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503 Exam 3 > Week 9 > Flashcards

Week 9 Flashcards

(47 cards)

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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?

Study These Flashcards
A

Mediastinal mass – send to ER

20
Q

How would a pt with superior vena cava syndrome present?

Study These Flashcards
A

Distended neck veins and plethora

21
Q

Staging criteria system for HLA

22
Q

What cells are indicative of Hodking’s lymphoma

Study These Flashcards
A

Reed-Sternberg Cell

23
Q

What are B symptoms?

Study These Flashcards
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?

25
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
26
What do you thenk when you see "blastoma"
Round blue cells
27
Location of neuroblastoma?
Adrenals
28
At what stage are most children diagnosed with neuroblastoma?
4 because it takes a while for symptoms to manifest
29
How common is neuroblastoma?
Most common extracranial solid tumor in infancy
30
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
31
How will 4S neuroblastoma present in a neonate?
Blueberry muffin baby (could be confused with congenityal rubella) Racoon eyes
32
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
33
How is Wilms tumor most often detected?
Incidental detection of asymptomatic mass
34
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
35
Why do you avoid palpation abdomen with Wilms tumor
Could rupture friable tumor into peritoneal cavity = STAGE 3 | **Refer to onc immediately
36
What should you ask parents in hx of child with retinoblastoma
Specifically about occurrence of retinoblastoma in the family
37
Physical findings in child with retinoblastoma
Leukocoria (white pupillary reflex/cat eye reflex) | No red reflex -- RED FLAG**
38
What assessment should be performed on child with strabismus?
Fundoscopic exam through well-dilated pupil must be performed in all cases of childhood strabismus
39
Treatment and management of retinoblastoma
Directed toward complete control of tumor and preservation of as much useful vision as possible
40
Where do osteosarcomas present?
Can occur in any bone but most commonly seen in long bones near growth plates
41
Is radiation effective in osteosarcomas?
No, high level of resistance
42
Physical exam for Ewing saracoma
Careful examination of painful sites with inspection and palpation
43
What treats symptoms of dyspnea in lung cancer?
Morphine
44
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
45
When do pts need weaned from opioids
7 days or greater
46
Pt teaching about SE of opioids
Most SE will lessen over 24 hrs except constipation | Prescribe stool softener and increase when opioid increases
47
What to write in pain diary
Every dose Helpful? SE

503 Exam 3 (3 decks)

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