Acute Care
Toby is 16yrs. What are the normal physiological ranges for RR and HR for his age group?
RR 16-25 breaths/min, HR 60-119 beats/min
Explain the pathophysiology of how ALL leads to pancytopenia (low red cells, white cells, and platelets).
Immature lymphoblasts divide uncontrollably in the bone marrow, filling the marrow space and stopping it from producing enough healthy blood cells
What metabolic criteria are required for a diagnosis of Laboratory Tumour Lysis Syndrome (LTLS)?
The presence of two or more metabolic abnormalities (Uric acid ≥ 0.476 mmol/L, Potassium ≥ 6.0 mmol/L, Phosphate ≥ 1.45 mmol/L, or Calcium ≤ 1.75 mmol/L) at presentation or a 25% change from baseline
List the four main phases of ALL treatment in their correct chronological order.
1. Pre-Induction/Pre-Phase
2. Induction
3. Intensification/Consolidation
4. Maintenance
Define "Gillick Competency" as it applies to an adolescent patient.
The patient is considered a mature minor and can give informed consent if they have sufficient understanding and intelligence to fully comprehend the proposed intervention
Toby is sitting in a tripod position and speaking in phrases. According to the Paediatric Emergency Care guidelines, what is his category of respiratory distress?
Moderate respiratory distress
Toby has a mediastinal mass. Statistically, what percentage of ALL cases are T-cell ALL, and why is this mass common in this subtype?
T-cell ALL accounts for about 2 in 10 cases (20%) and frequently involves the thymus (mediastinal mass) in adolescent males
For a patient at high risk of TLS, what is the recommended IV hydration rate and the target urine output?
Hydrate with 3 L/m²/day of IV fluid to maintain a urine output of at least 100 mL/m²/hour
Define Measurable Residual Disease (MRD) and explain why achieving a "Negative" status is a primary goal of induction.
MRD uses sensitive molecular tests to detect very low levels of leukaemia cells. Being MRD negative means no cells are found, which is highly predictive against relapse
As an adolescent moves from the paediatric system to adult healthcare, the "rules of engagement" change significantly. What are three practical differences between paediatric and adult care that Toby must be prepared for?
1. In adult care, doctors talk directly to the patient rather than the parents
2. Patient is responsible for managing their own appointments, treatment etc
3. Adult care may involve out-of-pocket costs
You observe a tracheal tug but note a "silent chest" on auscultation. What is the clinical significance of this finding?
Medical emergency suggestive of little to no gas exchange, indicating imminent respiratory failure
About 3 in 10 adults with B-cell ALL have the Philadelphia chromosome. What is the specific chromosomal translocation and the resulting fusion gene?
A swap between chromosomes 9 and 22 (t(9;22)), which creates the BCR::ABL1 (or BCR-ABL1) fusion gene
Why is Rasburicase the preferred agent over Allopurinol for a patient with pre-existing hyperuricaemia (>0.45 mmol/L)?
Allopurinol only blocks the formation of new uric acid; Rasburicase is a recombinant enzyme that converts existing uric acid into allantoin for easy excretion
Toby will receive intensive steroids during induction. Name three musculoskeletal or metabolic side effects he should be monitored for.
Muscle weakness (shoulders/hips), high blood sugar, weight gain (Cushingoid features), or bone pain/height loss
Why is the HEEADSSS framework designed to progress specifically from "Home" to "Sexuality/Suicide"?
It is designed to build rapport by progressing from important but less threatening questions to those considered highly personal