Pediatric Onco 1

Question 1

most common malignancy in pediatric age

Answer 1

hematologic malignancy (leukemia)

Question 2

most common solid tumor in pedia

Answer 2

brain and spinal tumor

Question 3

outcome of pedia tumors

Answer 3

more aggressive, rapid progression, but greater response to treatment

Question 4

t/f 80% of pediatric cases are diagnosed with metastasis

Answer 4

true, s/sx caused by systemic involvement

Question 5

s/sx of childhood cancer mimicking normal illness

Answer 5

table 2

Question 6

red flag signs

Answer 6

• lymphadenopathy >/= 2 cm
• morning symptoms
• rapid changes in vision +/- papilledema
• painless swelling
• fever associated with pallor +/- night sweats
• abdominal, bone, soft tissue masses
• scrotal masses that dont transilluminate
• urinary retention

Question 7

tumor location and ddx

Answer 7

table 3

Question 8

incidence of brain and spine tumors is highest in __

Answer 8

infants and children <5

Question 9

brain tumors accg to cell origin

Answer 9

• neuroepithelium !!
• cranial nerves
• meninges and sella
• hematopoietic cells
• germ cells

Question 10

brain tumors by age

Answer 10

1st year: supratentorial tumors (choroid plexus tumors and teratomas)

1-10 yo: infratentorial tumors (medulloblastoma and pilocytic astrocytoma)

> 10 yo: supratentorial tumors (diffuse astrocytoma!!)

Question 11

most common malignant brain tumor of childhood, most common primary brain tumor age 0-4

Answer 11

medulloblastoma

Question 12

most common location of brain tumors

Answer 12

infratentorial area

Question 13

most common symptoms reported by children

Answer 13

headaches, but presence of headache alone should not be a red flag for diagnosis

Question 14

red flag signs for headache

Answer 14

read

Question 15

structures in the supratentorial region

Answer 15

• optic pathway
• pineal region
• suprasellar region
• third ventricular region
• hypothalamic or pituitary

Question 16

presentation of supratentorial involvement

Answer 16

• focal motor weakness
• focal sensory changes
• language disorders
• focal seizures
• reflex asymmetry
• infants: premature hand preference

Question 17

presentation of vetricular system involvement

Answer 17

neuroendocrine deficits

• galactorrhea
• precocious puberty
• hypothyroidism
• subacute development of obesity
• abnormal linear growth velocity
• diabetes insipidus

Question 18

diencephalic syndrome

Answer 18

failure to thrive, emaciation despite normal caloric intake, inappropriately normal or happy affect

Question 19

parinaud syndrome

Answer 19

• paresis of upward gaze
• pupillary caliber reactive to accomodation but not to light
• nystagmus to convergence
• eyelid retraction

Question 20

classic symptoms of infratentorial tumor

Answer 20

headache, nausea, vomiting, papilledema

Question 21

most common pediatric brain tumor

Answer 21

astrocytoma

Question 22

pilocytic vs diffuse s pilomyxoid astrocytoma

Answer 22

read

Question 23

management of low grade astrocytoma

Answer 23

main is surgical, rad/chemo if needed or recurrence

good outcome

Question 24

types of high grade astrocytoma

Answer 24

anaplastic ang glioblastoma

Question 25

location of ependymoma

Answer 25

infratentorial

Question 26

subtypes of ependymoma

Answer 26

cellular !! anaplastic myxopapillary

Question 27

management of ependymoma

Answer 27

surgery!, radiation, chemo younger = poorer outcomes posterior fossa or infratentorial = poorer outcomes

Question 28

most common cns tumors in children <1 yo

Answer 28

choroid plexus tumors

Question 29

clinical course of choroid plexus tumors

Answer 29

increased icp, macrocephaly, focal neurologic defects

Question 30

subtypes of choroid plexus tumors

Answer 30

choroid plexus papilloma, atypical choroid plexus papilloma, choroid plexus carcinoma

Question 31

t/f all variants of embryonal tumors are grade 4

Answer 31

true - supratentorial pnet - ependymoma - medulloepithelioblastoma - atypical teratoid or rhabdoid tumor

Question 32

most common group of malignant cns tumors of childhood

Answer 32

embryonal tumors

Question 33

what is craniophayngioma

Answer 33

read - endocrinologic abnormalities - visual changes

Question 34

management of brainstem tumors

Answer 34

radiation therapy, chemo has no benefit

Question 35

most important prognostic factor in brainstem tumors

Answer 35

- location of lesion - structures being compressed - infiltrates - survival is 12 mos

Question 36

subtypes of brainstem tumors

Answer 36

- focal brainstem tumor - dorsal exophytic brainstem tumor - cervicomedullary tumor - diffuse intrinsic pontine glioma

Question 37

most common site of origin of germ cell tumors

Answer 37

pineal gland

Question 38

clinical course of germ cell tumors

Answer 38

- insidious course | - headache, parinaud syndrome, di, precocious puberty, ataxia, hemiparesis

Question 39

subtypes of germ cell tumors

Answer 39

- secreting germinoma | - nongerminomatous tumors (tumor markers!! afp and bhcg)

Question 40

subtypes of pineal parenchymal tumors

Answer 40

- pineoblastoma - pineocytoma multimodal approach

Question 41

most common intraocular tumor in children

Answer 41

retinoblastoma, average age is 2 yo

Question 42

histology in retinoblastoma

Answer 42

flexner winetsteiner rosettes, necrosis, calcification

Question 43

clinical manifestation of retinoblastoma

Answer 43

- leukocoria - strabismus - dec visual acuity - orbital inflammation - hyphema - vitreous hemorrhage - pain

Question 44

diagnosis of retinoblastoma

Answer 44

- directed opthalmoscopy - ct/mri/uts - clinical BIOPSY CONTRAINDICATED - lumbar puncture - bone scan - bone marrow biopsy

Question 45

t/f in retinoblastoma, primary goal is cure, secondary goal is preserving vision

Answer 45

true