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Paediatrics > Oncology / Haematology > Flashcards

Oncology / Haematology Flashcards

1
Q

What is the most common cancers in children

A

Leukaemia - 33%
Brain tumour - 25% but higher mortality (posterior common)
Extra-cranial

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2
Q

What are extra cranial

A 
Lymphoma - Hodgkin's / non-Hodgkin's 
Neuroblastoma
Soft tissue 
Nephroblastoma 
Retinoblastoma 
Malignant Bone 
Germ cell 
Hepatic
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3
Q

What causes cancer in childhood

A

Sporadic
Genetics
Environment - Radiation / infection - HPV
Iatrogenic - RT / chemo

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4
Q

What is the prognosis of childhood cancer

A

> 80% 5 year survival

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5
Q

How do you classify childhood cancer

A

International Classification of Childhood Cancer (ICCC)

Based on tumour morphology and primary site

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6
Q

What genes are involved

A 
Downs syndrome 
Fanconi 
Beckwith Weidemanne syndrome (BWS) 
Li-Fraumeni p53 
Neurofibromatosis
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7
Q

What age group is most likely to get cancer

A

Peak at 0-4 = highest rate

Another peak at 18-22

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8
Q

What are people with Down’s likely to get

A

Leukaemia

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9
Q

What is Li-Fraumeni syndrome

A

Autosomal dominant
p53 gene
50% chance of cancer by 30
90% chance of cancer by 70

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10
Q

What suggests immediate referral to hospital (same day)

A

Unexplained petechiae

HSM

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11
Q

What suggests urgent referral (48 hour)

A

Repeated attendance with same problem
New neuro symptoms
Abdominal mass

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12
Q

What suggests a referral (2 week) + FBC in 24 hours

A 
Rest pain
Back pain
Unexplained lump
Lymphadenopathy 
Unexplained and persistent symptoms
Extreme fatigue
Extreme weight loss
Changes in mole
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13
Q

Symptoms of brain tumour

A 
Commonly posterior 
Persistent vomiting - morning
Persistent headache 
Signs of raised ICP 
Cerebellar signs - DANISHP 
Behaviour change
Lethargy 
Fits / seizures 
Abnormal head position 
Blurred / double vision 
Delayed puberty 
CN palsies
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14
Q

Signs of cancer to be aware off

A 
UNEXPLAINED 
PERSISTENT 
Lump / bump / swelling 
Extreme tiredness
Excessive Sweating 
Significant weight loss
Changes in a mole / bruising
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15
Q

How do you Dx what the tumour is and where it is

Tumour markers of germ cell / liver

A 
Scans - USS for screen / MRI
Biopsy - pathology
Tumour marker on bloods / pregnancy test on man for bHCG  
ALP = live / baby / bone 
Stage - scans / bone marrow
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16
Q

How do you Rx cancer

A 
MDT
Chemo
Surgery
RT
CAR-T cells revolutionise leukaemia
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17
Q

What are acute risks of chemo

A 
Hair loss 
N+V
Mucositis
Diarrhoea
Constipation
Bone marrow suppression
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18
Q

What are chronic risks of chemo

A

Organ impairment - ECHO / bone density etc.
Reduced fertility
Second cancer

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19
Q

What are acute risks of RT

A 
Lethargy
Skin irritation
Swelling
GORD 
Cytsitis 
Dermatitis 
Organ inflammation
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20
Q

What are chronic risks of RT

A

Fibrosis
Reduced fertility
Second cancer

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21
Q

What are oncological emergencies due to treatment

A 
Sepsis
Febrile neutropenia
Raised ICP
Spinal cord compression
Mediastinal mass / SVC obstruction 
Tumour lysis syndrome
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22
Q

What do people who have had childhood cancer have a higher risk of

A

Chronic disease in adult life

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23
Q

What can be used to provide chemotherapy

A

Central line or port

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24
Q

What do child with splenectomy get

A

Pneumococcal vaccine

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25
Q

When can you not give NSAID

A

Chemo

DDAVP

26
Q

What is the mot common malignancy in childhood

A

ALL

- SEE HAEMATOLOGY

27
Q

When are you caution if going chemo

A

AVN

28
Q

What is a neuroblastoma

A

Most common solid tumour formed from neural crest cells in ANS
Common at adrenal gland and abdomen

29
Q

What are the symptoms

A

Mass

30
Q

How do you Dx

A

AXR
USS
IV urogram
Increased catecholamines in urine

31
Q

What does a nephroblastoma present

A 
Abdominal mass = most common 
Abdominal pain / flank - unilateral 
Haematuria
Lethargy 
Anorexia 
Weight loss 
Fever 
HYpertension 
Lung mets
Associated with Beckwith Weidman
32
Q

How do you Dx and treat a nephroblastoma

A 
USS 
IV urogram
CT / MRI to stage 
Biopsy for definite Dx 
Chemo
Surgery - nephrectomy 
Post-op RT
33
Q

What causes a retinoblastoma

A

Autosomal dominant

34
Q

What are features of retinoblastoma

A

Squint
Decreased vision
Proptosis
No red light reflex

35
Q

How do you treat retinoblastoma

A 
Surgery not the only option depending on how advanced - enucleation 
RT
Cyrotherapy 
Photocoagulation 
Screen parents and siblings as AD
36
Q

What is most common cause of anaemia in children

A

Iron deficiency

  • Blood loss e.g. menstruation
  • Diet - lots of milk
  • Malabsorption e.g. coeliac
37
Q

What are other causes

A 
Thalassaemia
Sickle cell
Sideoblastic 
Haemolytic
Bone marrow failure
38
Q

What causes normochromic

A

Chronic disease - renal / hypothyroid / infections

ALL / bone marrow failure

39
Q

What causes bone marrow failure

A

Leukaemia
Lymphoma
Storage disorders
Aplastic

40
Q

What causes haemolytic

A

Autoimmune
Hereditary spherocytosis
G6PD
Haemoglobinopathy - sickle cell / thalassemia

41
Q

What are symptoms of anaemia

A 
Lethargy
Pallor
SOB
Koilonychia
Atrophic tongue / mouth
Tachycardia
Flow murmur
42
Q

What is important not to miss

A

HSM - more severe
Petechiae
Jaundice
Height and weight

43
Q

What are important questions

A 
Diet / feeding
Milk = high risk
Weight loss
Bleeding or bruising
Jaundice
Bone pain
Fever
Hx illness
FH of disorders
44
Q

How do you investigate

A 
FBC + MCV
Film
Bone marrow aspirate if abnormal 
Reticulocyte / DAT to see if haemolytic 
Ferritin 
Anti TTG
Hb electrophoresis - haemoglobinopahy 
Blood / urine culture - chronic infection
45
Q

When do you do aspirate

A

If film abnormal

Shows blasts

46
Q

What does FBC show

A

Severity and type of anaemia

47
Q

What is less worrying

A

Single cytopenia over pancytopenia

48
Q

What is Ddx of lethargy

A 
Iron defieincy
Coeliac
Malabsorption
Blood disorder that cause anaemia 
ALL
49
Q

What blood disorder

A

Haemolytic anaemia - jaundice?
Thalassemia
Sickle cell
Hereditary spherocytosis / G6PD

50
Q

What is reticulocyte high in

A

Haemolysis as RBC need to be made as destroyed

51
Q

What is reticulocyte low in

A

Decreased production due to bone marrow failure
Lack of Fe
Lack of folate

52
Q

Wha causes bleeding / bruising in neonate

A 
Haemorrhagic disease of newborn 
Maternal thrombocytopenia
Trauma
Infection
Haemophilia
53
Q

What causes bleeding or bruising in infant / children

A 
Injury
Haemophilia
vWF
ITP 
Congenital infection / sepsis 
Liver disease 
ALL
54
Q

Main causes of bleeding

A

Trauma
Bleeding disorder - vWF / ITP
Malignancy - ALL

55
Q

What is important to ask

A 
FH bleeding disorder or heavy period 
What is bruises like
How long to go 
Any joint pain / limp / bleeding 
Any bleeding during dental surgery / vaccination
Any spontaneous bleeding 
Nose bleed 
Signs of anaemia
56
Q

What is normal length of nose bleed

A

<15 minutes

57
Q

What is important to look in examination

A

ALL - HSM / LN enlargement

58
Q

What investigations

A 
FBC, ferritin + clotting
vWF
Factor 8 (A)
Factor 9 (B)
Blood group O as causes low vWF
59
Q

What causes epistaxis

A

Nose picking
Foreign body
Allergic rhinitis / URTI

60
Q

When do you refer

A

<2
FH
>15 minutes

61
Q

If <2 what is it due to

A

Trauma

Bleeding disorder

62
Q

What can you prescribe if >2 and no evidence of abnormality

A

Topical neomycin

Discourage nose picking

Paediatrics (35 decks)

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