Neuroblastoma Flashcards

1
Q

Well child visits

A
Any illness/problems since last visit?
Birth history?
Developmental screening tests (PEDS)
Growth chart
Diet History
Social History
PE
Anticipatory Guidelines
Immunizations
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2
Q

Nutrition guidance

A

breast milk preferred for infants
milk or soy based formula (2 scoops for 4 ounces)
- transition to milk at 12 months

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3
Q

Caloric requirements of 1-2 month olds

A

100-120 cal/kg/day

- preterm and low birth weight require more calories

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4
Q

Early growth

A

babies can lose 10% of birth weight but should regain that by 2 weeks

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5
Q

Developmental Screening

A

Gross motor
Fine motor
Communication/Social
Cognitive/Adaptive

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6
Q

Anticipatory guidelines at 2 months

A

rice cereal by 4 months may be appropriate
Vit D = 400 units/day
Child care
Sleep - sleeping through night by 6 months, place on back
Safety - house, family members

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7
Q

Car seat safety

A

Under age 12 not in front seat
Under age 2 - rear facing seat
Back is safest

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8
Q

Immunizations in childhood

A
DTap - 5
IPV - 4
Hib - 3-4
PCV - 4
MMR - 2
Varicella - 2
RotaV - 2
Hep A - 2
Hep B - 3
Seasonal influenza - yearly after 6 months
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9
Q

Typical growth patterns

A

should double weight by 4-5 months, triple weight by 1 year, double length by 4 years

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10
Q

Red Reflex

A

Red or orange color reflected from fundus through pupil;

- absence? ==> refer to opthomologist

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11
Q

6 month milestones

A

Gross motor - rolls over, sit up
Fine motor - reach for objects, looks for dropped items
Language - turns to voice, babbles
Social - feeds self, stranger recognition

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12
Q

Toddler proofing home

A

install outlet covers, cabinet locks, stair barriers, cleaning supplies safe

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13
Q

Anticipatory guidlines at 6 months

A

car seat
walkers - NO
diet - new foods every 5 days

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14
Q

Tylenol and vaccines

A

don’t use tylenol unless necessary –> lower immune response

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15
Q

12 month milestones

A

Gross motor - stand alone, may not walk
Fine motor - well developed pincer grasp
Language - mama, dada
Social - hand parent book and imitates play

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16
Q

Neuroblastoma stage 4S prognosis

A

infants tumors may spontaneously regress (unique nature from embryonal cell lines)

17
Q

Genetics of Neuroblastoma

A

many chromosomal and molecular abnormalities have been found

- REALLY IMPORTANT ONE - MYCN gene (oncogene)

18
Q

Staging Neuroblastoma

A

1 - localized area
2 - extends beyond local area but doesn’t cross midline
3 - crosses midline and lymph nodes involved
4 - disseminated
4S - localized primary tumor with disseminated

19
Q

Rectal Exam in Infant

A

not routine part of exam but should be done with abdominal mass felt
- infant supine, hold extremities, lubricate finger

20
Q

DDx for RUQ mass and pallor in 9-month old

A
Hepatic neoplasm
Hydronephrosis
Neuroblastoma
Teratoma
Wilms' Tumor
21
Q

Hepatic neoplasm

A

rare in kids, can be asymptomatic

jaundice would be a common feature

22
Q

Hydronephrosis

A

obstruction of uretero-pelvic junction –> palpable kidney

- mutlicystic kidney disease can cause obstruction

23
Q

Neuroblastoma

A

most frequently diagnosed neoplasm in infants
Painless mass in neck, chest or abdomen
- fever, pallor, weight loss

24
Q

Teratoma

A

rare malignant tumor

painless abdominal mass without other symptoms

25
Q

Wilms’ Tumor

A

likely diagnosis in kid with asymptomatic RUQ mass with no lymphadenopathy or jaundice

  • discovered by parents or by routine exam
  • smooth mass rarely crossing midline
26
Q

Initial testing for RUQ mass

A

CBC with differential - anemia
Catecholamine VMA/HVA - elevated in neuroblastoma (90-95% sensitive in detection)
CXR - can identify metastasis
Ab US - ID mass on organ, best choice for 1st imaging
Ab Xray - can detect mass or calcification

27
Q

Presentation of neuroblastoma

A

Can be VARIABLE

Asymptomatic —-> ab pain, emesis, weight loss, anorexia, fatigue, bone pain