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PEDS Exam 2 Review Questions and Answers Leukemia Treatment - Answer-*Four phases of chemo: 1. Induction 2. CNS prophylaxis 3. Consolidation (then delayed intensification) 4. Maintenance (prevent remission)- can last a LONG time, 18 months - 2 years Radiation to brain may or may need *...

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  • August 3, 2024
  • 17
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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PEDS Exam 2 Review Questions
and Answers

Leukemia Treatment - Answer-*Four phases of chemo:
1. Induction
2. CNS prophylaxis
3. Consolidation (then delayed intensification)
4. Maintenance (prevent remission)- can last a LONG time, 18 months - 2 years

Radiation to brain may or may need

*HSCT:
AML in FIRST remission (check for a match right away)
ALL in SECOND remission (only go to transplant if they relapse)

Leukemia Prognosis Factors - Answer-1. WBCs @ diagnosis = (ALL) white cell <
50,000 usually do better
2. Age = less than 1 OR older than 10 HIGH RISK
3. Response to initial treatment = if in remission after first 4 weeks, move on to easier
treatment plan/ lower risk (if not responding, will need more intense chemo)

Iron Deficient Anemia Screening Lab Studies - Answer-*Hbg < 11 (if slightly low, may be
no S/S- dietary teaching)
*MCV = microcytic = small cells
*MCH = hypochromic = pale color

Reticulocyte count LOW
TIBC HIGH

Sickle Cell Disease - Answer-Abnormal sickle cell Hgb S replaces normal Hgb A

Both parents have to have trait (autosomal recessive)
Many people just have trait = might see mild anemia
(Babies may have delayed onset of symptoms for 4-6 months due to fetal Hgb)

*RBCs "sickled" = rigid, obstruct capillary blood flow
*Anemia, peripheral clotting, obstructions, ischemia, PAIN

SCD Lab Tests - Answer-All babies screened @ birth!
*Hemoglobin electrophoresis = definitive test. Tells if you have disease or trait and what
TYPE of Hgb
*Sickledex = screening tool (not able to tell if have disease or just trait)

,CBC- to detect anemia

Vaso-Occlusive Crisis - Answer-PAIN crisis of SCD. Most common crisis

*TRIGGERS- dehydration, temp extremes, high altitude, infection, stress

*Extreme pain- Ischemia is causing pain! Usually in bones, joints, sometimes abdomen.
Swelling of joints. Can develop blood in urine, avascular necrosis

Splenic Sequestration - Answer-SCD Crisis. *Life threatening- blood trapped in spleen

Sickle cells block blood vessels in spleen
Blood is not able to get out, spleen gets larger
Spleen can't do job (filter blood/ get infections OUT)
*One of main reasons why SCD high risk of infections!!!

Child usually has functional asplenia by 5 years old
Prophylactic antibiotics
Many children have spleen removed


Cardiac Cath - Answer-PRE:
-NPO 4-6 hours (sometimes clear liquids)
-Allergies- esp. iodine/ shellfish (dye), prior sedation history
-Baseline circulation + patient teaching
POST:
-*pressure for 5 mins, then pressure dressing placed
-LAY FLAT and bedrest for 6 hours- difficult for kids
-Encourage fluids = get dye out
-Minimal activity for 24 hours
-Prevent vomiting- don't want increased pressure

General Heart Defects S/S - Answer-*Heart murmur
*Cyanosis (as soon as cord is cut)
*Tachycardia - heart tries to compensate by beating faster
*Diaphoresis- classic sign of heart issue
*Poor weight gain (too tired to feed)
Delayed cap refill
Diminished pulses

Patent Ductus Arteriosus (PDA) - Answer-INCREASED PULM BLOOD FLOW
LEFT to RIGHT SHUNT- more blood to lungs
Patent = DA stays open, pressure on LEFT side higher, more blood to lungs

*Machinery murmur, wide pulse pressures, BOUNDING pulses, HIGH risk for
respiratory infections

, *IV Indomethacin (decreases need for surgery)
Cardiac cath or surgery

Arterial Septal Defect (ASD) - Answer-INCREASED PULM BLOOD FLOW
HOLE in atrium = L to R shunt = more blood to lungs

*Loud, harsh murmur, easy tiring, poor growth, CHF

Small = can resolve by 4 yo (do nothing)
Severe = patch/ occlude (CC, surgery)

Ventricular Septal Defect (VSD) - Answer-INCREASED PULM BLOOD FLOW
HOLE in ventricle = L to R shunt = more blood to lungs
*most common defect

*Loud, harsh murmur @ LEFT STERNAL BORDER

Most small close within 6 months
Closure surgery usually > 1 yr

Pulmonary Stenosis - Answer-OBSTRUCTIVE SYSTEMIC BLOOD FLOW
Pulm valve NARROWS = OBSTRUCTS blood flow to pulm artery
-DECREASED volume in RV
-DECREASED cardiac output (low pressure AFTER narrowing)
-HYPERTROPHY of RV (high pressure BEFORE narrowing)

*MURMUR, thrill, CYANOSIS (decreased CO)
Range from asymptomatic to cardiomegaly/ HF

Corrections depend on severity
Mild = do nothing
Moderate = cardiac cath, balloon
Severe = surgical valvotomy or resection

Coarctation of the Aorta (COA) - Answer-OBSTRUCTIVE SYSTEMIC BLOOD FLOW
NARROWING of Aorta- heart has to pump harder to force blood through narrow portion.
*Obstructed blood to LOWER extremities- more S/S here

*4 Quadrant BPs- lower BP distally, in lower extremities (hypotension in general)

S/S: cool skin, weak/ absent femoral pulses

Usually prefer to do surgery- high rate of reoccurrence

Hypoplastic Left Heart Syndrome (HLHS) - Answer-OBSTRUCTIVE SYSTEMIC
BLOOD FLOW

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