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: In this case, 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 asymptomatic abdominal mass, often incidentally discovered by parents or caregivers. The age of the patient described in the scenario (2-month-old) also aligns with the typical age range for Wilms tumor diagnosis. Option B) neuroblastoma is a tumor that arises from neural crest cells and usually presents with symptoms such as abdominal distension, weight loss, and other systemic signs. It is less likely in this scenario as the mass is described as a left renal mass, which is not characteristic of neuroblastoma. Option C) mesoblastic nephroma is a rare benign renal tumor that typically presents in the neonatal period. However, it is less likely in this case given the age of the infant and the fact that nephroblastoma is more common in the pediatric population. Option D) clear cell sarcoma is a rare tumor that typically occurs in older children and adolescents. It is not commonly associated with renal masses in infants. Educationally, understanding the typical presentations, age groups affected, and characteristics of different pediatric renal tumors is crucial for healthcare providers to make accurate diagnoses and provide appropriate treatment. Knowledge of these distinctions can guide clinical decision-making and improve patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) intensive chemotherapy. In this scenario, the presence of blast cells in the peripheral blood of a 20-day-old infant with hepatomegaly and abnormal blood counts suggests a high likelihood of acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), both of which require intensive chemotherapy for treatment. Option B) low dose chemotherapy pulses would not be the best approach as aggressive treatment is usually required for acute myeloproliferative disorders to achieve remission and prevent disease progression. Option C) bone marrow transplantation is typically reserved for cases of refractory or relapsed disease, not as initial management. Option D) close follow-up alone is insufficient as immediate treatment is necessary in the presence of blast cells and abnormal blood counts in a pediatric patient. From an educational standpoint, it is crucial for healthcare providers to recognize the urgency of appropriate management in pediatric patients presenting with concerning findings like blast cells in the blood. Understanding the treatment approaches for pediatric leukemias is essential for providing timely and effective care to these vulnerable patients.

Correct Answer: D

Rationale: In this case, the correct answer is D) stage IV S. This is because the scenario describes a 6-month-old girl with a neuroblastoma tumor that has already metastasized extensively, with involvement in the bone marrow, subcutaneous tissue, and a massive abdominal mass. The absence of N-myc amplification suggests a more favorable prognosis than if N-myc were amplified. Option A) stage I is incorrect because there is already metastasis present in this case. Option B) stage II A is also incorrect as the tumor has spread beyond the primary site. Option C) stage III is not the correct choice because of the extensive metastasis described in the scenario. Educationally, understanding the staging of neuroblastoma is crucial for pediatric practitioners as it guides treatment decisions and prognostication. This case highlights the importance of recognizing the extent of disease spread in neuroblastoma cases and how specific genetic markers can influence prognosis and treatment strategies. This knowledge is essential for providing optimal care to pediatric patients with neuroblastoma.

Correct Answer: B

Rationale: The correct answer is B) type of pure epithelial histology because hepatoblastomas with pure epithelial histology have been associated with the most favorable outcomes compared to other histological types. Pure epithelial hepatoblastomas typically respond better to treatment and have a higher survival rate. Option A) mixed type of pure epithelial and mesenchymal elements is incorrect because the presence of mesenchymal elements can indicate a more aggressive tumor behavior. Option C) type of mixed fetal and embryonal histology and Option D) type of undifferentiated histology are also incorrect as they are associated with poorer prognoses and more aggressive disease progression. In an educational context, understanding the histological classification of hepatoblastoma is crucial for pediatric oncology practitioners to make informed treatment decisions and predict patient outcomes. This question highlights the importance of recognizing the different histological types and their implications for patient management and prognosis in pediatric oncology.

Correct Answer: B

Rationale: The correct answer is B) There is an increased risk for ectopic pregnancy or infertility. Pediatric nurses play a crucial role in educating patients about the potential consequences of pelvic inflammatory disease (PID) on their reproductive health. PID can lead to scarring and damage to the fallopian tubes, increasing the risk of ectopic pregnancy (a serious condition where the fertilized egg implants outside the uterus) or infertility (difficulty conceiving). By choosing this option, the nurse addresses the patient's concerns accurately and provides important information for their future reproductive health decisions. Option A is incorrect because while PID can lead to complications during pregnancy, such as preterm birth, it does not specifically increase the occurrence of spontaneous abortion. Option C is incorrect as placenta previa is not directly associated with PID. Option D is incorrect as PID can indeed impact fertility and increase the risk of complications like ectopic pregnancy, making it an oversimplified and inaccurate response to the patient's inquiry. Educationally, this question highlights the importance of pediatric nurses being knowledgeable about the long-term effects of PID on adolescent patients' reproductive health. It emphasizes the need for clear and accurate communication with patients to empower them to make informed decisions about their healthcare and future fertility.