NUNP 6541 Pediatric Final Exam-Walden U

Recommended treatment for RSV in a 7 month old (outpatient)

Use of saline drops and suctioning of the nares. Indications of when to use antipyretics. Signs of respiratory distress or dehydration. Guidelines for feeding an infant with signs of mild respiratory distress which includes smaller more frequent feedings; monitoring of the respiratory rate; and guarding against vomiting. The parents should be educated that the child may have the symptoms over the course of 2-3 weeks

Epiglottitis s/s

Acute and rapid onset of high fever, chills, and toxicity. Severe sore throat and drooling saliva. Will not eat or drink, muffled (hot potato) voice, and anxiety. Sitting posture with hyperextended neck with open-mouth breathing. Stridor, tachycardia, and tachypnea

Epiglottitis prevention

Haemophilus influenzae type B (Hib) vaccine

Steeple sign

a radiologic sign found on radiograph where the subglottic tracheal narrowing produces a shape of a church steeple which supports a diagnosis of croup

Foreign body aspiration antibiotic?

Depends on the nature of the material aspirated, plus the location and degree of obstruction. Bronchial or laryngeal foreign body aspiration, a bronchoscopy must be performed for removal of the foreign body

Antibiotics for bronchiolitis?

Use of saline drops and suctioning of the nares. There is no evidence to support the routine use of antibiotics

Antibiotics for croup?

Nebulized epinephrine, corticosteroids (dexamethasone oral or IM), blow by oxygen or heliox in severe croup. Racemic epinephrine with the use of corticosteroids to limit rebound swelling

Antibiotics for epiglottitis?

Establish an airway preferably by nasotracheal intubation. Administer IV antibiotics such as rocephin to cover H.influenzae. Administer oxygen and respiratory support. Antibiotics should be continued for 10 days. Rifampin prophylaxis 20 mg/kg in a single dose (maximum of 600 mg) for 4 days for infants and children, 600 mg once a day for adults for 4 days. Should be provided for household contacts who are at risk (Younger than 4 years old who is non-immunized or incompletely immunized, children less than 12 months who have not received primary series of Hib, and immunocompromised children.

Asthma treatment

The pharmacological management of asthma in children is based on the severity of asthma and the child's age. After initial control, decrease treatment to the least amount of medication needed to maintain control. Systemic corticosteroids may be needed at any time and stepped up if there is a major flare-up of symptoms.

Step 1 Asthma management for children 0-4 years old

Step 1: SABA (Short acting beta2-agonist) PRN: With viral respiratory symptoms short acting beta 2-agonist should be used every 4-6 hours up to 24 hours (longer with a physician consult). Consider short course of oral systemic corticosteroids if severe exacerbation. Frequent use of SABA may indicate the need to step up treatment

Step 2 Asthma management for children 0-4 years old

Step 2: Consider consultation with asthma specialist. Low dose of inhaled corticosteroids.

Step 3 asthma mgmt for children 0-4 yrs

Step 3: Medium-dose of inhaled corticosteroids

Steps 4-6 asthma mgmt for children 0-4 yrs

Step 4: Medium-dose ICS and Long acting beta2-agonist or montelukast.

Step 5: High dose ICS and Long acting beta 2-agonist or montelukast.

Step 6: High dose of ICS and LABA or montelukast and oral corticosteroids

Steps 1-3 asthma mgmt for children 5-11 yrs

Step 1: SABA (Short acting beta 2-agonist) PRN: Increasing the use of short-acting beta 2-agonist or use greater than 2 days a week for symptom relief generally indicates inadequate control and the need to step up treatment.

Step 2: Consider consultation with asthma specialist. Low dose of inhaled corticosteroids.

Step 3: Low dose of inhaled corticosteroid and LABA. Or medium dose of inhaled corticosteroids.

Steps 4-6 asthma mgmt for children 5-11 yrs

Step 4: Medium-dose ICS and LABA or medium dose of inhaled corticosteroid and leukotriene receptor antagonist or theophylline. .

Step 5: High dose ICS and LABA or high dose of inhaled corticosteroid and leukotriene receptor antagonist or theophylline. .

Step 6: High dose of ICS and LABA and oral corticosteroids or high dose of inhaled corticosteroids and leukotriene receptor antagonist or theophylline and oral corticosteroids.

** Theophylline levels must be monitored.

Differentials for patient with sore throat

Strep pharyngitis

Peritonsillar abscess

Viral pharyngitis

Infectious mononucleosis

Epiglottitis

small-for-gestational-age infants: which type of chromosomal analysis should be included?

Trisomy 18

Holt-Olram

Trisomy 13

Turner Syndrome

Trisomy 21

Prader-Willi Syndrome

heart defects associated with Down syndrome

Atrioventricular Septal Defect

Ventricular Septal Defect

Persistant Ductus Arteriosus

Tetrology of Fallot

Contact sports with Down's Syndrome

Do not recommend due to atlantoaxial instability

Diagnosing Down Syndrome

Usually identified at birth by the presence of certain physical traits: low muscle tone, a single deep crease across the palm of the hand, a slightly flattened facial profile and an upward slant to the eyes. Because these features may be present in other babies, a chromosomal analysis called a karyotype is done to confirm the diagnosis. To obtain a karyotype, doctors draw a blood sample to examine the baby's cells. They photograph the chromosomes and then group them by size, number, and shape. By examining the karyotype, doctors can diagnose. Another genetic test called FISH can apply similar principles and confirm a diagnosis in a shorter amount of time

Diagnosing Trisomy 18 (Edwards Syndrome)

A sample of the baby's dna is extracted from a blood sample or other bodily cells or tissue and is cultured to examine a picture of the chromosomes called a karyotype. In order to get this picture, the chromosomes are isolated, stained, and examined under the microscope. Most often, this is done using the chromosomes in the white blood cells. A picture of the chromosomes is taken through the microscope. A visible extra 18th chromosome confirms a Trisomy 18 diagnosis

Diagnosing Holt-Oram Syndrome

A diagnosis may be suspected when a person is found to have changes in the way the bones of the wrist and other bones of the upper limb are formed. The diagnosis can be confirmed if a person has specific bone changes and a personal or family history of an atrial septal defect, ventricular septal defect, or cardiac conduction disease. In order to establish the diagnosis, a doctor may order tests including an x-ray of the hands, wrists, and arms, a echocardiogram, and an electrocardiogram. The diagnosis may also be confirmed with genetic testing of the TBX5 gene

Diagnosing Trisomy 13

Parents who are at risk to have a translocation due to their family history can have a blood test called a karyotype, which can determine if a translocation is present.

Prenatal testing or screening is also available to determine if a current pregnancy is at risk for chromosome disorders.

People with a family history who are interested in learning about genetic screening or testing for themselves or family members are encouraged speak with a genetic counselor or other genetics professional.

Diagnosing Turner Syndrome

A diagnosis may be suspected when there are a number of typical physical features observed such as webbed neck, a broad chest and widely spaced nipples. Sometimes diagnosis is made at birth because of heart problems, an unusually wide neck or swelling of the hands and feet.

This can be confirmed by prenatal testing to obtain cells from the unborn baby for chromosomal analysis. If a diagnosis is confirmed prenatally, the baby may be under the care of a specialist pediatrician immediately after birth

Diagnosis is confirmed by a blood test, called a karyotype. This is used to analyze the chromosomal composition of the female

Fragile X Syndrome (Martin-Bell Syndrome)

a genetic condition that causes a range of developmental problems including learning disabilities and cognitive impairment. Usually, males are more severely affected by this disorder than females.

Affected individuals usually have delayed development of speech and language by age 2, mild to moderate intellectual disability, about one-third of affected females are intellectually disabled. May also have anxiety and hyperactive behavior such as fidgeting or impulsive actions, (ADD), features of autism spectrum disorder that affect communication and social interaction, seizures occur in about 15 percent of males and about 5 percent of females with fragile X syndrome.

Most males and about half of females have characteristic physical features that become more apparent with age. These features include a long and narrow face, large ears, a prominent jaw and forehead, unusually flexible fingers, flat feet, and in males, enlarged testicles (macroorchidism) after puberty

Klinefelter syndrome

Most commonly, affected individuals are taller than average are unable to father biological children (infertile); however the signs and symptoms vary among boys and men with this condition. Boys and men typically have primary testicular insufficiency. Without treatment, the shortage of testosterone can lead to delayed or incomplete puberty, gynecomastia, decreased muscle mass, decreased bone density, a reduced amount of facial and body hair, and infertility. Some also have differences in their genitalia, including cryptorchidism, hypospadias, or a micropenis.

Children may have hypotonia and problems with coordination that may delay the development of motor skills, such as sitting, standing, and walking. Boys and men tend to have better receptive language skills than expressive language skills and may have difficulty communicating and expressing themselves.

Individuals tend to have anxiety, depression, impaired social skills, behavioral problems such as emotional immaturity and impulsivity, attention deficit hyperactivity disorder (ADHD), and limited problem-solving skills (executive functioning). About 10 percent of boys and men have autism spectrum disorder.

Triple X Syndrome

Characterized by the presence of an additional X chromosome in each of a female's cells. Although females with this condition may be taller than average, this chromosomal change typically causes no unusual physical features. Most females have normal sexual development and are able to conceive children.

Associated with an increased risk of learning disabilities and delayed development of speech and language skills. Delayed development of motor skills, hypotonia, and behavioral and emotional difficulties are also possible, but these characteristics vary widely among affected girls and women. Seizures or kidney abnormalities occur in about 10 percent of affected females.

XYY syndrome

A rare chromosomal disorder that affects males. It is caused by the presence of an extra Y chromosome. Males normally have one X and one Y chromosome. However, individuals with this syndrome have one X and two Y chromosomes. Affected individuals are usually very tall. Many experience severe acne during adolescence. Additional symptoms may include learning disabilities and behavioral problems such as impulsivity. Intelligence is usually in the normal range, although IQ is on average 10-15 points lower than siblings.

diet for cystic fibrosis patients

High calorie with added salt

A child has not received abx for a bacterial respiratory infection, what would you treat them with?

Amoxicillin

A 7-month old presents with 1-day cough, yellow sinus drainage and a low grade temp, treatment options?

Tylenol and monitor

A 3 yr old presents with wheezing for past 3 months, what tests would you order?

Spirometry

RSV symptoms in 6 wk old infant

In very young infants (less than 6 months old), the only symptoms of RSV infection may be:

irritability

decreased activity

decreased appetite

apnea (pauses while breathing)

Fever may not always occur with RSV infections

Rhinovirus symptoms in 6 wk old infant

The first indication of the common cold in a baby is often:

A congested or runny nose

Nasal discharge that may be clear at first but might thicken and turn yellow or green

Other signs and symptoms of a common cold in a baby may include:

Fever

Sneezing

Coughing

Decreased appetite

Irritability

Difficulty sleeping

Trouble nursing or taking a bottle due to nasal congestion

Streptococcus pneumonia in 6 wk old infant

Pneumonia in infants aged three weeks to three months is most often bacterial; Streptococcus pneumoniae is the most common pathogen

Listeria in 6 wk old infant

Listeriosis is caused by an infection with the bacterium Listeria monocytogenes . These bacteria can be carried by many animals and birds, and they have been found in soil, water, sewage, and animal feed. Listeriosis is considered a food-borne illness because most people are probably infected after eating food contaminated with Listeria monocytogenes

When a full-term baby becomes infected with Listeria during childbirth, that situation is called late-onset disease. Commonly, symptoms of late-onset listeriosis appear about two weeks after birth. Babies with late-term disease typically have meningitis; yet they have a better chance of surviving than those with early-onset disease

Listeriosis is treated with the antibiotics ampicillin or sulfamethoxazole-trimethoprim

Chlamydia trichomonas in 6 wk old infant

5 to 30% of infected neonates will develop pneumonia. Approximately half of these infants will have a history of C. Trachomatis conjunctivitis.

The condition is generally recognized between 4 and 12 weeks of age, although most infants are symptomatic as early as 8 weeks of age.

Cough and nasal congestion without discharge are common, although discharge can be thick.

Onset is insidious and characteristic features include a staccato cough, tachypnea.

Rales is common upon auscultation, but wheezing is not.

The liver and spleen may be palpable secondary to hyperinflated lungs.

The patient is usually afebrile, and does not appear particularly ill.

WBC is normal, but eosinophils can be elevated.

Arterial blood gas shows moderate hypoxemia.

Chest X-ray shows hyperinflation with bilateral, symmetrical interstitial infiltrates

2-year-old girl with increased work of breathing had a fever, abdominal pain, post-tussive emesis and no diarrhea. What lab test would be beneficial?

Rapid flu test, respiratory viral panel

Reactive Airway Disease (Asthma) symptoms

Most asthma flare-ups start slowly. You may notice small changes in your child's body before a flare-up. Changes include:

Runny or stuffy nose

Sneezing

Itchy or watery eyes

Itchy or sore throat

Tiredness

If you notice your child doing any of these things, start rescue medicine:

First signs of a cold

Wheezing

Noisy breathing

Chest tightness

Fast breathing

Coughing

For very young children, grunting during sucking or feeding, fussiness, or unusual tiredness

Sinusitis symptoms

The following are the most common symptoms of sinusitis:

Stuffy nose

Thick, colored drainage in the nose

Drainage down the back of the throat (postnasal drainage)

Headache

Cough

Pain or soreness over sinuses

Fever

Loss of smell

Bronchiolitis symptoms

Bronchiolitis may at first be mistaken for a common cold. It starts out with many of the same symptoms. But your child may have a cough and other breathing problems that get worse over time. Below are the most common symptoms of bronchiolitis:

Runny nose

Congestion

Fever

Cough

Fast or hard breathing

Wheezing

Loss of appetite

Irritability

Vomiting

These symptoms often last about a week.

Foreign body aspiration symptoms

Classic triad of cough, wheezing, and diminished breath sounds may not be present.

Patients often have an episode of choking and prolonged coughing, but symptoms may cease as the cough reflex is exhausted and/or the object lodges in a bronchus

Dyspnea

Neck or throat pain

Stridor and hoarseness may occur if object is lodged in upper airway (uncommon)

Asymmetric breath sounds

Tachypnea

Nasal flaring

Cyanosis

It is important to ask caregiver about the possibility of foreign body aspiration since patient's symptoms may resolve and imaging may be unremarkable

Mycoplasma pneumoniae (Walking pneumonia) symptoms

Fever, which can be high, but is usually low grade

Fatigue

Headache

Skin rash

General feeling of sickness

Cough, particularly one that progresses from a dry cough to a productive cough

Ear infections

Croup

Sinus infection

Sore throat

Bronchitis symptoms

Symptoms may include:

Runny nose, usually before a cough starts

Malaise

Chills

Slight fever

Back and muscle pain

Wheezing

Sore throat

In the earlier stages of the condition, children may experience a dry, nonproductive cough which progresses later to an abundant mucus-filled cough. Younger children may have some vomiting or gagging with the cough. The symptoms of bronchitis usually last seven to 14 days, but may also persist for three to four weeks

Respiratory Syncytial Virus (RSV) symptoms

The most common symptoms of RSV include:

Runny nose

Fever

Cough

Short periods without breathing (apnea)

Trouble eating, drinking, or swallowing

Wheezing

Flaring of the nostrils or straining of the chest or stomach while breathing

Breathing faster than usual, or trouble breathing

Turning blue around the lips and fingertips

Upper Respiratory Infection Symptoms

A cold affects the nose and throat. Symptoms usually start slowly and include:

runny or stuffy nose

sneezing

cough

sore throat

It may take 3 to 14 days for your child to get well. Usually, your child can do all of his or her normal activities

Peritonsillar abscess

As the infection progresses, the duct to the surface of the tonsil becomes progressively more obstructed from surrounding inflammation. The resulting tissue necrosis and pus formation produce the classic signs and symptoms of peritonsillar abscess

Patients with peritonsillar abscess appear ill and present with fever, malaise, sore throat, dysphagia, or otalgia. The throat pain is markedly more severe on the affected side and is often referred to the ear on the same side. Physical examination usually reveals trismus, with the patient having difficulty opening his or her mouth because of pain from inflammation and spasm of masticator muscles. Swallowing is also highly painful, resulting in pooling of saliva or drooling. Patients often speak in a muffled voice "hot potato voice". Markedly tender cervical lymphadenitis may be palpated on the affected side.

Death can occur from airway obstruction, aspiration, or hemorrhage from erosion or septic necrosis into the carotid sheath

Symptoms most suggestive of pneumonia

Bacterial pneumonia tend to happen suddenly with these symptoms:

Cough that produces mucus

Cough pain

Vomiting or diarrhea

Loss of appetite

Tiredness (fatigue)

Fever

Early symptoms of viral pneumonia are the same as those of bacterial pneumonia. But with viral pneumonia, the breathing problems happen slowly. Viral pneumonia may make a child more at risk for bacterial pneumonia.

In addition to the symptoms listed above, your child may have:

Chills

Fast or hard breathing

Headache

Fussiness

Diet and treatment for RSV

Fluids and tylenol

Which child should not receive a TB skin test?

One that has had a severe reaction to a previous PPD

Which of the following patients least warrants a sweat chloride test?

4-year-old female with nocturnal cough, which resolves after treatment with bronchodilators and short-term steroids; growth parameters at 10% for age.

Lung sounds with cystic fibrosis

Cystic fibrosis typically presents with rhonchi and/or crackles. Their wheezes may sound more congested due to the buildup of mucous in their bronchioles.

Lung sounds with asthma

Wheezing can be a symptom of asthma where a combination of swelling, mucus and muscles tightening can cause narrowing of the airways

Lung sounds with foreign body aspiration

If it causes airway occlusion it may lead to asphyxia and it is unfortunately a leading cause of death in childhood. However, it more often presents with a history of an initial episode of choking and coughing with subsequent respiratory symptoms. These include cough, wheeze, stridor, or pneumonia. The most common physical sign is decreased or abnormal breath sounds

Lung sounds with croup

Stridor is a harsh, raspy tight sound best heard with breathing in

Loud or constant stridor means severe croup. So does stridor at rest (when not crying or coughing).

All stridor needs to be treated with warm mist

Radiographic signs of croup

steeple sign (also known as "wine bottle sign"): seen on AP radiographs of the neck or chest and neck demonstrates uniform narrowing of the subglottic airway

Most common congential heart defect in children

Ventricular septal defect

Chest pain in children

anxiety is the most frequent cause of chest pain in children; costochondritis

Innocent heart mumurs

Grade 1 murmurs are barely audible; grade 2 murmurs are faint but can be heard immediately; grade 3 murmurs can be heard easily and are moderately loud

best heard at the LLSB and is vibratory or blowing and does not radiate

Most useful test of acute rheumatic fever

Streptococcal serology is most helpful in the diagnosis of ARF because of the delayed nature of the disease following GAS infection. Antibody titers are elevated, while culture or detection of the organism is usually no longer possible by the time ARF presents

Testing children with hypercholesteremia

Lower LDL cut points are proposed for initiation of treatment, depending on risk level

All children should be screened for cholesterol at least once between ages 9-11 years.

Screening should begin as early as 2 years for those with family history of premature cardiovascular disease

Who is most diagnosed with Kawasaki Disease?

Children of Japanese descent <5 years old

The essential test for managing Kawasaki Disease

Erythrocyte Sedimentation Rate

Physical findings in infant with Down's Syndrome

Brachycephaly

Gap between first and second toes

Loose skin on nape of neck

Hyperflexibility

Low set ears, folded, stenotic meatus

Protruding tongue secondary to small palate

Flat nasal bridge

Muscular hypotonia

Epicanthal folds

Brushfield spots (ring of iris speckles)

Short fifth finger

In-curved fifth finger

Short, broad hands

High arched palate

Single palmar crease

Congential heart defect

Transient myelodysplasia of the newborn

Duodenal atresia

Lab test should be done every year with a child with down syndrome

TSH

Physical signs of fragile x syndrome in adolescents

long face, large prominent ears, flat feet

hyperextensible joints, especially fingers

low muscle tone

males may have large testes after puberty

Type 1 diabetes mellitus

diabetes in which there is no beta cell production of insulin--the patient is dependent on insulin for survival

Type 2 diabetes mellitus

a result of the body's inability to make enough, or to properly use, insulin. May be controlled with diet, exercise, and weight loss, but it may also require oral or injected medication and/or insulin injections

Type 1 with HgbA1c of 14.9 what does this indicate?

Glucose has not been well controlled over the last 3 months

A 5-year-old with type 1 diabetes and management of the insulin requirement

Children with newly diagnosed type 1 diabetes usually require an initial total daily dose of ∼0.5-1.0 units/kg. In general, younger (and prepubertal) children require lower doses while the presence of ketoacidosis, use of steroids, and the hormonal changes of puberty all dictate higher doses

It is common for a newly diagnosed child's diabetes to enter a honeymoon phase with an increase in insulin production within several weeks after the initiation of insulin therapy. During this phase of diabetes, insulin requirements may fall well below the initial dose of 0.5-1.0 units/kg per day needed to maintain blood glucose targets. Children may require only minimal amounts of intermediate- or long-acting insulin, possibly combined with small amounts of rapid- or short-acting insulin. β-cell destruction continues during this honeymoon phase, and with the progressive loss of β-cell function, there is need for increased exogenous insulin to avoid elevated blood glucose levels

Physical findings of a teenager that might show that she has type 2 diabetes

Overweight

Yeast infections

Pseudoacanthosis nigricans

What does shift to the left mean in a white blood cell count?

a phrase used to note that there are a high number of young, immature white blood cells present (granulocytes). Bands or immature neutrophils are greater than mature or segmented neutrophils a left shift occurs. Most commonly, this means that there is an infection, leukemia or inflammation present and the bone marrow is producing more WBC's and releasing them into the blood before they are fully mature

What sort of labs would you draw for a patient with microcytic hypochromic anemia?

Iron, ferritin, TIBC, reticulocyte count, iron saturation %

Regarding measles, mumps, and rubella, what type of immunity would their mother have or not?

Active immunity

6-month-old with newly diagnosed sickle cell disease, what should you do on the visit of a well-baby visit?

Educate regarding risk of infection due to asplenia and need to seek medical attention promptly for eval of febrile illness. If febrile, immediate referral for blood culture and empiric abx against s.pneumo and Hib.

Prevention is key! Factors that may precipitate events: dehydration, hypoxia, fever, exposure to extreme temps; how to manage pain; how to recognize signs of serious prob.

Anticipatory guidance regarding developmental issues such as toilet training, school attendance, delayed growth & development

Examination of a 9-month-old with a palpable right supraclavicular node. What does this possibly indicate?

Suspect malignancy or TB if supraclavicular nodes are palpated

A 5-year-old with acute lymphocytic leukemia. What is he at risk for developing?

Bleeding febrile neutropenia

When should you start screening infants for anemia?

12 months

A male who is complaining of breast tissue enlargement, how would you treat that?

Usually, no treatment is needed. Most cases of gynecomastia lessen with time. However, if a medical condition is causing gynecomastia, medications may need to be given. If a medication is the cause, your doctor may tell you to stop taking it or may prescribe a different medication. Your doctor may suggest seeing an endocrinologist. Surgery is usually not recommended unless the gynecomastia is causing severe pain and tenderness or embarrassment

If you do have a male who has gynecomastia what else should you assess him for?

Illicit drug or steroid use

What does a low level of TSH indicate?

hypothyroidism

Symptoms of Cushing's syndrome

An enlarged thyroid gland

Difficulty swallowing

Prominent or bulging eyes

Weight loss or poor weight gain

Rapid pulse

Hair loss

Weakness or fatigue

Low tolerance of hot weather

Irritability and mood swings

Lack of concentration

Emotional outbursts, like crying or yelling

Rapid growth rate that slows and may ultimately lead to short stature

Symptoms in babies include:

Rapid heartbeat

Irritability

Swollen thyroid gland

Bulging eyes

Excessive hunger

UTI in a 2-year-old, what would your treatment be?

Amoxicillin, Cefdinir, Bactrim, or Cipro (complicated UTI only, not first choice)

Sickle cell anemia and prophylactic penicillin

initiate before 3 months of age and continue until at least 5 yrs of age- oral PCN VK 125 BID up to age 3, then 250mg BID

Peak incidence of osteosarcoma is what age group

Peak incidence between 15-19; more common in males

diagnosis of osteosarcoma in children

Physical exam

Chest x-ray, MRI, CT scan, bone scan, PET scan

Biopsy (CT-guided needle or surgical)

Pathology of the bone tissue

Blood tests (alkaline phosphate & lactate dehydrogenase specifically)

Diagnosis of Wilms tumor

Medical history

Physical examination

MRI, CT scan, X-ray

renal ultrasound

Urinalysis (looking for catecholamines to rule out a neuroblastoma)

Biopsy

Diagnosis of Acute Lymphocytic Leukemia

Medical history

Physical exam

CBC w/ diff and peripheral blood smear

Blood chemistry tests

Blood coagulation tests

Bone marrow aspiration and biopsy

The bone marrow (and sometimes blood) samples are looked at with a microscope by a pathologist and may be reviewed by the patient's hematologist/oncologist. Determining what percentage of cells in the bone marrow are blasts is particularly important. A diagnosis of ALL generally requires that at least 20% of the cells in the bone marrow are blasts. Under normal circumstances, blasts don't make up more than 5% of bone marrow cells

Cytochemistry

Flow cytometry and immunohistochemistry (samples of cells are treated with antibodies, which are proteins that stick only to certain other proteins on cells)

Immunophenotyping - classifying leukemia cells according to proteins on or in the cells

Cytogenics

Fluorescent in situ hybridization (FISH)

Polymerase chain reaction (PCR)

Lumbar puncture

Lymph node biopsy

Features of diGeorge syndrome

Heart murmur and bluish skin cyanosis as a result of a heart defect

Certain facial features, such as an underdeveloped chin, low-set ears, wide-set eyes or a narrow groove in the upper lip

A gap in the roof of the mouth (cleft palate) or other problems with the palate

Delayed growth

Difficulty feeding, failure to gain weight or gastrointestinal problems

4 year old being treated with chemotherapy; which immunizations should he avoid?

MMR and Varicella because they are live-attenuated vaccines

A 11-year-old who presents with weight loss, polyuria, and polydipsia. What do you need to rule out ?

Diabetes

congenital adrenal hyperplasia

Genetic disease in which the adrenal glands don't work properly, resulting in a deficiency of cortisol and aldosterone.

Individuals affected by classic CAH caused by 21-hydroxylase deficiency produce excess adrenal steroids that lead to the production of testosterone and related male-like hormones.

A 14-year-old who has not started menstrual cycle

Chromosomal or genetic abnormalities can cause the ovaries to stop functioning normally. Turner syndrome, a condition caused by a partially or completely missing X chromosome, and androgen insensitivity syndrome, often characterized by high levels of testosterone

Problems with the hypothalamus or pituitary gland in the brain can cause an imbalance of hormones that can prevent periods from starting

What could cause primary dysmenorrhea

The etiology of primary dysmenorrhea is not precisely understood, but most symptoms can be explained by the action of uterine prostaglandins, particularly PGF2α. During endometrial sloughing, the disintegrating endometrial cells release PGF2α as menstruation begins. PGF2α stimulates myometrial contractions, ischemia and sensitization of nerve endings. The clinical evidence for this theory is quite strong. Women who have more severe dysmenorrhea have higher levels of PGF2α in their menstrual fluid. These levels are highest during the first two days of menses, when symptoms peak

Signs and symptoms of primary hypothyroidism

A puffy-looking face

Large, thick tongue

Large soft spots of the skull

Hoarse cry

Distended stomach with outpouching of the belly button (umbilical hernia)

Feeding problems, including needing to be awakened for feedings and difficulty swallowing

Constipation

"Floppy" (hypotonia)

Jaundice

What signs and symptoms would be found in an adolescent with untreated graves' disease?

Myxedema

S/S of Turner syndrome

Wide or weblike neck

Low-set ears

Broad chest with widely spaced nipples

High, narrow roof of the mouth (palate)

Arms that turn outward at the elbows

Fingernails and toenails that are narrow and turned upward

Swelling of the hands and feet, especially at birth

Slightly smaller than average height at birth

Slowed growth

Cardiac defects

Low hairline at the back of the head

Receding or small lower jaw

Short fingers and toes

Slowed growth

No growth spurts at expected times in childhood

Adult height significantly less than might be expected for a female member of the family

Failure to begin sexual changes expected during puberty

Sexual development that "stalls" during teenage years

Early end to menstrual cycles not due to pregnancy

For most women with Turner syndrome, inability to conceive a child without fertility treatment

S/S of Marfan Syndrome

People with Marfan syndrome are often very tall and thin. Their arms, legs, fingers and toes may seem out of proportion, too long for the rest of their body. Their spine may be curved and their sternum may either stick out or be indented. Their joints may be weak and easily become dislocated. Often, people with Marfan syndrome have a long, narrow face and the roof of the mouth may be higher than normal, causing the teeth to be crowded.

Dental and bone problems

Eye problems

Changes in the heart and vessels (become weak and stretch)

Heart valve problems

Cardiomyopathy

Aortic root dilation

Arrhythmia

Lung changes

Skin changes

S/S of Beckwith-Wiedemann syndrome

Large birth weight and length (macrosomia)

Overgrowth of one side or one part of the body (hemihypertrophy/hemihyperplasia))

An enlarged tongue (macroglossia).

Hypoglycemia during the newborn period and sometimes prolonged hypoglycemia (due to hyperinsulinism).

Defects in the abdominal wall (umbilical hernia or an omphalocele)

Enlarged abdominal organs, such as the kidneys, liver and pancreas.

Pits or creases in the earlobe or behind the ear.

An increased risk of developing certain cancers during childhood (most which can be cured with proper treatment)

S/S of Klinefelter syndrome

Low muscle tone (hypotonia) and problems with coordination that may delay the development of motor skills, such as sitting, standing, and walking. Learning disabilities, resulting in mild delays in speech and language development and problems with reading. Tend to have better receptive language skills than expressive language skills and may have difficulty communicating and expressing themselves.

Have anxiety, depression, impaired social skills, behavioral problems such as emotional immaturity and impulsivity, attention deficit hyperactivity disorder (ADHD), and limited problem-solving skills (executive functioning).

Type 2 diabetes, hypertension, increased belly fat, hyperlipidemia. Increased risk of developing involuntary trembling (tremors), breast cancer (if gynecomastia develops), osteoporosis, and autoimmune disorders such as systemic lupus erythematosus and rheumatoid arthritis.