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Peds Exam (5900) #3 > Study guide > Flashcards

Study guide Flashcards

1
Q

ALL stands for?

A

Acute Lymphoblastic Leukemia

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2
Q

Factors that determine the prognosis of ALL:

1) WBC count
2) age
3) gender

A

1) > 50K
2) < 2 and > 10 at time of diagnosis
3) female have better prognosis than males

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3
Q

Pathophysiology of ALL

A
  • extreme proliferation of immature lymphocytes called Blast Cells
  • cells fill the bone marrow, impairing hematopoiesis
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4
Q

ALL originates in which type of cell?

A

Blast cells

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5
Q

ALL originates in which type of cells?

A

B and T lymphoid cells or lymphoblasts

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6
Q

Which type of ALL is more prevalent?

A

B-lymphoblastic leukemia

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7
Q

S/S of ALL?

A
  • Anemia
  • neutropenia
  • thrombocytopenia
  • extramedullary disease
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8
Q

The systemic spread of ALL outside the bone marrow and blood?

A
  • etramedullary disease

- can present at time of diagnosis or recurrence

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9
Q

What are the most common sites of extramedullary spread?

A
  • CNS, testes, liver, kidneys, and spleen
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10
Q

What are the first diagnostic procedures used to confirm leukemia (AML & ALL)?

A

CBC, lumbar puncture, bone marrow aspiration and biopsy

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11
Q

What is the first step and goal of treament for children with ALL?

A

to induce remission with combination chemo

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12
Q

Steps of treatment in leukemia?

A

1) combination chemo
2) further intensive chemo after remission is achieved
3) maintenance chemo over 2-3 yrs

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13
Q

How long is the maintenance chemo period for leukemia?

A

2 -3 yrs

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14
Q

Why are males treated for a longer period than females?

A

concern with testes as a sanctuary site for cancer cells

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15
Q

What are possible sanctuary sites for leukemia?

A

CSF and testes

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16
Q

Care during chemotherapy includes?

A

supportive care to prevent acute bleeding and infectious complications

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17
Q

Methods of reducing risks of infection for children during chemo?

A

wash hands, limit visitors and exposure to germs, prophylactic antibiotics

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18
Q

Clinical S/S of leukemia?

A 
Anemia: fatigue, malaise, pallor
Thrombocytopenia: gingival,cutaneous or nasal bleeding
Neutropenia: fever, recurrent infections
Hepatosplenomegaly, abd pain, N/V
Bone pain
Lymphadenopathy
Weight loss, anorexia,
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19
Q

Gastrointestinal side effects of chemo tx

A

N/V, diarrhea, constipation, impaired liver function, pancreatitis, anorexia, & electrolyte imbalances

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20
Q

Skin/mucosal side effects of chemo tx

A

mucositis, stomatitis, rashes, discoloration, increased sensitivity to sunlight, alopecia

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21
Q

Hematologic side effects of chemo tx

A

anemia, neutropenia, thrombocytopenia

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22
Q

Other side effects of CTX

A

immunosuppression, pulmonary, renal, neurological, cardiac damage, sterility

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23
Q

Why are children with leukemia diagnosed weeks after appreance of symptoms?

A

the care givers think they have the flu or other childhood illness

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24
Q

Wilms has a higher incidence in __________ and in familial cases, is an _____________ trait?

A

1) siblings

2) autosomal dominant

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25
Q

Wilms primary affects which organ?

A

kidney (nephroblastoma, which is the most common intraabdominal and kidney tumor in children)

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26
Q

Congenital anomalies associated with Wilm’s tumor?

A

Aniridia, , hemihypertrophy Genitourinary abnormalities, mental retardation

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27
Q

Stage I and V of Wilms Tumor?

A

Stage I: only 1 kidney involved, can be removed

Stage V: both kidneys affected

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28
Q

Does Wilm’s tumor a rapid or slow growing tumor?

A

rapid

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29
Q

What is the most common sign of Wilm’s tumor if child is asymptomatic?

A

non-tender abdominal mass, firm, confined to one side, deep within the flank

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30
Q

S/S of Wilm’s Tumor?

A

non-tender abdominal mass, abd pain, hematuria, HTN, weight loss, fever

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31
Q

the presence of distended abd veins may indicate what in a child diagnosed with Wilm’s Tumor?

A

occlusion of the inferion vena cava

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32
Q

Treatment of Wilm’s tumor?

A

surgical removal even if tumor has spread , followed by chemo

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33
Q

Wilm’s Tumor preop concerns?

A

do not palpate the abd mass (may cause spread)

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34
Q

Wilm’s Tumor post-op care?

A

monitor GI activitiy (BS, BM, distention and vomiting)

observe for s/s of infection (esp. during chemo)

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35
Q

A retinoblastoma is composed of which type of cells?

A

embryonal retinal cells

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36
Q

Most retinoblastomas are detected by what age?

A

2 y/o

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37
Q

What is the most common cause of death with a retinoblastoma diagnosis?

A

intracranial spread of the tumor

38
Q

Where does Retinoblastoma usually develop?

A

the posterior portion of the retina

39
Q

Malignancy of a retinoblastoma may appear as a signle tumor in a ___________, or have multiple centers of activity.

A

rosette formation

40
Q

How does a retinoblastoma metastasize locally?

A

usually occurs within the intraocular space, then invades the globes

41
Q

How does a retinoblastoma metastasize to the body?

A

tumor cells grow along the optice nerve,enter the subarachnoid space and spread to the CNS

42
Q

Why does necrosis occur in a retinoblastoma?

A

the tumor outgrows its blood supply

43
Q

What is an important diagnostic sign seen in patients with retinoblastomas?

A

Calcification in the necrotic areas of the tumor

44
Q

What is the difference in hereditatry vs non-hereditary retinoblastoma?

A

Hereditary: bilateral, increased risk of other malignancies

Non-hereditary: unilateral, no increased risk of other malignancies

45
Q

What classification system is used to stage a retinoblastoma and predicts what?

A

1) Reese-Ellsworth staging classification

2) tumor control and vision preservation

46
Q

S/S of retinoblastoma (small tumor)?

A

strabismus secondary to impaired vision

47
Q

S/S of retinoblastoma (large tumor)?

A

leukocoria or cat’s eye, tumor may be visualized easily

48
Q

Late S/S of retinoblastoma?

A

red, painful eyes, resulting from inflammation, uveitis, or vetreous hemorrhage

49
Q

a complete diagnosis of retinoblastoma is usually made following which exam?

A

a complete funduscopic exam

50
Q

retinoblastomas color?

A

creamy pink or white

51
Q

Treatment of retinoblastoma?

A

surgery, radiotherapy, phototherapy and cryotherapy

52
Q

enucleation

A

surgical removal of the eye

53
Q

a creamy white pupillary reflec caused by an enlarging retinoblastoma?

A

leukocoria

54
Q

When does a child get fitted for an ocular prosthesis following enucleation?

A

3 weeks, unless complications occur

55
Q

How to clean an ocular prosthesis?

A

place in water that is slightly warmer than room therapy and soak for several minutes

56
Q

Why are cancer cells difficult to treat when they are in the G0 phase?

A

because they are not actively dividing

57
Q

G1 phase?

A
  • first “gap phase”, lasts 8-48 hrs
  • DNA synthesis begins
  • active RNA and protein synthesis
58
Q

What happens during the S phase of cellular reproduction?

A
  • phase where most DNA synthesis occurs (doubles)

- lasts 10-30 hrs

59
Q

G2 phase?

A
  • RNA and protein synthesis

- lasts 1-12 hrs

60
Q

Steps of Mitosis?

A

Prophase, Metaphase, Anaphase, Telophase

61
Q

Phases of Chemo?

A

1) induction
2) consolidation
3) maintenance
4) observation

62
Q

What happens if a child relapses during the maintenance phase of chemo?

A

the tx protocol is changed and tx begins, starting in the induction phase

63
Q

Nursing assessments to be done prior to chemo?

A
  • need baseline organ function
    • liver
    • kidney: creatinine clearance
    • Heart: ECG
  • Lungs: pulmonary function test
  • Neuro: deep tendon and sensory
64
Q

Sigs of chemo toxicity?

A

Increased creatinine levels, presence of proteins, or hematuria, changes from baseline organ function

65
Q

What are the problems manifested in the Tetralog of Fallot?

A

1) large ventricular septal defect
2) right ventricular outflow obstruction or pulmonary stenosis
3) an overriding aorta (dextroposition of the aorta)
4) right ventricular hypertrophy

66
Q

Signs of anemia

A

malaise, fatigue, pallor

67
Q

signs of thrombocytopenia

A

gingival, cutaneous, or nasal bleeding

68
Q

signs of neutropenia

A

fever, recurring infections

69
Q

CNS manifestations of leukemia?

A

Increase ICP, HA, vomiting & visual disturbances

70
Q

Non-physical signs of abuse in children?

A
  • extreme efforts to please
  • withdrawal
  • anxiety,
  • are wary of adults
  • cringing with sudden movements
  • apathy
  • excessive daydreaming
  • depression,
  • not turning to the parent for support,
  • poor hygiene and unusual dress
71
Q

Common sites of intentional injury in children?

A
  • nose, groin, upper thigh, upper back, butt, back of knees and upper legs
72
Q

Common sites of unintentional injury in children?

A

Forehead, knees, shins, elbows

73
Q

Suspicious bruising on children?

A
  • patterns (iron, shoe)
  • bruises in different stages of healing
  • on the trunk and ear, genitals
  • bruises don’t match the hx
  • bruising on an infant
74
Q

Normal pathological conditions that mimic abuse in children?

A
  • Henoch-Schonlein Purpura (face, neck, upper chest)
  • Nevus Simplex (perm blanching at base of neck)
  • Mongolian Spots (asian/black, perm discoloration)
  • Bullous Impetigo (look like cigaretter burn)
  • Epidermolysis Bollusa
75
Q

Water temp should be set to?

76
Q

What to assess for if bilateral black eyes are present?

A
  • Consider basilar skull fracture
  • Neuroblastoma
  • Injury to forehead
  • Look for injury to surrounding tissue
77
Q

Signs of forced submersion burns?

A

uniform demarcation

78
Q

What is the most common location for inflicted burns in children?

A

dorsal aspect of the hand

79
Q

Signs of an accidental burn?

A

irregular, varying degrees of severity, splash marks

80
Q

Short falls (< 3ft) may cause what in children?

A

bruising, swelling, small skull fracture, SMALL subdural bleed

81
Q

Death trajectories?

A
  • Sudden, unexpected death
  • Death from potentially curable disease (ALL)
  • Lethal congenital anomaly (anencephaly)
  • Death from progressive conditions with intermittent crises (muscular dystrophy, get pneumonia, never recover)
82
Q

What does the acronym CHILD stand for in relation to child end of life treatment?

A 
Consider
Honesty
Include
Listen
Do (repeat)
83
Q

Term for the mental work following a loss? (e.g. death of loved one)

A

bereavement

84
Q

What are the stages of Grief?

A 
Denial
Anger
Bargaining
Depression
Acceptance
85
Q

Ductus venosus

A

shunts oxygenated blood from umbilical vein to inferior vena cava

86
Q

Foramen ovale

A

shunts oxygenated blood from R. atrium to L. atrium

87
Q

What is Ductus arteriosus?

A

shunts blood from pulmonary artery to aorta

88
Q

Infant presents with “machinery” type murmur upon auscultation, what do you suspect?

89
Q

Child presents with activity intolerance that has gotten worse as he has aged. What do you suspect?

90
Q

Infant presents with a systolic murmur along the left sternal border upon auscultation, what do you suspect?

91
Q

Amplatzer Duct occludor is used to treat?

Peds Exam (5900) #3 (10 decks)

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