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Flashcards in 9: Case Studies Deck (48):
1

Most common solid tumor of childhood.

Brain cancers

2

#1 cause of death among all childhood cancers.

Brain cancers

3

What is the role of the FNP in brain cancers?

Awareness of s/sx. Manage multitude of potential late effects of therapy. Liaison between pediatric and adult care to help provide continuity of care.

4

Brain tumor classification is based on histological criteria by _____.

WHO

5

Most common are neuroepithelial-derived tumors. Among neuroepithelial brain tumors, _____ are the most common.

Gliomas

6

Low-grade (stages 1/2) or high-grade/malignant (stages 3/4) glioma?
Juvenile piloocytic astrocytoma

Low-grade

7

Low-grade (stages 1/2) or high-grade/malignant (stages 3/4) glioma?
Diffuse fibrillary astrocytoma

Low-grade

8

Low-grade (stages 1/2) or high-grade/malignant (stages 3/4) glioma?
Anaplastic astrocytoma

High-grade/malignant

9

Low-grade (stages 1/2) or high-grade/malignant (stages 3/4) glioma?
Glioblastoma multiforme

High-grade/malignant

10

In assessing a 4 yo with headaches x 1 month, where do you begin?

OLDCART for headache.
PMH (seizures, migraines)
Meds
Family hx
Social hx
ROS

11

Would this tumor be located in the suprasellar/chiasmatic, pons, pineal/midbrain, cerebellum, basal ganglia/thalamus, cortex, or cervicomedullary junction?
Visual field deficit, precocious/delayed puberty, anorexia, diabetes insipidus.

Suprasellar/chiasmatic

12

Would this tumor be located in the suprasellar/chiasmatic, pons, pineal/midbrain, cerebellum, basal ganglia/thalamus, cortex, or cervicomedullary junction?
Diplopia, facial weakness, drooling, weakness, incoordination, dysconjugate gaze.

Pons

13

Would this tumor be located in the suprasellar/chiasmatic, pons, pineal/midbrain, cerebellum, basal ganglia/thalamus, cortex, or cervicomedullary junction?
Upgaze paralysis, vomiting, nystagmus, diplopia, tremor.

Pineal/midbrain

14

Would this tumor be located in the suprasellar/chiasmatic, pons, pineal/midbrain, cerebellum, basal ganglia/thalamus, cortex, or cervicomedullary junction?
Vomiting, ataxia, tremor, dysmetria, nystagmus, scanning speech.

Cerebellum

15

Would this tumor be located in the suprasellar/chiasmatic, pons, pineal/midbrain, cerebellum, basal ganglia/thalamus, cortex, or cervicomedullary junction?
Movement disorder, weakness, hemisensory deficit, visual deficit.

Basal ganglia/thalamus

16

Would this tumor be located in the suprasellar/chiasmatic, pons, pineal/midbrain, cerebellum, basal ganglia/thalamus, cortex, or cervicomedullary junction?
Seizures, weakness, disorder of language, encephalopathy, visual field deficit.

Cortex

17

Would this tumor be located in the suprasellar/chiasmatic, pons, pineal/midbrain, cerebellum, basal ganglia/thalamus, cortex, or cervicomedullary junction?
Head tilt, Horner syndrome, weakness, dysphagia, dysphonia, torticollis.

Cervicomedullary junction

18

Triad of headache, n/v, and gait imbalance is most common presentation of what?

Posterior Fossa Tumor. Posterior fossa is the midbrain, pons, cerebellum, 4th ventrical, medulla, and tentorium. Vomiting is often early morning vomiting. Early morning vomiting is related to nocturnal hypoventilation, hypercarbia, vasodilation of cerebral vessels, increased cerebral blood volume and increased CSF production. All while the child is lying down, sleeping. Head tilt or torticollis is present as well when there is invasion of the Luschka foramen.

19

T/F The majority of seizures are d/t brain tumors.

False. Mostly d/t other disorders.

20

In very young children who cannot tell you they have a headache, what do you look for with brain tumors (3)?

1. Vomiting
2. Irritability
3. Macrocephaly

21

What is the focus for the physical exam (8)?

1. Fundoscopic exam
2. Mental status
3. CNs
4. Motor skills
5. Sensation
6. Reflexes
7. Coordination
8. Gait

22

What are you looking for in the fundoscopic exam (2)?

1. Papilledema
2. Disc pallor

23

What are you looking for with CNs (9)?

1. Paralysis of upgaze
2. Pupils mid-dilated and poorly reactive to light
3. Convergence or retraction nystagmus
4. Eyelid retraction
5. Nystagmus in any direction
6. Limited upgaze or upgaze nystagmus
7. Opsoclonus myoclonus syndrome (involuntary conjugate eye movements of large amplitude and myoclonic jerks)
8. Abnormal visual field abnormalities
9. Cranial neuropathies (facial nerve palsy)

24

What is a common presenting palsy with tumors of the brainstem involving the pons?

Facial nerve palsy

25

In young children it can be difficult to test individual motor groups. How can you solve this problem?

Look for hand preference when grasping for objects.

26

In older children, the presence of _____ is a sensitive test for extremity weakness.

Pronator drift

27

Asymmetries in sensation can be clues to _____ tumors, _____ tumors, and, in the case of facial sensation, dysfunction of the divisions of the _____ nerve located throughout the brain stem.

Cortical tumors
Spinal cord tumors
Trigeminal nerve

28

In the lower extremities, asymmetries in the patellar and Achilles reflexes are generally associated with a _____, indicative of UPPER motor neuron dysfunction.

Babinski reflex

29

Coordination testing is extremely important in children who have suspected _____ and _____ tumors.

Cerebellar and brainstem tumors

30

Classic _____ testing must be performed to assess for cerebellar dysmetria.

Finger-to-nose testing

31

Classic wide-based ataxic gait, as well as an inability to perform tandem straight-line walking is indicative of _____ tumors.

Cerebellar tumors. Particularly those involving midline cerebellum.

32

Hemiparetic gait with circumduction of the leg and asymmetries in the swing phase of the arms is indicative of _____ tumors.

Cortical spinal tract tumors

33

Cafe au lait macules and axillary freckling raise suspicion for _____ and trigger fundoscopic exam and assessment for visual deficits (version 1) and hearing deficits (version 2).

Neurofibromatosis

34

Ash leaf spots, shagreen patches, and facial angiomatosis raise suspicion for _____ and trigger head circumference measurement and fundoscopic exam.

Tuberous sclerosis

35

What tumor location?
Early morning vomiting, recurrent vomiting, enlarging head (2).

1. Posterior fossa
2. Ventricular system

36

What tumor location?
FTT, anorexia (2).

1. Suprasellar
2. Hypothalamic

37

What tumor location?
Visual complaints, abnormal eye movements (4).

1. Optic pathway
2. Suprasellar
3. Brain stem
4. Spinal cord

38

What tumor location?
Tics, tremor, movement disorder (3).

1. Basal ganglia
2. Thalamus
3. Midbrain

39

What tumor location?
Early handedness (4).

1. Cortex
2. Subcortical
3. Brain stem
4. Spinal cord

40

What tumor location?
Facial nerve palsy (2).

1. Brain stem
2. Cerebellar pontine angle

41

What tumor location?
Hearing loss.

Cerebellar pontine angle

42

What tumor location?
Precocious puberty, nocturnal enuresis.

Suprasellar

43

What tumor location?
Head tilt, torticollis (2).

1. Cerebellar pontine angle
2. Cervicomedullary junction

44

Differentials for bilateral papilledema (4).

1. Astrocytoma (tumor)
2. Epedymoma (tumor)
3. Aseptic Meningitis
4. Bacterial Meningitis

45

What is included in the workup of a suspected brain tumor (9)?

1. CBC
2. Electrolytes
3. LFTs
4. Renal FTs
5. Thyroid
6. Viral Titers
7. CT +/- contrast
8. MRI +/- gandolineum
9. Bone scan
Consider hearing test, lumbar puncture, bone marrow aspirate/biopsy.

46

What must be r/o before lumbar puncture?

Hydrocephaly (via fundoscopic exam or CT/MRI).

47

Most children less than the age of _____ will not have radiation therapy to their brain tumor.

3 (places child at risk for neurocognitive defects and other complications).

48

Headaches occur in approximately _____ of children newly diagnosed with brain tumors.

1/3