A 2-mo-old male infant has a left flank mass discovered incidentally by the mother; radiological imaging reveals a left renal mass. Of the following, the MOST likely diagnosis is

Correct Answer: A

Rationale: The correct answer is A) nephroblastoma. Nephroblastoma, also known as Wilms tumor, is the most common renal tumor in children. It typically presents as an abdominal mass, often discovered incidentally, and is commonly seen in very young children. The age of the infant in the scenario fits the typical age range for Wilms tumor diagnosis. Option B) neuroblastoma is a neural crest tumor that typically arises in the adrenal glands or sympathetic ganglia, not in the kidney. Option C) mesoblastic nephroma is a rare benign renal tumor that is more commonly seen in infants less than 3 months of age, making it less likely in this case. Option D) clear cell sarcoma is a rare tumor that usually occurs in older children and adolescents, not in infants. In an educational context, understanding the typical age of presentation, common clinical features, and prevalence of different pediatric tumors is crucial for healthcare providers in diagnosing and managing pediatric patients effectively. Recognizing the characteristic features of nephroblastoma and distinguishing it from other pediatric renal masses is essential for providing appropriate care and guiding further diagnostic and treatment plans.

Correct Answer: A

Rationale: The correct approach for the management of a healthy 20-day-old male with a palpable liver margin, elevated white blood count, low hemoglobin, and blast cells consistent with acute myeloproliferative disorder is intensive chemotherapy (Option A). Intensive chemotherapy is the standard treatment for acute myeloproliferative disorders in children. It aims to reduce the blast cell population, restore normal blood cell production, and prevent disease progression. Low dose chemotherapy pulses (Option B) may not be sufficient to adequately treat the aggressive nature of acute myeloproliferative disorders in pediatric patients. Bone marrow transplantation (Option C) is usually reserved for cases of refractory or relapsed disease, or when intensive chemotherapy fails. Close follow-up (Option D) alone is not a sufficient treatment for acute myeloproliferative disorders, as prompt intervention with chemotherapy is necessary to improve outcomes in these cases. In an educational context, understanding the appropriate treatment for pediatric hematologic disorders is crucial for healthcare providers working with children. Recognizing the need for intensive chemotherapy in this scenario highlights the importance of timely and effective management to improve patient outcomes and reduce the risk of disease progression.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) stage IV S. The key to determining the correct stage lies in the extent of disease spread. Stage IV neuroblastoma is characterized by the presence of distant metastasis, which is evident in this case with the massive abdominal mass, subcutaneous nodules involvement, and bone marrow involvement. The absence of N-myc oncogene amplification is also a crucial factor in the staging process. Option A) stage I is incorrect because there is clear evidence of distant metastasis in this case. Option B) stage II A is incorrect as it does not encompass the extensive disease involvement seen in this patient. Option C) stage III is also incorrect as it does not reflect the presence of distant metastasis as seen in this case. From an educational perspective, understanding the international neuroblastoma staging system is crucial for healthcare providers involved in the care of pediatric oncology patients. It aids in determining prognosis, guiding treatment decisions, and facilitating communication among healthcare teams. This case underscores the importance of a comprehensive evaluation and knowledge of staging criteria in managing pediatric oncology cases effectively.

Correct Answer: B

Rationale: In pediatric oncology, understanding the histological classification of tumors is crucial for treatment planning and prognostication. In the case of hepatoblastoma, the correct answer is B) type of pure epithelial histology, which predicts the most favorable outcome. This is because hepatoblastomas with pure epithelial histology have been associated with a better response to treatment and overall improved outcomes compared to other histological types. Pure epithelial tumors typically have a more differentiated cellular appearance, which may make them more responsive to chemotherapy and surgical interventions. Regarding the other options: A) Mixed type of pure epithelial and mesenchymal elements: This combination suggests a more complex tumor composition, which may indicate a less favorable prognosis due to the presence of mesenchymal elements. C) Type of mixed fetal and embryonal histology: This combination is associated with intermediate outcomes, not the most favorable as indicated in the question. D) Type of undifferentiated histology: Tumors with undifferentiated histology are typically more aggressive and associated with poorer prognosis compared to tumors with more differentiated features. Educationally, this question highlights the importance of histological classification in pediatric oncology and how different tumor subtypes can impact treatment strategies and patient outcomes. Understanding these nuances is essential for healthcare providers involved in the care of pediatric oncology patients.

Correct Answer: B

Rationale: In this scenario, the best response for the pediatric nurse to provide to the adolescent patient with pelvic inflammatory disease (PID) is option B: "There is an increased risk for ectopic pregnancy or infertility." This answer is correct because PID can lead to serious complications, such as scarring of the fallopian tubes, which can increase the risk of ectopic pregnancy (a pregnancy that occurs outside the uterus) and infertility. Option A, stating that the occurrence of spontaneous abortion during pregnancy increases with PID, is incorrect because while PID can lead to complications during pregnancy, such as preterm birth, it does not directly increase the risk of spontaneous abortion. Option C, mentioning an increased risk of placenta previa, is also incorrect as PID is not directly associated with this specific pregnancy complication. Option D, suggesting that there should be no problems with the patient's ability to conceive, is incorrect as PID can indeed impact fertility. Educationally, it is crucial for pediatric nurses to have a comprehensive understanding of the potential consequences of PID on reproductive health to provide accurate and supportive information to adolescent patients. By choosing the correct response, nurses can help patients make informed decisions about their reproductive health and seek appropriate medical care if needed.