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CSO Exam 2023 > Chapter 13: Pediatrics > Flashcards

Chapter 13: Pediatrics Flashcards

1
Q

What is the leader cause of disease-related death in children aged 0-14?

A

Cancer

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2
Q

What is the 5-year survival rate for children with cancer?

A

84%

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3
Q

What is the most common childhood cancer?

A

Brain and Central Nervous System

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4
Q

What is the second most common childhood cancer?

A

Leukemia

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5
Q

Why are children at a high risk of malnutrition during cancer treatment, compared to adults?

A

Metabolic demand per kg body weight increases
Need to maintain appropriate weight gain and linear growth

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6
Q

What is Acute Lymphoblastic Leukemia?

A

Cancer of blood and bone marrow
Most common childhood malignancy

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7
Q

What is a long-term side effect of treatment for ALL?

A

Reduced bone mineral density

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8
Q

Why would a child with ALL need a hematopoietic stem cell transplant (HCT)?

A

Early relapse or refractory ALL

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9
Q

What is Acute Myeloid Leukemia (AML)?

A

2nd most common type of childhood leukemia

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10
Q

What is the initial treatment for AML?

A

Chemotherapy

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11
Q

Why would a child with with AML need an HCT?

A

High risk or relapsed disease

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12
Q

List 6 common nutrition related side effects of treatment for AML

A

Anorexia
Weight Loss
Malnutrition
Nausea
Vomiting
Mucositis

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13
Q

What is a late effect of treatment for AML?

A

Cardiomyopathy

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14
Q

Patients with a BMI below the 5th or above the 85th percentile have lower survival rates. True or False? Justify your answer.

A

TRUE

These children are prone to infections.

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15
Q

Primary Brain Tumor/CNS may be ______ or ______.

A

Benign or malignant

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16
Q

Why would a patient with PBT develop dysphagia? Hint: 2 reasons

A

Patients with posterior fossa brain tumors following tumor resection OR Patients with progressive disease that affects the cerebellum and brainstem areas.

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17
Q

What are some long term complications of treatment for PBT? List 4

A

Cognitive and motor skill deficits
Weight gain
Central adiposity
Feeding difficulties

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18
Q

Why would a patient with PBT, undergoing radiation, have an increased appetite?

A

Radiation may disrupt ghrelin & leptin cues.

These are hormones that control your appetite and sense of satiety.

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19
Q

What is ghrelin?

A

A hormone that increases your appetite.

It is made in the stomach and signals to the brain that you are hungry. Plays a role in short-term control of appetite.

Source: Cleveland Clinic

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20
Q

What is leptin?

A

A hormone that decreases your appetite. Leptin is produced by fat cells. Leptin sends signals to the brain letting you know that you are full. Leptin controls long-term weight control.

Source: Cleveland Clinic

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21
Q

Increased cardiovascular complications following chemotherapy are associated with what?

A

Central adiposity and overall fat mass

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22
Q

What is Hodgkin Lymphoma?

A

3rd most common type of childhood cancer

Includes Hodgkin lymphoma (HL) & non-Hodgkin lymphoma (NHL).

NOTE: Hodgkin lymphoma has also been historically called Hodgkin disease. You may see “HD” listed under medicine charts while studying for this exam!

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23
Q

What is an initial presenting nutrition related symptom of HL or NHL?

A

Weight loss

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24
Q

What is the survival rate of HL and NHL?

A

95%

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25
Q

What medication leads to weight gain in HL & NHL?

A

Steroids

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26
Q

Patients with HL and NHL receive mediastinal radiation. What 3 organs can this cause abnormal function in later?

A

Thyroid, heart, & lung

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27
Q

Survivors of HL and NHL are at an increased risk of secondary cancers. What are the 3 most common secondary cancers?

A

Breast
Thyroid
Skin

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28
Q

How is body composition altered after treatment for HL & NHL?

A

Decreased lean body mass
Increased body fatness

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29
Q

Non-Hodgkin Lymphoma encompasses all childhood lymphomas that are not HL. List 4 most common subtypes

A

Precursor lymphoblastic lymphoma
Burkitt or Burkitt like lymphoma
Diffuse large B-cell lymphoma
Anaplastic large cell lymphoma

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30
Q

List 4 nutrition symptoms associated with treatment for NHL

A

Nausea
Vomiting
Anorexia/loss of appetite
Constipation

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31
Q

Patients with NHL are usually on steroids. List 2 effects of steroids.

A

Fluid retention
Hyperglycemia

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32
Q

What are less common (but not unheard of) nutrition related symptoms of treatment for NHL?

A

Mucositis
Diarrhea

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33
Q

What are potential post-treatment effects for NHL? Hint: 4 listed in book

A

Obesity
Hypertension (HTN)
Impaired mobility
Reduced strength

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34
Q

What is neuroblastoma?

A

Solid tumor that commonly arises from cells in the sympathetic nervous system

Most common solid tumor in children

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35
Q

At what age is neuroblastoma typically diagnosed?

A

1 year or under

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36
Q

Older children may develop neuroblastoma. What is the concern with diagnosis at an older age?

A

Disease is usually more aggressive.
Metastatic disease usually present at time of diagnosis.
Intensive treatment is required.

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37
Q

Malnutition at time of diagnosis of neuroblastoma has been reported in ____ - _____ % of cases.

A

20-50%

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38
Q

List nutrition impact symptoms of neuroblastoma

A

Nausea
Vomiting
Dysgeusia
Anorexia
Abdominal discomfort

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39
Q

Why is abdominal discomfort a symptom of neuroblastoma?

A

Most neuroblastomas begin in the abdomen

Usually in an adrenal gland or in sympathetic nerve ganglia.

Source: American Cancer Society

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40
Q

Is HCT a common treatment for neuroblastoma?

A

Yes

Neuroblastoma is one of the most common indications for auto-HCT in pediatrics. It is often used in children with high-risk neuroblastoma who are unlikely to be cured with other treatments.

Source: American Cancer Society

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41
Q

Chemo for neuroblastoma usually includes a combination of drugs. The main chemo drugs used include:

A

Cyclophosphamide
Cisplatin or carboplatin
Vincristine
Doxorubicin (Adriamycin)
Etoposide
Topotecan
Melphalan (sometimes used during stem cell transplant)
Busulfan (sometimes used during stem cell transplant)
Thiotepa (sometimes used during stem cell transplant)
The most common combination of drugs includes cisplatin (or carboplatin), cyclophosphamide, doxorubicin, vincristine, and etoposide, but others may be used.

Source: American Cancer Society

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42
Q

Types of radiation used to treat neuroblastoma. Hint: 2

A

External beam radiation therapy
MIBG radiotherapy

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43
Q

What is rhabdomyosarcoma?

A

Soft tissue tumor

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44
Q

What are the common sites of rhabomyosarcoma?

A

Head and neck
Genital urinary tract
Extremities
Trunk (less common)

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45
Q

Common treatment side effects (list 3)

A

Anorexia
Jaw pain
Constipation

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46
Q

Late effects of treatment for neuroblastoma (list 4)

A

Small bowel obstruction
Esophageal strictures
Renal tubular dysfunction
Secondary malignancies

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47
Q

Radiation to the head and neck area may result in ____ _____ & ____ ____ _____.

A

Dental problems
Growth hormone deficiency

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48
Q

What is Wilms Tumor?

A

Most common kidney malignancy in children.

Note: may also be references as nephroblastoma.

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49
Q

At what age are Wilms Tumors most commonly diagnosed?

A

Under age 5.

Source: https://www.ncbi.nlm.nih.gov/books/NBK442004/

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50
Q

Overall 5-year survival rate for Wilms tumor?

A

92%

Source: https://www.ncbi.nlm.nih.gov/books/NBK442004/

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51
Q

Why might a pt with Wilms Tumor develop radiation enteritis?

A

Whole abdomen or flank radiation

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52
Q

List 2 late effects of treatment from Wilms tumor

A

Cardiotoxicity
Secondary malignancies

53
Q

A patient with Wilms Tumor has bilateral disease. What condition may occur?

A

End Stage Renal Disease

54
Q

What is osteosarcoma?

A

Most common bone tumor in pediatric patients

55
Q

When does osteosarcoma typically develop?

A

During periods of rapid growth

56
Q

Most common symptom of osteosarcoma at time of diagnosis?

A

Pain

57
Q

What is the typical treatment for osteosarcoma?

A

Chemotherapy & Complete Resection

Surgery may include amputation or limb salvage surgery.

58
Q

What are 5 common nutrition impact symptoms associated with treatment of osteosarcoma?

A

Nausea
Vomiting
Anorexia
Metallic taste
Mucositis

59
Q

Which lab may be decreased due to treatment of osteosarcoma?

A

Magnesium

60
Q

Late effects of treatment for osteosarcoma

A

Cardiotoxicity
Nephrotoxicity

61
Q

What is Ewing Sarcoma?

A

2nd most common bone tumor in children

62
Q

Most common sites of Ewing Sarcoma?

A

Lower extremities
Pelvis
Chest Wall

Can occur in almost any bone or soft tissue.

63
Q

Typical treatment for Ewing Sarcoma?

A

Chemo
Surgery or radiation for local control

64
Q

List 4 nutrition related side effects from chemotherapy for Ewing Sarcoma

A

Nausea
Vomiting
Anorexia
Weight loss

65
Q

Pelvic radiation can lead to ____, ____, and _____.

A

Enteritis
Obstruction
Perforation

66
Q

Surgery and radiation may affect ____, ____, and ____ ____.

A

Mobility
Growth
Functional status

67
Q

What is hepatoblastoma?

A

Most common liver malignancy in children

68
Q

At what age is hepatoblastoma typically diagnosed?

A

Under age 3

69
Q

List 2 risk factors for hepatoblastoma

A

Prematurity at birth
Familial cancer syndromes

70
Q

Why would a pt with hepatoblastoma have anorexia at time of diagnosis?

A

Abdominal tumor growth

71
Q

Nutrition side effects of treatment for hepatoblastoma include? List 7

A

Anorexia
Nausea
Vomiting
Mucositis
Diarrhea
Renal toxicity
Electrolyte wasting

72
Q

Treatment for hepatoblastoma typically includes?

A

Chemo & complete resection

73
Q

What is chimeric antigen receptor T-cell therapy? Also called CAR T-Cell Therapy.

A

In CAR T-cell therapies, T cells are taken from the patient’s blood and are changed in the lab by adding a gene for a receptor (called a chimeric antigen receptor or CAR), which helps the T cells attach to a specific cancer cell antigen. The CAR T cells are then given back to the patient.

Source: American Cancer Society

74
Q

Examples of CAR T-Cell Therapy include

A

Tisagenlecleucel, also known as tisa-cel (Kymriah)
Axicabtagene ciloleucel, also known as axi-cel (Yescarta)
Brexucabtagene autoleucel, also known as brexu-cel (Tecartus)
Lisocabtagene maraleucel, also known as liso-cel (Breyanzi)
Idecabtagene vicleucel, also known as ide-cel (Abecma)
Ciltacabtegene autoleucel, also known as cilta-cel (Carvykti)

75
Q

CAR T-cell therapy has been approved for use in which childhood cancer?

A

Relapsed or refractory B-cell ALL

76
Q

Infusion of CAR-T cells can cause cytokine release syndrome. What are some symptoms of CRS?

A

Fever
Nausea
Vomiting
Vascular leakage
Renal complications
Seizures

77
Q

What is HIPEC (hyperthermic intraperitoneal chemotherapy) used for?

A

Used to treat extensive peritoneal disease

Includes administering heated chemo agents directly into the peritoneal cavity

78
Q

Which cancer is HIPEC most effective for?

A

Desmoplastic small cell round tumors

79
Q

At time of diagnosis, what percentage of children are malnourished? Hint: a range

A

5-21.5%

80
Q

Malnutrition incidence increases by ____% during cancer treatment.

A

65%

81
Q

Which cancer type is at a higher risk of malnutrition?

A

Patients with solid tumors

82
Q

Obesity affects what percentage of children with cancer?

A

8-78% of children

Very large range. More research is needed.

83
Q

What is SCAN?

A

Nutrition screening tool for childhood cancer.

Only validated tool to identify children at the highest risk for malnutrition

84
Q

Best screening tool for hospitalized pediatric cancer patients?

A

Pediatric SGA.

Not validated for use in cancer.

85
Q

Estimating calorie requirements

A

Indirect calorimetry = Gold Standard

WHO equation for REE can be used if this is not available or feasible. WHO equations change based on age and sex. Must be adjusted for stress factors.

86
Q

Estimating protein needs

A

Non-stressed: RDA
Stressed: RDA x 1.5-2

87
Q

Protein Needs (age 0-6 months) (g/kg)

A

Normo: 1.52
Stressed: 2.3-3.0

88
Q

Protein Needs (age 7-12 months) (g/kg)

A

Normo: 1.20
Stressed: 1.8-2.4

89
Q

Protein Needs (age 1-3 years) (g/kg)

A

Normo: 1.05
Stressed: 1.6-2.1

90
Q

Protein Needs (age 4-13 years) (g/kg)

A

Normo: 0.95
Stressed: 1.4-1.9

91
Q

Protein Needs (age 14-18years) (g/kg)

A

Normo: 0.85
Stressed: 1.3-1.7

92
Q

Fluid Needs (Holliday-Segar method)

A

<10 kg: 100 mL/kg
10-20 kg: 1000 mL + 50 mL/kg for each kg over 10 kg
>20 kg: 1500 mL + 20 mL/kg for each kg over 20 kg

93
Q

Which 2 micronutrients are typically low in pediatric cancer patients?

A

Vitamin D3
Calcium

94
Q

3 appetite stimulants used in pediatric cancer patients

A

Cyproheptadine (Periactin)
Dronabinol (Marinol)
Megestrol acetate (Megace)

95
Q

Conditions in which parenteral nutrition may be used?

A

Severe mucositis
Ileus
Neutropenic colitis or typhlitis (neutropenic enterocolitis of the ileocecal region)
GI hemorrhage
Penumatosis intestinalis
Intractable nausea, vomiting, diarrhea

96
Q

Weight Percentiles (underweight, overweight, obese)

A

Underweight (< 5th percentile)
Overweight (85th to 94th percentile)
Obese (=/> 95% percentile)

97
Q

7 factors are included in the SGNA

A

Height (stunting)
Weight (wasting)
Unintentional change in weight (increase or decrease)
Adequacy of dietary intake
GI symptoms
Functional capacity
Metabolic stress of disease

98
Q

Sinusoidal obstruction syndrome (SOS)

A
  • Formerly called veno-occlusive disease (VOD)
  • Complication of hematopoietic stem cell transplantation
  • Can occur with nontransplant-associated chemotherapy.

Source: https://pubmed.ncbi.nlm.nih.gov/33902061/

99
Q

Why should lipase be monitored in pediatric patients?

A

Patients can develop pancreatitis from chemo, including steroids or asparaginase

100
Q

What unique pediatric population is at higher risk for leukemia?

A

Down Syndrome

101
Q

What could be the true cause of an elevated ferritin level?

A

Inflammation

102
Q

What is a nutritional concern for Vitamin D levels? What is an appropriate minimum level for patients/survivors?

A

Often deficient in patients, supplement likely needed — important for bone health and immune health

30 mg/mL for 25-hydroxyvitamin D

103
Q

What is the hallmark outcome of cachexia in pediatrics?

A

Growth failure

104
Q

What % of cancers occur in children?

A

1%

105
Q

DRI for vitamin D in children aged 1-12 months is ____ and for children age 1-18 years is ____

A

400 IU, 800 IU

106
Q

Assess dynamic changes in growth over time and a decrease of more than ____ Z score is problematic.

A

1

107
Q

Most children with leukemia have ____ needs at diagnosis and during anti-cancer treatment.

A

Near normal energy needs

108
Q

BMI for age at or above ____ reflects obesity and _____ reflects overweight

A

95%, 85-95%

109
Q

Because of research inconsistencies, what is the most appropriate tool for estimating energy needs in normal weight children with cancer?

A

DRI (EER)

110
Q

Long-term effects of malnutrition in childhood cancer patients include which of the following
a. compromised bone health
b. stunted growth
c. compromised eating behaviors
d. reduced quality of life
e. all of the above

A

e. all of the above

111
Q

Which would NOT be a part of pediatric nutrition assessment?
a. Comparison of height to the WHO or CDC growth charts
b. PG-SGA
c. Gastrointestinal tests (e.g., fecal fat test)
d. Triceps skinfold

A

b. PG-SGA

Rationale: the SGNA is the validated tool

112
Q

Underweight is a common finding in all survivors of ALL, in particular, those who have received cranial irradiation.

True or False

A

FALSE

113
Q

With increased stool output, what should be monitored and supplemented provided there’s a deficiency?
a. Potassium
b. Magnesium
c. Zinc
d. Sodium

A

c. Zinc

114
Q

True or False. All HCT patients undergoing an allogeneic transplant should be placed on a neutropenic diet and avoid all restaurant and fast foods until after day 100.

A

TRUE

115
Q

Protein needs may increase by how much during cancer treatment?
a. 25%
b. 33%
c. 50%
d. 100%

A

c. 50%

116
Q

Latent side effects from radiation include which of the following (choose all that apply).
a. altered bone development
b. hearing impairment
c. neutropenia
d. secondary malignancies

A

a. altered bone development
b. hearing impairment
d. secondary malignancies

117
Q

The following pediatric diagnoses would be classified as high nutrition risk
a. non-metastatic solid tumors
b. medulloblastoma
c. neuroblastoma
d. newly diagnosed AML

A

b. medulloblastoma
c. neuroblastoma
d. newly diagnosed AML

118
Q

IC is the preferred method for estimating needs for which pediatric cancer population?
a. Wilms tumor
b. HCT
c. osteosarcoma
d. neuroblastoma

A

a. Wilms tumor

119
Q

PN is indicated in children with GI dysfunction that has been present for how long
a. 7 days
b. 5 days or more
c. 10 days
d. 3 days or more

A

d. 3 days or more

120
Q

What may alleviate the effect of PN associated liver disease in the pediatric population?
a. IV lipids that contain fish oil
b. increase amount of amino acids provided
c. increase total volume
d. combine the use of EN and PN

A

a. IV lipids that contain fish oil
d. combine the use of EN and PN

121
Q

You are assessing the needs of a 12 y/o patient with AML who will be having HCT. What would their protein needs be?
a. 2 g/kg
b. 2.5 g/kg
c. 1.8 g/kg
d. 3 g/kg

A

a. 2 g/kg

122
Q

Typically what happens to REE following HCT?
a. Increases
b. Decreases
c. Stays the same

A

b. Decreases

123
Q

Which of the following pediatric diagnoses would be assessed within 24 hours?
a. Wt loss of 3-5% in the last month
b. Orders for nutrition support
c. modified diet orders
d. non-chemo induced nausea, vomiting, diarrhea

A

a. Wt loss of 3-5% in the last month
b. Orders for nutrition support

124
Q

The Holliday Segar MEthod is the most common method for estimating fluid needs in children

True or False

A

True

125
Q

What 2 micronutrients are a concern for pediatric oncology patient because a child’s bone health may be compromised during the course of cancer treatment?
a. calcium, vitamin E
b. calcium, vitamin D
c. calcium, iron
d. calcium, vitamin K

A

b. calcium, vitamin D

126
Q

A z-score between -2 and -3 indicated which level of malnutrition?

A

Moderate malnutrition

127
Q

A 10 y/o male, normal weight, is hospitalized and seen resting quietly in bed. What is the appropriate activity factor for estimated energy needs?

A

1.1-1.2 x BMR

128
Q

True or False. Iron supplementation is always recommended for children undergoing multiple blood transfusions during treatment.

A

False

129
Q

A child weighs 16 kg and does not have a fever. What are their fluid needs?

A

1300 mL using Holliday Segar method (1000 mL + 50 mL per every kg over 10 kg

CSO Exam 2023 (12 decks)

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