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Primary PNP > PNP-PC Part 3 > Flashcards

PNP-PC Part 3 Flashcards

1
Q

Most common anemia in childhood

A

Iron-deficiency anemia

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2
Q

When is the routine screening of hemoglobin?

A

Between 9-12 months

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3
Q

What is the common age of Iron-deficiency anemia?

A

1-3 years of age

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4
Q

What is classified as mild Iron-deficiency anemia?

A

9.5-11

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5
Q

What is classified as severe Iron-deficiency anemia?

A

8-9.5

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6
Q 
Poor weight gain
Sclera or palmar pallor
Splenomegaly
Tachycardia
Systolic flow murmurs with progression
A

Iron-deficiency anemia severe

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7
Q

What will RBC be for Iron-deficiency anemia?

A

Microcytic and hypochromic

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8
Q

What will MCV be for iron deficiency anemia?

Increased, decreased, normal

A

Decreased

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9
Q

What will serum ferritin be for iron deficiency anemia?

Increased, decreased, normal

A

Decreased

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10
Q

What will serum iron be for iron deficiency anemia?

Increased, decreased, normal

A

Decreased

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11
Q

What will total iron-binding capacity be for iron deficiency anemia?

Increased, decreased, normal

A

Increased

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12
Q

What will iron saturation be for iron deficiency anemia?

Increased, decreased, normal

A

Decreased

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13
Q

What nutrition changes should be changed for iron deficiency anemia?

A

reduce milk to no more than 16- 24 oz/day at 1 year

Increase intake of high-iron foods (dark green veggies, beans, whole cereals, pork, beef)

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14
Q

What is iron therapy for mild to moderate iron-deficiency anemia?

A

Ferrous sulfate

3-6 mg/kg/day in 2 divided doses

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15
Q

What is iron therapy for severe iron deficiency anemia?

A

4-6 mg/kg/day in 2-3 doses

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16
Q

How early can you start ferrous sulfate in premature infants?

A

2 months

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17
Q

How early can you start ferrous sulfate in term infants?

A

4-6 months

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18
Q

Inherited anemia that affects both males and females

Most often affects Italian, Greek, Middle Eastern, Asian, and African descent

A

Thalassemia

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19
Q

Pale, poor appetite, dark urine, jaundice, liver, spleen, and heart enlargement, bone problems, and failure to thrive

A

Severe Thalassemia

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20
Q

Hemoglobin electrophoresis testing

A

Thalassemia

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21
Q

Moderate/Severe Thalassemia management

A

Referral to hematolgoy

Regular blood transfusions, iron chelation therapy, folic acid, B vitamins help build healthy RBCs

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22
Q

Autosomal-recessive heme disorder

A

Sickle cell disorder

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23
Q 
Pallor, jaundice, tachycardia, fatigue
Vaso-occlusion 
Cerebrovascular accident
Acute Chest Syndrome
Priapism
Ocular retinopathy
Gallbladder disease
Splenomegaly
Cardiomegaly
Failure to thrive
Dactylitis
A

Sickle cell disorder

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24
Q

What are important education points for sickle cell anemia?

A

Adequate fluid intake

Fever (101F) is an emergency

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25
Q

Emergency admission for sickle cell disorder

A

Fever (1010)
Acute chest syndrome–pneumonia, chest pain
Sequestration crisis (left-sided abdominal pain, difficulty breathing, fever, pain, vomiting)
Aplastic crisis
Severe painful crisis
Unusual headache, visual disturbance
Priapism

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26
Q

How often do you check infant birth to 6 months with sickle cell disease?

A

CBC every 2 months

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27
Q

How often do you see infants 6 months to 2 years with sickle cell disease?

A

Every 3 months
CBC every 3-6 months
UA annually
Ferritin, TIBC, BUN, CREAT, LFTs once at 1-2 years

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28
Q

Hemolytic anemia that is characterized by deficiency or abnormality of RBC membrane protein which reduces RBC surface area; sequestered in the spleen due to shape

Seen in northern European ancestry

A

Hereditary Spherocytosis

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29
Q 
Jaundice in the newborn period
Splenomegaly after 2 years of age
Chronic fatigue
Malaise
Abdominal pain
A

Hereditary Spherocytosis

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30
Q

Splenectomy is curable

A

Hereditary Spherocytosis

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31
Q

At what age should splenectomy be performed for severe Hereditary Spherocytosis?

A

6 years old

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32
Q

What vaccines must be given before splenectomy can be performed for Hereditary Spherocytosis?

A

Pneumococcal and Meningococcal

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33
Q

Headache, stomach ache, irritability, tiredness, poor appetite, poor attention span and memory, sleep disturbances, weight loss, muscle weakness, diminished DTRs, seizures, loss of visual-motor coordination

A

Lead Poisoning

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34
Q

Free erythrocyte protoporphyrin (FEP)

A

lead poisoning diagnosis

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35
Q

What blood level lead is required to refer?

A

All values >70

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36
Q

Thrombocytopenia (less than 150,000) in absence of other occurs; peak occurrence between 2-4 years

Most common after a febrile, viral illness

A

Idiopathic Thrombocytopenic Purpura (ITP)

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37
Q

Acute onset of petechiae, purpura, and bleeding in otherwise healthy child
Recent viral illness (1-4 weeks)
Hemorrhage of mucous membranes (gums, lips)
Epistaxis that is difficult to control
Menorrhagia
Liver, spleen, lymph nodes normal
Bone pain and pallor are rare

A

Idiopathic Thrombocytopenia Purpura (ITP)

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38
Q

Low platelet count (severe = <20,000)
Normal PT, aPTT
Normal WBC and RBC

A

Idiopathic Thrombocytopenia Purpura (ITP)

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39
Q

Labs:
PT & aPTT are elevated
Thrombocytopenia

A

DIC

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40
Q

Labs:
Prolonged PT and aPTT
Normal platelet

A

Coagulation factor deficiency

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41
Q

Sick, febrile child
Isolated thrombocytopenia
Petechia/Purpura

A

Meningococcemia

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42
Q

If platelet is >20,000 and no bleeding is observed what is the treatment for ITP?

A

Avoid contact sports, aspirin, and NSAIDs

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43
Q

If a child has an increased risk for serious bleeding with ITP, what is the treatment?

A

Corticosteroids

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44
Q

Most common form of systemic vasculitis in children

results from autoimmune reaction where body attacks its own tissues usually after respiratory infection, immunization, insect bite, or allergic reaction

Mean age: 6-7 years old

A

Henoch-Schonlein Purpura (HSP)

45
Q

Purpura
Arthralgia/arthritis
Colicky abdominal pain

A

Henoch-Schonlein Purpura (HSP)

46
Q

What should be performed on all patients with Henoch-Schonlein Purpura (HSP)?

A

Urinalysis to screen for renal involvement

47
Q

What is management for Henoch-Schonlein Purpura (HSP)?

A 
Most recover spontaneously
Primarily supportive (adequate hydration, rest, relief of pain)
48
Q

X-linked recessive hereditary disease

Most exclusively in males

A

Hemophilia A and B

49
Q

Excessive bruising
Prolonged bleeding from mucous membranes after minor lacerations, circumcisions, or menstruation
Hemarthrosis charactered by pain and swelling in elbows, knee, and ankles

A

Hemophilia A and B

50
Q

Which is most common between hemophilia A and B?

A

hemophilia A

51
Q

What is the leading type of significant bleeding with hemophilia A and B?

A

Hemarthrosis

52
Q

How do you treat hemarthrosis?

A

Apply ice and pressure to affected joints

53
Q

What medications should patients with hemophilia A and B avoid?

A

Aspirin and NSAIDs

54
Q

How should immunizations be given for hemophilia A and B?

A

Subcutaneous with 26G needle
IM with 23G needle
Hold pressure and ice for several minutes

55
Q

Autosomal dominant
Most common inherited bleeding disorder
Occurs in both sexes

A

von Willebrand Disease

56
Q

Epistaxis, menorrhagia
Easy bruising
Excessive posttraumatic or post-op bleeding
Hx of ecchymosis of trunk, upper arms, thighs

A

von Willebrand Disease

57
Q 
Labs:
CBC w/ diff
Normal platelet count
PT, aPTT
von Willebrand panel
A

von Willebrand Disease

58
Q

What should workup include for unexplained splenomegaly?

A 
H&P
CBC with differential
Reticulocyte count
Peripheral blood smear
LFTs
EBV and CMV chest x-ray
Abdominal US
59
Q

URI is most common cause
Ill-appearing, febrile, progressive or persistent symptoms with CBC w/ diff, GAS, ESR, CRP, hepatic profile, blood culture, EBV, CMV, HIV, Chest-x-ray

A

Acute bilateral cervical lymphadenopathy

60
Q 
Usually caused by S. aureus
Children with poor oral hygiene
Blood culture if ill-appearing
Throat culture
Empiric therapy for moderate symptoms
A

Acute unilateral cervical lymphadenopathy

61
Q 
Unexplained weight loss
Headache in the early morning
Swelling/persistent pain in joints/back, or legs
Lumps/masses
Excessive bruising/bleeding
Rash
Recurrent infections
Persistent N/V
Fatigue
Vision changes
Recurrent fever without cause
A

Cancer

62
Q

Most common form of childhood cancer

A

Leukemia

63
Q

80% of childhood leukemia cases

A

Acute lymphoblastic leukemia (ALL)

64
Q

Peak incidence of ALL

A

2-6 years

65
Q

Anemic, pale, listless, irritable, or chronically tired
History repeat infections, fever, weight loss
Bleeding episodes
Lymphadenopathy
Hepatosplenomegaly
Bone/Joint Pain

A

Leukemia

66
Q

Thrombocytopenia and anemia
WBC may be elevated, normal, or low
Malignant cells on peripheral smear
Bone marrow aspiration

A

leukemia

67
Q

Solid tumors in lymphatic system; higher incidence in males; more common in 2nd decade of life

A

Non-Hodgkin Lymphoma

68
Q

Acute abdomen pain, distention, fullness, and constipation

Nontender lymph nodes enlargement

A

Non-Hodgkin Lymphoma

69
Q

Cervical nodes and spreads to other nodes; rare in children under 15

A

Hodgkin Lymphoma

70
Q

Painless enlargement of lymph node (cervical)
Chronic cough (trachea compressed)
Fever
Decreased appetite
Weight loss of 10% or more within 6 months

A

Hodgkin Lymphoma

71
Q

Anemia
Elevated ESR, CRP
Abnormal LFTs
UA-proteinuria

A

Hodgkin Lymphoma

72
Q

most common primary site of neuroblastoma

A

adrenal gland

73
Q 
In advanced disease, appear ill on presentation with systemic signs and symptoms:
**Abdominal mass
Abdominal pain/constipation
Proptosis
Horner syndrome
Localized back pain and weakness
Scoliosis, bladder dysfunction
Plapalte non-tender subcutaneous nodules
Fever, weight loss
Heterochromia iridis
A

Neuroblastoma

74
Q

Presents with leukocoria (white reflex) in child <3

Strabismus, nystagmus, red inflamed eye

A

Retinoblastoma

75
Q

2nd leading cause of cancer death in children

A

CNS tumor

76
Q

headache early in the morning relieved by vomiting

A

CNS tumor

77
Q

What diagnostic tools are used to diagnose CNS tumors?

A

MRI or CT

78
Q

Diagnosis requires persistent arthritis for more than 6 weeks in patients less than 16 years

A

Juvenile Idiopathic Arthritis

79
Q

Is juvenile idiopathic arthritis more common in males or females?

A

Females

80
Q

Polyarthritis JIA

A

> 5 inflamed joints

81
Q

Oligoarthritis JIA

A

<5 inflamed joints

82
Q

Systemic-onset JIA

A

arthritis with characteristic fever

83
Q 
Pain aching
Joint stiffness (worse in the morning and after rest)
Swelling of joint with effusion
Heat over inflamed joint
Loss of ROM of affected joints
A

Juvenile Idiopathic Arthritis

84
Q 
Fever
salmon-colored rashes
leukocytosis
lymphadenopathy
rheumatoid nodules
A

Juvenile Idiopathic Arthritis

85
Q

What is the common treatment for JIA?

A

NSAIDs
Corticosteroids
Antirheumatic drugs/Methotrexate
Physical Therapy

86
Q

5 joints or more, symmetrical affected
Females more than males
Fever and rash are possible
Subcutaneous rheumatoid nodules

A

Polyarthritis JIA

87
Q

What is the treatment for polyarthritis JIA?

A

NSAIDs and DMARDs (Methotrexate)

88
Q

4 or fewer joints affected
Peak onset 1-2 years
Females > Males
Uveitis–must have slit-lamp eye exam every 3 months

A

Oligoarticular JIA

89
Q

Onset anytime before 16 years
Female and Males equally affected
Fever, rash, arthritis
Inflammation in and around internal organs (carditis/pericarditis, pneumonitis/pleuritis)
Swollen lymph nodes, enlarged liver, and spleen
Elevated ESR, CRP, ferritin, WBC
Prolonged clotting time, low fibrinogen, elevated d-dimer

A

Systemic JIA

90
Q 
Ocular pain and redness
Change in vision
Photophobia
headache
Asymptomatic
A

Uveitis

91
Q 
JIA
Reactive arthritis
Kawasaki disease
Bechet's 
HSP
Wegener's Grandulomatosis
Pars planitis
HIV, EBV, Cat-srtach
Herpes
Lyme disease

all have which condition in common

A

Uveitis

92
Q

What is the first line of treatment for uveitis?

A

Refer to ophthalmologist

Topical corticosteroids with mydriatics

93
Q

Chronic, systemic disease characterized by altered immune regulation that can involve inflammation in multi-organ systems

A

Systemic Lupus Erythematosus (SLE)

94
Q

What is the median age of onset for Systemic Lupus Erythematosus?

A

11-12 years

95
Q

What is the hallmark for systemic lupus erythematosus?

A

Butterfly or malar erythematous facial rash which increases in intensity in sunlight

96
Q 
**Joint pain
Low-grade fever
Weight loss
Painless mouth ulcerations
Skin rashes
Sun sensitivity
Fatigue
Proteinuria
Hematologic disorders
Pallor, petechiae
Purpura
Malar
Mouth ulceration, gingivitis, serositis
Cardiac friction rub (pericarditis)
Pleural friction rub (pleurtic)
Hepatosplenomegaly
Lymphadenopathy
A

Systemic lupus erythematosus

97
Q

What is common treatment for systemic lupus erythematosus?

A

Sunscreen
NSAIDs, oral steroids, antimalarial drugs
Vitamin D and calcium supplementation

98
Q

Chronic, idiopathic pain syndrome
Females > Males
Mean onset of age is 12

A

Fibromyalgia Syndrome

99
Q

If ANA is - what does this mean for systemic lupus erythematosus?

A

It is ruled out

100
Q 
Pain at multiple sites (muscles and soft tissues around joints)
Pain may awaken from sleep and interfere with activities
Fatigue and malaise
Paresthesia and headache
Insomnia or prolonged night wakening
Depression
Anxiety
School absence due to pain
A

Fibromyalgia Syndrome

101
Q

What is the management for fibromyalgia syndrome?

A

Physical therapy
Psychotherapy and relaxation
NSAIDs
Gabapentin

102
Q

Diagnosis requires __ or 10 major criteria, more than __ of 18 tender points, and pain in at least ___ different areas for more than __ months with normal labs

A

3 out of 10
5 out of 18
3 different areas
more than 3 months

103
Q

Genetic disorder in which both “arms (B and T cells)” of adaptive immune system are impaired

“bubble boy disease”

A

Severe Combined Immunodeficiency (SCID)

104
Q

Why is there a delay in the detection of SCID?

A

Newborns carry their mother’s antibodies for the first few weeks of life so infants originally look normal/healthy

105
Q 
8 or more ear infections
2 or more cases of pneumonia
infections that do not resolve with antibiotic treatment for 2+ months
**Failure to thrive
Infections that require IV antibiotic treatment
Deep-seated infections
Persistent thrust
Family hx of immune deficiency

Evaluation for which disease?

A

Severe Combined Immunodeficiency (SCID)

106
Q

What is a key characteristic of SCID?

A

Low antibody levels and lack of specific antibodies after vaccination or natural infection

107
Q

Treatment for SCID

A

Enzyme therapy
Gene therapy
**bone marrow transplant

108
Q

What is a significant risk factor for HSP?

A

Hypertension

109
Q

Regulates growth, puberty, reproduction, homeostasis, and energy level

A

Endocrine system

Primary PNP (8 decks)

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