Paeds cancer

Question 1

Which are the 2 potentially dangerous infections in a non-immune, immunocompromised child?

Answer 1

1. Measles → (no treatment)
2. Chickenpox (varicella zoster virus) → Aciclovir

→ if at risk from contact then give immunoglobulin or zoster immune globulin.

Question 2

During chemotherapy, can vaccines be given?

Answer 2

Live vaccines should NOT be given during chemo or 6-12 months afterwards.

Question 3

What is the SPIKES framework?

Answer 3

Tool for sharing information

S - setting: privacy, time to talk, who is present, equal height chairs, toys for child, play therapist / nurse

P - patient perception: what they know so far, their agenda, ICE

I - invitation - sign-posting, keeping structure, taking the lead

K - knowledge: chunking and checking, avoiding jargon, pictures, organise knowlegde, printed info, avoid false reassurance

E - explore emotions/empathy: how are you feeling about x? I can see this is upsetting

S - summary and strategy: Qs, clarify, summarise

Question 4

What are the tumours of the supratentorial cortex?

What do they present with?

Answer 4

astrocytoma

seizures, hemiplegia, focal neurological signs

Question 5

Tumours of the midline?

Answer 5

Craniopharyngioma

Visual field loss - bitemporal hemianopia

Pituitary failure - growth failure, DI, W/G

Question 6

Infratentoral tumours?

Answer 6

Cerebellar - medulloblastoma, astrocytoma, ependymoma

Brainstem - brainstem glioma

Question 7

What is the most common leukemia in children?

Answer 7

Acute Lymphoblastic leukemia (ALL)

Question 8

What would you see on the FBC of a child with leukemia?

Answer 8

• Anaemia (↓Hb)
• Thrombocytopenia (↓platelets)
• Blood film - blast cells

Question 9

absent red reflex is likely what?

Answer 9

Retinoblastoma

Question 10

How urgently should you refer suspected leukemia?

Answer 10

Urgently - 48hrs