Alveolar type of rhabdomyosarcoma accounts for approximately 1/3 of all cases of pediatric RMS and carries the poorest prognosis. Of the following, the MOST common site of involvement by alveolar type RMS is

Correct Answer: C

Rationale: In pediatric oncology, understanding the different types of rhabdomyosarcoma (RMS) and their common sites of involvement is crucial for accurate diagnosis and treatment planning. In the case of alveolar type RMS, the most common site of involvement is the extremities. This is because alveolar RMS is more likely to arise in the soft tissues of the limbs, leading to its predilection for the extremities. Option A, orbit, is less common for alveolar RMS and is more typically associated with embryonal RMS. Option B, middle ear, is also less common for alveolar RMS and is more often seen in tumors like Ewing sarcoma. Option D, bladder, is not a typical site for alveolar RMS involvement. Educationally, understanding the specific characteristics and common sites of different RMS subtypes helps clinicians in making accurate diagnoses, determining appropriate treatment strategies, and predicting prognosis. This knowledge is essential for pediatric oncologists, radiologists, and pathologists involved in the care of children with RMS.

Correct Answer: A

Rationale: In Hodgkin lymphoma, poor prognostic factors indicate a higher likelihood of treatment failure or disease progression. The correct answer, A) age of more than 15 years at the time of diagnosis, is not considered a poor prognostic factor. In fact, younger age is generally associated with better outcomes in Hodgkin lymphoma due to the more favorable biology of the disease in this age group. Option B) stage IV disease is a poor prognostic factor as it signifies more extensive disease spread and a higher tumor burden, leading to a worse prognosis. Option C) manifested by positron emission tomography (PET) scan positivity is also a poor prognostic factor, as it indicates more aggressive disease behavior. Option D) poor response to therapy is an obvious poor prognostic factor as it suggests that the disease is not responding adequately to treatment, leading to a worse outcome. Understanding these poor prognostic factors is crucial for clinicians in determining the appropriate treatment approach and predicting patient outcomes in Hodgkin lymphoma. Educationally, this question highlights the importance of recognizing poor prognostic factors in Hodgkin lymphoma to guide clinical decision-making and prognosis assessment. It reinforces the significance of age, disease stage, imaging findings, and treatment response in predicting outcomes in pediatric patients with Hodgkin lymphoma.

Correct Answer: D

Rationale: The correct answer is D) biopsy of the mass. In the case of a suspected Wilms tumor in a pediatric patient, obtaining a biopsy of the mass is least likely to be performed as the initial diagnostic investigation. This is because biopsy carries the risk of seeding tumor cells and potentially altering the staging and prognosis of the tumor. Option A) plain abdominal radiography may be used to assess for the presence of a mass or calcifications. Option B) and C) suggest performing CT scans of the abdomen and chest, respectively, which are commonly used to evaluate the extent of the tumor and assess for metastasis. In an educational context, understanding the appropriate diagnostic approach in suspected cases of Wilms tumor is crucial for healthcare providers managing pediatric oncology cases. By recognizing the importance of avoiding biopsy as the initial step, providers can ensure optimal patient care and outcomes by following evidence-based diagnostic guidelines.

Correct Answer: D

Rationale: Kasabach-Merritt syndrome is a rare condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy. The correct answer is D) association with infantile hemangiomas. This is because Kasabach-Merritt syndrome is not directly associated with infantile hemangiomas; rather, it is a severe complication that can occur alongside large vascular tumors like kaposiform hemangioendothelioma and tufted angioma. Option A) thrombocytopenia is a characteristic feature of Kasabach-Merritt syndrome, as the vascular tumor can lead to platelet consumption and subsequent low platelet counts. Option B) microangiopathic hemolytic anemia is also seen in this syndrome due to the destruction of red blood cells as they pass through the abnormal blood vessels. Option C) coagulopathy is a common manifestation in Kasabach-Merritt syndrome, as the abnormal blood vessels can lead to abnormal clotting factors and bleeding tendencies. In an educational context, understanding the features of Kasabach-Merritt syndrome is crucial for healthcare providers, especially those working in pediatrics. Recognizing these clinical signs early can lead to prompt diagnosis and appropriate management, which often involves a multidisciplinary approach. This question helps reinforce the key characteristics of Kasabach-Merritt syndrome and highlights the importance of considering this diagnosis in pediatric patients presenting with vascular tumors and associated complications.

Correct Answer: A

Rationale: The correct answer is A) Let's talk about preventing and managing your asthma on a daily basis at home. This response is the best because it acknowledges the adolescent's concerns, shows empathy, and shifts the focus to empowering the patient to take control of their asthma management. By discussing prevention strategies and daily management techniques, the nurse can help the patient feel more confident in managing their condition outside of the hospital setting. Option B is incorrect because it bypasses directly addressing the adolescent's feelings and needs by immediately involving the parents. While parental involvement is essential, the immediate need is to address the adolescent's emotional state and empower them. Option C is incorrect because it does not address the underlying issue of helping the patient manage their asthma effectively at home. Prolonged hospital stays are not always the best solution and can disrupt the patient's daily life and routine. In an educational context, it is crucial for pediatric nurses to recognize and address the emotional well-being of adolescent patients with chronic conditions like asthma. By providing support, education, and tools for self-management, nurses can help adolescents feel more in control of their health and reduce the likelihood of hospital readmissions. Empowering patients to manage their conditions independently is key to improving their quality of life and health outcomes.