Heme/oncology Flashcards
What diagnosis should you consider in a teenager with leg pain who is going through a growth spurt?
Osteogenic sarcoma
What is the treatment of osteogenic sarcoma ? (2)
Amputation or limb salvage
Chemotherapy
What is the most common site of metastasis from osteogenic sarcoma?
Lung
What type of bone sarcoma presents with a soft tissue component?
Ewing sarcoma
What is the most common type of solid tumor in children?
Brain tumors
What diagnosis presents with left leg pain that is worse at night but relieved with ibuprofen?
Osteoid osteoma
What is the diagnosis of a femur with central radiolucent area surrounded by thick sclerotic bone?
Osteoid osteoma
What are 3 poor prognostic signs of ALL?
Age <2
WBC > 50
T cell precursor
Which sanctuary sites of ALL are most resistant to therapy and common sites of relapse?
CNS and testes
What is the correct first step in diagnosis in a child with unexplained lymphadenopathy and cough?
Chest X-ray
What diagnosis should you consider in a teenager who presents with non tender cervical lymph node and high WBCs?
Hodgkin lymphoma
What cells would you expect to find on lymph node biopsy in a patient with Hodgkin lymphoma ?
Reed sternberg
What is the first course of action in a patient with fever who has had splenectomy?
Sepsis workup
What is the difference between lymphoblastic and nonlymphoblastic non Hodgkin lymphoma?
Lymphoblastic is t. Cell origin and non lymphoblastic is b. Cell origin
Where are the 3 most common sites of mass secondary to non Hodgkin lymphoma ?
Head, neck, abdomen
What 3 tumors should you consider in a child with non tender abdominal mass?
Wilms
Neuroblastoma
Non Hodgkin lymphoma
What is the difference in bone marrow findings between leukemia and lymphoma?
Leukemia has >25% blasts
Lymphomas has <25% blasts
How is langerhans cell histiocytosis diagnosed?
Skin biopsy and electron microscopy
How is langerhans cell histiocytosis treated ? (3)
Surgery, steroids or chemo
What diagnosis should you consider in a patient with a lytic skull lesion and seborrheic rash?
Langerhans cell histiocytosis
What urinary problems are associated with langerhans cell histiocytosis?
Diabetes insipidus and excessive urination
Where is the most common place for presentation of neuroblastoma?
Adrenal gland
What is the prognosis of neuroblastoma?
Survival 95% if occurs prior to 1 year - poor prognosis of older than 1
How is neuroblastoma diagnosed?
Tumor biopsy or high urine VMA/HMA plus bone marrow tumor
What is the best imaging study to find neuroblastoma?
CT with contrast
What are 3 common lab abnormalities associated with neuroblastoma ?
Pancytopenia
Elevated ferritin
Elevated LDH
What is the most Likely cause of HTN in a patient with neuroblastoma?
Renal artery compression
What diagnosis should you consider in a patient with non tender abdominal mass, HTN and diarrhea ?
Neuroblastoma
What syndrome can occur from mediastinal tumor in a patient with neuroblastoma ?
Horner syndrome (compression of recurrent laryngeal nerve)
What is the chance that a woman with retinoblastoma in both eyes will have a child with retinoblastoma?
50% chance of any of her children having retinoblastoma
What is the chance that a woman with retinoblastoma in one eye will have a child with retinoblastoma?
5% chance
What are the 3 treatment options for retinoblastoma?
Surgery, chemotherapy or radiation
A child with retinoblastoma is at greater risk for later development of what Cancer?
Osteosarcoma
What is the appropriate management in a patient with vomiting who has a full fontanelle on exam and develops posturing after being given IV fluids?
Steroids &
Measures to reduce intracranial pressure
A child presents with grape-like mass protruding from the vagina, what is the likely diagnosis ?
Rhabdomyosarcoma
What are two types of cancer that can get worse or present after a traumatic injury ?
Rhabdomyosarcoma and osteogenic sarcoma
A child presents with constipation and on rectal exam you palpate a mass, what Cancer should you consider ?
Rhabdomyosarcoma
What diagnosis should you consider in a patient with non tender abdominal mass, HTN and gross hematuria?
Wilms tumor
What ophthalmologic finding is associated with Wilms tumor?
Aniridia
What two diagnoses are associated with hemihypertrophy?
Wilms tumor
Beckwith wiedemann
What 3 lab abnormalities should be monitored for in a patient getting initiation of chemotherapy ?
Hyperphosphatemia
Hyperkalemia
Hyperuricemia
What is the treatment for tumor lysis? (3)
Hydration
Alkalinization
Allopurinol
What should be done in a patient on chemotherapy who is exposed to varicella ?
Varicella zoster IG
What 4 things cause symptoms associated with anterior mediastinal masses?
Thymoma
Teratoma
Thyroid
T cell lymphoma
When should you intubate a patient suspected of having anterior mediastinal mass?
Never - airway compression Is below the vocal cords and it is dangerous to anesthetize these patients !!!
What diagnosis should you consider in a patient with a red face that is swollen as well as arm swelling and distended neck veins?
Superior vena cava syndrome
What is a potential side effect with use of cyclophosphamide? What can be done to prevent this side effect?
Hemorrhagic Cystitis - aggressive hydration and serial urinalysis
What is the potential side effect with use of bleomycin ?
Pulmonary fibrosis
What is a potential side effect with use of anthracycline (doxorubicin)?
Cardiac toxicity
What is a potential side effect of vincristine?
Neurotoxicity and SIADH
What side effect is associated with use of asparaginase?
Pancreatitis
What side effect is associated with use of procarbazine?
CNS toxicity
What hormone should be monitored in children having cranial radiation therapy?
Growth hormone
What potential side effect is associated with use of methotrexate?
Oral and GI ulcers
What is the cause of physiologic anemia of infancy?
Low erythropoietin production
What is the normal MCV for babies and toddlers?
70-90
What are 4 major causes of microcytic anemia in children ?
Iron deficiency
Thalassemia
Anemia of chronic illness
Lead poisoning
What diagnosis should you consider in a small for age Greek boy with anemia and large spleen?
Thalassemia major
What X-ray findings are compatible with thalassemia and why?
Thickened bone on X-ray
Skull with “hair on end” appearance - secondary to extramedullary hematopoiesis
What hemoglobin electrophoresis results are consistent with a diagnosis of beta thalassemia?
Low hemoglobin A1
High hemoglobin A2 (alpha delta)
High hemoglobin F
What are 2 long term complications of beta thalassemia and chronic transfusion therapy?
Cholelithiasis
Hemosiderosis
What are the results of hemoglobin electrophoresis in a patient with sickle cell anemia?
High hemoglobin F
High hemoglobin S
How long should iron deficiency anemia by treated?
Until 2 months after hgb levels are normal
What is the underlying cause of anemia in an 18 month old child with pallor whose diet consists mainly of milk?
Nutritional - low amount of iron is absorbed from cows milk
When is IV iron the correct treatment for anemia?
Only if child is Unable to take PO
What’s the difference in the RDW when comparing iron deficiency anemia and thalassemia?
RDW is high in iron deficiency
RDW is low in thalassemia