peds- cancer and fever

Non-clonal disorders

- neutropenia, Agranulocytosis , leukomoid reactions and infectious mono

Non hodkins - causes - who - CM -Dx -progosis

1) cause- Unknown- maybe Epstein barr- esp in endemic burketts 2) more so in older, white, males and it is more common than Hodkins 2) CM- persistence abdomical pain, V/D, often abdomical palpable mass, +/- intusseption or weight loss 3) diagnotics- CBC, ERS, UA and electrolyites ** elevasted LAH and no Reed Sternberg cells - PE, Xray, CT, PET, test bone marrow 4( prognosis - generally excellent- 90% 5 year survival **dependent on stage and age

Abx 1) younger than one month 2) older than one month urinary findings 3) 1-3 months - no meningitis 4) 1-3 months- meningitis is concern 5) 1-3 months and listeria or enterococcus is a concern 6) > 3 months and suspected PNA

1) younger than one month -Ampicillin +gentimycin OR ampicillin + cefotaxime 2) older than one month urinary findings -Cefotaxime 3) 1-3 months - no meningitis -ceftriaxone 4) 1-3 months- meningitis is concern -higher dose ceftriaxone 5) 1-3 months and listeria or enterococcus is a concern = Add ampicillin 6) > 3 months and suspected PNA -Amoxicillin Alt: Azithromycin

Clinical red flags for Serious infection in children > 1 month 1. General assessment 2. Child behavior 3. Circulatory/resp 4. Others

1. General assessment - parental concerns - physician instinct 2. Child behavior - changes in crying patterns, drowsiness, inconsolable, moaning 3. Circulatory/resp- crackles, cyanosis, decreased breath sounds, poor peripheral circulation, rapid breathing and SOB 4. Others- decreased skin elasity, hypotension, meningeal irritation, petechial rash, siezures, unconciosuness -

Sarcoma 1. Types 2. peak incidence 3. CM 4. Dx 5. Complications

1. Types - Soft tissue sarcomas- most common Rhabdomyosarcoma (2-6 years) -Bone sarcoma- most common is Osteosarcoma (during growth spurt)- also Ewing sarcoma (10-20 years) 2. peak incidence 3. CM -Rhabdomyosarcoma- eye issues (periorbital swelling), nasal mass, chronic OM, ear discharfe, neck mass, CN involvement, urethral or vaginal mass (paratesticular swelling, hematuria, urinary retention/frequency) - Osteosarcoma- most often epiphysis/metaphysis of Distal femur or proximal tibia/humerus - localized pain -Ewing sacoma- femur and pelvis most common- localized pain and swelling 4. Dx- DEFINITIVE is biopsy - Light microscopy- rhabdo/ewing- small round blue cells in tumor - LP -MRI -Chest CT and BOne scan for mets 5. Complications - surgery can result in loss of limb or limitation of function -radiation- interference of growth and development in irradiated tissues

Hodkins 1. casue 2.who 3. Cm 4. Dx 5. prognosis

1. cause- UNKNOWN- maybe Epstein barr virus (esp in endemic burkitt) 2.who- BIMODAL - peaks in adolescent and then after 50 -rare in kids <5 but B>G in peds and adolescents = 3. Cm- Painless mass in neck, perisitent cough or SOB secondary to mediatinal mass - splenomegaly or enlarged supraclavicular/cervials 4. Dx -CBC, ESR, BMP, LDH - Reed Sternberg cells - tissue biopsy 5. prognosis- 70-905 3 year survival CHIPS score = Stage IV dz, large mediastinal adenopathy, albumin <3.5 and fever 5. prognosis

Neuroblastoma 1. cause 2. who and when 3. Cm 4. Dx 5. Comlications of dz and tx 6. prognosis

1. cause- derived from neural crest cells, unknown -maybe hereditary 2. who and when -MOST COMMON EXTRACRANIAL solid tumor or childhood (spine, neck and chest) AND most common malignancy of INFANCY - median age is 20 months 3. Cm -localized- often none -metastatic- fever, weight loss and pain -MOST COMMON symptom- ABD PAIN or MASS in flank -paraneoplastic syndrome (diarrhea and sweating) and opsomyoclonus ( feet) 4. Dx -CBC -Abd Xray - urine catecholamine detection -biopsy DEFINITIVE- tissue sample for light/electon microscopic and immunohistological exam 5. Comlications of dz and tx Dz- spinal cord compression - neuro deficits and emergency Tx- ototox, nephrotox, growth probs and second malignancies 6. prognosis - WIDE range- sometimes spontaneous regression others have rapid progression to death 6. prognosis

Younger that 29 days - in/out patients - Tests -Abx

1. in/out patients- inpatient 2. Tests ALL: a. Blood tests- CBC with diff and Blood culture b. UA and urine culture c. Lumbar puncture d. Chest radiography IF diarrhea present: Stool culture and fecal WBC count 3. Abx- begin empiric once cultures obtained 1st line:Ampicillin + gentamicin alt: Ampicillin + cefotaxime

> 29 days and no signs of serious illness 1. in/outpatient 2. tests 3. Abx- general, urinary and respiratory

1. in/outpatient - only outpatient if good follow up is available 2. tests a. Blood tests -1-3 mo: CBC with diff to evaluate need for LP 3-36: not recommended b. Urine tests: 1-24mo: UA and culture c. LP 1-3 mo: may consider omitting if WBC between 5000 and 15000 and no bacteriuria or pyuria 3-36: not recommended d. Chest radiography: 1-36 months: if fever >102.2 and WBC >20,000 or respiratory signs present 3. Abx general: ceftriaxone urinary: cefixime respiratory: amox or azithromycin

Wilms 1. what 2. who and when 3. CM 4. Dx 5. Complications 6. Prognosis

1. what- arises from primitive metanephric blastoma- precursor to normal kidney 2. who and when -most common malignant RENAL tumor in childhood - mean is 3.5-5.5 years 3. CM - most present with ABD mass found by parent - followed by abd pain, fever, HTN, and hematuria 4. Dx- -CBC, UA, LFT, renal function - Abd US/CT and Chest Xray -EVALUATE IVC - diagnosis confirmed by histologic eval 5. Complications- cardiomyopathy, scoliosis, HTN, renal and bladder probs, hepatic dysfunction, infertility or complicated pregnancies 6. Prognosis - good overall cure rate for localized is >85%

> 29 days and signs of serious illness ( cyanosis, poor circ, meningial irritation, neuro changes or rash) - in/out patients - Tests -Abx for general/urinary

1.in/out patients- in 2.Tests a. Blood tests 1-36 months: CBC w/ diff and culture b. Urine tests -1-24 mo: UA and culture c. LP -1-3 mo: for all ill appearing -3-36 mo: if neuro or meningeal signs d. Chest Xray 1-36 mo: if fevere >102.2 and WBC count >20,000 or if respiratory signs present 3. Abx general- Ceftriaxone urinary- cefotaxime

Clinial fever

100.4

- neutropenia= causes

<2000 BMS, disease and drug reactions

infectious mono = -pathophys -charcterisitics

= Absolute and relative lymphocytosis with atypical lymphs -EBV invades B lymphs - atypical lymphs transformed to T lymphs reacting to infected B cells - patient has + heterophile antibody and elevated liver enzymes - atypical lymphs- larger, bluer cytoplasm, radial basophilia, plasmocytoif, nucleoli

leukemoid reactions = types

= WBC flood circulation, and resembles leukemia due to high numers and immature cells -SECONDARY TO another condition 1) neutrophilic- shift to left, bacterial infection, burns and malignancy 2) lymphocytic- mono, whooping cough ( chronic bacterial or viral infections) 3) eosinophilic- allergies and parasitic infection

agranulocytosis= causes sxs

= disappearance of neutrophil precursors in bone marrow and decreased granulocyte count in the blood -drug reaction, autoimmune dz or infection sxs- fever, severe sore throat infection (pure agranulocytosis is rare since most offending agents also affect RBC and platelets)

Clonal disorders = types

=unregulated and incontrolled growth and proliferation of cells 1) myeloproliferative - leukemias, chronic diseases, myelodysplasias 2) Lymphoproliferative- acute and chronic diseases, leukemia and lymphoma 3) Immunoproliferative (B lymphocytes)

CBC components Hemoglobin for M and F most common WBC in adult vs kid

CBC- Hbg, Hct, RBC count, WBC count, platelet count and indicies (RBC) and differential (WBC) M- 14-19 F-12-16 WBC adult: neutrophils child: lymphocytes - until about 4- then changes

what are signs of bacterial infection in WBC? -mono? - what is a left shift?

bacterial= toxic granulation and vacuoles mono- atypical/ reactive lymphs left shift= increase in immature neutrophils (bands, metas and myelos)