Differences and similarities between purpura and petechiae?
Petechiae are lass than 5 mm, Purpura is more. They are both nonblanching purple-pink lesions
Where is the mediastinum? What vital structures are contained there?
1) suprasternal notch and diaphragm
2) sternum and spine
3) between the parietal pleura (pleura that lines the inner chest well and covers the diaphragm)
Contains thymus, thyroid, esophagus, lymph nodes, tracheo, bronchi, heart, major vessels and nerves
Cough, wheezing, orthopnea and respiratory distress could be signs of?
mediastinal mass. get CXR
Precautions in a child with a mediastinal mass?
never force to lie down because it could shirt and cause respiratory arrest. Sedation should never be given unless proper personnel and equipment. When sedates, chest muscles relax and the mass could compromise the airway
Face swelling, upper arms, and engorged vessels could be?
Superior Vena Cava Syndrome due to compressing the SVC and vital structures. Sometimes misdiagnosed as an allergic reaction
What is a ‘matted’ lymph node?
When a group of nodes feels connected and seem to move as one unit. This is often related to cancer.
What is an abnormally enlarged lymph node?
greater than 1 cm, (matted is not great, nor is a large node in the hollow above the elbow)
Possible signs of increased intraabdominal pressure?
Dyspnea, pain, n/v, constipation, diarrhea, urinary retention or hematuria, appetite decrease
Classical presentation for CNS tumors - headache timing
morning or postnap, n/v, palsies. morning n/v. seizures are only in about 15%
Workup for suspected CNS tumors?
Immediate CT or MRI, immediate neurosurgical consult. LPs should be avoided in children with headaches (without fevers) until a CT shows normal ventricular size to prevent herniation
Head tilt, macrocephaly, short stature, bulging fontanel, irritability and lethargy, torticollis, precocious puberty may be
CNS tumor related. Sometimes short stature, FTT and precocious puberty due to hypothalamix-pituitary
What is the ‘setting sun sign’
impaired upward gaze, sign of possible CNS tumor
What is the buffy coat?
WBCs and platelets, middle layer between plasma and RBCs after spin down
On a CBC, what is MCH, MCHC, and RDW?
MCH indicates amount of hemoglobin in each RBC.
MCHC indicates the concentration of hemoglobin per RBC (related to the hydration status of the RBC).
MCH and MCHC are both indicative of RBC color (pale versus normal). Pale is associated with anemia.
RDW indicates variations in the size of RBCs.
What could an elevated MCV mean?
immature cells, fetal hemoglobin, vitamin B12 or folic acid deficiency, methotrexate chemotherapy. Dr Camilo says it is also related to taking 6mp and can be a measure of compliance
Different types of WBCs: Infection fighters? immunity? phagocytes? allergy/parasites? hypersensitivity?
- neutrophils (infection)
- lymphocytes (immunity)
- monocytes (phagocytosis)
- eosinophils (allergy, parasites)
- basophils (hypersensitivity)
What is a ‘left shift’ with neutrophils
and increase in immature forms due to bacterial infection
These things could cause an increase in neutrophils
bacterial infections, glucocorticoid therapy, stress, epinephrine
These meds could cause what symptom: viral infections, bactrim, chloramphenicol, gantrisin, tegretol, dilantin, bone marrow disease
segs % (polys) + bands% (stabs) X total WBC
Two ways to evaluate creatinine clearance?
12-24 hr urine collection or a GFR (radiographic glomerular filtration rate, a nuc med test). Some chemo is based on creat clearance.
When a GFR is scheduled, what should you check that could make it falsely low?
recent radiographic study like MIBG scan
Difference between indirect and direct bili?
indirect is water insoluble, direct is after it has travelled through the bloodstream to the liver where it is changed into water soluble form (direct)
Children with APL or sepsis may present with
coagulopathies. get PT/PTT, d dimer and fibrinogen
Asplenic or functionaly asplenic patients with a fever
EMERGENCY just like neutropenic patients
In all patients with shaking chills, you should check
a cap refill and report if delayed >2 secs
Shaking chills with amphotericin, IVIG, monoclonal antibodies or blood products may be treated by administering:
meperidine, hydrocortisone and benadryl