You are discussing physical child abuse with medical students; you state that fractures are common presentation and those that should raise suspicion for abuse include fractures that are unexplained, occurring in young, non-ambulatory children, or involve multiple bones. Of the following, the site of the fracture that is LESS specific for abuse is

Correct Answer: D

Rationale: In the context of discussing physical child abuse, it is crucial to highlight the specific signs that may raise suspicion for abuse. In this case, the correct answer is D) vertebra. Fractures involving the vertebra are less specific for abuse compared to fractures in other locations such as ribs, scapula, or skull. Vertebral fractures can sometimes occur due to accidental trauma or medical conditions, making them less indicative of abuse on their own. On the other hand, fractures in ribs, scapula, and skull are more concerning in the context of child abuse due to their relative rarity in accidental injuries, especially in young, non-ambulatory children. Educationally, understanding the patterns of injuries associated with child abuse is essential for healthcare professionals, particularly those working with pediatric patients. By recognizing the specific signs that raise suspicion for abuse, medical students can advocate for the well-being of their young patients and ensure appropriate intervention and support for victims of abuse. This knowledge is vital in protecting vulnerable children and promoting their safety and health.

Correct Answer: D

Rationale: In this scenario, the most effective treatment for the 5-year-old child with ileocecal Burkitt lymphoma and elevated serum uric acid levels is option D, recombinant urate oxidase. This is because the child is at risk for tumor lysis syndrome (TLS), a potential complication of cancer treatment characterized by metabolic abnormalities like hyperuricemia. Recombinant urate oxidase helps convert uric acid into a more soluble form, preventing uric acid crystallization and subsequent kidney damage. Option A, excessive hydration, is not the most effective treatment as it may dilute the uric acid concentration but does not address the underlying issue of converting uric acid into a more soluble form. Option B, sodium bicarbonate, is used to alkalinize the urine in TLS but does not directly lower uric acid levels. Option C, xanthine oxidase inhibitor, is used in chronic hyperuricemia but may not be as effective in acute TLS. Educationally, understanding the pathophysiology of TLS and the role of recombinant urate oxidase in managing hyperuricemia can help healthcare providers make informed treatment decisions in pediatric oncology cases. This case highlights the importance of prompt and appropriate management to prevent complications associated with TLS in pediatric patients with malignancies.

Correct Answer: A

Rationale: 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 abdominal mass, often discovered incidentally, and is commonly seen in very young children. The age of the infant in the scenario fits the typical age range for Wilms tumor diagnosis. Option B) neuroblastoma is a neural crest tumor that typically arises in the adrenal glands or sympathetic ganglia, not in the kidney. Option C) mesoblastic nephroma is a rare benign renal tumor that is more commonly seen in infants less than 3 months of age, making it less likely in this case. Option D) clear cell sarcoma is a rare tumor that usually occurs in older children and adolescents, not in infants. In an educational context, understanding the typical age of presentation, common clinical features, and prevalence of different pediatric tumors is crucial for healthcare providers in diagnosing and managing pediatric patients effectively. Recognizing the characteristic features of nephroblastoma and distinguishing it from other pediatric renal masses is essential for providing appropriate care and guiding further diagnostic and treatment plans.

Correct Answer: A

Rationale: In the context of nasopharyngeal carcinoma prognosis, an elevated lactate dehydrogenase (LDH) level carries the worst outcome among the options provided. LDH is a marker of tissue damage and cell turnover, and elevated levels are associated with more aggressive disease and poorer prognosis in various cancers, including nasopharyngeal carcinoma. Option B, advanced disease, is a general term that does not specify a specific prognostic factor, whereas LDH level directly correlates with disease aggressiveness. Option C, extensive cervical lymph node involvement, is a common feature of nasopharyngeal carcinoma but may not necessarily indicate the worst prognosis. Option D, evidence of Epstein-Barr virus (EBV) DNA, is actually associated with a better prognosis as EBV positivity is linked to a more favorable response to treatment. In an educational context, understanding prognostic factors in pediatric oncology is crucial for healthcare providers to make informed decisions regarding patient management and treatment strategies. Recognizing the significance of specific markers like LDH levels can guide clinicians in determining the appropriate interventions and predicting patient outcomes.

Correct Answer: A

Rationale: The correct approach for the management of a healthy 20-day-old male with a palpable liver margin, elevated white blood count, low hemoglobin, and blast cells consistent with acute myeloproliferative disorder is intensive chemotherapy (Option A). Intensive chemotherapy is the standard treatment for acute myeloproliferative disorders in children. It aims to reduce the blast cell population, restore normal blood cell production, and prevent disease progression. Low dose chemotherapy pulses (Option B) may not be sufficient to adequately treat the aggressive nature of acute myeloproliferative disorders in pediatric patients. Bone marrow transplantation (Option C) is usually reserved for cases of refractory or relapsed disease, or when intensive chemotherapy fails. Close follow-up (Option D) alone is not a sufficient treatment for acute myeloproliferative disorders, as prompt intervention with chemotherapy is necessary to improve outcomes in these cases. In an educational context, understanding the appropriate treatment for pediatric hematologic disorders is crucial for healthcare providers working with children. Recognizing the need for intensive chemotherapy in this scenario highlights the importance of timely and effective management to improve patient outcomes and reduce the risk of disease progression.