of HSP

A

Palpable purpura
Arthritis/Arthralgia
Abd pain
Renal dz

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80
Q

Labs of HSP

A 
normal or ELEVATED platelet count
ASO elevated
Serum igA may be elevated
Hemoccult (+)
UA: hematuria, sometime protein
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81
Q

Benefits of circumcision

A 
Decrease rate of:
UTI
penile CA
penile inflammation/dermatoses
some STD
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82
Q

Risk of circum

A

procedure related complications: inadequate skin removal, bleeding, infection, urethral comps

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83
Q

Contraindications to circum

A

Unstable infant

Congenital penile abn

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84
Q

Phimosis

A

inability to retract foreskin

physiologic vs pathologic

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85
Q

Presentation of Pathologic Phimosis

A 
Non-retractable after previousl being able to retract
Painful erection
Irritation/bleeding
Dysuria/ urinary retention
Recurrent infection
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86
Q

Tx of pathologic phimosis

A

Stretching exercises
Topical steroid
Circumcision (often not needed though)

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87
Q

Paraphimosis

A

MEDICAL EMERGENCY
retracted skin that cannot be returned to normal position- entrapment- cut off blood flow- engorgement - arterial compromise

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88
Q

Paraphimosis (!)

A 
caused by:
forced retraction by caretaker
infection or inflammation
GU procedure
sexual activity, trauma
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89
Q

Paraphimosis Physical Exam

A 
Color change (blue/black) if ischemia is present
Edema and tend of glans
tender swelling of distal retracted foreskin (constricting band)
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90
Q

Tx of Paraphimosis (!)

A

Pain control
Timely manual reduction in office or ED
Surgical intervention by urology (DORSAL SLIT PROCEDURE)

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91
Q

Epispadias

A

DORSAL
displacement of urethra

May happen with Bladder Exstrophy (exposed bladder)

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92
Q

Hypospadias

A

VENTRAL displacement of urethra

can be on glans, shaft, scrotum, perineum

May also involve chordee (curvature)

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93
Q

Pt has hypospadias and chordee, and cyptor…. consider

A

DSD Disorder of Sexual Development

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94
Q

Tx of Hypospadias +/- Chordee, and cyptor …

A

DO NOT DO CIRCUM during newborn period

need that foreskin to perform surgery at ~6 months of age to fix Hypo and Chordee

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95
Q

Cryptor

A

testis do not descend by 4 months

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96
Q

Cryptor

A

most common GU congenital abn- 70% resolve spontaneously

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97
Q

Cryptor can increase risk of

A

Testicular torsion
Subfertility (risk improves if corrected b4 1 YO)
Testicular CA

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98
Q

Retractile

A

overactive cremasteric reflex pulls testis back inside

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99
Q

Cryptor

A

usually unilateral, if bilateral (10%) further testing is recommended!!

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100
Q

Most common location for Cryptor (hidden testis)

A

Suprascrotal

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101
Q

Tx for Cryptor

A

Urology referral
If they haven’t descended by 4 mo, rare that they will on their own

Surgery recommended ASAP after 4 mo mark- ideally before 2 YO

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102
Q

Orchiopexy surgery

A

Tx Cryptor: testicle is repositioned and attached into the scrotum

Allows for improved testicular growth and fertility potential

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103
Q

Testicular torsion (!)

A

twisting of spermatic cord d/t poorly anchored testicule

*Risk of vascular compromise

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104
Q

Two peak incidences of Testicular torsion

A

Neonatal period

Puberty 12-18

105
Q

Sx and PE of Testicular Torsion

A

Abrupt onset of severe pain- constant
N/V

Swollen, indurated, red sctorum
“High riding scrotum”
Absent cremasteric reflex
Negative Prehn sign (elevated it does not help pain)

106
Q

Testicular torsion

A

“High riding”

  • Absent cremasteric reflex
  • Negative Prehn sign
107
Q

Dx of Test Torsion

A

Hx and PE can be enough

but DOPPLER US- confirmatory test of choice

108
Q

Tx of Test Torsion (!)

A

Immediate consult with urologist

Surgical detorsion and fixation (Orchiopexy) of both testes if viable

109
Q

Test torsion (!) can it be saved?

A

Detorsion within:
4-6 hrs: 100% viable
12 hrs: 20% viable
after 24 hrs: 0% viable

110
Q

Cystitis vs Pyelonephritis

A

Cys: bladder
Pyelo: kidney

111
Q

Most common cause UTI

A

bacterial- E. COLI (80%)

112
Q

Risk Factor for UTI

A

Highest in uncircum boys <3 months

Girls have 2-4x greater risk than circumsized boys

113
Q

How to collect UA

A

potty trained: clean voided specimen

not potty trained: CATHETER SPECIMEN RECOMMENDED

bag collection NOT recommended!

114
Q

UTI dx

A

obtain UA AND Culture

UA: show significant bacteria with Pyuria (usually)
Leukocytes
Nitrites

C&S: help direct tx

115
Q

UTI tx

A

Febrile: 10 days

Afebrile (and immune competent): 3-5 days

116
Q

UTI tx

A

Cephalosporin is 1st line oral agent in kids

Start empiric and then adjust based on C&S

117
Q

F/u UA or culture for UTI?

A

not recommended when using C&S as long as kid is improving

118
Q

Order RBUS (Renal and Bladder US) IF:

A

Non invasive 1st line imaging study for pts with UTI if:
<2YO with first Febrile UTI
Any age with UTI and FH of Renal or urologic dz, poor growth, or HTN
Children who aren’t responding to abx

119
Q

VCUG

A

invasive, radiation, catheter

TEST OF CHOICE to detect VUR

120
Q

When to order VCUG?

A

-Children any age with 2 or more Febrile UTIs
-Children of any age with 1st Febrile UTI AND on of following:
any anomaly on RBUS, temp 102.2 and pathogen other than E.Coli, or Poor growth/HTN

121
Q

Clinical presentation of VUR

A

Hydronephrosis (prenatal, seen on US, fluid around the kidneys)
Post natal febrile UTI

122
Q

Risks of pts with VUR

A

Recurrent infections
Scarring and damage to kidney

Many cases spontaneously resolve

123
Q

Controversy regarding management of VUR

A

Watchful waiting
Low dose abx to prevent UTI
Surgical correction

Monitor reflux
Aggressive screening (UA) in febrile/symptomatic pts
124
Q

Renal Scintigraphy (not ever 1st time)

DMSA

A

Nuclear medicine scan

Detect Pyelonephritis and Renal Scarring

areas of decreased uptake indicate scarring and inflammation

125
Q

DMSA scans

A

expensive, invasive, exposure to radiation

Not recommended in routine eval of kids w/first UTI

126
Q

When to refer kids w/ UTI

A 
Recurrent UTI
Severe VUR (grade 3-4)
Renal abn
Impaired kidney fx
Elevated BP
Bowel/ bladder dysfx
127
Q

Horseshoe kidney

A

most common type of Renal fusion- fusion of one pole of each kidney

caused by abnormal migration of kidneys 5-9th week gestation

128
Q

Sx of Horseshoe kidney

A

Pts usually Asx

May have pain and hematuria if infection or obstruction

129
Q

Associated stuff w horseshoe kidney

A

1/2-1/3 have something else:
VUR
Hypospadias
Cryptor

May be assoc with other genetic factors
Small increased risk for Wilms tumor

130
Q

Wilms tumor

A

most common Renal malignancy in kids

131
Q

Horseshoe kidney eval and tx

A

US, VCUG (if UTI) and Serum creatinine

If creatinine normal and no hydronephrosis- no further eval needed

if either is abnormal, need to get additional renal scans

132
Q

Horseshoe kidney

A

excellent prognosis in most pts w/o any intervention

133
Q

Horseshoe kidney AND VUR

A

consider Prophlyactic Abx

134
Q

Nocturnal Enuresis: kids 5 yr or older

A

spontaneous resolution 15%/year

Reassurance, Pharm: Desmopressin (synthetic ADH): works but high relapse rate after d/c

135
Q

Hematuria

A

positive dipstick is confirmed by Microscopic Examination

Microscopic hematuria >5 RBCs per hpf

136
Q

Micro hematuria, if pt has no sx and normal physical,

A

Repeat UA weekly for 2 wks

137
Q

If hematuria persists

A

Urine culture if UTI suspected
Close watch BP
RBUS
Referral

138
Q

Gross hematuria

A

UA w microscopy/ urine culture
Serum creatinine
Serum complement
Consider ASO, streptozyme, ANA

Imaging: RBUS/ CT Without contrast
May need to refer

139
Q

Post strep Glomeruloneph

A

7-14 days after GAS
usually pharyngitis or impetigo

Acute onset sx

140
Q

Sx of Post strep glomeruloneph

A

Edema (periorbital, peripheral)

bc kidneys arent removing waste and fluid efficiently

Cola colored urine, elevated BP, Some renal insuff

141
Q

Labs of poststrep glomeruloneph

A

Gross hematuria
RBC Casts - diagnostic of glomerulonephritis, Tubular shaped RBC

Proteinuria, increased serum creatinine

Demonstration of recent strep infection
+ throat or skin culture
+ASO or streptzyme

142
Q

Tx for post strep glomeruloneph

A

supportive

143
Q

HSP (IgA vasculitis Henoch-Schonlein Purpura)

A

immune mediated IgA Vasculitis

cause unknown

Classic tetrad:

  1. palpable purpura (usually on legs)
  2. Arthritis/arthralgia
  3. Abd pain
  4. Renal dz
144
Q

Tx of IgA HSP

A

supportive

sx usually spontaneously resolve

145
Q

HUS

A

One of main causes of AKI in kids

Classic triad:
-Hemolytic anemia
-Thrombocytopenia
AKI (hematurie, proteinuria –> severe renal failure)

146
Q

HUS

A

can be genetic
but also SHIGATOXIN producing E Coli is most common cause

Prodromal illness (abd pain, n/v/d) precedes HUS by 5-10 days

147
Q

Proteinuria

A 
Nephrotic syndrome: 
Renal dz (intrinsic of post infectious) causing massive protein loss
148
Q

Four main sx of Nephrotic syndrome

A

Nephrotic range proteinuria
Hypoalbuminemia
Edema (O face)
Hyperlipidemia

149
Q

Reflux is common in infants what age

A

< 6 months

150
Q

Unhappy spitter “GERD”

A

complications arise
FTT, esophagitis, respiratory complications
Irritable dystonic neck
occult blood in stool

151
Q

GERD sx usually resolve by

A

9-12 months

no big workup needed unless there are signs of something worse or other complications

152
Q

GERD tx

A 
1st line: lifestyle mod
avoid tobacco smoke
upright position 30 min after feed
hypoallergenic diet
do not overfeed
153
Q

Complicated dz GERD

A

underlying medical condition i.e. Cystic Fibrosis

Esophagitis on endoscopy

154
Q

Pharm Med for GERD

A

PPI (Omeprazole) vs H2 blocker (Ranitidine)

155
Q

Hypertrophic Pyloric Stenosis

A

hypertrophy of pylorus can progress to near or complete gastric obstruction

156
Q

Pyloric Stenosis

A

Genetic preD and environmental factors

Assoc with MACROLIDE us during first few weeks of life

157
Q

Sx of Pyloric Stenosis

A

3-6 wk old infant with FORCEFUL vomiting

Non bilious PROJECTILE emesis

immediately after eating (postprandial)

Hungry vomiter

FTT and dehydration

158
Q

Physical exam of pyloric stenosis

A

Olive like mass in RUQ

159
Q

Dx Pyloric Stenosis

A

US: test of choice

160
Q

Tests for Pyloric stenosis

A

US (test of choice) shows elongation and thickening

Upper GI Barium contrast study: use if US is non-dx. shows STRING sign of narrowed lumen

161
Q

Tx of Pyloric stenosis

A

SURGERY :pyloromyotomy

cut through the thickened area to open it up

162
Q

Intestinal atresia

A

blockage of lumen!

Duodenum is most common site

163
Q

Increased risk of intestinal atresia in pts with:

A

Cystic Fibrosis
Down Syndrome
Maternal cig smoking

164
Q

Congenital atresia (blockage) sx

A

Bilious Vomiting within 48 hrs of life
Abdominal distension
Failure to pass meconium +/-

165
Q

Dx of intestinal atresia

A

Abdominal X Ray
Duodenal: “Double bubble” d/t gas and dilation in both stomach and duod

Jujenoileal/colonic atresia: dilated loops of bowel with air fluid levels

Can also do UGI or Contrast enema for confirmation

166
Q

Tx of Congenital Atresia

A

Surgery!
feedings withheld
fluids, correct electrolytes
Broad spectrum abx to prevent post op infection

good prognosis

167
Q

Midgut malrotation +/- Volvulus

A

Volvulus: small bowel twists around Superior Mesenteric Artery

Vascular compromise can lead to Small bowel ischemia and Necrosis!!

168
Q

Sx of Midgut rotation +/- Volvulus

A

Vomiting (bilious)
Abd pain
Hemodynamic instable
+/- Hematochezia (passage of fresh blood) - sign of bowel ischemia

169
Q

Physical exam findings of Midgut rotation

A

Abd distension and tenderness

170
Q

Midgut rotation workup

A

X Ray to r/o perforation

UGI: GOLD STANDARD to detect malrotation +/- volvulus

  • displacement of duod
  • duod obstruction
  • “corkscrew appearance”

US helpful to use with UGI but not best for confirming malrotation

171
Q

Tx for Midgut rotation

A

Surgical Ladd Procedure: untwist bowel and reposition in abdomen- adhesions keep it in place

great prognosis

172
Q

Intussusception: telescoping of intestine

A

Most common abdominal emergency in kids <2 yO!!

173
Q

Intuss

A

usually kids 6 mo-3 YO

most common cause of obstruction in these kids

174
Q

Intuss sx

A

sudden onset intermittent, severe, crampy, progressive abdominal PAIN

crying, drawing up legs, vomiting becomes bilious as obstruction progresses

175
Q

PE of Intuss

A

Sausage shaped mass (swollen bowel)

Currant jelly stools

176
Q

Triad of intuss

A

Abd pain
Abd mass
Currant jelly stool

177
Q

Etiology of Intuss

A

Idiopathic 75%

Other causes: Lead point- one part of bowel messed up and drags folding of rest of bowel with peristalsis

178
Q

Contributing factors to “Lead point theory” and Intuss

A 
Meckel divert (most common)
Crohn, Celiac, CF, Rotavirus!!! vaccine removed from marker
179
Q

Intuss dx

A

US: test of choice!!

“Target sign, coiled spring”

180
Q

Intuss tx

A

Hydrostatic/ pneumatic enema is BOTH diagnostic and therapeutic

Tx of choice if there is no perforation or shock

181
Q

Labs for Appendicitis

A

WBC > 10K increases likelihood

182
Q

Diarrhea

A

3 or more water stools /day

183
Q

Flagyl is tx for what types of diarrhea:

A

C-Diff and

Parasitic

184
Q

Most common cause of diarrhea

A

Viral: noravirus, rotavirus, adenovirus

185
Q

Diarrhea red flags

A 
Fever
sever abd pain
blood in stool
recent abx
persistent sx
dehdyation
leukocytosis
growth/dev delays
186
Q

Chronic diarrhea

A

> 1 month

187
Q

Celiac dz

A

Immune mediated inflammatory dz of small intesting caused by GLUTEN insensitivity

Dx: igA to TTG, small bowel biopsy

188
Q

Functional/ toddler’s diarrhea

A

6 months - 5 YO

self limited

189
Q

2 main types if IBD

A

Crohn and Ulcerative Colitis

190
Q

IBD can affect

A

mouth, skin, liver, joints also

may get these extraintestinal sx before traditional sx

191
Q

Crohn dz

A 
Transmural inflammation (deeper)
Mouth to anus
SKIP lesions
Cobblestone appearance
Endoscopy OR Colonoscopy diagnostic
192
Q

Ulcerative Colitis

A

CONTINUOUS from rectum to colon
superficial
Diffuse/continuous edema, erythema, friability, ulcers
*Inc risk of Colon CA!!
Dx: Colonoscopy only bc problem is closer to rectum

193
Q

IBD tx

A

“Step up” therapy for most
“Step down” for high risk pts

Meds
Surgery
Nutritional rehab
Behavioral health supp
Colorectal screening for CA (older pts)
194
Q

Meds for IBD

A 
Aminosalic
Immunomodulating 
Steroids- primary for acute flare!
\+/- Abx
Surgery- refractory cases
195
Q

Meckels divertic

A

outpouching of small intestine
rule of 2s
problem is gastric acid is released from the gastric epithelium where its not supposed to be released!!

Bleeding from mucosal ulceration

196
Q

Meckels divertic

A

most common congenital anomaly of GI tract

197
Q

Mecksl divertic sx

A

PAINLESS rectal bleeding
obstruction
diverticulitis

198
Q

Labs for Meckels

A

Technetium 99 scan- this shows ectopic gastric mucosa in the diverticulum (where it should not be)

199
Q

Tx for Meckels

A

Surgical resection

200
Q

Encopresis

A

leakage of retained stool

201
Q

Fiber rec for <2 YO

A

5g/day

202
Q

Hirchsprung dz

A

Aganglionic megacolon!!
absence of ganglion cells
Spasm and abnormal movement!!

colon fails to relax –> can lead to obstruction

203
Q

Hirchsprung dz higher risk in

A

Down syndrome

204
Q

Sx of Hirchsprung dz

A

Classic: failure to pass meconium in first 48 hrs of life
Bilious vomiting
Abdominal distention

205
Q

Unclassic sx of Hirchsprung dz

A

Later, if newborn passes meconium but develop later sx:

Chronic constipation and FTT (the later the dz, the less severe)

206
Q

Physical exam and dx of Hirchsprung

A

Abdominal distension
Squirt sign!! tight anal sphincter- relieves obstruction temporarily

Dx:

  • Rectal biopsy: GOLD STANDARD for dx
  • Contrast enema to localize “transition zone”
207
Q

Tx of Hirchsprung

A

Surgical resection of aganglionic colon

overall: good prognosis

208
Q

ALL

A

Most common malignancy of childhood OVERALL

209
Q

ALL

A

Bone pain
Anemia
Neutropenia
Lymphoblasts on smear* or biopsy. Replacing normal marrow

210
Q

Tx of ALL

A

may take 2-3 yrs
Chemo-multidrug
Stem Cell transplant- best if from matched sibling

211
Q

Independent predictors of Tumor Lysis Synd

A

Age >10
Splenomegaly
Mediastinal Mass
Initial WBC >20,000

212
Q

AML

A

Myeloid cells get stuck in that stage
CNS sx maybe
Anemia, thrombocytopenia, neutropenia
WBC >100,000

213
Q

AML and hyperleukocytosis

A

Hyperleuko >100,000 associated with life threatening complications!

214
Q

AML

A

Circulating myeloblasts >20% are diagnostic!
Auer Rods- pathognomonic o myeloblasts

Dx: requires BOTH

  • 20% or more blasts on biopsy
  • leukemic cells must be myeloid
215
Q

AML tx

A

2 courses chemo

Stem cell transplant may be helpful

216
Q

CML

A

Myeloprolif disorder

Uncontrolled dividing of MATURE granulocytes

217
Q

CML

A

Philadelphia chromosome!!

Only risk factor known: exposure to Ionizing Radiation

218
Q

Tx for CML

A

Cure: STEM CELL
Control: Tyrosine Kinase Inhibitor

219
Q

Hodkin Lymphoma

A

Familial dz
Epstein Barr Virus assoc

Starts in lymph nodes–> surrounding areas

REED STERNBERG cells
(b cells)

220
Q

Hodkin Lymphoma sx

A

Painless cervical or supraclavicular adenopathy

Mediastinal mass- caution SVC syndrome

221
Q

Tx for Hodkin

A

Chemo- combo
Radiation-low dose
Autologous stem cell

222
Q

Non Hodkin lymphoma

A

Can arise in ANY SITE of lymphoid tissue –> DISTANT nodes

Associated with Immunodeficiency syndromes!!! & Epstein Barr Virus again

223
Q

Unlike Adult Non Hodkin Lymphoma.. most children’s cases are:

A

Rapidly prolif
High grade
Diffuse

224
Q

Clinical findings of Non- Hod Lymphoma

A

FAST, 1-3 wks
Enlarging non tender lymphadenopathy

may see other classic sx and Hepato/Splenomegaly in advanced stage

Dx: tissue biopsy

225
Q

Non- Hod Lymph Tx

A

BEWARE of TLS
Chemo
Stem cell option for those that relapse

226
Q

Brain tumor

A

most common Solid tumor of childhood

Leading cause of death from CA

227
Q

30% brain tumors have this triad

A

Morning HA
Vomiting
Papilledema (eye)

228
Q

Brain tumor dx

A

MRI: PREFERRED diagnostic study

229
Q

Two categories of brain tumor

A

Glial (usually benign)
Nonglial (usually CA)
-Medulloblastoma

230
Q

Neuroblastoma

A

most common ABDOMINAL tumor, most common solid outside of CNS

231
Q

Neuroblastoma

A

Abdominal mass- fixed, irregular, CROSSES MIDLINE

doesnt stay in ints lane

often mets to bone

232
Q

Labs with Neuroblastoma (abdominal)

A

Anemia

Urinary Catecholamines***

233
Q

Neuroblastoma dx

A

Histology confirmation OR

Evidence of mets to bone + Urine catecholamines

234
Q

Tx for Neuroblastoma

A

Surgery + Chemo

surgery alone if low grade

235
Q

Nephroblastoma

A

Wilms tumor
Second most common abdominal
KIDNEYS

236
Q

Nephroblastoma/Wilms tumor sx

A

Asx abdominal mass/swelling
Smooth, firm, well demarcated
DOES NOT cross midline

237
Q

Dx of Wilms

A

Histology confirm from biopsy or surgical excision

238
Q

Tx of Wilms/nephroblastoma

A

Surgical, chemo, radiation

239
Q

Osteosarcoma

A

Most common primary bone CA in peds
peak incidence: 13-16
time of rapid bone growth

240
Q

Osteosarcoma

A

occurs in long bones (Metaphysis)

241
Q

Cardinal sx of bone tumor

A

Bone pain @ site
Mass formation
Fracture thru area of destruction

242
Q

Evaluate for mets to lungs after dx with:

A

Osteosarcoma

243
Q

Tx for Osteosarcoma

A

Surgery

Chemo

244
Q

Ewing Sarcoma

A

White Males: 20s

Often in long bones, but in the DIAPHYSIS (long shaft part)

245
Q

Ewing Sarcoma sx

A

Extremities & pelvis
Worsening localized pain
WORSE AT NIGHT

246
Q

Tx of Ewing

A

Chemo, surgery, radiation, or combo

247
Q

Retinoblastoma

A

Mets rare

death within 1 year is typical

248
Q

Retinoblastoma presentation

A

Leukocoria: white pupillary reflex (most common sign)

Others: strabismus, nystagmus, red inflamed eye

249
Q

Dx of Retinoblastoma

A

Chalky, off white retinal mass with soft, friable consistency = diagnostic

250
Q

Should you do biopsy of Retinoblastoma?

A

NO!!

Contraindicated d/t risk of Tumor Seeding

251
Q

Tx for Retinoblastoma

A

Variety of options
Several “Vision sparing” options
External beam radiation
Chemo if confined to globe

252
Q

Rhabdomyoscaroma

A 
RARE
Any body part can be affected
Most common places for-
Younger children: head and neck
Teen: extremities
Infant: GU
253
Q

Rhabdomyoscaroma sx

A

Painless enlarging mass
Orbital: exopth
Bladder: hematuria, urinary obstruction, pelvic mass

254
Q

Dx of Rhabdo

A

X Ray/CT/MRI of mass

Chest CT and Skeletal survery to r/u mets to bone or lungs

255
Q

Tx for Rhabdo

A

Surgery
Chemo
Radiation

256
Q

Hepatic tumors (liver)

A

2/3 liver masses are malignant!

257
Q

hepatic tumors

A

Serum a-fetoprotein

excellent marker for response to tx

258
Q

Hepatic tumors

A

Enlarging abdomen

259
Q

Hepatic tumors Tx

A

Surgery and chemo
Complete resection is essential for survival!!

liver transplant when tumors are unresectable

Quarter 3 (17 decks)

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