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Pediatrics Exam 2 > Peds. Heme > Flashcards

Peds. Heme Flashcards

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1
Q

The two reasons why physiologic jaundice occurs:

A
  1. Increased destruction of RBC - lifespan of RBC is 70-90 d

2. Hepatic uptake is lower (decreased glucuronyl transferase) - this conjugates bilirubin

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2
Q

When does physiologic jaundice appear and pattern?

A

Days 3-5; cephalopods –> caudal

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3
Q

Breastfeeding jaundice is when:

A

The mom is not producing enough milk - their jaundice is MORE EXAGGERATED because they are dehydrated and nutrient deprived

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4
Q

Breast Milk jaundice is when:

A

There is a LATER onset of physiologic jaundice with peak bilirubin levels 2-3 weeks after birth (slower progression)

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5
Q

What is the normal level of diapers for elimination?

A
  • 6 wet

- 3-4 dirty

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6
Q

Bilirubin levels and regions of the body:

A 
Safe (II): Head and to the nipple line = 12
Dangerous (III): Lower abdomen and legs = 8-16
More dangerous (IV): Arms and lower legs: 11-18
BAD (V): Palms and soles (15)
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7
Q

What do you order and treatment level for bilirubin assessment?

A

TSB; treat after 12

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8
Q

What is Kernicterus:

A

Acute bilirubin encephalopathy - stains the basal ganglia, pons or cerebellum

Bilirubin >20
Symptoms when bilirubin >25

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9
Q

Major risk factors for hyperbilirubinemia

A 
Jaundice within 24 hours of birth
A sibling with jaundice as a neonate
Unrecognized hemolysis
Nonoptimal sucking/nursing
Def. in glucose-6-phosphate
Infection 
Cephalohematoma (extra blood)
East Asian or mediterranean
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10
Q

When do you treat a baby with phototherapy? Day 3 and day 5 levels:

A

Day 3: At 16/17

Day 5: Over 20

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11
Q

Kernicterus has not been documented to show:

A

A relationship with Breast milk jaundice

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12
Q

What are the therapies for breast milk jaundice (2)?

A
  • 1-2 days of formula (keep pumping) and breast feed later

- Phototherapy

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13
Q

What is the therapy for breastfeeding failure jaundice?

A
  • 1-2 days of formula and then re-begin breast feeding 5 days later (jaundice usually does not return)
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14
Q

If you see jaundice in the first 24 hours of life, think of:

A

Hemolytic anemia

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15
Q

What are the two causes of hemolytic anemia?

A
  • Mom is rh - and baby is rh +

- Mom is O and baby is A or B

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16
Q

Hemolytic disease of the newborn is from:

A

Mom is Rh- and formed AB against previous Rh + baby - now her Ab are attacking baby #2 RBC = lysis

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17
Q

To prevent AB formation to an Rh+ baby, mom is given shots when?

A

28 weeks and within 72 hours of birth

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18
Q

To test if the baby is a different blood type than mom, you can perform the:

A

Direct Coomb’s test - Looking for AB on the baby RBC

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19
Q

If the direct coomb’s test is positive, you should:

A

Switch the infant to formula

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20
Q

What do you do for a baby with Hemolytic anemia of the newborn?

A
  • hospitalize

- exchange transfusion

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21
Q

Anemia is diagnosed when:

A

It is two SD below the normal

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22
Q

Pattern of H and H in newborns:

A

Newborn: HIGH: 18.5 and 56%
1 mo - 2 yr: Decreases to 13 and 36%
12: Adult levels

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23
Q

What is the most common cause of anemia in kids?

A

Iron def. during times of rapid growth - toddlers and adolescents

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24
Q

When does a normal term and a premature infant run out of its iron stores?

A

Normal: 4-6 months
Premature: 3-4 months

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25
What three things would make a child vulnerable to anemia?
- Low SES (mex. Americans) - Lead exposure - Exclusively breast feeding beyond 4 months
26
IDA is more common where?
Inner city (8%)
27
When is routine Fe screening and when should it be done early?
Routine: at 12 months Early: - 9-12: Low SES, immigrated to USA - 6 months: Pre-term/low birth weight
28
How should you treat IDA? Recovery?
- 3-6 mg of iron/kg/day TID or BID Response: 1g/dL/week Recovery: 6-8 weeks
29
What are two PE findings of sickle cell?
- Maxillary hyperplasia | - Dactylysis
30
What is the most common reason for early mortality in sickle cell patients?
Acute Chest Syndrome
31
What are the three symptoms of pediatric acute chest syndrome?
- Fever - Cough - Upper lobe
32
What are the three symptoms of adult acute chest syndrome?
- Afebrile - Pain - Lower lobe
33
What are lab findings for Sickle cell?
Increased: MCV, WBC, Platelets Decreased: H & H
34
An aplastic crisis can result from:
A parvovirus infection - slapped cheek rash
35
What is hereditary spherocytosis and treatment?
The RBC membrane is rigid and gets clogged in the spleen - treatment is to remove the spleen
36
When should you perform a splenectomy on someone with hereditary spherocytosis?
Age 5/6 or unless they are being hospitalized for crisis before then
37
You are susceptible to parvovirus causing problems with what two illnesses?
- Hereditary spherocytosis | - Sickle cell
38
Primary hemostasis involes what two things:
Platelets and endothelial cells
39
What does secondary hemostasis involve?
Coagulation factors
40
ITP only affects the ___ in the body and is most common in ____ YO (time of year?)
Platelets; 2-5 - Summer and spring
41
Progression of ITP in kids:
Follows a viral illness from 1 month ago and resolves within 6 months
42
What are some symptoms of a primary bleeding disorder?
- Bleeding from mucous membranes - Epistaxis - Eccymosis - Petechiae - Prolonged bleeding from wound
43
What are some symptoms of a secondary bleeding disorder?
- Palpable SC/IM hematomas | - Hemarthroses
44
What should you avoid with ITP?
IM injections and NSAIDS
45
Under a platelet count of 30,000 for ITP you should treat with:
- Tranfusion - Corticosteroids - IVIG - Anti-D immune globulin * Recover in 3-6 months
46
Grade I - Minor ITP findings:
Few petechiae <100, and <5 bruises <3 cm diameter
47
Grade II - Mild ITP findings:
Many petechia >100 and or >5 large bruises >3 cm in diameter
48
Grade III - Moderate ITP findings
Mucosal bleeding
49
What is Henoch-Schonlein Purpura NOT
a platelet disorder
50
What are 5 PE findings of Henoch-Schonlein Purpura?
- Nonthrombocytopenic purpura - Arthritis - Arthralgias - GI sx - Renal findings
51
What age are people normally with Henoch-Schonlein Purpura?
6-7 (older than ITP)
52
What are two features of the clinical presentation for Henoch-Schonlein Purpura?
- Previously well child with a history of illness or immunization - Rashon hands, legs and feet + abdominal pain and arthralgia
53
Rash is ___% present in cases of Henoch-Schonlein Purpura but:
100% present; but not always the first thing to develop
54
The rash in Henoch-Schonlein Purpura becomes:
Confluent over time
55
What two sites are the most common for arthralgia pain in Henoch-Schonlein Purpura?
Knees and ankles
56
Antibody in Henoch-Schonlein Purpura?
IgA
57
What are the three problematic systems in someone with Henoch-Schonlein Purpura?
- Renal - GI - Arthralgia
58
What tests should you order in someone with Henoch-Schonlein Purpura?
- CBC - rule out ITP | - Renal function tests **Renal damage is permanent if not treated
59
When should someone be hospitalized for Henoch-Schonlein Purpura?
- Cannot orally drink - Significant abdominal pain - Change in mental status - Renal insufficiency - Mental problems - Self care issues (cannot walk d/t pain)
60
What are the two issues with von Willebrand disease?
- Platelets cannot adhere | - VWf is a carrier for factor VIII (results in deficiency)
61
VWf affects:
Men and women - many different levels of severity
62
Presentation of VWF?
Bleeding from mucous membranes - nose, vaginal, GI
63
What are the labs for VWF?
Prolonged PT and bleeding time
64
What is the management for VWF (2)?
- Supportive | - DDAVP - releases VWF from platelets
65
What is a huge sign for Hemophilia A?
Bleeding in male circumcision
66
What are the labs for Hemophilia A?
ONLY PROLONGED PTT
67
What are the two therapies for Hemophilia A?
- Replacement therapy and DDAVP for VIII replacement
68
When is lymphadenopathy concerning in kids?
Under 12: over 1 cm | Over 12: Over 0.5 cm
69
What kills kids most under the age of 15?
- Accidents (44%) | - Cancer 10% of kid deaths under 15
70
75% of all childhood leukemia:
ALL
71
__ is rare in kids and ____ is very rare
CML is rare | CLL is very rare
72
What two things are commonly associated with having leukemia?
Down syndrome | Having a sibling with leukemia
73
What are three odd signs of leukemia?
- Gingival hyperplasia - Rashes - CN palsy
74
What will you see on a CBC for someone with leukemia?
High WBC, low RBC
75
What confirms a diagnosis of leukemia?
Bone marrow biopsy
76
Brain tumors are the __ most common cancer in kids
Second
77
What three things indicate a kid may have a brain tumor?
- Loss of dev. milestones - Poor performance in school - Increased head circumference or expanded fontanelles
78
What are two signs of a BT in kid regarding their eye:
Marcus Gunn pupil, CN 6 palsy
79
Lymphoma in kids presents like:
2-3 months of painless growing cervical/supraclavicular lymph nodes
80
How does Non-Hodgkin Lymphoma present?
SOB, cough, SVC, hepatosplenomegaly, mediastinal mass, abdominal mass/tenderness
81
What is a wilms tumor?
Nephro tymor
82
Wilm's tumor is __ most common cancer in kids:
Second
83
What age is most common for a Wilm's tumor and what is the peak age?
Most common in 6mo - 10 yr; peak age is 2-3
84
Most are asymptomatic with a Wilm's tumor but 30% can have:
Abdominal pain, malaise, gross hematuria, hypertension
85
To diagnose a Wilm's tumor...
US and CT
86
Osteosarcomas are common where and with what sign?
Metaphysic; Sun burst
87
Ewing sarcoma is common where and with what sign?
Flat bones, diaphysis (hip); Onion peel
88
What tests do you order if you suspect osteosarcoma or Ewing's?
Xray then CT or MRI - Chest X-ray to look for mets

Pediatrics Exam 2 (7 decks)

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