What is the purpose of the immune system?
What are the primary lymphoid immune system organs? Secondary?
Differentiates self and non-self.
Primary - thymus, bone marrow, liver.
Secondary - lymph nodes, spleen, gut associated lymphoid tissue.
What is the difference between nonspecific and specific immune function?
Nonspecific - activated on exposure to any foreign substance, reacts the same regardless! Phagocytosis, neutrophils/monocytes.
Specific is humoral immunity and involves antibody production and complement - B lymphocyte. Differentiates!
What is cell mediated immunity?
Involves a variety of specific functions mediated by the T lymphocyte. Occurs within the cells! Includes cytotoxic t cells, helper T cells, and suppressor T cells. Protection against viral/fungal/protozoan infections and slow-growing infections such as TB. Rejection, etc.
HIV - primarily infections subset of ___ lymphocyte.
T lymphocyte.
What are some symptoms of HIV?
Diarrhea, growth delay (length and weight), lymphadenopathy, recurrent opportunistic infections, autoimmune disorders, and persistent oral candidiasis, neurological impairment.
When is testing done for HIV (think kids!)
Birth, 3/6/12/18 months.
What are therapy goals for HIV?
Slow the growth of HIV, promote/restore normal G&D, prevent complication infections and cancers, improve quality of life, prolong survival.
What are some ways to prevent transmission of HIV?
AZT therapy, avoiding breastfeeding, standard precautions, discourage high risk behaviors, minimize exposure to infections, nutritional support, psychological support, education, avoid live vaccines, etc.
What is SCID?
defect characterized by absence of both humoral and cell-mediated immunity. Unknown cause.
How do we treat SCID?
Histocompatible HSCT
what are some symptoms of cancer?
Pain, fever, bruising, headache/vomiting, vision changes
What are some treatment options for cancer?
Biopsy, removal, chemo, radiation, biologic response modifiers, bone marrow transplant
What are some complications of cancer therapy?
Tumor lysis syndrome, superior vena cava syndrome, spinal cord compression, DIC
What is tumor lysis syndrome? Treatment?
Electrolyte imbalances (hyperuricemia, hyperkalemia, hyperphophatemia, hypocalcemia) - might need fluids, etc. Treatment includes hydration, allopurinol, NaHCO3, dialysis.
What is superior vena cava syndrome? Symptoms? Treatment?
Swelling of face/arms/chest, cough, SOB, pain. Treatment = chemo, radiation, blood thinners for clots.
What are some side effects of cancer therapy?
Infection, hemorrhage, anemia, N/V, altered nutrition, neurologic problems, hemorrhagic cystitis, alopecia, steroid effects.
What is leukemia?
Non-functional blast cells, cannot fight infection, and they multiply continuously. This affects the bone marrow so they have anemia, thrombocytopenia, immunosuppression.
Acute leukemia - ALL - most common or least common?
Peak onset - __ to __ years.
Boys more than girls?
Most common.
2-5 years.
Boys.
What is AML?
Acute myelogenous leukemia. Similar between genders. Higher rates in less than 2 years. 40-50% cure rate.
How do we treat leukemia?
IV Chemo, divided into phases.
What are the 5 phases of leukemia treatment?
Induction - getting blasted with chemo. Intensification - different meds. Consolidation - less chemo. Delayed intensification - another blasting! Maintenance - some IV meds...
what does hodgkin’s lymphoma include?
Reid steinburg cells. Diagnosed by Ct/MRI, bone scan, etc.
How do we treat hodgkin’s lymphoma?
Chemo, radiation, etc.
Do non-hodgkin’s lymphoma patients have the reid steinburg cells?
NO.
Non-hodgkins lymphoma - also classified by what?
Cell - t-cell, b-cell, non-t, non-b, etc.
Brain tumors - 60% are infratentorial - four types?
Brainstem glioma, infratentorial ependymoma, cerebellar astrocytoma, medulloblastoma, etc.
Brain tumors - 40% supratentorial - four types?
Craniopharyngioma, optic nerve glioma, cerebral astrocytoma, ependymoma, s/s related to their anatomic location/size.
what are the functions of the cerebrum?
Composed of the right/left hemispheres. Initiation of movement, coordination of movement, temperature, touch, vision, hearing, judgment, reasoning, problem solving and learning.
what are the functions of the brainstem?
sensory, movement of eyes, body temp, cardiac function, consciousness, involuntary muscle movement, etc.
What are the functions of the cerebellum?
Located at the back of the head - infratentorial), coordinate voluntary muscle movements, maintains posture, etc.
neuroblastoma - most common extra cranial solid tumor. T/F?
TRUE
Neuroblastoma - primary site within ____ - other sites include what?
Primary = abdomen.
Other sites = head, neck, chest, pelvis, etc.
Neuroblastoma - abdomen will feel like what?
Firm, nontender, irregular mass in the abdomen.
Neuroblastoma - compression of kidney, ureter, or bladder may cause urinary frequency or retention. T/F?
TRUE
what are some signs and symptoms of neuroblastoma?
Supraorbital ecchymosis, periorbital edema, proptosis (protrusion of the eyeball) lymphadenopathy, hepatomegaly, skeletal pain, pallor, weakness, irritability, anorexia, weight loss - just depends on the location.
how do we diagnose neurblastoma?
CT scan, bone scan, bone marrow aspiration, urine catacholamines
Neuroblastoma - it’s okay to palpate the abdomen. T/F?
FALSE - do not.
How do we treat neuroblastoma?
Surgery, chemotherapy, irradiation, stem cell transplantation
osteogenic sarcoma - common? When does it commonly grow? Sites?
Common…most commonly occurs in teens during growth spurt. Diametaphyseal region of long bones. Half in femur, half in humerus.
how do we treat osteogenic sarcoma?
Surgery, biopsy, limb salvage, chemo, etc.
Ewing’s Sarcoma (Primitive Neuroectodermal Tumor of the bone) - arises in where? Treatment?
Arises in bone marrow spaces. Originates in the shaft of the long and trunk bones. Treated with radiation and chemotherapy.
what is van ness rotationplasty?
The heel becomes the patient’s knee!
what is wilm’s tumor? Diagnosed by?
Nephroblastoma - most common kidney tumor. Associated with several congenital malformation syndromes. Diagnosed by ultrasound, CT/MRI
How long is treatment for wilm’s tumor? what is the treatment?
6 months - chemo/surgery.
what is rhabdomyosarcoma?
Most common soft tissue sarcoma in children - 4th most common type of solid tumor in children. Found almost anywhere in the body.
What are the 3 classifications of rhabdomyosarcoma?
Embryonal, alveolar, pleomorphic
How do we diagnose rhabdomyosarcoma? how is it staged?
Ct/MRI, LP, Metastatic evaluation, bone scan
staged upon resection of tumor and residual disease.
how do we treat rhabdomyosarcoma?
Chemo, surgical resection, radiation.
Rhabdomyosarcoma - prognosis is good the first time (if not metastatic) but bad if it’s a relapse. T/F?
TRUE
Retinoblastoma - what is the cat’s eye reflex?
It looks like a red-eye without the red.
How do we diagnose retinoblastoma?
indirect opthalmoscopy, ultrasound, CT
How is a retinoblastoma treated?
Chemoterhapy, irradiation, brachyterhapy, photocoagulation, cryotherapy, radiation, enucleation for advanced disease with optic nerve invasion, intrathecal chemo, eye removal.
what are germ cell tumors?
Like ovarian/testicular cancer. Yolk sak tumor/sacrococcygeal teratoma.
Liver tumor - most common subtype is what?
Hepatoblastoma, treated with surgery/chemo
what are some late effects of cancer?
Emotional, CNS (seizures, lower IQ scores, lower academic performance, etc), language/math issues, cardiovascular problems, eye issues, small teeth, missing teeth, teeth sensitivity, gum disease, short stature, skeletal issues, hearing (ringing), need for hearing aids, respiratory issues, urianry issues, etc.