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Pediatrics 1 Flashcards

1
Q

Uniqueness of the physical exam: you have ____ patients

A

2! the child and the parent

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2
Q

Uniqueness of the physical exam: the manner in which you examine the chid will vary based on their ____

A

age

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3
Q

Uniqueness of the physical exam: the child’s behavior will depend on where they are _____

A

developmentally

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4
Q

Uniqueness of the physical exam: vital signs include…

A

percentiles of:
height
weight
head circumference

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5
Q

Uniqueness of the physical exam: based on age of the patient, there will be unique ____ to examine and specific ______ to perform

A

body parts

maneuvers

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6
Q

When thinking about what to expect on PE, kids under ____ should be happy, smiling unless hungry or have a dirty diaper

A

6 months

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7
Q

When does stranger anxiety begin?

A

6 months

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8
Q

When does separation anxiety begin?

A

9 months

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9
Q

What can you expect when a 9 month old is taken from the parent?

A

a high-pitched, sustained vocal response

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10
Q

How long do stranger and separation anxiety persist?

A

toddler age group- 2 years and older

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11
Q

Changing the PE approach based on age: 0-6 months

A

proceed with traditional HtT exam

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12
Q

Changing the PE approach based on age >6 months when there is stranger and separation anxiety (5 tips)

A
  • DON’T begin by examining the head/ears/nose/throat
  • DON’T examine the child on the examining table
  • Examine the child while in the parent’s lap
  • BEGIN the exam with the least anxiety-provoking area, usually start with the chest and abdomen
  • Do the head and neck exam LAST, end the exam with the ears followed by the throat
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13
Q

Should you immediately place the stethoscope on the child?

A

no, have the child first hold the auscultation end of the stethoscope to become familiar and have a penlight, small toy, etc that they can be distracted with

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14
Q

Are your parents useful in the exam?

A

Yes, they’re your ally

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15
Q

On the newborn and infant exam, how should you proceed?

A

start with what the baby gives you

if the baby is quiet, start with the heart and lung exam

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16
Q

What percent of children have an innocent heart murmur on physical exam?

A

50%

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17
Q

what are you inspecting for on the CV exam?

A
  • skin color
  • pallor, cyanosis, plethora (polycythemia)?
  • chest wall movement.. heaves, symmetry
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18
Q

How do you assess vasculature on the CV exam?

A
  • check cap refill
  • palpate brachial and femoral pulses
  • Assess for brachio-femoral delay
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19
Q

What is brachio-femoral delay an indication of?

A

coarctation of the aorta
or
aortic stenosis

LIFE THREATENING, no blood getting to the body

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20
Q

When does brachio-femoral delay manifest?

A

1-2 weeks

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21
Q

what is plethora/polycythemia?

A

too many RBCs causes a ruddy (reddish purple) complexion

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22
Q

4 places to auscultate on CV exam

A

RUSB
LUSB
LLSB
apex

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23
Q

In newborns, you also auscultate on the back for ____

A

peripheral pulmonary branch stenosis

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24
Q

What is peripheral pulmonary branch stenosis?

A

stenosis where the pulmonary artery bifurcates

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25
Q

what does peripheral pulmonary branch stenosis sound like on auscultation?

A

high-pitched whoosh… sounds will echo equally to both lung fields

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26
Q

What can you do if the child is crying on CV exam? (we need a quiet room)

A

give them something to suck on

take your time

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27
Q

name 2 challenges on the CV exam

A
  • lung sounds often sound like heart sounds

- rate: infants have a baseline rate in the 100s

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28
Q

What’s special about the patient’s position in a pediatric CV exam?

A

MUST examine in both supine and and upright

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29
Q

Why examine peds supine and upright on CV exam???

A

Normal heart sounds when sitting up, but systolic murmur when lying down is normal.

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30
Q

What do you expect to hear differently between sitting up and laying down on CV auscultation?

A

As blood comes back to the hear, the venous return is impacting the murmur..
Sitting up: VR is reduced, murmur is decreased
Laying down: VR is increased, murmur is pronounced

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31
Q

What would you hear if there is Hypertrophic Obstructive Cardiomyopathy (HOCM)?

A

Opposite of a normal heart murmur..
Sitting up: murmur increased
Laying down: murmur decreased

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32
Q

What are you observing for on the Lung/Thorax exam?

A
  • RR and effort, chest wall movement

- Manifestations of respiratory distress

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33
Q

What are manifestations of respiratory distress?

A
  • nasal flaring
  • tracheal “tag”
  • sternal retractions
  • subcostal retractions
  • paradoxical movement between chest and abdomen, “see saw” respirations
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34
Q

What are “see saw” respirations?

A

Normally, when we breathe in, the chest AND abdomen expand. With these, the chest expands, the abdomen sucks in.
This is due to diaphragmatic fatigue and use of the abdominals to compensate

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35
Q

What should you think about if you see “see saw” respirations?

A

the patient is on the verge of respiratory failure and need of intubation!

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36
Q

2 tips for auscultating the lungs

A
  • coughing or crying is an excellent opportunity to listen to the lungs
  • hold your finger in front of the child and have them imagine it is a candle, then ask them to blow it out
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37
Q

What’s different about a pediatric abdominal exam?

A

compared to adults, the liver and spleen are easily palpable

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38
Q

If you feel a kidney on abdominal palpation, what do you do and what should you be thinking about?

A

Mention it!!

Wilm’s Tumor

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39
Q

What should you pay close attention to on a newborn abdominal exam?

A

the umbilicus and umbilical cord remnant

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40
Q

Abdominal exam findings: diastasis rectus

A

abdominal fascial is weak, and the abdomen protrudes

a very common variant, nothing to do!

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41
Q

Abdominal exam findings: umbilical hernia

A

common benign finding in infants and toddlers

nothing to do unless it persists beyond 4 years old

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42
Q

Abdominal exam findings: linea nigra

A

a line running midline from the umbilicus to the suprapubic area

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43
Q

GU exam positioning

A

frog leg posture

on parent’s lap or on the exam table

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44
Q

Describe the male GU exam

A
  • inspect urethral opening, foreskin, shaft
  • if uncircumcised, DO NOT forcefully retract the foreskin, only retract enough to visualize the urethral opening to make sure there’s no hyper or hypospadias
  • palpate for BOTH testicles
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45
Q

Describe the female GU exam

A

inspect labia, clitoris, urethral opening, and external vaginal vault

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46
Q

What are you looking for on anus inspection?

A

patency

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47
Q

What are you assessing for on a newborn MSK exam and how do you do so?

A

hip dysplasia

compare gluteal folds and skin folds of right and left legs
perform Barlow and Ortolani maneuvers

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48
Q

What else do you look for on MSK exam?

A

deformities, hypermobility of joints, instability, curvature of spine

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49
Q

What are you observing for on eye exam?

A

alignment of eyes via corneal light reflex
strabismus=misalignment of the eyes

EOMs

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50
Q

Other than the corneal light reflex, what other test do you do on the eye exam?

A

red reflex

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51
Q

Infants generally don’t demonstrate sustained tracking until approximately ____ of age

A

12 weeks

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52
Q

When does vision become 20/20?

A

3 years

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53
Q

How do you perform red reflex?

A
  • be sure to encircle both eyes with the light
  • compare left and right eyes at the same time
  • may need to turn off lights with newborns and infants
  • try to avoid prying the eyes open with your hands
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54
Q

What is leukocoria?

A

white cornea instead of red on when the red reflex is performed

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55
Q

What are you looking for on inspection during ear exam?

A 
skin tags
preauricular pits
abnormally shaped pinna
ear "set"
symmetry/asymmetry
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56
Q

What’s significant about ear development and what we think of when we see abnormalities on inspection?

A

the kidneys develop at the same time as the ear… abnormalities of the ears can pint to kidney issues&raquo_space;> get kidney US

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57
Q

How to hold the otoscope with the insufflator bulb

A
  • hold otoscope in dominant hand with bulb in the palm

- Use the other hand to gently pull the pinna posteriorly

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58
Q

How to position the patient for an ear exam

A
  • in the parents lap
  • one hand holding head, one hand across the child’s body holding their arm
  • child’s other arm is under, behind the parent’s back
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59
Q

What if there is wax?

A
  • try to clean it out, under the supervision f a resident or attending (a skill worth perfecting)
  • if wax looks dried, it can be harder to remove… may have become dried due to the canal lining, hence causing pain/bleeding on attempted removal
  • soft, “wet” appearing wax is easier to remove
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60
Q

How to use a tongue blade in toddlers

A

insert blade along the side of the mouth, move posteriorly, then gag the child

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61
Q

What are you inspecting for in the oral exam?

A

Size and color of the tonsils
oral dentition and palate
tongue and gums for any lesion

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62
Q

In newborns and young infants, you need to exam the oral cavity by _____

A

inserting a gloved finger to assess palate and strength of suck

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63
Q

What do you palpate for on head exam?

A

fontanelles, anterior and posterior (MC vital sign that’s mis-measured)
suture lines

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64
Q

What do you inspect for on head exam?

A

asymmetry

abnormalities

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65
Q

what are common abnormalities on head exam?

A

cephalohematoma
caput succedaneum
overriding sutures
molding

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66
Q

when do you stop measuring FOC?

A

after 24 months

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67
Q

Importance of a skin exam

A

newborns and infants have many common skin findings- become familiar with as many as possible
BUT, skin findings in infants can be a harbinger of neurologic disease… remember that the ectoderm develops into the neurologic systems and the skin. Find out which diseases these findings can be a sign of.

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68
Q

Cafe-au-lait spots are associated with

A

neurofibromatosis

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69
Q

Ashley spots are associated with

A

tubosclerosis

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70
Q

Ear is to kidney as

Skin is to ____

A

nervous system

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71
Q

When do you perform developmental exams?

A

during well child visits or if there is concern regarding child’s development

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72
Q

What’s included in a neuro exam?

A

toddler/school aged children: similar to adult exam, mostly observation of coordination, gait, motor skills

infants: encompassed within other parts of the physical, but also includes assessment of primitive reflexes

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73
Q

CN II, III, IV, VI assessment

A

fixing/following, absence of ptosis

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74
Q

CN V assessment

A

rooting reflex

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75
Q

CN VII assessment

A

symmetric facial expressions during cry or smile

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76
Q

CN VIII assessment

A

startles to noise

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77
Q

CN IX,X assessment

A

suck, gag reflex

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78
Q

CN XI assessment

A

symmetric movement of UEs

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79
Q

CN XII

A

symmetric tongue

80
Q

6 solid tumors unique to children

A 
neuroblastoma
retinoblastoma
wilms' tumor
rhabdomyosarcoma
osteosarcoma
ewings sarcoma
81
Q

_____ is the fourth most common type of cancer in children

A

neuroblastoma

82
Q

MC malignancy in infants

A

neuroblastoma

83
Q

MC extracranial solid tumor of childhood

A

neuroblastoma

84
Q

Neuroblastoma is MC in
sex:
age:
race:

A

male: female 1.2:1
2 years
white > black/hispanic

85
Q

Neuroblastoma develops from ______ cells normally found in the_______ and _____

A

neural crest cells;

sympathetic ganglia, adrenal medulla

86
Q

____ can be described as a solid mass with areas of hemorrhage, calcification, and necrosis

A

neuroblastoma

87
Q

4 places a neuroblastoma can be found and what is most common?

A

abdominal mass (MC), often involving the adrenal gland
paraspinal mass
bone met
bone marrow

88
Q

What would be the S/Sx of an abdominal neuroblastoma?

A

distention
pain
constipation
“blueberry muffin sign”

89
Q

What is blueberry muffin sign?

A

bluish purple, palpable sucutaneous abdominal nodules

90
Q

What would be the S/Sx of a paraspinal neuroblastoma?

A

Spinal cord compression with change in gait or sensation

Avoiding use of a limb

91
Q

What would be the S/Sx of a bone met neuroblastoma?

A

bone pain
limp
if orbital involvement: proptosis, periorbital ecchymosis

92
Q

What would be the S/Sx of neuroblastoma with bone marrow involvement?

A

low grade fever
malaise
myelosuppression

93
Q

What does orbital/skull envolvement of neuroblastoma look like?

A

cephalomegaly and mass

sunken, raccoon eyes

94
Q

Neuroblastoma might present with this syndrome

A

Horner Syndrome

95
Q

Neuroblastoma might secrete catecholamines, causing …

A

HTN

96
Q

Neuroblastoma might cause intractable diarrhea due to

A

tumor secretion of VIP (vasoactive intestinal peptide)

97
Q

Neuroblastoma work up includes: (7 things)

A
  1. complete H&P
  2. CT or MRI of primary tumor
  3. Bone films and MIBG scan
  4. Bilateral bone marrow aspirate and Bx
  5. Urinary catecholamines (VMA, HVA)
  6. Labs: CBC, ferritin, neuron specific enolase
  7. Bx tumor tissue
98
Q

What part of the lab workup for neuroblastoma is most diagnostic?

A

urinary catecholamines

99
Q

What is MIBG scan used for ?

A

to image both primary and metastatic neuroblastoma

used SPECIFICALLY for neuroblastoma

100
Q

How is MIBG scan performed?

A

Prep with thyroid blockade (K+ iodide) which prevents excessive radioiodine levels in the thyroid

Radiolable attached to Iodine-131, injected into vein, then scanned

101
Q

MC sites of neuroblastoma mets

A

BONE MARROW
BONE (commonly orbits/skull)
LYMPH NODES

soft tissue
liver
lung
leptomeningeal involvement (late stage)

102
Q

Staging neuroblastoma

A

based on age, risk, bodily involvement

classifications: high, intermediate, or low risk

103
Q

Who has the prognosis with neuroblastoma?

A

children diagnosed at 12 months old or younger

104
Q

How to treat neuroblastoma?

A

based on age, risk, stage

chemo
surgery
radiation to tumor bed
autologous bone marrow transplant followed by 6 months of cis-retinoic acid
MIBG therapy
antibody therapy
105
Q

Neuroblastoma is almost always diagnosed at stage:

A

3 or 4

106
Q

An adverse indicator in neuroblastoma is:

A

N-myc amplification

107
Q

MC intraocular malignancy of childhood

A

retinoblastoma

108
Q

Retinoblastoma is MC in:
sex:
age:
race:

A

M=F
<4 years
no race predominance

109
Q

A mutation in what gene is associated with retinoblasoma

A

RB gene

110
Q

Where do retinoblastomas originate?

A

posterior retina

111
Q

What can be described as a mass characterized by areas of necrosis, frequently calcified foci?

A

retinoblastoma

112
Q

retinoblastoma can originate from one or more foci in one or both eyes, in rare cases it can be trilateral with a focus in the ___

A

pineal gland

113
Q

S/Sx of retinoblastoma

A
  • LEUKOCORIA: white reflex or “cat’s eye” reflex
  • strabismus
  • inflammation of conjunctiva or sclera
  • orbital cellulitis
  • proptosis
114
Q

Retinoblastoma work up includes (4 things)

A
  1. Complete H&P
  2. Funduscopic exam under anesthesia!!
  3. CT scan and MRI of the orbits and brain
  4. Bone marrow aspirate and spinal tap for disseminated disease (rare)
115
Q

3 patterns of retinoblastoma spread

A
  1. local intraocular extension into the vitreous
  2. Distant mets through the optic nerve or hematogenous dissemination
  3. trilateral retinoblastoma: pineal tumor
116
Q

Tx of retinoblastoma

A

ENUCLEATION

  • systemic chemo
  • cryotherapy
  • laser photocoagulation
  • brachytherapy/plaque
  • intra-arterial chemo via opthalmic artery (v complex and risk, not many docs trained to do this)
  • Intra-vitreal chemo
  • external beam radiotherapy
117
Q

5-year prognosis of retinoblastoma

A

95% disease-free survival

118
Q

What is associated with very poor outcomes of retinoblastoma?

A

CNS involvement

119
Q

What predisposes child to a second malignancy, especially osteosarcoma?

A

Bilateral familial retinoblastoma

120
Q

Neuroblastoma is to adrenal gland as Wilm’s tumor is to

A

kidney

121
Q

MC primary malignant tumor

A

Wilms’ tumor

122
Q

unilateral Wilm’s tumor is most commonly Dx at what age?

A

boys: 41.5 months
girls: 46.9 months

123
Q

bilateral Wilm’s tumors are most commonly Dx at what age?

A

boys: 29.5 months
girls: 32.6 months

124
Q

describe wilms’ tumor on imaging

A

well-defined borders due to the pseudocapsule, tumor coming out of the kidney

125
Q

Wilms’ tumor is MC in
sex:
age:
race:

A

M:F .9:1.0
3-4 years
black > caucasian > asian

126
Q

what type of tumor can be described as a rapidly growing soft kidney mass, cystic, vascular, friable, often with pseudocapsule

A

Wilm’s tumor

127
Q

There is favorable histology in ____% of cases of wilm’s tumor

A

95%

128
Q

what are the three types of favorable wilm’s tumor histology?

A

blastemal, stromal, epithelial

129
Q

what is the unfavorable type of wilm’s tumor histology?

A

anaplastic

130
Q

S/Sx of Wilm’s tumor

A

asymptomatic abdominal mass!!
Macroscopic or gross PAINLESS hematuria!!

HTN in 25% of cases
abdominal pain
malaise
anorexia
vomiting
anemia
rapid abdominal enlargement, significant anemia, and hypotension are seen in a subset of patients with sudden subcapsular hemorhage (worry about capsular rupture!)
neuro signs if brain mets
131
Q

primary wilm’s tumor may spread to the ___ or ___, which is associated with much worse prognosis

A 
IVC (3%)
right atrium (.8%)
132
Q

Wilms’ tumor workup includes: (5 things)

A
  1. complete H&P, note size of mass, location, presence of GUi anomolies
  2. Labs: CBC, renal and liver function, chemistries, UA
  3. US and CT of the abdomen
  4. Chest CT (MC site of mets, everyone gets one no matter what)
  5. Tumor tissue (nephrectomy) rare, imaging is usually Dx
133
Q

3 patterns of Wilm’s tumor spread and the most common

A
  1. lung mets are MC site of mets, followed by liver
  2. Extrarenal spread from direct extension through the renal capsule and/or lymphatic vessels
  3. Regional lymph nodes and the vena cava may be involved
134
Q

Wilms’ tumor Tx

A
  • Surgery for Tx and staging. MUST BE V CAREFUL NOT TO RUPTURE PSEUDOCAPSULE&raquo_space; high rate of abd recurrence
  • Chemo
  • Radiation therapy
135
Q

Radiation therapy for Wilms’ tumor according to stage

A

I-II: not typically necessary
III: abdominal
IV: abdominal + lung
IF ANY TUMOR SPILLAGE: whole abdominal radiation

136
Q

Prognosis of Wilms’ tumor is related to: (5 things)

A
  1. stage of disease
  2. histology (favorable vs unfavorable)
  3. Patient age (younger is better)
  4. Tumor size
  5. Team approach to Tx: surgery, nephrology, oncology
137
Q

Poor prognosticators for wilms’ tumor (5 things)

A
  1. mets at time of Dx
  2. lymph node involvement
  3. early recurrence (within one year of Dx)
  4. increased age
  5. anaplastic histology
138
Q

What type of tumor is described as a malignant tumor of mesenchymal cell origin most often arising from skeletal muscle lineage?

A

rhabdomyosarcoma

139
Q

Rhabdomyosarcoma is most common in
sex:
age:
race:

A

M:F 1.3:1
<9 years old
caucasian, african

140
Q

2 associations with rhabdomyosarcoma

A

NF

Li-Fraumeni– a P53 mutation that predisposes pts to multiple cancers including rhabdomyosarcoma

141
Q

pathophys of rhabdomyosarcoma: a ___, ___, ____ cell arising from ____ cells

A

small, round, blue

mesenchymal

142
Q

rhabdomyosarcoma has characteristics of ____ cells

A

muscle (actin, myosin, desmin, myoglobin)

143
Q

5 histological types of rhabdomyosarcoma and the MC

A 
embryonal (MC)
alveolar (MC)
botryoidal 
spindle cell
undifferentiated
144
Q

Rhabdomyosarcoma:
The ____ type involves mucosa
The _____ type involves the extremities

A

embryonal;

alveolar

145
Q

Orbital S/Sx of rhabdomyosarcoma

A

ptosis, lid swelling, proptosis

146
Q

Paranasal sinus S/Sx of rhabdomyosarcoma

A

chronic sinusitis, epistaxis, swelling, pain

147
Q

Nasal pharynx S/Sx of rhabdomyosarcoma

A

nasal speech, discharge, obstruction, mass

148
Q

Middle ear S/Sx of rhabdomyosarcoma

A

chronic OM, mucopurulent or serosanguinous drainage, facial nerve palsy, mass in ear canal

149
Q

Head lesions of rhabdomyosarcoma may lead to…

A

intracranial spread with S/Sx of increased ICP, meningeal S/Sx

150
Q

rhabdomyosarcoma may present with mass in the…

A

trunk, extremity, paratesticular region

151
Q

Prostate/bladder S/Sx of rhabdomyosarcoma

A

urinary tract obstruction, other urinary Sx

152
Q

Vagina/uterus S/Sx of rhabdomyosarcoma

A

discharge, bleeding, polypoid mass

153
Q

Rhabdomyosarcoma workup includes: (7 things)

A
  1. complete H&P
  2. CT or MRI and plain film of primary site
  3. bone scan
  4. CXR and CT scan (often spreads to lungs)
  5. Bilateral bone marrow aspirate and Bx (can easily spread to bone marrow, poor prognostic indicator)
  6. Tumor Bx
  7. Labs: CBC, chemistries, liver and kidney function
154
Q

Rhabdomyosarcoma Tx

A
  • chemo
  • surgery (preferred to radiation)
  • radiation
155
Q

Combo chemo therapy for rhabdomyosarcoma

A

VAC:
Vincristine
Actinomycin D
Cyclophosphamide

156
Q

____ and ____ rhabdomyosarcoma have the best prognosis

A

orbital, GU

nonbladder, nonprostate

157
Q

____, _____, ____, ____, ____, and _____ rhabdomyosarcoma have the worst prognosis (~70%)

A 
extremity
cranial parameningial
trunkal
pelvic
retroperitoneal
paravertebral
158
Q

Prognosis for rhabdomyosarcoma that involves the bone marrow

A

<20%

159
Q

two positive prognostic indicators for rhabsomyosarcoma

A

early response to Tx

localized Dz

160
Q

What is the most important negative prognostic indicator for rhabdomyosarcoma?

A

PAX-FOXO1 fusion!!!

161
Q

What is the MC bone tumor of childhood?

A

osteosarcoma

162
Q

Osteosarcoma is MC in
sex:
age:
race:

A

M:F 1.5:1
adolescent
all

163
Q

peak age for osteosarcoma

A

12-16

164
Q

3 predispositions to osteosarcoma

A

Li-Fraumeni syndrome
hereditary retinoblastoma
TALL!!

165
Q

osteosarcoma arises from _____ and produces _____.

A

connective tissue

bone

166
Q

what is a multifocal osteosarcoma?

A

involves more than one bone.

v rare but v poor prognosis

167
Q

MC sites for osteosarcoma

A 
tend to happen near a joint... 
distal femur
proximal tibia
proximal humerus
distal tibia
proximal femur

may occur in any bone

168
Q

S/Sx of osteosarcoma

A 
pain, swelling
limited ROM
increased warmth, vascularity
pathological Fx
pain worse at night
169
Q

Tell pts with osteosarcoma not to _____ because _____

A

walk!

they could get a fracture at any time, then suffer pain and spread of the cancer

170
Q

4 patterns of spread of osteosarcoma

A
  1. hematogenous to the lungs– by far the MC site of mets
  2. skip mets
  3. bone mets (rare)
  4. brain, lymph, kidney (rare, towards end of Dz)
171
Q

What are skip mets?

A

a met to the same bone, with healthy bone in between

172
Q

Workup for osteosarcoma includes: (10 things)

A
  1. complete H&P
  2. x-ray of primary tumor
  3. CT scan and MRI of primary tumor
  4. Nuclear bone scan/PET-CT
  5. CXR and chest CT looking for lung mets
  7. Labs: CBC, chemistries, kidney and liver function, coag studies, UA, urine Cr clearance
  8. Tumor markers: LDH, Alk Phos!!
  9. EKG, ECHO
  10. audiogram
173
Q

Standard Tx for osteosarcoma

A
  • neoadjuvant chemo
  • local control (amputation, limb sparing surgery, radiation)
  • adjuvant chemo
174
Q

neoadjuvant vs adjuvant chemo for osteosarcoma

A

Neoadjuvant: MAP= Methotrexate, Adromycin (Doxorubicin), Cisplatin

Adjuvant: same as neoadjuvant

175
Q

Limb salvage surgery for osteosarcoma

A

metal endoprosthesis, autograft, allograft, composite with bone + metal

176
Q

4 types of surgery to Tx osteosarcoma

A

limb salvage
amputation
rotationplasty (must be in distal femur)
resection of primary tumor without need to reconstruct

177
Q

what is an autograph?

A

replace a section of bone with a piece of another bone

178
Q

Main Tx for osteosarcoma

A

surgery surgery surgery

179
Q

2 things that are associated with improved outcomes of osteosarcoma

A

localized Dz

response to pre-op chemo

180
Q

the second MC malignant bone tumor of childhood (can also be found in soft tissue)

A

Ewing’s sarcoma of bone

181
Q

ewings sarcoma of bone is MC in
sex:
age:
race

A

M:F 1.3:1
second decade of life
rare in asian, african

182
Q

Genetic predisposition to ewings sarcoma of bone

A

translocation t(11;22)!!!!!

Can’t make the Dx without a translocation here

183
Q

ewings originates in the _____

A

neural crest

184
Q

ewings sarcoma is a ____, ____, _____ cell

A

small round blue

185
Q

What test detects cells with rearranged Ewings gene?

A

FISH: fluorescent in-situ hybridization

186
Q

S/Sx of Ewings

A

pain
palpable mass
primary sites evenly distributed between extremities and central axis
pathologic Fx possible
extremity lesions tend to occur in diaphysis
if paravertebral: neurologic Sx (can even be CC)
unexplained fever
malaise
weight loss
increased skin temp

187
Q

MC bony sites of Ewings

A

LEs, chest wall, pelvis

188
Q

MC outside bone sites of Ewing

A

trunk, extremity, H/N

189
Q

2 patterns of Ewings spread

A
  1. lungs MC site of mets

2. bone marrow may be involved at Dx

190
Q

Ewings workup:

A

same as osteosarcoma except:

  • bone marrow aspirate and Bx might be done
  • audiogram and Cr clearance not required
191
Q

Tx of Ewings

A

chemo, local control, more chemo

surgery when possible

radiation therapy might replace surgery or used in addition to surgery

192
Q

chemo for Tx of Ewings

A 
combo: 
Vincristine
Adriamycin
Cyclophosphamide
Ifosfamide/Etoposide
193
Q

prognosis of Ewings differs greatly between ____ and ____ disease

A

localized

metastatic

194
Q

Cancer survivors can suffer from many effects from treatment with ___, ___, ___, and often have to be managed ____.

A

radiation
chemo
surgery

long term

195
Q

Long term management of cancer survivors includes multiple tests: (10 things)

A
  1. Echo: if RT to chest (monitor for HF)
  2. PFTs: any Sx or with certain chemo drugs
  3. carotid doppler: 7-10 years s/p
  4. colon cancer screening earlier than normal: if received craniospinal RT
  5. CBC: look for secondary malignancy (leukemia)
  6. neuropsych testing: chemo brain
  7. infertility
  8. ototoxicity
  9. renal toxicity
  10. reduced bone density

BCM (8 decks)

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