Week 9 Flashcards
What is most important to include in comprehensive history?
ROS
Physiology of ALL
Immature abnormal cells leave no room for WBC, RBC, and platelets to be made
How might your patient with ALL present?
- Recurrent infection because of this
- Pallor
- Fatigue, not keeping up with academics (may be misinterpreted as behavioral issues or ADD/ADHD)
- Petechiae (does NOT blanch), nose bleeds
How long are patients treated with ALL?
Girls 2 years
Boy 3 years
Physical findings for pt with ALL?
- Anemia (fatigue, pallor)
- Thrombocytopenia (petechiae, bleeding, purpura) (Does not blanch: petechiae and purpura)
- Neutropenia (fever, recurrent infections)
- Bone pain
Why do ALL patients have bone pain?
Infiltration of bone marrow “packed marrow” causes increased pain
Where do cancer cells like to hide?
CNS & testes
Do ALL patients need a fundoscopic exam? Why?
Yes. R/O papilledema
S&S of testicular involement of ALL?
Unilateral painless testicular enlargement (look for other constitutional signs)
What needs to be evaluated in CBC?
Smear to check for lymphoblasts (not normal)
Hem-onc eval (leukocytes > 10 x 10 occurs in ALL pts)
Will WBC be high or low in ALL?
It can be either!
What are pts with higher WBC at risk for?
Thrombosis
What is pancytopenia?
neutropenia, anemia, and thrombocytopenia due to ALL
Should a cancer pt receive live vaccines?
No (MMR, rubella, varicella)
Can family members get MMR vaccine?
Yes, it does not shed.
Can family members get varicella?
Yes, it does shed, but benefits outweigh risks
Pt reports with recurrent ear infections, pallor, and fatigue. What is your next step?
R/O cancer and consider differentials.
How long is maintenance/continuation therapy?
Females – 2.5 years
Males – 3.5 years d/t testiuclar involvement
**Consult with oncology if pt develops AE during this time
Pt presents with dyspnea or stridor? What is the diagnosis and how do you treat it?
Mediastinal mass – send to ER
How would a pt with superior vena cava syndrome present?
Distended neck veins and plethora
Staging criteria system for HLA
Ann Arbor
What cells are indicative of Hodking’s lymphoma
Reed-Sternberg Cell
What are B symptoms?
Unexplained fever w/temps above 38C for 3 consecutive days
Unexplained weight loss of 10% or more during previous 6 months
Drenching night sweats
Which lymphnode stations would you check?
ALL of them.
What is most important to know about treatment and management?
Tx strategies focus on reducing late effects of therapy while maintaining excellent cure rates with risk-adapted chemotherapy alone or response-adjusted combined-modality regimens
What do you thenk when you see “blastoma”
Round blue cells
Location of neuroblastoma?
Adrenals
At what stage are most children diagnosed with neuroblastoma?
4 because it takes a while for symptoms to manifest
How common is neuroblastoma?
Most common extracranial solid tumor in infancy
Describe Stage 4S of neuroblastoma
Small primary tumor and metastatic disease confined to liver, skin, and bone marrow
Regresses on its own without chemo or radiation
How will 4S neuroblastoma present in a neonate?
Blueberry muffin baby (could be confused with congenityal rubella)
Racoon eyes
If a child presents with HTN what do you assess?
Recheck BP in both arms
Then get subjective hx, family hx, kidney disorders
Constitutaional symptoms?
Behavior
How is Wilms tumor most often detected?
Incidental detection of asymptomatic mass
Physical findings of Wilms tumor pt?
Firm smooth or abdominal flank mass (not across midline)
Elevated BP
Left varicocele if spermatic cord obstructed
Assess to r/o WAGR
Why do you avoid palpation abdomen with Wilms tumor
Could rupture friable tumor into peritoneal cavity = STAGE 3
**Refer to onc immediately
What should you ask parents in hx of child with retinoblastoma
Specifically about occurrence of retinoblastoma in the family
Physical findings in child with retinoblastoma
Leukocoria (white pupillary reflex/cat eye reflex)
No red reflex – RED FLAG**
What assessment should be performed on child with strabismus?
Fundoscopic exam through well-dilated pupil must be performed in all cases of childhood strabismus
Treatment and management of retinoblastoma
Directed toward complete control of tumor and preservation of as much useful vision as possible
Where do osteosarcomas present?
Can occur in any bone but most commonly seen in long bones near growth plates
Is radiation effective in osteosarcomas?
No, high level of resistance
Physical exam for Ewing saracoma
Careful examination of painful sites with inspection and palpation
What treats symptoms of dyspnea in lung cancer?
Morphine
Initial dosing of pain medication for cancer patients
Start short acting before long acting
Typical start dose is 5 mg oxycodone q4h PRN = 10 mg morphine
When do pts need weaned from opioids
7 days or greater
Pt teaching about SE of opioids
Most SE will lessen over 24 hrs except constipation
Prescribe stool softener and increase when opioid increases
What to write in pain diary
Every dose
Helpful?
SE
