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Paediatrics > Paediatric Oncology > Flashcards

Paediatric Oncology Flashcards

1
Q

What are the most common paediatric malignancies?

A
  • Leukaemias
  • Brain tumours
  • Lymphomas
  • Extracranial solid tumours
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2
Q

How are paediatric cancers classified?

A
  • International classification of childhood cancer

- Based on tumour morphology and primary site

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3
Q

Which genes can cause cancer in childhood?

A
  • Down
  • Fancomi
  • BWS
  • Li-Fraumeni syndrome
  • Neurofibromatosis
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4
Q

What can cause childhood cancer?

A
  • Genes
  • Radiation and chemo
  • Infection
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5
Q

Which type of cancer has the highest mortality?

A

Brain

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6
Q

Which presentations would have you worried that a child may have cancer?

A
  • Unexplained petechiae and hepatosplenomegaly (immediate referral)
  • Repeat attendance with the same problem, no clear diagnosis, new neuro symptoms and abdo mass (urgent referral)
  • Rest pain, back pain and unexplained lump (refer for urgent investigation
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7
Q

What are the risks of chemotherapy (acute/chronic)?

A
  • Acute: hair loss, nausea, vomiting, mucositis, diarrhoea, constipation and bone marrow suppression (anaemia, bleeding and infection)
  • Chronic: organ impairment, reduced fertility and second cancer
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8
Q

What are the risks of radiotherapy (acute/chronic)?

A

Acute: lethargy, skin irritation, swelling and organ inflammation
-Chronic: fibrosis/scarring, second cancer and reduced fertility

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9
Q

What are the risks for developing sepsis/febrile neutropenia?

A
  • ANC <0.5x10^9
  • Indwelling catheter
  • Mucosal inflammation
  • High dose chemo/SCT
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10
Q

Which organisms cause sepsis/febrile neutropenia?

A
  • Pseudomonas aeruginosa
  • E coli
  • Klebsiella
  • Strep pneumoniae
  • Enteroccoci
  • Staph
  • Fungi e.g. candida, aspergillus
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11
Q

How does sepsis/febrile neutropenia present?

A
  • Fever (or low temp.)
  • Rigors
  • Drowsiness
  • Shock (tachycardia, tachypnoea, hypotension, prolonged cap refill, reduced urine output and metabolic acidosis)
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12
Q

How can sepsis/febrile neutropenia be managed?

A
  • IV access
  • Blood culture, FBC, coag, U&Es, LFTs, CRP and lactate
  • CXR
  • Urine culture, throat swab, sputum culture, LP, viral PCRs, CT or USS
  • ABC: oxygen and fluids
  • Broad spectrum antibiotics
  • Inotropes and PICU if necessary
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13
Q

How does raised ICP present?

A
  • Early: early morning headache, tense fontanelle and increasing head circumference
  • Late: constant headache, papilloedema, diplopia, loss of upgaze, neck stiffness, status epilepticus, reduced GCS, low HR and high BP
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14
Q

How should raised ICP be investigated?

A
  • CT: good for screening

- MRI: more accurate diagnosis

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15
Q

How can raised ICP be treated?

A
  • Dexamethasone (if due to tumour)

- Neurosurgery: ventriculostomy, EVD and VP shunt

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16
Q

How does spinal cord compression present?

A
  • Weakness
  • Pain
  • Sensory disturbance
  • Sphincter disturbance
17
Q

How is spinal cord compression managed?

A
  • Urgent MRI
  • Dexamethasone
  • Definitive treatment with chemo where appropriate (radiotherapy and surgery are also options)
18
Q

What are the common causes of superior vena cava syndrome (SVC)?

A
  • Lymphoma
  • Neuroblastoma
  • Germ cell tumour
19
Q

How does SVC syndrome present?

A
  • Face, neck and upper thoracic plethora
  • Oedema
  • Cyanosis
  • Distended veins
  • Ill and anxious
  • Reduced GCS
20
Q

How does SMS (genetic syndrome) present?

A
  • Dyspnoea
  • Tachypnoea
  • Cough
  • Wheeze
  • Stridor
  • Orthopnea
21
Q

How can SVC syndrome and SMS be investigated?

A
  • CXR/CT chest

- ECHO

22
Q

How can SVC syndrome be managed?

A
  • Keep upright and calm
  • Urgent biopsy
  • FBC, BM, pleural aspirate and GCT markers
  • Chemo
  • Steroids
  • Radiotherapy
  • Any thrombosis should be threated with thrombolytic therapy
23
Q

What is tumour lysis syndrome?

A

Metabolic derangement caused by the death of tumour cells and the subsequent release of intracellular contents (secondary to treatment)

24
Q

How does tumour lysis syndrome present?

A
  • Increased potassium
  • Increased urate
  • Increased phosphate
  • Reduced calcium
  • Acute renal failure: urate load and CaPO4 deposition in renal tubules
25
Q

How can tumour lysis syndrome be treated>

A
  • Avoidance
  • ECG monitoring
  • Hyperhydrate
  • Electrolytes x4 daily
  • Diuresis
  • Lowe uric acid: allopurinol etc.
  • Treat hyperkalaemia: Ca resonium, salbutamol and insulin
  • Renal replacement therapy
  • Never give potassium

Paediatrics (17 decks)

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