The serum alpha-fetoprotein (AFP) level is elevated with some malignant germ cell tumors (GCTs) especially endodermal sinus tumors; it can be used as a measure of treatment response and during follow-up after completion of chemotherapy. However, it is normally elevated during infancy. At which age does AFP physiologically fall to normal adult level?

Correct Answer: C

Rationale: In pediatric oncology, understanding tumor markers like alpha-fetoprotein (AFP) is crucial for diagnosis and monitoring treatment response. The correct answer is C) one year because AFP physiologically falls to normal adult levels around this age. During infancy, AFP levels are naturally elevated, making it challenging to detect abnormalities. By one year of age, the AFP levels typically decrease to adult levels, allowing for accurate interpretation in the context of GCTs. Option A) three months is incorrect because AFP levels are still elevated at this age, reflecting normal infant physiology. Option B) eight months is also incorrect as AFP levels usually remain elevated in infancy. Option D) three years is incorrect as AFP levels should normalize by one year, not three years. Educationally, this question highlights the importance of understanding age-related variations in tumor markers like AFP in pediatric oncology. Recognizing the normal developmental patterns of AFP levels can help healthcare providers differentiate between benign elevations and those indicative of malignant conditions, guiding appropriate clinical management.

Correct Answer: C

Rationale: The correct answer is C) myxopapillary ependymoma. This type of tumor commonly arises from the filum terminale and conus medullaris, which are the exact locations described in the scenario. Myxopapillary ependymomas are slow-growing tumors that predominantly affect the lower spinal cord region, leading to symptoms such as lower limb weakness, sensory deficits, and bladder dysfunction, as seen in the case of this 6-year-old child. Option A) medulloblastoma is incorrect because it is a malignant embryonal tumor that typically arises in the cerebellum, not in the filum terminale or conus medullaris. Option B) anaplastic astrocytoma is incorrect as it is a type of high-grade glioma that arises from astrocytes in the brain, not in the spinal cord. Option D) choroid plexus carcinoma is incorrect because it originates from the choroid plexus within the brain ventricles, not in the spinal cord. Educationally, understanding the specific locations and characteristics of different CNS tumors is crucial for accurate diagnosis and management. This question highlights the importance of recognizing the typical presentation and site of origin of myxopapillary ependymoma in pediatric patients with spinal cord involvement.

Correct Answer: D

Rationale: The correct answer is D) it can be associated with von Hippel-Lindau disease. This is false because renal cell carcinoma (RCC) in children is not typically associated with von Hippel-Lindau disease, unlike in adults where this genetic condition can predispose individuals to RCC. Option A is true as patients with RCC may present with hematuria, flank pain, and/or a palpable mass. Option B is also correct as RCC can be asymptomatic and incidentally detected on imaging studies. Option C is true as RCC in children can indeed metastasize to the lungs, bone, liver, and brain, highlighting the aggressive nature of this cancer in pediatric patients. Educationally, understanding the unique characteristics of renal cell carcinoma in children is crucial for healthcare providers working in pediatric oncology. Recognizing the clinical presentation, metastatic potential, and associated genetic conditions can aid in early diagnosis and appropriate management of this rare but serious pediatric malignancy.

Correct Answer: E

Rationale: In Langerhans cell histiocytosis (LCH), the organ that is LEAST likely affected is the ear. LCH is a rare disorder characterized by the overproduction of Langerhans cells in the body. These cells can infiltrate various organs and tissues, causing a range of symptoms. The skin is commonly affected in LCH, presenting as rashes, papules, or nodules. Bones are another commonly affected site, leading to bone pain, fractures, and deformities. Involvement of lymph nodes, especially the mediastinal lymph nodes, is also common in LCH. The ear, however, is less frequently affected in LCH compared to the skin, bones, and lymph nodes. While it is still possible for Langerhans cells to infiltrate the ear and cause symptoms such as otitis externa or otitis media, it is relatively less common compared to other organs. Educationally, understanding the typical organ involvement in LCH is crucial for healthcare professionals caring for pediatric patients. Recognizing the pattern of organ involvement can aid in early diagnosis and appropriate management of this condition, improving patient outcomes.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) lawyer regarding a child abuse case. This is in alignment with the Health Insurance Portability and Accountability Act (HIPAA) regulations that permit the disclosure of patient information without consent in cases of suspected child abuse. It is crucial for healthcare providers to comply with reporting requirements to protect vulnerable children from harm. Option A) consulting physician to evaluate the patient is incorrect because sharing patient information with another healthcare provider requires patient consent or a valid legal reason. Option C) school nurse to update the school records is incorrect as sharing patient information with school personnel typically requires parental consent to maintain confidentiality. Option D) teacher regarding behavioral issues is also incorrect as sharing patient information with school staff for non-medical reasons would violate patient privacy rights. Educationally, understanding HIPAA regulations is essential for healthcare professionals, especially when dealing with sensitive issues like child abuse. By knowing the exceptions to confidentiality rules, nurses can ensure they are acting ethically and legally in their practice, prioritizing the well-being of children above all else.