question

When are MMR and Varicella immunizations given?

answer

After 12 mo of age, *not before*

question

What is the first immunization infants' receive?

answer

Hep B (at birth)

question

When in the first DTaP administered?

answer

2 mo

question

Yearly influenza vaccine is recommended for all children over the age of...

answer

6 mo up to 18 years

question

What is the current recommendation from the American Academy of Pediatrics related to infants and car seats?

answer

-children remain in rear facing child restraint seats until the age of 2 years or until they reach the maximum height and weight for the seat -Children should then be transition from rear-facing seat to forward-facing seat with a harness until they reach the maximum weight or height for the seat. -When children reach the maximum weight and height for the front facing child restraint seats, the AAP recommends a high back booster seat to ensure the vehicle's lap-and-shoulder belt fit properly -shoulder belt should fit across the middle of the chest and shoulder, not near the neck or face and the lap belt should fit low and snug on the hips and upper thighs, not across the abdomen "belly" -Children should ride in a belt-positioning booster sear until they have reached 4 feet 9 inches tall, usually between 8 to 12 years of age. Children under the age of 13 should not ride in the front seat of vehicles.

question

conjunctivitis symptoms

answer

RED SWOLLEN, EXCESSIVE TEARING, CLEAR/WATERY, YELLOW/GREEN DRAINAGE & EYELID CRUSTING

question

Periorbital cellulitis

answer

concern of conjunctivitis INFECTION OF THE EYELID & SURROUNDING TISSUES USUALLY CAUSED BY BACTERIA, signs and symptoms- EDEMATOUS TENDER, RED/PURPLE EYELIDS; RESTRICTED, PAINFUL MOVEMENT OF THE AREA AROUND THE EYE & FEVER (TREAT WITH IV FLUIDS);

question

Strabismus (CROSS EYE)

answer

Symptoms- ONE EYE DEVIATES FROM THE POINT OF FIXATION, THE WEAK EYE BECOMES LAZY, CAN BE CONGENITAL/ACQUIRED, concerns (leads to Amblyopia (LAZY EYE) if untreated)

question

Disuse amblyopia

answer

leads to blindness from disuse, usually follows undetected strabismus - remember strabismus needs to be detected and corrected by age 4 to 6 years to prevent disuse amblyopia from happening

question

otitis media

answer

symptoms (ACUTE OTITIS MEDIA- FEVER, BULGING, RED TYMPANIC MEMBRANE, PAIN)( OTITIS MEDIA WITH EFFUSION- DULL, RETRACTED TYMPANIC MEMBRANE, FULLNESS) treatment- AMOXICILLIN, complications- CHRONIC EAR INFECTIONS, MENINGITIS, EAR DRUM PERFORATION risk factors refer to lecture

question

Nasopharyngitis aka URI/common cold

answer

symptoms- LETHARGY, FEEDING POORLY, IRRITABILITY and treatment- ANTIPYRETICS- to help reduce fever and help with comfort, SALINE DROPS- MAY BENUSED EVERY 3-4 HOURS FOR INFANTS ESPECIALLY BEFORE FEEDING, LASTS 4-10 DAYS

question

pharyngitis

answer

Know viral or bacterial- THROAT CULTURE TO RULE OUT STREPTOCOCCAL PHARNGITIS - Symptoms- ENLARGED TONSILS, SORE THROAT, HEADAHCE, FEVER and complications

question

What does it mean when a child is swallowing excessively after any kind of throat surgery? (example-Tonsilectomy)

answer

possible bleed

question

Chronic lung disease aka bronchopulmonary dysplasia

answer

ASSOCIATED WITH PROLONGED OXYGEN THERAPY & MECHANICAL VENTILATION COMMON IN PREMIES, DISCHARGE- TRACH CARE, OXYGEN THERAPY, CPR TRAINING FOR FAMILY

question

Cystitis Fibrosis (salty skin)

answer

-pancreatic enzyme supplements are administered to promote digestion of fats and proteins; they come in powder sprinkles and capsule form and are taken orally before all meals and snacks - the amount needed is based on the child's nutritional needs and digestive response (look at stool), risk for prolapsed rectums, the ultimate goal is to achieve near-normal, well-formed stools and of course adequate weight gain) sweat test to diagnose initial presentation of CF in the neonate appears in GI system - meconium ileus, meconium is sometimes so thick it causes obstruction and requires surgical removal - prolapsed rectum may occur in infancy and childhood

question

Croup

answer

*epiglottis is a bacterial infection and a life-threatening emergency - never attempt an oral assessment in these children*, tracheitis is also bacterial, laryngotracheobronchitis (common cause RSV) and spasmodic laryngitis are both viral

question

bronchiolitis

answer

usually caused by RSV

question

pneumonia

answer

rest, push and increase fluids especially water

question

asthma

answer

heightened airway reactivity

question

asthma treatment

answer

short-acting beta2-agonists such as albuterol - relaxes smooth muscle in airway leading to quick bronchodilation; corticosteroids such as methylprednisolone, prednisone, prednisolone (oral) - diminishes airway inflammation, enhances bronchodilating effect of beta2-agonists; long-acting beta2-agonists such as salmeterol which is a dry powder inhaler and relaxes smooth muscle in airway but remember not to be used for acute asthma episode

question

passive smoking increases

answer

risk for asthma, otitis and other respiratory conditions. Educate parents if child is ;6, if 6 you can start educating both the parents and the child

question

how to care for children with cardiovascular conditions

answer

organize care, want them to REST! DO NOT INTERRUPT, TRY TO DO EVERYTHING AT ONCE. OBSERVE FOR SWEATING, FATIGUE. NOTIFY HCP IF YOU, THE NURSE CANNOT IMPROVE STATUS. SOMETIMES CONTACTING THE PROVIDER IS AN ACTION THAT IS NEEDED

question

Cardiac catheterization

answer

Pre-OP NPO FOR 4-6 HOURS, TELL CHILD WHAT THEY WILL FEEL SEE ; HEAR, OBTAIN V/S HEMOGLOBIN HEMATOCRIT CAPILLARY REFILL TIME and Post-procedure- MONITIOR FOR BLEEDING, NEUROVASCULAR CHECKS, BEDREST WITH AN EFFORT TO KEEP THE LEG STRAIGHT care along with discharge teaching- TEACH SIGNS OF COMPLICATIONS (BLEEDING, INFECTIONS, THROMBOSIS), ENCOURAGE QUIET PLAY, ENCOURAGE FLUIDS FOR HYDRATION AND TO GET RID OF DYE

question

Congenital heart defects

answer

RISK FOR CHF, MONITOR CHILDREN CLOSELY, REVIEW S/S FOR CHF, ALWAYS CONCERNED WITH CARDIAC FAILURE

question

congenital heart defects cont.

answer

Patent Ductus Arteriosus (PDA) - medical management with Indomethacin to close, Atrial Septal Defect (ASD) - systolic injection murmur, congestive heart failure, Ventricular Septal Defect (VSD) - spontaneous closure might occur, Pulmonary Stenosis (PS) - congestive heart failure occurs when severe, heart murmur present Aortic Stenosis (AS) - audible murmur during systolic phase of cardiac cycle, a click may be heard and a thrill may be present, Coarctation of the Aorta (COA) - blood pressure differences between upper and lower extremities, femoral pulses weak or absent, CVA may occur due to hypertension, Transposition of Great Vessels (TGA) - survival depends on foramen ovale remaining open, symptoms appear at birth or soon afterwards, must be surgically corrected

question

tetralogy of fallot

answer

four defects present (DON'T NEED TO KNOW SPECIFICS, THESE KIDS DO NOT GAIN WEIGHT, DON'T HAVE ENERGY, THEY WILL REST A LOT, TIRE EASILY, ALLOW THEM TO REGULATE THEIR OWN ACTIVITIES, PAY ATTENTION TO THEIR TIREDNESS, THEY WILL SQUAT BC THEY HAVE PROBLEMS BREATHING), diagnosis based on signs and symptoms, defects must be corrected

question

tet spells

answer

when caring for a child with Tetralogy of Fallot take immediate action by placing child in knee-chest position when he or she has increased respiratory rate and becomes cyanotic

question

congestive heart failure

answer

signs- SWEATING OF SCALP IN INFANTS, FATIGUE DURING FEEDING, IRRITABLE, WEIGHT LOSS, TACHYCARDIA, TACHPNEA, PALLOR, RESPIRATRORY DISTRESS management- REMOVE FLUID, DECREASE CARDIAC DEMANDS, IMPROVE TISSUE OXYGENATIONATION AND DECREASE CONSUMPTION, and medications - review PowerPoint side and lecture about digoxin- THERAPEUTIC LEVEL 0.8-2, COUNT APICAL FOR 1 MINUTE HOLD IF LESS THAN 90 IN INFANTS AND 70 IN CHILDREN ; VERIFY WITH ANOTHET NURSE, OBSERVE FOR CARDIAC ARRYTHMIAS, OBTAIN SERUM LEVEL AT LEAST 6 HRS AFTER DAILY DOSE

question

Rheumatic fever (SCARELT FEVER)

answer

secondary to group A beta-hemolytic streptococcus infection, symptoms, treatment (bedrest until ESR normal, anti-inflammatory and analgesic, prophylactic penicillin or erythromycin to reduce risk of reoccurrence ** KNOW PLAY ACTIVITIES FOR RHEUMATIC FEVER- THEY WANT THEM TO REST (SCHOOL AGED- MOVIES, PUZZLES, COLORING)

question

Kawasaki's disease

answer

multisystem vasculitis, symptoms, treatment (IVIG and aspirin therapy 80-100 mg/kg/day), 20% of children develop cardiac sequelae

question

dyslipidemia

answer

presymptomatic phase of arteriosclerosis

question

hypertension

answer

persistently between 90th and 95th percentile on at least 3 occasions, treatment diet and exercise, children should have 30 to 60 minutes of exercise each day.

question

GI conditions

answer

MAKE SURE THEY'RE HYDRATED, USE ORAL REHYDRATION BC ITS MORE APPROPRIATE, SMALL AMOUNTS AT FREQUENT INTERVALS, DON'T USE HIGH SUGAR DRINKS, USE PEDIALYTE, USE IV PUMPS BC KINDNEY FUNCTION, REMBER TO CHECK THE ORAL MUCOUS MEMBRANES (DRY LIPS ARE NOT AN INDICATOR)

question

Celiac disease

answer

results for the inability to digest protein of wheat, barley, rye, and oats, life-long deficiency, requires life-long diet modification (nurse may refer to nutritionist), parents and children must learn to read labels, again concern about growth failure

question

Child's fluid balance system

answer

Higher rate of peristalsis, small stomach capacity, and higher percentage of water in extracellular fluid compartments -infants can dehydrate quickly

question

Signs of dehydration

answer

MILD- NORMAL V/S, FUSSY, RESLTELSSNESS, ALERT, THIRSTY, NORMAL MUCOUS MEMBRANES ; TURGOR, ANTERIOR FONTANEL ; EYES NORMAL, CAPILLARY REFILL 5 SECS, ;1.030

question

degrees of dehydration

answer

MILD- 4-5%, MODERATE- 6-10%, SEVERE- ;10%

question

most accurate measurement of total body fluid loss

answer

WEIGHT IS THE MOST IMPORTANT DETERMINANT OF TOTAL BODY FLUID LOSS ACCURATE WAY OF DESCRIBING DEHYDRATIONS IN 48 HRS OR LESS IS ML PER KG OF BODY WEIGHT

question

folic acid

answer

taking it during pregnancy decreases risk for neural tube defects and cleft abnormalities

question

greatest challenge for cleft patients

answer

providing adequate nutrition for growth.

question

pyloric stenosis

answer

projectile vomiting, visible peristaltic waves from left to right, failure to thrive/weight loss, treatment surgery

question

gastroesophageal reflux

answer

failure to thrive, treatment with medications or sometimes surgery - Elevate infant after feeding

question

intussusception

answer

one part of the bowel into another part of bowel causing obstruction, classic sign "currant jelly-like stool", and palpable sausage shaped abdominal mass, treatment sometimes corrected with barium enema

question

Hirschsprung disease

answer

"congenital aganglionic megacolon", failure to pass meconium is sometimes the first sign, failure to thrive

question

appendicitis

answer

most common condition requiring abdominal surgery in pediatric population, first periumbilical pain followed by the classic sign of right lower quadrant pain, remember to test for rebound tenderness, surgery is always indicated for cure

question

irritable bowel syndrome

answer

"nervous stomach", no specific test, and treatment is dietary

question

inflammatory bowel disease

answer

Crohn's disease - no cure Ulcerative colitis - acute and chronic inflammation, bloody diarrhea, curable with surgery

question

gastroenteritis (diarrhea)

answer

rehydration is the key to prevent dehydration most accurate means of describing dehydration to reflect acute loss is in *ml/kg* of body weight - weight is an important determinant of percent of total body loss in infants and children infants/children are prone to fluid overload and imbalance because of *immature kidney functioning* Always use an electronic infusion device when administering IV fluids and medications to children. Important always check for kidney functioning before adding KCL to primary IV fluids.

question

hepatitis

answer

Vaccines for A and B - Hepatitis A - highly contagious and has been called infectious hepatitis, spread primarily through fecal-oral route, there is a vaccine available for Hepatitis A. Hepatitis B is serum hepatitis, transmission is through blood and body fluids can be transferred from mother to fetus in utero, there is a vaccine for Hepatitis B

question

Human Immunodeficiency Virus (HIV)

answer

progresses to AIDS HIV destroys the body's ability to fight infection; Most HIV cases in children are caused by perinatal transmission leading cause of newly acquired HIV infection in teens is unprotected sex Causes a wide spectrum of illness in children, from no symptoms to severe symptoms - AIDS is the most severe - the most common source of infection in children is perinatally, from infected mother to infant

question

pregnant HIV pt treatment

answer

CDC recommends to test and treat HIV-positive pregnant women with zidovudine [ZDV/AZT] during pregnancy and delivery and infant is treated for 6 weeks after delivery) - the child of a HIV+ mother, who did not receive ZDV during pregnancy, is followed closely for 18 months before it can be determined that is child is definitely infected

question

HIV test and symptoms in infants

answer

ELISA test is performed after maternal antibodies have disappeared symptoms in infants that may be of concern are chronic diarrhea, failure to thrive, delayed development, and frequent infections including candidiasis, Streptococcus pneumonia, Haemophilus influenzae, Staphylococcus aureus, ; herpes simplex - the focus is on prevention and treatment is management of symptoms including medications

question

Juvenile idiopathic arthritis

answer

clinical manifestations- single or multiple joints may be involved, stiffness, swelling, loss of motion in affected joints, sometimes joints are swollen and warm to touch, children complain of "morning stiffness." (KEEP WARM ; PERFORM PLAY ; PHYSICAL ACTIVITY) No definitive tests and symptoms should be present greater than 6 weeks. Treatment includes nonsteroidal anti-inflammatory medications; physical therapy and occupational therapy are needed

question

the only way to collect sterile urine

answer

catheterization

question

urinary tract infections

answer

characterized by bacteria in the urine along with signs and symptoms of infection. Most common cause is E. coli. Fever without focus is suggestive of UTI. Young girls are prone to UTIs because of short urethra - remember no bubble baths, etc. Should always test for cure after treatment for UTI; clinical manifestations of UTIs in infants (fever, irritability, dysuria - crying when voiding, change in urine color or odor, poor weight gain, feeding difficulties); in children (abdominal pain, urinary frequency and urgency, dysuria, fever, new onset of enuresis). Children with pyelonephritis may have the same symptoms but also complain of back pain, CAV tenderness, nausea and vomiting - they also appear very ill; treatment for UTIs requires antibiotic therapy for 7 to 10 days (IV antibiotics for pyelonephritis followed by oral therapy)

question

Hypospadias and Epispadias

answer

both are congenital anomalies involving an abnormal location of the urethral meatus; most cases of hypospadias are mild, with the meatus slightly off center from the tip of the penis; in severe cases the meatus if located on the scrotum; diagnosis is made by prenatal ultrasound or by examination at birth; repair is made surgically usually during 1st year of life

question

vesicoureteral reflux

answer

usually congenital abnormality, two contributing factors to UTIs - bacteria in the urine can be carried up to the kidney and cause pyelonephritis and renal damage or urine that has refluxed into the ureter can return to the bladder and leave urine residual which is a medium for bacterial growth. Severity of reflux determines the treatment

question

grades of vesicoureteral reflux

answer

classified Grade I-V. Grade I-III require no surgery only prophylactic antibiotic therapy and the children are monitored closely and screened every few months or as needed if febrile. Children usually have spontaneous resolution of these. Grade IV and V require surgical intervention to reimplant the ureters into the bladder IF ITS IN THE KIDNEYS ITS BAD, PRONE TO UTIS (KEEP ON PROPHYLAXIS)

question

nephrotic syndrome

answer

A kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, hypoproteinemia, hyperlipidemia, and altered immunity Manifestations: edema, anorexia, fatigue, abdominal pain, increased weight gain; Treatment: prednisone 2mg/kg/day BID or TID until zero trace of protein in the urine for 5 to 7 days, steroids must be tapered before discontinuing, and also these children must adhere to a no-added-salt diet

question

Acute Poststreptococcal Glomerulonephritis

answer

self-limiting, occurs suddenly, and resolve completely. Most common is post streptococcal glomerulonephritis which follows a strep infection. Characterized by hematuria (usually number one sign and ranges from microscopic to gross), proteinuria, edema, renal insufficiency, and hypertension. Treatment includes bedrest, monitor fluid and electrolyte, monitor intake and output, daily weights, fluid restrictions may be ordered, sodium, potassium, and protein may be limited No medication is needed unless strep has not been completely treated or symptoms such as hypertension needs medication

question

hemolytic uremic syndrome

answer

most common cause of renal failure in children, usually caused by ingesting beef contaminated with E. coli, potentially lethal outcome causes acute renal failure

question

signs of increased ICP

answer

infants- extremely irritable, bulging fontanel, shrill or high pitched cry, lethargy, poor feeding, setting sun sign, distended scalp veins older children- headache, N/V, irritability, lethargy, diplopia, seizures Cushing's triad (1. Hypertension (progressively increasing systolic bp). 2. Bradycardia. 3. Widening pulse pressure (increase in difference between systolic and diastolic pressure)

question

seizure care

answer

AIRWAY, SUCTION, DESCRIBE WHAT HAS HAPPENED, CHECK BLOOD LEVELS IF GIVEN DRUGS- CHECK FOR TOXICITY ON LONG TERM DRUGS, MAKE SURE DRUGS ARE GIVEN AT THE SAME TIME EVERY DAY

question

febrile seizure

answer

usually this does not lead to permanent seizure disorder or any neurological problems with the child involved

question

bacterial and viral meningitis

answer

bacterial meningitis is treated with IV antibiotics and viral meningitis is self-limiting and resolves spontaneously

question

Reye syndrome

answer

associated with aspirin use and viral illnesses especially influenza and Varicella

question

hydrocephalus

answer

buildup of too much csf in the brain

question

hydrocephalus is treated with

answer

VP shunt if malfunctioning, child will show signs of increased ICP

question

care of spina bifida pt

answer

prevention of infection if sac is actually outside the spinal cord, neonates are place prone position, no rectal temps, sac must be kept moist (covered with sterile saline) until surgery is performed

question

cerebral pasly

answer

leading cause is anoxia or hypoxia at birth causes delays and impairments in motor function

question

Traumatic brain injury

answer

if loc, have to be hospitalized if no loc SEND HOME AND EDUCATE PARENTS TO WAKE THEM UP, CHECK FOR VOMITING, LOOK AT PUPILS, ORIENTED, IF THERE HAS BEEN A CONCUSSION PT NEEDS TO REST AND MAY NOT RETURN TO NORMAL IF SERIOUS

question

ADHD

answer

test before giving meds

question

Developmental Dysplasia of the Hip (DDH)

answer

Clinical Manifestations in infants include shortening of the limb on the affected side, unequal gluteal folds when in prone position, restricted abduction of hip on affected side, Positive Ortolani (click or popping sound) and Positive Barlow test Treatment varies depending on the severity of the symptoms; during neonatal period a corrective device is placed to maintain the hip in flexion and abduction

question

scoliosis

answer

lateral curvature of the spine - good posture is indicated, bracing and surgery may be needed if severe (MAKE SURE THEY CAN STILL PARTICIPATE IN ACTIVITIES

question

osteomyelitis

answer

Infectious process of the bone - Symptoms include fever, abrupt pain (point tenderness above the bone, swelling and warmth over the bone), and unwillingness to bear weight or move limb, irritability, possible poor appetite. Treatment is usually IV antibiotics for 4 to 6 weeks, bedrest, and affected limb may be splinted or cast, surgery may be performed, ELEVATED ESRS

question

fractures

answer

Fracture with infant suspect child abuse; compound fracture may lead to infection; compartment syndrome occurs when swelling causes pressure within closed space to rise this can lead to paralysis and necrosis of tissue - an example would be the child complaining of not being able to extend fingers with a fracture of forearm (NURSE CANNOT DO ANYTHING USUALLY CALL HCP, IF SWOLLEN, ELEVATE)

question

DM type 1 symptoms

answer

WEIGHT LOSS, EXCESSIVE URINATION, EXCESSIVE THIRST

question

ketoacidosis

answer

thirst, frequent urination, nausea, abdominal pain, weakness, fruity-scented breath, and confusion.

question

impetigo

answer

Highly contagious bacterial infection - Staphylococcus aureus and Streptococcus pyogenes or both, Signs & symptoms: lesion starts as a vesicle or pustule with edema and erythema - later the lesions erupt, leaving honey-colored exudate which is crusty in appearance and sticky to touch Good handwashing necessary for prevention, keep infants nails trim and short, may apply mittens to infant hands to prevent scratching, instruct parents to remove crust from lesions before applying topical medication. Severe cases require systemic antibiotics

question

cellulitis

answer

bacterial infection that enters the body via existent openings in the skin caused by dermatological conditions or trauma - Most common bacteria Staphylococcus aureus and Streptococcus pyogenes, Signs and symptoms: edematous, erythematous, warm or hot to touch, pain at affect area, Treatment: mild cases may be treated at home with oral antibiotics, severe cases need hospitalization and intravenous medications, some cases require incision and drainage (I & D)

question

pediculosis

answer

Itching is only symptoms - Treatment rid hair of "nits"

question

primary concern with burns

answer

infection MEDICATE WITH ORAL MEDS 20-30 MINS PRIOR TO PREVENT PAIN BEFORE PROCEDURES

question

iron deficiency in children <1 yo can be caused by

answer

drinking cows milk

question

taking iron supplements can cause

answer

black tarry stools

question

sickle cell

answer

HYDRATION IS KEY, THEY HAVE JOINT PAIN, INFLAMMATION, THEY NEED PAIN MANAGEMENT, REST- THEY CAN GO THE BR, BUT NOT RUN AROUND TOO MUCH, CONCERNED WITH CVA

question

hemophilia

answer

THEY CAN BLEED! IF THEY FALL MAKE SURE YOU ELEVATE THEM swimming is a good sport

question

chemo

answer

lowers immune system

question

iron deficiency anemia is not usually seen before the child is

answer

9 mo Infants born before 32 weeks' gestation need iron supplementation sooner than term infants

question

signs of iron deficiency anemia

answer

extreme pallor, tachycardia, tachypnea, lethargy, fatigue, and irritability (these vary with the degree of anemia). If the anemia is severe, a heart murmur may be heard which disappears when the anemic state is corrected.

question

iron supplements

answer

best absorbed on an empty stomach, but may be given with vitamin C such as orange juice

question

sickle cell disease

answer

autosomal recessive condition whereby normal hemoglobin is partially or completely replaced by the sickle-shaped, abnormal hemoglobin S (Hgb. S) Hypoxia, fever, dehydration and emotional or physical stress can trigger a crisis. Symptoms do not usually occur until 4 to 6 months of age. The sickling of cells is prevented secondary to the high levels of fetal hemoglobin

question

common hemophilia types

answer

factor VIII deficiency (hemophilia A) and factor IX deficiency (hemophilia B - Christmas disease) are inherited as an X-linked recessive trait.

question

care for hemophilia pt

answer

avoid the use of aspirin products with these children, no rectal temperatures, soft toothbrushes and regular dental checks are needed, may control localize bleeding through topical coagulants, pressure, elevation, and ice. Factor VIII is a plasma product and children who received impure forms in the past are at risk for HIV/AIDS.

question

neuroblastoma

answer

found only in infants and children primary abdominal mass and a protuberant firm abdomen, impaired range of motion and mobility, limping, pain and limping, large abdominal mass may disrupt urinary and bowel function, chest tumors may cause cough and decreased chest expansion/respiratory compromise, spinal cord compression may cause inability to walk, etc., superior vena cava compression causes facial and periorbital edema.

question

neuroblastoma dx and tx

answer

Diagnostic test: chest x-ray, CT of chest, abdomen, and pelvis; bone marrow aspiration and biopsy. Treatment: depends on the presence and extent of metastasis. Surgery to remove the tumor, radiation, chemotherapy, and bone marrow transplants.

question

Wilm's Tumor (Nephroblastoma)

answer

Most common malignant renal and intrabdominal tumor of childhood - nephroblastoma Peak age of diagnosis is around 3 years of age, seen more commonly in boys than in girls 85% all patients are diagnosed under the age of 5 years - rarely seen after age 7 Clinical manifestations: Abdominal swelling or mass - firm, nontender, confined to one side (Do not palpable the abdomen!) Fatigue/malaise Weight loss, anorexia Fever Hypertension (occasionally) Hematuria (sometimes) Diagnostic Tests Abdominal ultrasound CT of the abdomen Complete blood count Urinalysis Treatment Surgery to remove the affected kidney Postoperatively, radiation therapy and/or chemotherapy Prognosis - survival rates are the highest among all childhood cancers

question

osteosarcoma

answer

Most common tumor (malignant bone tumor) affecting the skeleton system of children - peak incidence is during rapid growth years (13 years for girls and 14 years for boys)

question

lukemia

answer

A proliferation of abnormal white blood cells (WBCs) and is the most common form of cancer in children under the age 14. Manifestations: fever (persistent or recurrent), pallor, excessive bruising, bone or joint pain (usually leg pain), lymphadenopathy, malaise, hepatosplenomegaly, abnormal WBC counts (either lower or higher than normal for age), and mild to profound anemia and thrombocytopenia. Diagnostic test: clinical manifestation and abnormal CBC - bone marrow aspiration and biopsy confirms diagnosis.

question

management of lukemia

answer

Aggressive chemotherapy - divided into three phases: induction - usually first month designed to achieve a remission, intensification - serves to maintain remission, and maintenance - may continue for 2 to 3 years - girls for 2 years and boys for 3 years (boys have a higher relapse rate). Children who have relapse during maintenance usually have a poor prognosis. The goal of therapy after achieving remission is to maintain remission and prevent progression of the disease to the testes and CNS, known as "sanctuary" sites because systemic therapy is poorly delivered to these areas. Remember these children are at a constant risk for infection due to immunosuppressed state.

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