PNP-PC Part 3 Flashcards
1
Q
Most common anemia in childhood
A
Iron-deficiency anemia
2
Q
When is the routine screening of hemoglobin?
A
Between 9-12 months
3
Q
What is the common age of Iron-deficiency anemia?
A
1-3 years of age
4
Q
What is classified as mild Iron-deficiency anemia?
A
9.5-11
5
Q
What is classified as severe Iron-deficiency anemia?
A
8-9.5
6
Q
Poor weight gain Sclera or palmar pallor Splenomegaly Tachycardia Systolic flow murmurs with progression
A
Iron-deficiency anemia severe
7
Q
What will RBC be for Iron-deficiency anemia?
A
Microcytic and hypochromic
8
Q
What will MCV be for iron deficiency anemia?
Increased, decreased, normal
A
Decreased
9
Q
What will serum ferritin be for iron deficiency anemia?
Increased, decreased, normal
A
Decreased
10
Q
What will serum iron be for iron deficiency anemia?
Increased, decreased, normal
A
Decreased
11
Q
What will total iron-binding capacity be for iron deficiency anemia?
Increased, decreased, normal
A
Increased
12
Q
What will iron saturation be for iron deficiency anemia?
Increased, decreased, normal
A
Decreased
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)
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
15
Q
What is iron therapy for severe iron deficiency anemia?
A
4-6 mg/kg/day in 2-3 doses
16
Q
How early can you start ferrous sulfate in premature infants?
A
2 months
17
Q
How early can you start ferrous sulfate in term infants?
A
4-6 months
18
Q
Inherited anemia that affects both males and females
Most often affects Italian, Greek, Middle Eastern, Asian, and African descent
A
Thalassemia
19
Q
Pale, poor appetite, dark urine, jaundice, liver, spleen, and heart enlargement, bone problems, and failure to thrive
A
Severe Thalassemia
20
Q
Hemoglobin electrophoresis testing
A
Thalassemia
21
Q
Moderate/Severe Thalassemia management
A
Referral to hematolgoy
Regular blood transfusions, iron chelation therapy, folic acid, B vitamins help build healthy RBCs
22
Q
Autosomal-recessive heme disorder
A
Sickle cell disorder
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
24
Q
What are important education points for sickle cell anemia?
A
Adequate fluid intake
Fever (101F) is an emergency
25
Emergency admission for sickle cell disorder
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
26
How often do you check infant birth to 6 months with sickle cell disease?
CBC every 2 months
27
How often do you see infants 6 months to 2 years with sickle cell disease?
Every 3 months
CBC every 3-6 months
UA annually
Ferritin, TIBC, BUN, CREAT, LFTs once at 1-2 years
28
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
Hereditary Spherocytosis
29
```
Jaundice in the newborn period
Splenomegaly after 2 years of age
Chronic fatigue
Malaise
Abdominal pain
```
Hereditary Spherocytosis
30
Splenectomy is curable
Hereditary Spherocytosis
31
At what age should splenectomy be performed for severe Hereditary Spherocytosis?
6 years old
32
What vaccines must be given before splenectomy can be performed for Hereditary Spherocytosis?
Pneumococcal and Meningococcal
33
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
Lead Poisoning
34
Free erythrocyte protoporphyrin (FEP)
lead poisoning diagnosis
35
What blood level lead is required to refer?
All values >70
36
Thrombocytopenia (less than 150,000) in absence of other occurs; peak occurrence between 2-4 years
Most common after a febrile, viral illness
Idiopathic Thrombocytopenic Purpura (ITP)
37
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
Idiopathic Thrombocytopenia Purpura (ITP)
38
Low platelet count (severe = <20,000)
Normal PT, aPTT
Normal WBC and RBC
Idiopathic Thrombocytopenia Purpura (ITP)
39
Labs:
PT & aPTT are elevated
Thrombocytopenia
DIC
40
Labs:
Prolonged PT and aPTT
Normal platelet
Coagulation factor deficiency
41
Sick, febrile child
Isolated thrombocytopenia
Petechia/Purpura
Meningococcemia
42
If platelet is >20,000 and no bleeding is observed what is the treatment for ITP?
Avoid contact sports, aspirin, and NSAIDs
43
If a child has an increased risk for serious bleeding with ITP, what is the treatment?
Corticosteroids
44
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
Henoch-Schonlein Purpura (HSP)
45
Purpura
Arthralgia/arthritis
Colicky abdominal pain
Henoch-Schonlein Purpura (HSP)
46
What should be performed on all patients with Henoch-Schonlein Purpura (HSP)?
Urinalysis to screen for renal involvement
47
What is management for Henoch-Schonlein Purpura (HSP)?
```
Most recover spontaneously
Primarily supportive (adequate hydration, rest, relief of pain)
```
48
X-linked recessive hereditary disease
| Most exclusively in males
Hemophilia A and B
49
Excessive bruising
Prolonged bleeding from mucous membranes after minor lacerations, *circumcisions*, or menstruation
Hemarthrosis charactered by pain and swelling in elbows, knee, and ankles
Hemophilia A and B
50
Which is most common between hemophilia A and B?
hemophilia A
51
What is the leading type of significant bleeding with hemophilia A and B?
Hemarthrosis
52
How do you treat hemarthrosis?
Apply ice and pressure to affected joints
53
What medications should patients with hemophilia A and B avoid?
Aspirin and NSAIDs
54
How should immunizations be given for hemophilia A and B?
Subcutaneous with 26G needle
IM with 23G needle
Hold pressure and ice for several minutes
55
Autosomal dominant
Most common inherited bleeding disorder
Occurs in both sexes
von Willebrand Disease
56
Epistaxis, menorrhagia
Easy bruising
Excessive posttraumatic or post-op bleeding
Hx of ecchymosis of trunk, upper arms, thighs
von Willebrand Disease
57
```
Labs:
CBC w/ diff
Normal platelet count
PT, aPTT
von Willebrand panel
```
von Willebrand Disease
58
What should workup include for unexplained splenomegaly?
```
H&P
CBC with differential
Reticulocyte count
Peripheral blood smear
LFTs
EBV and CMV chest x-ray
Abdominal US
```
59
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
Acute bilateral cervical lymphadenopathy
60
```
Usually caused by S. aureus
Children with poor oral hygiene
Blood culture if ill-appearing
Throat culture
Empiric therapy for moderate symptoms
```
Acute unilateral cervical lymphadenopathy
61
```
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
```
Cancer
62
Most common form of childhood cancer
Leukemia
63
80% of childhood leukemia cases
Acute lymphoblastic leukemia (ALL)
64
Peak incidence of ALL
2-6 years
65
Anemic, pale, listless, irritable, or chronically tired
History repeat infections, fever, weight loss
Bleeding episodes
Lymphadenopathy
Hepatosplenomegaly
Bone/Joint Pain
Leukemia
66
Thrombocytopenia and anemia
WBC may be elevated, normal, or low
Malignant cells on peripheral smear
Bone marrow aspiration
leukemia
67
Solid tumors in lymphatic system; higher incidence in males; more common in 2nd decade of life
Non-Hodgkin Lymphoma
68
Acute abdomen pain, distention, fullness, and constipation
| Nontender lymph nodes enlargement
Non-Hodgkin Lymphoma
69
Cervical nodes and spreads to other nodes; rare in children under 15
Hodgkin Lymphoma
70
Painless enlargement of lymph node (cervical)
Chronic cough (trachea compressed)
Fever
Decreased appetite
Weight loss of 10% or more within 6 months
Hodgkin Lymphoma
71
Anemia
Elevated ESR, CRP
Abnormal LFTs
UA-proteinuria
Hodgkin Lymphoma
72
most common primary site of neuroblastoma
adrenal gland
73
```
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
```
Neuroblastoma
74
Presents with leukocoria (white reflex) in child <3
| Strabismus, nystagmus, red inflamed eye
Retinoblastoma
75
2nd leading cause of cancer death in children
CNS tumor
76
headache early in the morning relieved by vomiting
CNS tumor
77
What diagnostic tools are used to diagnose CNS tumors?
MRI or CT
78
Diagnosis requires persistent arthritis for more than 6 weeks in patients less than 16 years
Juvenile Idiopathic Arthritis
79
Is juvenile idiopathic arthritis more common in males or females?
Females
80
Polyarthritis JIA
>5 inflamed joints
81
Oligoarthritis JIA
<5 inflamed joints
82
Systemic-onset JIA
arthritis with characteristic fever
83
```
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
```
Juvenile Idiopathic Arthritis
84
```
Fever
salmon-colored rashes
leukocytosis
lymphadenopathy
rheumatoid nodules
```
Juvenile Idiopathic Arthritis
85
What is the common treatment for JIA?
NSAIDs
Corticosteroids
Antirheumatic drugs/Methotrexate
Physical Therapy
86
5 joints or more, symmetrical affected
Females more than males
Fever and rash are possible
Subcutaneous rheumatoid nodules
Polyarthritis JIA
87
What is the treatment for polyarthritis JIA?
NSAIDs and DMARDs (Methotrexate)
88
4 or fewer joints affected
Peak onset 1-2 years
Females > Males
Uveitis--must have slit-lamp eye exam every 3 months
Oligoarticular JIA
89
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
Systemic JIA
90
```
Ocular pain and redness
Change in vision
Photophobia
headache
Asymptomatic
```
Uveitis
91
```
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
Uveitis
92
What is the first line of treatment for uveitis?
Refer to ophthalmologist
| Topical corticosteroids with mydriatics
93
Chronic, systemic disease characterized by altered immune regulation that can involve inflammation in multi-organ systems
Systemic Lupus Erythematosus (SLE)
94
What is the median age of onset for Systemic Lupus Erythematosus?
11-12 years
95
What is the hallmark for systemic lupus erythematosus?
Butterfly or malar erythematous facial rash which increases in intensity in sunlight
96
```
**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
```
Systemic lupus erythematosus
97
What is common treatment for systemic lupus erythematosus?
Sunscreen
NSAIDs, oral steroids, antimalarial drugs
Vitamin D and calcium supplementation
98
Chronic, idiopathic pain syndrome
Females > Males
Mean onset of age is 12
Fibromyalgia Syndrome
99
If ANA is - what does this mean for systemic lupus erythematosus?
It is ruled out
100
```
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
```
Fibromyalgia Syndrome
101
What is the management for fibromyalgia syndrome?
Physical therapy
Psychotherapy and relaxation
NSAIDs
Gabapentin
102
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
3 out of 10
5 out of 18
3 different areas
more than 3 months
103
Genetic disorder in which both "arms (B and T cells)" of adaptive immune system are impaired
"bubble boy disease"
Severe Combined Immunodeficiency (SCID)
104
Why is there a delay in the detection of SCID?
Newborns carry their mother's antibodies for the first few weeks of life so infants originally look normal/healthy
105
```
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?
Severe Combined Immunodeficiency (SCID)
106
What is a key characteristic of SCID?
Low antibody levels and lack of specific antibodies after vaccination or natural infection
107
Treatment for SCID
Enzyme therapy
Gene therapy
**bone marrow transplant
108
What is a significant risk factor for HSP?
Hypertension
109
Regulates growth, puberty, reproduction, homeostasis, and energy level
Endocrine system
