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You are evaluating a 6-mo-old girl with a firm right suprarenal mass. Histologically, there is no bony involvement, 10% bone marrow involvement, subcutaneous nodules involvement, and massive abdominal mass. The N-myc oncogene is not amplified. According to the international neuroblastoma staging system, the infant is stratified as
- A. stage I
- B. stage II A
- C. stage III
- D. stage IV S
Correct Answer: D
Rationale: Stage IV S refers to infants <1 year with localized primary tumor, distant metastases limited to liver, skin, or bone marrow (with <10% involvement), and no amplification of N-myc.
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An adult is on a clear liquid diet. Which food item can be offered/
- A. Milk
- B. Orange juice
- C. Jello
- D. Ice cream
Correct Answer: C
Rationale: When an adult is on a clear liquid diet, foods that are easy to digest and leave little residue in the gastrointestinal tract are recommended. Clear liquids include water, broth, fruit juices without pulp, and gelatin desserts like Jello. Jello is a good option because it is easily digestible, does not leave residue, and provides some calories and hydration. Milk, orange juice, and ice cream should be avoided on a clear liquid diet as they are not considered clear liquids and may not be as easily digestible.
The parent of a 3-year-old with suspected Wilms tumor says, 'How could I have missed a lump this big?' Which is the best response?
- A. Don't be hard on yourself; it's easy to miss something growing slowly.
- B. I understand you're upset; earlier detection might have improved prognosis.
- C. It takes a trained professional to notice such a lump.
- D. This tumor grows rapidly and may not have been noticeable just a few days ago.
Correct Answer: D
Rationale: Wilms tumor can grow very quickly, so a lump that was not evident previously may become noticeable in a short period.
Orchitis and sterility in male result as serious complication of
- A. rubella
- B. measles
- C. mumps
- D. diphtheria 126
Correct Answer: C
Rationale: Orchitis refers to the inflammation of the testicles, which can occur as a complication of mumps infection in males. Mumps is a viral infection caused by the mumps virus, and one of the common complications of mumps in males is orchitis. Orchitis can lead to testicular damage and potentially result in sterility if both testicles are affected. It is essential for males to receive the MMR (measles, mumps, rubella) vaccine to prevent mumps infection and its associated complications, including orchitis and sterility.
A one month old infant is admitted for confirmation of the diagnosis of ventricular septal defect. During the initial admission assessment, the nurse would expect to find:
- A. Bradycardia at rest
- B. Bounding peripheral pulses
- C. An activity related cyanosis
- D. A murmur at the left sternal border. 105
Correct Answer: D
Rationale: A ventricular septal defect (VSD) is a congenital heart defect where there is an abnormal opening between the two ventricles of the heart. One of the hallmark signs of VSD is the presence of a murmur, specifically a holosystolic murmur, which is typically heard best at the left sternal border due to the turbulent blood flow through the defect. This murmur is a key finding during the initial assessment of a patient with a suspected VSD. Other common symptoms of VSD include poor feeding, failure to thrive, tachypnea, and frequent respiratory infections.
A 5-year old boy presents with afebrile generalized tonic-clonic seizure lasting for 5 minutes. Previously he was healthy and had no such problem. On examination there is no abnormality. Your plan of management should be:
- A. Start anticonvulsant therapy
- B. Request for an EEG and wait for its report
- C. Request for an EEG and start anticonvulsant therapy immediately
- D. Request for EEG and MRI brain
Correct Answer: C
Rationale: In a first-time generalized seizure, an immediate EEG and starting anticonvulsant therapy is prudent to prevent recurrence, especially if the EEG shows epileptiform activity.