Sexual abuse should be considered in children who have behavioral problems, although no behavior is pathognomonic. Which of the following behavior should raise the suspicion of sexual abuse?

Correct Answer: D

Rationale: In pediatric practice, the identification of potential signs of sexual abuse is crucial for early intervention and protection of the child. The behavior of hypersexuality should raise suspicion of sexual abuse due to its association with exposure to inappropriate sexual behaviors or experiences beyond the child's developmental stage. Children who exhibit hypersexual behavior may have been exposed to sexual content or actions that are not age-appropriate, indicating possible abuse. Aggressive behavior (option A) can be a response to various stressors and is not specific to sexual abuse. Obsessive-compulsive behavior (option B) is more commonly associated with anxiety disorders or certain developmental conditions rather than sexual abuse. Dissociative behavior (option C) might be present in children who have experienced trauma, including sexual abuse, but it is not specific enough to solely indicate sexual abuse. Educationally, it is important for healthcare providers and educators to be aware of the signs and symptoms of sexual abuse in children to provide appropriate support and referrals. Understanding the nuances of different behaviors and their potential causes can aid in early identification and intervention, ultimately safeguarding the well-being of children who may be at risk.

Correct Answer: B

Rationale: In discussing the risk of radiotherapy in children with medulloblastoma, it is crucial to address the concerns of parents regarding late neurological complications. Option B, "children with an age of less than 3 years," is the correct answer for the statement about late neurological sequelae post radiotherapy being more severe. This is because younger children have developing brains that are more sensitive to the effects of radiation, leading to increased risk and severity of neurological complications. Option A, "focal radiotherapy rather than craniospinal irradiation," is incorrect because craniospinal irradiation often involves a larger area but does not necessarily correlate with increased severity of late neurological sequelae. Option C, "concomitant chemo-radiotherapy," is incorrect as the addition of chemotherapy does not specifically worsen late neurological complications compared to radiation alone. Option D, "low-grade tumors rather than high-grade tumors," is incorrect since tumor grade does not directly impact the severity of late neurological sequelae post radiotherapy. Educationally, this question highlights the importance of considering age as a significant factor in treatment decisions for pediatric patients with medulloblastoma undergoing radiotherapy. Understanding the impact of age on treatment outcomes and potential complications is essential for healthcare providers when discussing treatment options with parents and making informed decisions for the well-being of the child.

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: C

Rationale: In Langerhans cell histiocytosis (LCH), manifestations in the lung are not typically associated with high mortality risk. The correct answer is C) lung. The lung involvement in LCH is common but usually does not lead to mortality. On the other hand, liver involvement (option A), splenic involvement (option B), and hematopoietic system involvement (option D) in LCH can lead to severe complications and increase the risk of mortality in patients. Educationally, understanding the specific organ involvement and associated risks in LCH is crucial for healthcare providers managing pediatric patients with this condition. This knowledge helps in early recognition of potentially life-threatening complications and enables prompt intervention to improve outcomes. It also highlights the importance of a multidisciplinary approach in the care of children with LCH, involving specialists from various fields to address the diverse manifestations of the disease.

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.