Unit1 Pediatric Heme/onc

Front 1

What is the most common cancer diagnosis in children?

Back 1

ALL

Front 2

Blasts, anemia, thrombocytopenia, and chemical abnormalities are suggestive of what?

Back 2

Acute leukemia

Front 3

Hyperleukocytosis is a WBC count over what?

Back 3

100,000

Front 4

Tumor lysis syndrome, hyperleukocytosis, airway compromise, SVC syndrome, fever, neutropenia, and neurological signs are what?

Back 4

Oncological Emergencies

Front 5

What are some DDxs for acute leukemia?

Back 5

Infection (especially EBV)
ITP
Aplastic anemia
Juvenile rheumatoid arthritis
Histiocytoses
Other malignancies (neuroblastoma)

Front 6

What are the indications for bone marrow aspiration in children?

Back 6

at least 2 of 3 cell lines abnormal (between WBCs, Hgb, platelets)

Front 7

What is the percentage of blasts in the bone marrow for acute leukemia?

Back 7

equal to/over 25%

Front 8

What other test besides bone marrow should also be performed in diagnosis of acute leukemia?

Back 8

lumbar puncture

Front 9

Neurocognitive delay, endocrinopathies, gonadal failure/sterility, cardiac dysfunction, and second malignancies are later effects of what?

Back 9

ALL therapy

Front 10

What is the recommended workup for cervical adenopathy?

Back 10

CBC w/diff
LDH
ESR
CXR, PA & LAT

Front 11

What should you do before doing a biopsy on a child with cervical adenopathy?

Back 11

Contact pediatric oncology

Front 12

What is the only way to make a certain diagnosis in cervical adenopathy?

Back 12

Biopsy

Front 13

Firm, nontender cervical and or supraclavicular adenopathy, cough, and orthopnea are signs of what?

Back 13

lymphoma

Front 14

T-cell lymphoma usually occurs where?

Back 14

Thymus - thorax

Front 15

B-cell lymphoma usually occurs where?

Back 15

belly - Burkitt's

Front 16

Wilms tumor is a cancer of what organ?

Back 16

Kidney

Front 17

What symptoms are present in Wilms tumor?

Back 17

Child is usually well
Hematuria
hypertension
abdominal pain

Front 18

How do you differentiate quickly between Wilms tumor and neuroblastoma of the kidney?

Back 18

Wilms tumor patients are usually well; neuroblastoma patients are usually sick

Front 19

What are the symptoms of neuroblastoma of the kidney?

Back 19

bruising/petechiae
Pain/irritability
pallor
fever

Front 20

Headache, vomiting (especially in the morning), ataxia, and cranial nerve palsies are signs of what?

Back 20

CNS tumors

Front 21

What Hgb level indicates physiologic anemia of infancy in a term baby?

Back 21

9-11 g/dl

Front 22

What Hgb level indicates physiologic anemia of infancy in a preterm baby?

Back 22

7-9 g/dl

Front 23

If the retic count is low, what kind of problem do you have?

Back 23

Production problem

Front 24

If the retic count is high, what kind of problem do you have?

Back 24

Destruction/blood loss

Front 25

What is the mean MCV for term newborns?

Back 25

108

Front 26

What is the low normal MCV for children over 1 year of age?

Back 26

70 + age in years

Front 27

What are the microcytic anemias?

Back 27

Iron deficiency
Thalassemia
Lead poisoning
Chronic disease
Sideroblastic anemia

Front 28

If a patient has a low MCV, and if the MCV / RBC is over 13.5, is it iron deficiency or thalassemia?

Back 28

Iron deficiency

Front 29

If the patient has a low MCV, and the MCV / RBC is less than 11.5, is it thalassemia or iron deficiency?

Back 29

Thalassemia

Front 30

RDW is normal in _______ and increased in _________.

Back 30

Normal in thalassemia
Increased in iron deficiency

Front 31

What does the iron panel show in iron deficiency anemia?

Back 31

Serum iron - low
Ferritin - low
TIBC - high
% saturation - low

Front 32

What cells can be seen on the blood smear in thalassemia?

Back 32

Target cells

Front 33

What is the most common worldwide anemia?

Back 33

Iron deficiency

Front 34

What are the most common causes of iron deficiency anemia?

Back 34

dietary deficiency
excessive blood loss

Front 35

What are the best sources of heme iron?

Back 35

Red meats - best
also in fish, poultry, eggs

Front 36

When should you begin feeding babies iron fortified cereal?

Back 36

4-6 months of age

Front 37

What are sources of non-heme iron?

Back 37

Iron-fortified cereals, green vegetables, nuts

Front 38

At what age do iron requirements exceed breast milk supply?

Back 38

at 4-6 months of age

Front 39

What age is it acceptable to begin feeding cow's milk?

Back 39

12 months of age

Front 40

What is a common cause of iron deficiency in toddlers?

Back 40

Drinking too much milk - over 16 oz

Front 41

What is the therapy for iron deficiency anemia?

Back 41

Ferrous sulfate, 3-6 mg/kg elemental iron per day
Vitamin C

Front 42

How long should iron therapy continue in iron deficiency anemia?

Back 42

until MCV and Hgb are normal, plus 2-3 months to replete iron stores

Front 43

Staining of teeth, dark stools, constipation, irritability, and abdominal pain are side effects of what?

Back 43

iron supplementation

Front 44

What iron therapy may cause fewer GI side effects than ferrous sulfate?

Back 44

Polysaccharide-iron complex
Nulron, Niferex

Front 45

What are reasons for poor response to iron therapy?

Back 45

Noncompliance
Not altering milk intake
Ongoing blood loss
Antacids
Incorrect diagnosis

Front 46

Inner city children, children with malnutrition, and Hispanic children are at high risk for what?

Back 46

Iron deficiency anemia

Front 47

What is the most serious complication of iron deficiency anemia?

Back 47

Neuro - possible irreversible damaging brain changes

Front 48

What age does transient erythroblastopenia of childhood appear?

Back 48

6 months - 5 years

Front 49

What is the etiology of TEC?

Back 49

unknown, but history of a viral infection is common

Front 50

What do the labs show in TEC?

Back 50

Reticulocytopenia
normal MCV
increased serum iron

Front 51

What is the treatment for TEC?

Back 51

Observation until normal counts
Rarely - transfusion
Self resolving in 1-2 months

Front 52

What is the most common RBC membranopathy?

Back 52

hereditary spherocytosis

Front 53

What is the genetic inheritance in hereditary spherocytosis?

Back 53

autosomal dominant

Front 54

Patients with hereditary spherocytosis are at risk for what crisis?

Back 54

Aplastic crisis

Front 55

What is the treatment for mild hereditary spherocytosis?

Back 55

Nothing
Folic acid
Education/genetic counseling

Front 56

What is the treatment for moderate/severe hereditary spherocytosis?

Back 56

consider splenectomy
folic acid
education/genetic counseling

Front 57

What happens to neutrophils in macrocytic anemias?

Back 57

hypersegmented neutrophils

Front 58

What hemoglobin is consistent with alpha thalassemia trait?

Back 58

Barts hemoglobin

Front 59

Hemoglobin E is common in persons of what descent?

Back 59

southeast Asian

Front 60

Hemoglobin E is clinically significiant only when combined with what?

Back 60

beta thalassemia

Front 61

What is the low normal ANC count in Caucasians?

Back 61

1500/mm^3

Front 62

If blasts are seen in peripheral blood, what disease is it until proven otherwise?

Back 62

leukemia

Front 63

What is the most common cause of thrombocytosis?

Back 63

Infection

Front 64

What is the therapy for children with thrombocytosis?

Back 64

Nothing

Front 65

What is the percentage of children with acute ITP that make a complete recovery?

Back 65

80-90%

Front 66

What is the most serious complication of ITP?

Back 66

Intracranial hemorrhage