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503 Exam 3 > Week 9 > Flashcards

Week 9 Flashcards

1
Q

What is most important to include in comprehensive history?

A

ROS

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2
Q

Physiology of ALL

A

Immature abnormal cells leave no room for WBC, RBC, and platelets to be made

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3
Q

How might your patient with ALL present?

A
  1. Recurrent infection because of this
  2. Pallor
  3. Fatigue, not keeping up with academics (may be misinterpreted as behavioral issues or ADD/ADHD)
  4. Petechiae (does NOT blanch), nose bleeds
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4
Q

How long are patients treated with ALL?

A

Girls 2 years

Boy 3 years

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5
Q

Physical findings for pt with ALL?

A
  1. Anemia (fatigue, pallor)
  2. Thrombocytopenia (petechiae, bleeding, purpura) (Does not blanch: petechiae and purpura)
  3. Neutropenia (fever, recurrent infections)
  4. Bone pain
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6
Q

Why do ALL patients have bone pain?

A

Infiltration of bone marrow “packed marrow” causes increased pain

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7
Q

Where do cancer cells like to hide?

A

CNS & testes

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8
Q

Do ALL patients need a fundoscopic exam? Why?

A

Yes. R/O papilledema

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9
Q

S&S of testicular involement of ALL?

A

Unilateral painless testicular enlargement (look for other constitutional signs)

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10
Q

What needs to be evaluated in CBC?

A

Smear to check for lymphoblasts (not normal)

Hem-onc eval (leukocytes > 10 x 10 occurs in ALL pts)

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11
Q

Will WBC be high or low in ALL?

A

It can be either!

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12
Q

What are pts with higher WBC at risk for?

A

Thrombosis

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13
Q

What is pancytopenia?

A

neutropenia, anemia, and thrombocytopenia due to ALL

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14
Q

Should a cancer pt receive live vaccines?

A

No (MMR, rubella, varicella)

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15
Q

Can family members get MMR vaccine?

A

Yes, it does not shed.

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16
Q

Can family members get varicella?

A

Yes, it does shed, but benefits outweigh risks

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17
Q

Pt reports with recurrent ear infections, pallor, and fatigue. What is your next step?

A

R/O cancer and consider differentials.

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18
Q

How long is maintenance/continuation therapy?

A

Females – 2.5 years
Males – 3.5 years d/t testiuclar involvement

**Consult with oncology if pt develops AE during this time

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19
Q

Pt presents with dyspnea or stridor? What is the diagnosis and how do you treat it?

A

Mediastinal mass – send to ER

20
Q

How would a pt with superior vena cava syndrome present?

A

Distended neck veins and plethora

21
Q

Staging criteria system for HLA

A

Ann Arbor

22
Q

What cells are indicative of Hodking’s lymphoma

A

Reed-Sternberg Cell

23
Q

What are B symptoms?

A

Unexplained fever w/temps above 38C for 3 consecutive days

Unexplained weight loss of 10% or more during previous 6 months

Drenching night sweats

24
Q

Which lymphnode stations would you check?

A

ALL of them.

25
Q

What is most important to know about treatment and management?

A

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

26
Q

What do you thenk when you see “blastoma”

A

Round blue cells

27
Q

Location of neuroblastoma?

A

Adrenals

28
Q

At what stage are most children diagnosed with neuroblastoma?

A

4 because it takes a while for symptoms to manifest

29
Q

How common is neuroblastoma?

A

Most common extracranial solid tumor in infancy

30
Q

Describe Stage 4S of neuroblastoma

A

Small primary tumor and metastatic disease confined to liver, skin, and bone marrow

Regresses on its own without chemo or radiation

31
Q

How will 4S neuroblastoma present in a neonate?

A

Blueberry muffin baby (could be confused with congenityal rubella)
Racoon eyes

32
Q

If a child presents with HTN what do you assess?

A

Recheck BP in both arms
Then get subjective hx, family hx, kidney disorders
Constitutaional symptoms?
Behavior

33
Q

How is Wilms tumor most often detected?

A

Incidental detection of asymptomatic mass

34
Q

Physical findings of Wilms tumor pt?

A

Firm smooth or abdominal flank mass (not across midline)
Elevated BP
Left varicocele if spermatic cord obstructed
Assess to r/o WAGR

35
Q

Why do you avoid palpation abdomen with Wilms tumor

A

Could rupture friable tumor into peritoneal cavity = STAGE 3

**Refer to onc immediately

36
Q

What should you ask parents in hx of child with retinoblastoma

A

Specifically about occurrence of retinoblastoma in the family

37
Q

Physical findings in child with retinoblastoma

A

Leukocoria (white pupillary reflex/cat eye reflex)

No red reflex – RED FLAG**

38
Q

What assessment should be performed on child with strabismus?

A

Fundoscopic exam through well-dilated pupil must be performed in all cases of childhood strabismus

39
Q

Treatment and management of retinoblastoma

A

Directed toward complete control of tumor and preservation of as much useful vision as possible

40
Q

Where do osteosarcomas present?

A

Can occur in any bone but most commonly seen in long bones near growth plates

41
Q

Is radiation effective in osteosarcomas?

A

No, high level of resistance

42
Q

Physical exam for Ewing saracoma

A

Careful examination of painful sites with inspection and palpation

43
Q

What treats symptoms of dyspnea in lung cancer?

A

Morphine

44
Q

Initial dosing of pain medication for cancer patients

A

Start short acting before long acting

Typical start dose is 5 mg oxycodone q4h PRN = 10 mg morphine

45
Q

When do pts need weaned from opioids

A

7 days or greater

46
Q

Pt teaching about SE of opioids

A

Most SE will lessen over 24 hrs except constipation

Prescribe stool softener and increase when opioid increases

47
Q

What to write in pain diary

A

Every dose
Helpful?
SE

503 Exam 3 (3 decks)

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