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Ped RC > Onc > Flashcards

Onc Flashcards

1
Q

When can you give vaccines (live) post chemo

A
  • wait at least 3-6 months from the end of immunosuppressive therapy
  • extend this to 24mths for post BMT
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2
Q

Hodgkin lymphoma: presentation

A

● Patients mostly present w/ painless, nontender, firm, rubbery cervical and supraclavicular LN
- Usually have some degree of mediastinal involvement
- HSM is rare
⅓ have B symptoms
● Presence of B Sx is key for staging
→ defined as unexplained fever > 38 Celsius, wt loss > 10% of total BW over 6m, and drenching night sweats

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3
Q

List 5 childhood conditions that predispose them

to development of leukemia

A
  1. Trisomy 21
  2. Neurofibromatosis Type 1
  3. Ataxia Telangiectasia
  4. Fanconi anemia
  5. Li-Fraumeni Syndrome
  6. Bloom syndrome
  7. Noonan syndrome
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4
Q

Indications for a BMA?

A

▫ Unexplained and significant depression ≥ 1 cell
lines
▫ Blasts on peripheral smear
▫ Leukoerythroblastic changes on peripheral smear
▫ Association with unexplained lymphadenopathy
or hepatosplenomegaly
▫ Association with an anterior mediastinal mass

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5
Q

%age of each subtype of ALL?

A

B-cell ALL: 85%

T-cell ALL: 15%

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6
Q

Peak age for ALL?

A

3-5 year

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7
Q

What is prognosis for ALL?

What are prognostic factors?

A

90% cure

Factors:

  • Age: <1, >10
  • WBC>50
  • CNS/Testic disease
  • Cytogenetics
  • MRD (at end of induction)
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8
Q

Prognosis for AML

A

60% cure

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9
Q

Late Effects of Onc Therapy

A 
Varies according to therapy received and
complications:
▫ Obesity --> steroids
▫ Bone health issues --> steroids
▫ Endocrine dys-regulation --> steroids
▫ Neurotoxicity --> intra-thecal chemo, MTX
▫ Cardio-toxicity --> anthracyclines (doxo/dauno)
▫ Secondary neoplasms --> lots of drugs
▫ Psychosocial Effects
▫ ? Infertility
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10
Q

Leukemia: acute management

A 
• PIV for supportive care
• CXR
• Labs- CBC/smear, critical chemistries, coags,
type and screen, cultures (if febrile)
• Hydration (IVF)
• Allopurinol (rasburicase)
• Antibiotics (if febrile)
• Blood products (as indicated)
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11
Q

What are Leukemia emergencies

A
  • Hyperleukocytosis
  • Tumour lysis syndrome
  • Mediastinal mass
  • Sepsis
  • Bleeding diathesis
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12
Q

Hodgkin Lymphoma: prognosis

A

> 90% cure

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13
Q

Risk factors for NHL

A
  • Ataxia telangiectasia
  • Wiskott Aldrich syndrome
  • Congenital hypogammaglobulinemia
  • Post SOT
  • HIV

• Think immunodeficiency …..

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14
Q

Types of NHL

A

1) Mature B-cell:
- Burkitts
- Large B-cell

2) Mature T-cell
- Anaplastic large

3) Precursor B or T cell
- Lymphoblastic (like leukaemia but <25% BM, mostly T-cell, Med mass)

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15
Q

Concerns/complications of mediastinal mass?

A 
▫ Airway compromise
         (CXR, CT, PFTs, no lying flat!)
▫ SVC syndrome
         (echo)
▫ RVOT obstruction
         (echo)
▫ Cardiac tamponade
         (pulsus paradoxus, EKG, echo)
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16
Q

Lab findings consistent with TLS?

A
  • hyper-k
  • hyper-PO3
  • hypo-Ca
  • hyperuricemia
  • hypo-Na (~)
  • low bicarb (acidosis)
17
Q

3 side effects of : vincristine

A
  • peripheral neuropathy

- SIADH

18
Q

3 side effects of : asparaginase

A
  • allergic reaction
  • hepatitis/pancreatitis
  • coagulopathy/thrombosis
19
Q

3 side effects of : prednisone

A
  • weight gain/obesity
  • bone health
  • endocrine (DM), HTN
20
Q

Expected side effects of treatments for:

  • Teens with sarcomas
  • Teens with HL
  • AML
  • High risk neuroblastoma
A

• Teens with sarcomas
▫ Cardiac toxicity due to anthracyclines
▫ Alkylators (ifosfamide/cyclo) –> infertility

• Teens with HL
▫ Heart, lungs, fertility, risks of RT

• AML
▫ Very high dose of anthracyclines (heart)

• High risk neuroblastoma
▫ Hearing loss, renal toxicity

21
Q

List 6 long-term side effects of Hodgkin’s Lymphoma treatment

A

Hypothyroidism (RT)
Infertility (Alkylator, RT)
Cardiomyopathy, CAD (Anthracycline, RT)
Pulmonary Fibrosis (Bleomycin, RT)
Second CA – breast, thyroid, skin, … (RT)
MDS/Leukemia (Alkylator)
Avascular Necrosis. (Steroid)

22
Q

The most common organism isolated in episodes

of febrile neutropenia

A

CONS

23
Q

Beckwith Wiedemann - associated with what malignancy?

A

Hepatoblastoma : AFP q 3 months until age 4

Wilms’ Tumor : Abdo U/S q 3 months until age 8

24
Q

Wilm’s tumour associated with what conditions?

A
    • 11p deletion/WAGR
    • BWS
    • NF-1
25
Q

LCH: features

A
  • Single bone lesion
  • Multiple bone lesions
  • Multi-organ involvement:
    • Bone (skull, limb, single or multiple) - 80%
    • Skin/scalp (scaly, waxy rash) – 50%
    • CNS, Pituitary (DI)
    • Lungs
    • Bone marrow, liver, spleen
    • Eyes, ears,
26
Q

LCH: treatment

A

▫ Curretage/biopsy for isolated bone lesion
▫ Topical therapy if rash only
▫ Chemo for wide spread disease

27
Q

HLH: 2 types

A

1) Primary/familial
- younger, AR

2) Secondary/acquired
- Usually older child/adult
• Triggered by:
• Infection (viral [EBV], bacterial)
• Rheum condition (MAS)
• Cancer

28
Q

HLH: Diagnostic criteria

A

Diagnostic criteria (5 of 8):

  • Fever
  • Cytopenia
  • Splenomegaly
  • Hemophagocytosis
  • Hyperferritinemia
  • Hypertriglyceridemia or hypofibrinogemia
  • Low/absent NK cell activity
  • Increased sIL2R
29
Q

HLH: Treatment

A
  • Chemo
  • IVIG
  • Steroids
30
Q

what is osteopetrosis

A

• Inherited bone disease:

  • dense, sclerotic bones –> fracture
  • growth impairment, dental abnormalities, HSM, epilepsy, ID
  • BM can be affected due to bone density –> cytopenias

Tx: BMT

31
Q

Most common type of solid tumor in children?

A

Brain tumours

32
Q

Headaches: features/indications for head imaging (r/o ca)

A

The headache:
• Change in type, increasing severity/frequency
• Sudden/severe onset, associated with trauma
• Early AM, awakens from sleep, assoc w/
straining

The patient:
• Abnormal neurologic signs/symptoms
• Seizures or loss of consciousness
• Linear growth regression
• School or behavior change
33
Q

DDx for an abdominal tumour

A
  1. Neuroblastoma
  2. Wilms tumor
  3. Hepatoblastoma
  4. Lymphoma
34
Q

List investigations for abdominal mass NYD

A
  1. Imaging: Ultrasound, CT Scan, bone scan, MIBG
  2. Blood work: lytes, urate, LDH, AFP
  3. Urine: HVA/VMA, Urinalysis
  4. Other: BMA +/- biopsy
35
Q

Most common extra-cranial solid malign tumour?

A

Neuroblastoma

36
Q

Predisposing conditions for hepatoblastoma?

A
  • BWS, Hemihyperplasia
  • FAP – family history of polyps
  • Prematurity/LBW

Ped RC (9 decks)

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