newman- all the SBL pediatric clin Flashcards
(33 cards)
define lymphadenopathy
LNs that are abnormal in size, number, or consistency
the most important part of the work up in a child w lymphadenopathy
H&PE
quality of LNs: what is good, what is more concerning
good: they’re where you expect, soft, mobile, NOT warm, tender, or red: pt feels okay
more concerning: multiple locations, very large, matted and stuck down, fluctuant, tender, associated w big liver/spleen
when do you biopsy an unusual LN: if watchful waiting is the plan, what do you have to make sure to do
biopsy if the nodes get bigger, more developed, or don’t go away after 4-6 weeks of watching and waiting
if watching and waiting, ALWAYS lock your patient into follow up with instructions to return sooner if things get worse
what do you have to make sure to do when ordering labs on a patient who’s systemically ill/has respiratory sx, or B-signs
actively look for the results
communicate with the patient and their family as soon as the results are available
what is the best test for enlarged/unusual LN
excisional biospy
common viral causes of lymhadenopathy in children
EBV –> mono (severe pharyngitis, cervical LAD, splenomegaly)
HIV– wasting away, diffused LAD
common bacterial causes of lymhadenopathy in children
cat scratch ds: bartonella henselae (ipsi axillary LAD)
tularemia (skinning rabbits)
staph/strep: super common: look for lesion on skin in region of body that drains into the enlarged node
most common tumor of infancy
hemangioma (tumor)
hemangioma:
clinical manifestations
what finding requires specific investigation
cavernous (big, dilated, deformed vessels)
skin of infants, usually raised and usually get a little bigger before regressing
ANY growth or deep dimple over a baby’s lumbosacral area –> MRI or US to check for spinal cord or vertebral abn
what are the malignant tumors of childhoods
how do they present
NEUROBLASTOMA: of sympa ganglia and adrenal medulla
elevated urine VMA and HVA
if cut: blueberry muffin baby
WILMS TUMOR: most common primary renal tumor of kids, peak 2-5 yo
what syndrome has an increased risk of wilms tumor
beckwith-weidmann syndrome
=macroglossia, organ enlargement, hemi-hypertrophy, omphalocele
most common malignancy in kids <10 yo
leukemia (AML or ALL)
most common malignancy in adolescents 15-19 yo
hodgkin lymphoma
EBV, Reed Sternberg Cells, B sx: fever, weight loss, night sweats
level of thrombocytopenia
~primary hemostasis impaired
~spontaneous bleeding
~clin sign bleeding
~life threatening bleeding
~ <75k
~< 50k
~ <20 k
~ <10 k
causes of thrombocytopenia in..
fetal
early onset neonatal (<72 hrs)
late onset neonatal (>72 hrs)
fetal = alloimmune, autoimmune, chr abn, congenital infection
early onset neonatal (<72 hrs): placental abn, perinatal asphyxia or infection, DIC, alloimmune/autoimmune
late onset neonatal (>72 hrs) = late onset sepsis
HUS present in kids
present after acute gastroenteritis w classic triad:
- microangiopathic hemolytic anemia
- thrombocytopenia
- acute renal damage/failure
young M w eczema and recurrent infection and small platelets
dx?
wiscott-aldrich syndrome (aka x-linked thrombocytopenia)
= x-lined caused for thrombocytopenia and immune deficiency
ITP in kids
ACUTE vs CHRONIC
labs
peak age: (A) 2-6 yrs (C) 20-40yo sex: (C) F antecedent infection: (A) common, 1-3 wks onset of bleeding: (A) abrupt (C) insidious plt count: (A) <20k (C) 30-80k eosinophilia/lymph: (A) y (C) rare duration: (A) 2-6 wks (C) months-yrs spont remission: (A) ~80% (C) rare
(ACUTE): suddent petechiate and bruising, 30% mucosal hemorrhage.
have anti-plt Ab, n PT/PTT,
(CHRONIC) at 12 months, eval for other ds too (SLE, HIV, H pylori, Xlinked TP)
LABS:
CBC- isolated thrombocytopenia
WBC, reticulotyte, RBC indices, peripheral blood smear, quantitative Igs= normal
DAT= (-)
usual trx from ITP
trx in severe/life threatening hemorrhage w ITP
usually= supportive, keep plts >20k
severe: IVIG, prednisone, anti-D Ig
kasabach-merrit syndrome = who he?
thrombocytopenia and hypo-fibrinogemia secondary to giant hemangioma and associated intravascular coagulation
congenital/hereditary ds that cause thrombocytopenia in children VIA impaired thrombopoiesis
TAR= thrombocytopenia with absent radii syndrome
fanconi syndrome (macrocyti anemia, reticulocyto+thrombocyto+leukocyto -penia) ~ progress to pancytopenia, may not see sx until 10yo
Schwachman-Diamond syndrome= congenital pure red cell aplasia
Wiskott Aldrich
physiologic response to anemia
concentration (2,3-DPG) increases w/i the RBC
O2 dissociation curve shifts to the right
transfer of oxygen to the tissues is more complete
clinical features of anemia present once Hgb falls below what??
sx=
Hgb < 7-8 g/dL
pallor, sleepiness, flow murmur, SOB exertion, high output HF
