W08 - PAEDS: Oncology; Rheumatology Flashcards
Epidemiology & Classification
*based on tumour morphology and primary site
commonest:
- leukemias
- CNS tumours
- lymphomas
- soft tiss. tumours
- neuroblastomas
- 0-4yo highest distribution and prevalence
- 5 - 14 similar distribution
- genetic predisposition: trisomy 21; fanconi; BWS, neurofiromatosis
- radiation & infection
- iatrogenic: chemoT, RT
Red Flag Symptoms / who to be worried about
immediate referral:
* unexplained petechiae
* hepatosplenomegaly
~ leukemia; ~ NH lymphoma
urgent referral:
* rpt attendance, same problem, nil dx.
* new neuro symptoms
* abdo masss
refer:
* rest pain, back pain, unexplained lump
* lymphadenopathy
Important Emergencies
Sepsis / febrile neutropenia
Raised ICP
Spinal cord compression
Mediastinal mass
Tumour lysis syndrome
Sepsis / febrile neutropenia
pseduomonas aeruginosa
e coli
klebsiella
s pneumoniae
- fever, rigors, drowsiness, SHOCK
> IV accss
ABC
broad spectrum
urine / blood / swab culture investigations
Raised ICP
Early
early morning headache/vomiting
tense fontanelle
increasing HC
Late
constant headache
papilloedema
diplopia (VI palsy)
Loss of upgaze
neck stiffness
status epilepticus,
reduced GCS
Cushings triad (low HR, high BP)
- CT = screening
- MRI = accurate dx.
> DEXAMETHASONE IV dt tum.
Sx. urgent CSF diversion
- ventriculostomy
- EVD
- VP Shunt
Spinal cord compression
Compl of most paediatric malignancies
* Invasion from paravertebral disease via intervertebral foramina (40 % extradural)
* vertebral body compression
- weakn., pain, sensory, sphincter disturbance symptoms
> urgent MRI
DEXAMETHASOME = reduce oedema
ChemoT
SVC Syndrome
Obstruction of sup. vena cava dt mediastinal mass dt
- LYMPHOMA
- neuroblastoma, germ cell tumour, thrombosis
- facial, neck and upper thoracic plethora oedema, cyanosis, distended veins, ill, anxious, reduced GCS
> CXR / CT chest
ECHO
keep upright!; urgent biopsy
>Definitive tx: ChemoT, RT, Thrombotic Rx.
Tumour Lysis Syndrome
- metab. derangement, release of intracellular contents of lysed tumour cells
- 2º to TREATMENT - rarely spontaneous
↑ potassium
↑ urate, relatively insoluble
↑ phosphate
↓ calcium
Acute renal failure
Urate load
CaPO4 deposition in renal tubules
*ecg, IV hydration = avoid tumour lysis
> diuresis
never give K+
↓uric acid: allopurinol; urate oxidase-uricozyme
> hyperkalemia: salbutamol, insulin, calcium gluconate, calcium resonium
> dialysis
Information oncologists require and investigate for
- harm and risks:
- scans => MRI mainstay in paeds oncology
- biopsy
- cytogenetics
- tumour markers
- staging: CT, biopsy, PET
Risks of treatment
ChemoT
- hair loss, NV, mucositis, Diarrhoea, BM suppr., bleeding, infection
- organ impairment, reduced fertility
RT
- lethargy, skin irritation, swelling
- fibrosis /scarring
- 2º scarring
Describe the epidemiology of Juvenile Idiopathic Arthritis (JIA)
*commonest
- multifactorial
- immune response, pro-inflamm markers, presence of Ab.
- ARTHRITIS FOR AT LEAST 6W*
- morning stiffness
- irritability or refusal to walk in toddlers
- Phsycial activity = impact on school
+ periarticular edema, TENOSYNOVITIS
+ inflamm upset picture
+ poor appetite wt loss
+ delayed pub. - limited motion
Be aware of the medical and surgical differential diagnosis of a limp/joint pain in children
a
To recognise transient synovitis and its self-limiting nature
Transient synovitis is an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight. This occurs in pre-pubescent children and is the most common cause of hip pain. It occurs when a viral infection, such as an upper respiratory infection, moves to and settles in the hip joint.
Recognise the clinical manifestations and types of JIA
1) Psoriatic Arth: FHx 1º relative, nail pitting, dactylitis, achilles
2) Systemic Arth: min. 2w. and 1+ joint, unwell, intermittent fever
+ erythematous rash; lymphadenopathy; hepato/splenomegaly; serositis
3) Oligorth.: 4 or fewer joints during first 6mos of disease
- girls 1-5yo pres. = ANA+; uveitis; knees ankles hands; NO HIP
- boys 8yo+ pres = ANA-; hip involvement
4) Polyarth.: 5+ joints, fewer systemic manifestations
F>M
seropos. = 8yo+
seroneg. = under 5yo
* temporomandibular joint injury = functional bite affected
* large fast growing joints mostly affected
5) ENTHESITIS:
hla, boy 8yo+, uveitis, spinal pain, sacroiliac joint, FHx
Discuss the principles of investigation and assessment of JIA and joint disease
Plain XR
US
MRI
