1Acute Graft v. Host Disease (AGVHD) is a serious complication of _________ which typically occurs _______ after transplant and is characterized by ________. it is primarily _______ mediated
- allogeneic hematopoietic stem cell transplant
- in the first 100 days
- inflammation of the skin, liver, and gastrointestinal systems
- T cell
2Chronic GVHD presents after ___ days and is accompanied by ________. Usually involves the ______, _____, ____, and _____
- 100
- Severe immunologic dysfunction
- MSK, mucous membranes, skin, and respiratory syndrome
3Clinical manifestations of AGVHD include
generalized erythematous maculopapular rash which can progress to bullae formation and desquamation, hyperbilirubinemia, transaminitis, vomiting, diarrhea, abdominal pain, anorexia, mucosal sloughing, bloody stools, and ileus.
4Graft v. Host Disease cutaneous initially presents as erythematous __________ on the _____, _____, or ________; and then generalizes into a morbilliform or ________ type rash, _____, _____, ______
- Blanchable macules
- Ears, palms, or soles
- Measels like
- Hyperkeratotic, bullae, sloughing
5Graft v. Host Disease Cutaneous treatment includes _______, _______, ________ for chronic, ________, and oral care
- Systemic steroids, topical steroids, UV light therapy (chronic), cyclosporine,
6Graft v. Host Disease GI presentation includes _______, _______, _______, & increased _______
- Diarrhea, sloughing, hematochezia, increased bilirubin
7Graft v. Host Disease GI treatment includes _____, _______, & _______
- Steroids
- Mycophenolate (immunosuppressant)
- Cyclosporine
8Typhlitis aka _________ triad symptoms....
- Neutropenic Enterocolitis
- Neutropenia, abdominal pain, fever
9Typhlitis aka Neutropenic Enterocolitis is a potentially life-threatening infection d/t ________ damage from ______
- GI mucosal
- Cytotoxic therapy
10Oral open lesions can be associated with ______ and can also be a port for systemic infection
typhlitis
11What medications should you avoid in patients with Typhitis?
- Anticholinergics, antidiarrheals, narcotics
12Veno-Occlusive Disease (VOD) is blockage of the venous system of the _____ leading to _____
- Liver
- Vasculitis
13Risk Factors of Veno-Occlusive Disease (VOD) include ______ & ______
- Actinomycin-D chemo
- Liver radiation
14Superior Vena Cava Syndrome is _____ of the SVC by _____, _____, or _____ leading to _______ --> ______
- Compression
- Tumor, lymphadenopathy, or thrombus
- Increased venous pressure -> decreased cardiac output
15Hyperleukocytosis is a dangerously high WBC count > _____; risk for ____
- 100,000
- Leukostasis
16Hyperleukocytosis is most commonly seen in ____
- AML
17Most common complication of Hyperleukocytosis is _______
- Stroke
18In a pt with Hyperleukocytosis you should avoid _____ & _____ to prevent further_______; Goal Hgb is _____
- Diuretics & PRBC
- Increase in blood viscosity
- < 10
19Elevated ______, _______, & ______ levels are indicative of tumor lysis syndrome, a side effect of chemotherapy when tumor cells are broken down. Elevated ______ with low _____ can indicate renal failure which occurs as a result of tumor lysis syndrome.
- potassium, phosphorous, and uric acid
- BUN and creatinine
- calcium
20Tumor Lysis Syndrome (TLS) is associated with _______; especially with ____, ____, or _____
- Initiation of chemo
- Leukemia/lymphoma/fast growing tumors
21Tumor Lysis Syndrome (TLS) impacts the _____, ____, _____, & _____ function
- Neurologic, pulmonary, cardiac, and renal
22Risk Factors for Tumor Lysis Syndrome (TLS) include ______, ______, _____, _____, & ______
- High initial uric acid, high tumor burden, NHL, T-cell leukemia, hyperleukocytosis
23Bone Marrow Aspirate (BMA) w/ _____% blasts = leukemia
>25%
24Leukemia is the abnormal _______ & ______ of immature _________ in blood/ bone marrow causing _________; & in other organs including ______, ____, _____, _____, _____, & _______
- Proliferation and accumulation
- WBC
- Bone marrow suppression
- Lymph nodes, testes, liver, spleen, CNS, & skin
25Most common childhood cancer is ________
ALL
26CAR-T Cell therapy Modifies autologous T cells to express a receptor which targets _____ on the surface of ____
- Antigens
- Lymphoblasts
27CAR-T cell therapy has risks for serious and potentially fatal complications, including ______, _______, & _______
- TLS, cytokine release syndrome, and neurotoxicity
28Prophylaxis for every leukemia patient is _______
IT methotrexate
29CNS treatment for high risk leukemia patients include ______, _____, _____, _____, _____ & _______
IT methotrexate, cytarabine, steroids, plus IV methotrexate, asparaginase, radiation
30Lymphoma is malignancy of the _____ arising in the ______; It is the _____ most common pediatric cancer
- Lymphocytes
- Lymph tissue/node
- 3rd
31Hodgkins lymphoma is more common in ______ & ________; Ages _____ to _____ y.o
- Adolescents and young adults
- 15-35
32Hodgkins lymphoma spreads in a contiguous (contact) manner to _______ but rarely involves ____ sites; Spreads ____ than NHL
- Nearby lymph nodes
- Extranodal
- slower
33Children with _________ are at greater risk for Hodgkins lymphoma; also associated w/ _____
- Immunodeficiency
- EBV
34Non-Hodgkins Lymphoma is more common in ______ children, ages ___ to ___
- School-age
- 5-15
35Non-Hodgkins Lymphoma can spread _______ & involve extranoday sites including the ____, _____, & _____; Spreads more ______ & ____ than HL
- Non-Contiguously
- Skin, brain, & GI tract
36Osteosarcoma & Ewing’s Sarcoma is proliferation of the ______ or _______ cell with peak incidence during ______
- Osteoblasts
- Mesenchymal stem
- Growth spurts
37Osteosarcoma effects the _______ region; Up to 20% metastasize at dx to the ____ and _____
- Metaphyseal
- Lungs and Brain
38Ewing Sarcoma effects the _____ regions or ______; 25% metastisize to _____, _____, or _____
- Diaphyseal
- Soft tissues around the bone
- Bone, bone marrow, or lungs
39Codman triangle seen on xray in _____ or ______ is a _____ reaction seen when an aggressive bone lesion...... Only the periosteum at the very margin of the lesion has time to ossify creating a triangular lip of _______
- Osteosarcoma or Ewing's sarcoma
- Periosteal
- Grows faster than new periosteum can be ossified
- New bone
40Rhabdomyosarcoma is a _______ tumor from _______ cells; 50% originate from ________ cells & has 3 main variants including ______, _____, & _______
- Soft tissue
- Mesenchymal
- Striated muscle progenitor
-Embryonal Form (most common)
- Botryoid
- Alveolar
41Embryonal Form of Rhabdomyosarcoma occurs _________ but most often in the ______, _____, ______, and ______ and is more common in ___ to ___ y.o
- Anywhere on the body
- Head, neck, orbits, and GU
- 1-8
42Botryoid Rhabdomyosarcoma is seen in the _____ or ______ and is more common in ______
- Bladder or vagina
- Infants
43Alveolar Rhabdomyosarcoma occurs in the _____ or ______ and is more common in ____ & _____
- Extremities or bone marrow
- Adolescents and young adults
442/3rds of Rhabdomyosarcoma cases occur in pts <_____ y.o. It is slightly more common in _____ and ______; Associated with _____
- 10
- Males
- African descent
- RB gene mutation
45Wilms Tumor or Nephroblastoma is a tumor from _______ precursor cells; Most common in kids b/t ___ to ___ y.o; 90% dx before _____
- Renal
- 2-3
- 5 y.o
46Wilms Tumor or Nephroblastoma is associated with ____ syndromes, including _____ & ______
- Genetic
- Denys-Drash syndrome
- Beckwith-Wiedemann
47Wilms Tumor or Nephroblastoma is usually found by ____ during _____ or during ________
- Caregiver
- Bathing
- Routine physical exam
48Neuroblastoma is a neoplasm of the ________; It's the most common ______ solid tumor
- Sympathetic nervous system
- extracranial
49Neuroblastoma is the most frequently diagnosed malignancy during _____ & is slightly more common in ______ descent
- Infancy
- Caucasian
50Neuroblastoma is associated with ______, _____, and _______ aka _______
- Hirschsprung’s
- Neurofibromatosis
- Congenital hypoventilation aka neural crest disorders
51Opsoclonus-myoclonus ataxia (OMA) is ______, ______, +/- ______. 50% of patients who present with OMA have ________
- Myoclonic jerking, random eye movements, +/- cerebellar ataxia
- Neuroblastoma
52Infratentorial or _______ brain tumors occur in the _______ / _______
- Posterior Fossa
- Cerebellum/Brainstem
53Supratentorial brain tumors occur in the _______, _____, ______, _____, & ______ or ______
- Cerebrum, basal ganglia, hypothalamus, optic chiasm, parasellar or pituitary
54Retinoblastoma is a neoplasm of the retinal cells that can extend into the ______; It accounts for ____ to ___ % of childhood cancers. Commonly metastasizes to the ____, ____, & _____
- Vitreous humor
- 1 to 3%
- Orbit, brain, lymph
55Retinoblastoma is associated with _____; 2/3rds of cases are kids ____ y.o; 95% diagnosed by _____ y.o
- RB1 gene
- < 2
- 5
56Hepatoblastoma is the most common liver mass in children. An elevated _______ is present in 90% of children
- α-fetoprotein
57Many chemotherapy agents are considered _______ , so a baseline _______ is indicated along with interval checks
- cardiotoxic
- EKG or echocardiography
58Iron overload has been reported in patients following chemotherapy and hematopoietic stem cell transplant. A prolonged elevated ferritin level can lead to
liver dysfunction, endocrine disorders, and altered cardiac function.
59Mucositis can be a severe complication of an immunocompromised state and in the preparation process for stem cell transplant, due to the increased doses of chemotherapy and radiation. The most important prevention method is
meticulous mouth care.
60The most sensitive scan to detect a new soft tissue mass in a previously radiated site is _______.
- PET scan
61A PET scan is a nuclear medicine imaging technique that uses tracers to indicate ________. It can identify _____
- tissue metabolic activity by regional glucose uptake
- very small lesions early in the course.