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CP2 PAEDS > Oncology and Haematology > Flashcards

Oncology and Haematology Flashcards

1
Q

Most common type of paediatric cancer

A

Leukaemia (32%)

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2
Q

Which cancer is down’s syndrome associated with?

A

Leukaemia

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3
Q

What cancer is associated NFM?

A

Glioma

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4
Q

4 most common types of cancer (4)

A

Leukaemia (NHL)
Neuroblastoma
Wilms
Retinoblastoma

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5
Q

Presentation brain tumours in children (2)

A

Incr ICP

Neurological signs

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6
Q

Presentation retinoblastoma

A

White pupillary reflex

Squint

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7
Q

Presentation lymphomas

A

Enlarged LN in head, neck or abdomen

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8
Q

Presentation of Wilms tumour (4)

A

Large abdominal mass in well child

? Anorexia, abdo pain, haematuria

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9
Q

Langerhans cell histiocytosis presentation (4)

A

Seborrhoeic rash
Widespread soft tissue infiltration
Bone pain, swellnig, fracture
Diabetes insipidus

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10
Q

Neuroblastoma presentation (5)

A 
SC mass crossing midline 
SC compression 
W loss + malaise 
Pallor, bruising 
Bone pain
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11
Q

What % of leukaemia in children is ALL?

A

80%

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12
Q

When does clinical presentation of ALL peak?

A

2-5years

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13
Q

S+S ALL

A

Malaise + anorexia
BM infiltration - anaemia + neutropaenia (infection), thrombocytompaenia (brusing, bleeding petechiae) + bone pain
HPmegaly
Organ infiltration - CNS - nn palsy, headaches, vomiting, Testes enlargement

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14
Q

Ix ALL (3)

A

FBC
BM exam
CXR - mediastinal mass

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15
Q

What would you find on a FBC for ALL?

A

Decr Hb
Decr platelets
Evidence of leukaemic blast cells

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16
Q

What are the 2 subclassifications of ALL?

A 
Common subtype (75%)
T-Cell subtype (25%)
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17
Q

What stage of treatment is initiated at diagnosis ALL?

A

Remission induction

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18
Q

Tx - remission induction ALL

A

Vincristine
Steroids
Methotrexate
L-asparginase

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19
Q

What should you do before starting Tx for ALL?

A

Correct anaemia w/ blood + platelet transfusion

Tx infection

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20
Q

Tx weeks 5-8 ALL (Consolidation + CNS protection)

A

Methotrexate
Vincristine
Steroids
Thiopurine

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21
Q

What type of chemo in ALL is required for CNS penetration?

A

Intrathecal chemo

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22
Q

Tx w8-16 ALL (interim maintenance)

A

Prophylactic co-trimox
Monthly vincristine
5 day steroid daily, 6-mercaptopurine
Weekly PO methotrexate

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23
Q

Tx ALL week 16-23 (Delayed intensification)

A

Vincristine
Methotrexate
Dexamethasone

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24
Q

Tx ALL week 23 –> 2+years

A

Same as interim maintenance

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25
What is TUmour lysis syndrome?
Metabolic derangement due to release of intracellular contents from chemotherapy destroying leukaemic blast cells
26
Features of tumour lysis syndrome (4)
Hyperuricaemia Hypophosphatemia Hypocalcaemia Hyperkalaemia
27
Mx Tumour lysis syndrome
IV fl
28
ALL -Poor prognostic factors - age
<1 or >10
29
ALL -Poor prognostic factors - tumour load
>50x109/L
30
ALL- Poor prognostic factors - cytogenic abnormalities
MLL rearrangement
31
ALL -Poor prognostic factors - speed of response to initial chemo
Persistance of leukaemia blasts in BM
32
ALL Poor prognostic factors - Minimal residual disease assessment
High
33
ALL -Poor prognostic factors - gender
Male
34
ALL -Poor prognostic factors - spread
CNS involvement
35
ALL - Tumour cells L1
Small uniform cells
36
ALL - Tumour cells L2
Large varied cells
37
ALL - Tumour cells L3
Large varied cells + vacuole
38
Anaemia - neonate
<140
39
Anaemia - 1-12months
<100
40
Anaemia - 1-12years
<110
41
What are the 3 main mechanisms leading to anaemia?
Decr RBC production Incr RBC destruction/haemolysis Blood loss
42
E.g.s of Decr RBC production in anaemia (5)
``` IDA (most common) Folic defic Chronic inflamm Chronic renal failure Red cell aplasia ```
43
What infection is red cell aplasia associated with?
Parovirus B19
44
E.g.s of Haemolysis causing anaemia (4)
Membrane disorder - spherocytosis Enzyme disorder - G6PD def Haemoglobinopathies (SC, Thal) Immune - haemolytic disease
45
E.g.s of blood losses causing anaemia (v uncommon) (2)
Chronic GI bleed - Meckels | Inherited - vWD
46
Causes of microcytic anaemia (TICS - 3)
Thalassaemia IDA Chronic disease/renal failure Sideroblastic anaemia
47
Causes normocytic anaemia (6)
``` Acute blood loss Anaemia chronic disease BM failure Renal failure Hypoothyroid Haemolysis ```
48
Causes macrocytic anaemia (3)
B12 Folate Reticulocytosis
49
What would make you suspect a haemolytic anaemia?
Incr reticulocytes | Incr bilirubin
50
What are reticulocytes?
Immature RBC | Circulate for 1 day --> RBC
51
Where are blood cells prdoduced post-natally?
Bone marrow
52
What type of Hb do newborns predominantly have (75%)
HbF (higher O2 affinity)
53
What type of Hb do children >1 predominantly have (97%)
HbA
54
What can incr HbF be a indicator of?
Inherited disorder of Hb prod (Sickle cell)
55
WCC in neonates
10-25 x10 9/L
56
Platelets in neonates
150-400x10 9/L (norm)
57
How much iron intake does a newborn need /day?
8mg
58
Where does a newborn get the majority of its iron from?
Breast milk
59
Clinical features IDA (4) | Hb<70g/l
Fatigue Slow feeding Pallor Innapprop eating non-food material
60
Ix IDA (2)
Blood film | Low Se ferritin
61
Mx IDA (2)
Diet | Supplement - iron-sytron/niferex 3 months
62
What is folate vital for?
Prod RBC
63
What is B12 vital for?
DNA synth
64
What is haemolytic anaemia?
Incr RBC destruction, BM compensates, then --> anaemia
65
Signs haemolytic anaemia (2)
HSmegaly | Incr unconjugated bilirubin
66
Causes of haemolytic anaemia (5)
``` Hereditary spherocytosis G6PD deficiency Pyruvate Kinase deficiency Thalassaemia Sickle Cell ```
67
What is Hereditary spherocytosis
Mutation in gene --> spheroidal shape --> spleen --> destroyed
68
Sx Hereditary spherocytosis (5)
``` Jaundice Anaemia Splenomegaly Aplastic crisis Gall stones ```
69
G6PD features
Neonatal jaundice | Acute haemolysis
70
What is the 2nd most common cause of haemolytic anaemia?
Pyruvate kinase deficiency
71
When does Sickle Cell disease start to present?
After 6 months
72
Where is Sickle cell common?
Africa or Carribean
73
Homogenous HbS
Sickle cell mutation in both B-chains
74
HbSC
1 HBs from one parents 1 HBc from other No HbA - near normal Hb + fewer painful crises
75
Sickle-B thalassemia
HbS from one parent | B-thalassaemia from other
76
Sickle train
HbS from 1 parent, norm from other 40% Hb = HbS Asymp
77
Affect of HbS on life
Shorter life span
78
Sx Sickle Cell (3)
Anaemia Incr infection susceptibility Priaprism
79
What occurs in a Sickle Cell painful crises (5)
``` Vaso-occlusive Pain + swelling in hands + feet Acute chest syndrome Severe hypoxia req ventilation Avascular necrosis of femoral heads ```
80
Long term problems Sickle cell (7)
``` Short stature + delayed puberty Stroke/cognitive issues Adenotonsilar hypertrophy - OSA Cardiac enlargement Heart failure Renal dysfunction Pigment gallstones ```
81
How is Sickle cell screened for?
Guthrie test
82
What prophylaxis can be given for Sickle cell
Penicillin
83
Prenatal diagnosis Sickle cell
CVS @ end trim1
84
Mx Sickle Cell
Pen prophylaxis Imms Daily folic acid Avoid cold, dehydration, excessive exercise, hypoxia
85
Prognosis Sickle cell
50% Die before 40
86
What is B-thalassaemia
Severe reduction prod B-globin chains hence reduction ni HbA prod
87
Where is B-thalassaemia most common?
India Mediterranean Middle East
88
What are the 3 types of B-thalassaemia
B-T major B-T intermedia Hb trait
89
Which is the most severe type of B-thalassaemia
B-T major
90
B-T major - HbA
No HbA production
91
B-T intermedia HbA
Small no' HbA + HbF prod
92
Which type is the B-thalassaemia is Asymp carrier?
Hb trait
93
Features B-thalassaemia (4)
Severe anaemia Jaundice FTT Bone deformity (maxillary overgrowth, skull bossing)
94
Diagnosis B-thalassaemia
Prenatal | CVS + DNA analysis
95
Mx B-thalassaemia
Montly blood transfusions Iron chelation BM transplant = cure
96
What % patients w/ B-thalassaemia live to 40?
90%
97
What is repeated blood transfusions in B-thalassaemia associated with? (4)
Cardiac failure Liver cirrhosis DM Infertility

CP2 PAEDS (18 decks)

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