Osteosarcoma is the most common primary malignant bone tumor in children and adolescents; it has multiple subtypes and requires different modalities of treatment including surgery and chemotherapy. Of the following, the subtype of osteosarcoma which is treated by surgery alone is

Correct Answer: D

Rationale: The correct answer is D) periosteal. Periosteal osteosarcoma is a subtype that is typically treated with surgery alone. Unlike other subtypes such as fibroblastic, chondroblastic, and parosteal osteosarcoma which often require a combination of surgery and chemotherapy, periosteal osteosarcoma is a low-grade tumor that can often be effectively treated through surgical resection alone. Fibroblastic and chondroblastic osteosarcomas are more aggressive subtypes that usually necessitate a multimodal approach involving surgery and chemotherapy to achieve the best outcomes. Parosteal osteosarcoma, although less common, also typically requires a combination of surgery and chemotherapy due to its location and characteristics. In an educational context, understanding the different subtypes of osteosarcoma and their respective treatment modalities is crucial for healthcare providers working with pediatric oncology patients. This knowledge helps in making informed decisions regarding treatment planning and providing optimal care to patients with osteosarcoma. By differentiating the subtypes and their treatment approaches, healthcare professionals can tailor interventions to individual patient needs, improving outcomes and quality of life.

Correct Answer: D

Rationale: In anaplastic large cell lymphoma (ALCL), primary mediastinal involvement is more specific compared to other types of non-Hodgkin lymphoma. The characteristic presentation of ALCL often includes a mass in the mediastinum. This is due to the high expression of the CD30 antigen in ALCL cells, leading to a propensity for mediastinal lymph node involvement. This feature helps differentiate ALCL from other lymphomas. Option A, primary bone marrow involvement, is not specific to ALCL and can be seen in various lymphomas. Option B, intestinal involvement, is more typical of other types of lymphoma such as mucosa-associated lymphoid tissue (MALT) lymphoma. Option C, CNS involvement, is more commonly associated with lymphomas like Burkitt lymphoma or primary CNS lymphoma. Educationally, understanding the distinct clinical features of different types of lymphomas is crucial for accurate diagnosis and appropriate management. Recognizing specific manifestations like primary mediastinal involvement in ALCL can aid healthcare providers in providing targeted care and optimizing patient outcomes.

Correct Answer: B

Rationale: In this scenario, the BEST therapeutic approach for a 2-year-old child with a ruptured Wilms tumor is concomitant chemotherapy-radiotherapy (Option B). This approach is chosen because Wilms tumor is a type of kidney cancer that commonly affects children, and a multimodal treatment plan involving both chemotherapy and radiotherapy has been shown to be the most effective in improving survival rates and reducing the risk of recurrence. Option A, radiotherapy alone, is not the preferred treatment because Wilms tumor typically requires a combination of chemotherapy and radiotherapy for optimal outcomes. Option C, another surgery, is not the immediate course of action for a ruptured Wilms tumor as the primary treatment involves a combination of chemotherapy and radiotherapy. Option D, observation, is not suitable in this case as Wilms tumor is an aggressive cancer that requires prompt and aggressive treatment to improve outcomes. Educationally, it is crucial for healthcare providers, especially those specializing in pediatric oncology, to understand the importance of multimodal treatment approaches in managing pediatric cancers like Wilms tumor. This case emphasizes the significance of evidence-based practice and multidisciplinary collaboration in providing the best possible care for pediatric oncology patients.

Correct Answer: C

Rationale: In this scenario, option C, stating that supraphysiologic levothyroxine therapy is required during long-term follow-up, is the most appropriate statement to include in the discussion with the parents of a 12-year-old girl diagnosed with papillary thyroid carcinoma (PTC). The rationale for choosing option C is that children with PTC often require thyroid hormone replacement therapy to suppress thyroid-stimulating hormone (TSH) levels, which can help prevent the recurrence of cancer. Supraphysiologic doses of levothyroxine are often necessary to achieve this goal, making this statement crucial for the long-term management of the condition. Option A is incorrect because PTC, while a serious condition, does not necessarily have a grim overall prognosis, especially with appropriate treatment and follow-up care. Option B is incorrect because radioactive iodine therapy is commonly used in the treatment of differentiated thyroid cancers like PTC. Option D is incorrect because calcitonin/carcinogenic antigen monitoring is more relevant for medullary thyroid carcinoma, not papillary thyroid carcinoma. In an educational context, understanding the specific management strategies and follow-up care for pediatric patients with papillary thyroid carcinoma is essential for healthcare providers working with this population. Providing accurate information to parents and caregivers can help them better understand the treatment plan and support the long-term health and well-being of their child.

Correct Answer: A

Rationale: In this scenario, the correct action for the pediatric nurse to take is option A) ask the parent in a nonjudgmental manner about the herbs. This is the most appropriate initial step because it allows the nurse to gather information directly from the parent about the herbs, their purpose, and their administration to the child. By approaching the parent in a nonjudgmental manner, the nurse can establish open communication, gather pertinent information, and address any concerns or misconceptions the parent may have regarding the use of herbs. Option B) coordinating a nursing care conference to discuss the patient's plan of care is not the most immediate or relevant action in this situation. While discussing the patient's plan of care is important, addressing the use of herbs should take precedence as it directly impacts the child's treatment and well-being. Option C) discussing the risks of using alternative therapies with the parent may be appropriate but should follow gathering more information about the specific herbs being used. Jumping straight to discussing risks without understanding the parent's perspective may lead to misunderstandings and hinder effective communication. Option D) referring the family to a social worker for possible nonadherence with the healthcare regimen is premature without first clarifying the situation with the parent. This option assumes nonadherence without gathering facts and could potentially strain the nurse-parent relationship. In an educational context, this question highlights the importance of effective communication and collaboration with families in pediatric care. Nurses must approach situations with cultural humility, respect for diverse beliefs and practices, and a commitment to understanding families' perspectives to provide holistic and patient-centered care. Asking open-ended, nonjudgmental questions promotes trust and allows nurses to address parental concerns, ensure safe care practices, and enhance overall patient outcomes.