Pediatrics/Oncology

Question 1

MCCs of death in children older than 1

Answer 1

1. injuries

2. cancer

Question 2

most common type of pediatric malignancy

Answer 2

1. leukemia
2. brain tumors
3. lymphomas

Question 3

more prevalent malignancies:
Newborn
infancy and childhood
adolescence

Answer 3

Newborns: neuroblastoma, other embryonal tumors(wilm’s)

infancy: leukemia, neuroblastoma, wilm’s, retinoblastoma
adolescence: lymphoma, gonadal tumors, bone tumors

Question 4

prevalency of leukemias

Answer 4

ALL>AML>CML

Question 5

HTLV association with leukemia

Answer 5

T-cell leukemia

Question 6

prognosis of ALL & AML

Answer 6

ALL>AML

Question 7

EBV associated lymphoma

Answer 7

African Burkitt’s lymphoma

Question 8

what is the difference between children and adult non-hodgkin lymphoma?

Answer 8

rapidly growing tumor with distant metastases in children

Question 9

hodgkin or non hodgkin patients are older

Answer 9

hodgkin lymphoma

Question 10

most common brain tumor in children

Answer 10

cerebellar astrocytoma

Question 11

common location for brain tumors

Answer 11

60% infratentorial

Question 12

clinical presentation of infratentorial tumors

Answer 12

increased ICP, 
vomiting.
morning headache, 
increased HC
CN 6 palsy
UWG
ataxia

Question 13

clinical presentation of supratentorial tumors

Answer 13

focal deficit
seizure
long tract sign
visual field defect

Question 14

most common primary renal neoplasm of childhood

Answer 14

Wilms tumor (nephroblastoma)

Question 15

both kidney in wilms

Answer 15

5-10%

Question 16

DDx for Wilms

Answer 16

hydronephrosis
polycystic kidney dis.
RCC
neuroblastoma

Question 17

Clinical presentation of Wilms

Answer 17

80% asymptomatic: unilateral abdominal mass
HTN, hematuria, abd. pain, vomitting
respiratory symptoms

Question 18

metastasis of wilms

Answer 18

may have pulmonary metastasis at time of primary Dx

Question 19

associated congenital abnormalities with wilms

Answer 19

WAGR syn.
Beckwith-Wiedemann syn.
Denys-Drash syn.

Question 20

prognosis of wilms

Answer 20

90% longterm survival

Question 21

Rx of wilms

Answer 21

nephrectomy

staging and chemo;radiation for higher stage

Question 22

most common cancer in 1st year of life

Answer 22

neuroblastoma

Question 23

most common site for neuroblastoma

Answer 23

adrenal medulla

Question 24

neuroblastoma at presentation time

Answer 24

metastases are common,>50% present with advanced stage dis.

Question 25

metastases of neuroblastoma

Answer 25

usually to bone or bone marrow

Question 26

periorbital ecchymoses, abd. pain, emesis, fever, weight loss, anorexia, hepatomegaly, blueberry muffin skin nodule

Answer 26

neuroblastoma

Question 27

neuroblastoma paraneoplastic Sx

Answer 27

HTN
Palpitation
sweating
diarrhea
FTT
opsomyoclonus

Question 28

diagnostic criteria for neuroblastoma

Answer 28

• unequivocal histologic Dx from tumor Bx
• evidence of metastases to bone marrow (‘rosettes”) on aspirate analysis, with concomitant elevation of urine or serum catecholamine metabolite (VMA,HVA)

Question 29

staging for neuroblastoma

Answer 29

CT or MRI of chest, abd., pelvis, bone scan, MIBG scan

Question 30

good prognostic factors for neuroblastoma

Answer 30

age and stage
<1y
I,II,IV-S
primary site: post. mediastinum
low serum ferritin
specific histology
tumor cell markers(aneuploidy, absent M-myc)

Question 31

prognosis of neuroblastoma

Answer 31

poor

Question 32

common extracranial solid tumors

Answer 32

neuroblastoma
wilms
rhabdmyosarcoma

Question 33

common sites for rhabdomyosarcoma

Answer 33

H&N
GU
Ext.

Question 34

presentation of rhabdomyosarcoma

Answer 34

firm, painless mass

Question 35

metastases of rhabdomyosarcoma

Answer 35

lung, bone, bone marrow

Question 36

generalized LAD

Answer 36

CBC diff, B/C
Uric acid, LDH
ANA, RF, ESR
EBV, CMV, HIV serology
toxoplasma titre
fungal serology
CXR
PPD
biopsy

Question 37

regional LAD

Answer 37

period of observation in an asymptomatic child
trial of oral antiobiotics
ultrasound
biopsy (especially if persistent>6w and/or B symptoms)