Module Seven: Pediatric Oncology, MSK, Neuromuscular, Endocrine, Mental Health, and Emergencies

150 flashcards covering pediatric oncological, musculoskeletal, neuromuscular, endocrine, mental health, and emergency topics from Module 7.

What is a fundamental principle regarding pediatric patients?

Pediatric patients are not little adults.

What aspect should be incorporated into all aspects of pediatric care?

Play

What are three types of pediatric organ neoplasms?

Wilms Tumor, Neuroblastoma, and Brain Organ Neoplasms.

What are two types of pediatric blood neoplasms?

Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia.

What are three types of pediatric bone and soft tissue cancers?

Rhabdomyosarcoma, Osteosarcoma, and Ewing’s Sarcoma.

What is the most common childhood cancer of the kidney?

Wilms Tumor

What percentage of Wilms Tumor cases occur in children under the age of $5$?

$$75\%$$

What percentage of Wilms Tumor cases are considered familial?

$$5\%$$

What is a key expected finding of a Wilms Tumor regarding its location?

A painless abdominal mass that does NOT cross the midline.

What abdominal assessment action is strictly prohibited when a Wilms Tumor is suspected?

Palpating the abdomen, as it could cause the spread of tumor cells.

What are the primary treatments for Wilms Tumor?

Surgery and Chemotherapy.

What are common findings for Wilms Tumor besides an abdominal mass?

Weight loss, enlarged liver, spleen, and anemia.

What is the most common cancer of infancy?

Neuroblastoma (affecting children $<22\,mos$).

From which type of cells does a Neuroblastoma arise?

Fetal cells that form the adrenal medulla and the sympathetic nervous system (SNS).

What is the primary site for a Neuroblastoma?

The abdomen

What percentage of children with Neuroblastoma have metastasis prior to diagnosis?

$$70\%$$

How does an abdominal mass in Neuroblastoma differ from a Wilms Tumor during physical assessment?

The firm, painless abdominal mass in Neuroblastoma CROSSES the midline.

What urinary symptoms might a patient with Neuroblastoma exhibit?

Urinary frequency or retention due to bladder compression by the tumor.

What are common signs and symptoms of Neuroblastoma metastasis?

Periorbital edema, supraorbital ecchymosis, exophthalmos, hepatomegaly, respiratory obstruction, fatigue, weight loss, and anorexia.

What are the primary treatments for Neuroblastoma?

Surgery, radiation, and chemotherapy.

What unusual phenomenon can sometimes occur with a Neuroblastoma tumor?

It may regress spontaneously.

What accounts for $25\%$ of childhood cancers, making it the most common organ tumor in children?

Brain organ neoplasms

In which parts of the brain do most pediatric brain tumors occur?

The brainstem or cerebellum.

From which type of cells do pediatric brain tumors most commonly originate?

Glial cells (Glial tumors).

What is the second most common cell origin for pediatric brain tumors?

Astrocytoma

What is a classic expected finding for a child with a brain tumor upon awakening?

Headache

What determines the expected findings for a brain tumor?

The location and size of the tumor.

From which tissue does Rhabdomyosarcoma arise?

Muscle tissue

What determines the clinical presentation of Rhabdomyosarcoma?

The location of the tumor and the resulting dysfunction or obstruction of the affected organ.

What are the three treatment modalities for Rhabdomyosarcoma?

Surgery, Radiation, and Chemotherapy.

What is the most common bone cancer in children?

Osteosarcoma

In what age group is Osteosarcoma most frequently diagnosed?

Children over $10$ years old.

Where do more than $50\%$ of Osteosarcoma cases occur?

The femur (specifically the metaphysis growth plate).

What type of pain is characteristic of Osteosarcoma and how is it often relieved?

Localized pain often relieved with flexion.

What are two surgical treatment options for Osteosarcoma?

Limb salvage or amputation.

How does Ewing’s Sarcoma differ in location from Osteosarcoma?

Ewing’s Sarcoma presents in the diaphysis (shaft) of the bone, whereas Osteosarcoma is usually in the metaphysis.

Which is rarer: Ewing’s Sarcoma or Osteosarcoma?

Ewing’s Sarcoma

What is Hodgkin Disease (HD) Lymphoma?

A malignancy of the lymph system.

In what age range is Hodgkin Disease most likely to occur?

Between $15$ and $19$ years of age.

Where are painless enlarged nodes commonly found in Hodgkin Disease?

Subclavicular or cervical nodes.

What are some constitutional symptoms of Lymphoma?

Nonproductive cough, abdominal pain, low-grade fever, anorexia, pruritus, night sweats, and weight loss.

What is Acute Lymphoblastic Leukemia (ALL)?

A malignancy of the bone marrow characterized by an overproduction of immature white blood cells.

What is the common age range for a child diagnosed with ALL?

$2$ to $6$ years old.

Which specific group is commonly associated with ALL?

White males with Down Syndrome.

What are typical expected findings for ALL related to bone marrow failure?

Low-grade unresolving fever, pallor, bruising, petechiae, lethargy, joint pain, nausea/vomiting, weakness, and anorexia.

What are the treatment options for ALL?

IV/Intrathecal Chemotherapy, Corticosteroids, Bone marrow transplant, and Hematopoietic stem cell transplant.

Why is a port or central line placed for chemotherapy?

To deliver agent-specific chemotherapy safely into the bloodstream.

How does chemotherapy affect cells throughout the body?

It affects rapidly growing cells.

What are two major side effects of chemotherapy mentioned in the notes?

Immunosuppression and Pancytopenia.

How is radiation therapy dosage typically delivered?

In divided treatments over several weeks.

Why are tattoo marks used in radiation therapy?

To ensure the accurate delivery of the radiation beam.

What are the localized side effects of radiation?

Lymphedema and scar tissue.

What are four types of musculoskeletal disorders categorized as congenital?

Osteogenesis Imperfecta, Clubfoot, Hip Dysplasia, and Scoliosis.

What are the risk factors for pediatric fractures?

Obesity, poor nutrition, and developmental characteristics.

What are the clinical findings of a fracture?

Pain, crepitus, deformity, edema, ecchymosis, and decreased use of the affected area.

Which type of fracture is also known as a 'compound' fracture?

Open fracture

What is a greenstick fracture?

An incomplete fracture where one side of the bone is broken and the other is bent.

What are the '5 Ps' included in neurovascular checks?

Pain, Pulse, Pallor, Paresthesia, and Paralysis (implied by the transcript's mention of sensation and pulses).

What are the four types of traction listed?

Skin Traction, Skeletal Traction, Halo Traction, and Manual Traction.

What are five potential complications of pediatric fractures?

Compartment Syndrome, Volkmann Contracture, Renal Calculi, Embolism, and Osteomyelitis.

What is the clinical name for Clubfoot?

Talipes Equinovarus

What is the physical presentation of Clubfoot?

The heel tilts down and the toes turn in.

What is the progression of therapeutic interventions for Clubfoot?

Serial casting, followed by surgical correction of the tightened tendon, and then a brace for $2$ to $4$ years.

What happens to the head of the femur in Legg-Calve Perthes Disease?

The blood supply is significantly reduced temporarily.

What is a major potential complication of Legg-Calve Perthes Disease?

Avascular necrosis of the hip joint.

How does Legg-Calve Perthes disease initially present?

An initial limp without pain.

Which medication class is being tested for Legg-Calve Perthes Disease?

Bisphosphonates

What birth presentation is commonly associated with Developmental Dysplasia of the Hip (DDH)?

Breech birth

What physical signs indicate DDH?

Limited abduction, difference in leg length, asymmetric gluteal folds, and an audible click.

What is the function of a Pavlik Harness?

It prevents hip flexion and adduction.

How long is Pavlik Harness therapy typically used?

$12$ weeks.

What are the guidelines for Pavlik Harness wear time?

$23$ hours per day.

How often should the Pavlik Harness straps be readjusted by a provider?

Weekly

What clothing should a child wear under a Pavlik Harness to protect the skin?

An undershirt and knee socks.

What should be avoided on the skin of a child in a Pavlik Harness?

Lotions and powders.

What is the goal of surgical reduction and Spica cast placement in DDH?

To place the femoral head into the acetabulum and maintain that position.

What is a hallmark finding of Osteogenesis Imperfecta regarding the eyes?

Blue Sclera

What are the findings associated with Osteogenesis Imperfecta?

Multiple bone fractures, blue sclera, early hearing loss, and small, discolored teeth.

How is Osteogenesis Imperfecta diagnosed?

Bone biopsy

What specific nursing action is required for blood pressure measurement in children with Osteogenesis Imperfecta?

Manual blood pressures (to prevent potential fractures from automatic cuffs).

What is the definition of Scoliosis?

Abnormal lateral and rotational curvature of the spine.

At what degree of curvature is a brace indicated for Scoliosis?

Between $25$ and $45$ degrees.

At what degree of curvature is spinal fusion surgery indicated for Scoliosis?

Greater than $50$ degrees.

What physical signs suggest Scoliosis during an exam?

Clothes hang unevenly, uneven shoulders, uneven shoulder blades (rib hump), and hips at different heights.

What are the three categories of Cerebral Palsy (CP)?

Spastic, Dyskinetic, and Ataxic.

What is the most common type of Cerebral Palsy?

Spastic CP

How are muscles described in Spastic Cerebral Palsy?

Stiff and rigid.

What is the difference between diplegia and quadriplegia in CP?

Diplegia affects two limbs; quadriplegia affects all four limbs.

What characterizes Ataxic Cerebral Palsy?

It affects muscle movement and coordination.

What are three prenatal risk factors for Cerebral Palsy?

Brain anomalies, maternal chorioamnionitis, and multiple births.

What are three perinatal risk factors for Cerebral Palsy?

Low birth weight, premature birth, and asphyxia.

What is a postnatal risk factor involving head trauma for CP?

Shaken baby syndrome

What medications are used to manage Cerebral Palsy?

Baclofen, Diazepam, Botulinum Toxin A, and Valproic Acid/Carbamazepine.

What causes Spina Bifida?

The neural tube fails to close.

What nutritional deficiency is a major risk factor for Spina Bifida?

Folic Acid Deficiency

What level of paralysis can occur with Spina Bifida?

Complete or incomplete paralysis below the level of the lesion.

What are two common comorbidities of Spina Bifida?

Hydrocephalus and Chiari II malformation.

What is a common allergy associated with children who have Spina Bifida?

Latex allergy

What is Juvenile Idiopathic Arthritis?

An autoimmune disorder that targets the synovial joints.

How does inactivity affect a child with Juvenile Idiopathic Arthritis?

Inactivity increases stiffness.