A 4-year-old child is brought to the pediatric clinic with complaints of abdominal swelling.
On examination, a firm, non-tender mass is palpable in the right flank.
The child's mother reports no pain or fever but mentions that her child was born with aniridia (genetic eye disorder). Based on these findings, what is the most likely diagnosis?
Nephroblastoma.
Neuroblastoma.
Hepatoblastoma.
Hydronephrosis.
The Correct Answer is A
Choice A rationale
Nephroblastoma, also known as Wilms tumor, is the most common malignant renal tumor in young children, typically presenting between the ages of 3 and 4 years. A firm, non-tender abdominal mass, often in the right flank, is a classic finding. The association with aniridia, a congenital absence of the iris, is a known risk factor for Wilms tumor, occurring in WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies, and intellectual disability).
Choice B rationale
Neuroblastoma is a cancer that arises from immature nerve cells and can occur in various locations, most commonly the adrenal glands. While it can present with an abdominal mass, it is often associated with other symptoms such as fever, weight loss, and irritability due to catecholamine secretion. It is less specifically linked to aniridia than nephroblastoma.
Choice C rationale
Hepatoblastoma is a rare malignant tumor of the liver that typically presents in children younger than 3 years old. While it causes abdominal swelling due to a liver mass, it is not typically associated with aniridia. Palpation might reveal a mass in the upper right quadrant rather than the flank.
Choice D rationale
Hydronephrosis refers to the swelling of a kidney due to a buildup of urine. While it can cause an abdominal mass, it is often associated with urinary symptoms or pain, which are not reported in this case. Furthermore, it is not a malignancy and has no known association with aniridia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Washing bedding and recently worn clothing in hot water (above 54°C or 130°F) helps to kill lice and their nits (eggs) that may be present on these items, preventing re-infestation or spread to others. The heat denatures the proteins essential for the lice's survival.
Choice B rationale
Sealing non-washable items in a plastic bag for 2 weeks suffocates any lice and allows any hatched nymphs to die due to lack of a blood meal. Lice cannot survive for extended periods away from a human host.
Choice C rationale
Both washing bedding and clothing in hot water and sealing non-washable items are crucial steps in eliminating head lice and preventing recurrence or transmission. Therefore, all of the above instructions should be provided to parents.
Choice D rationale
Notifying the school allows for screening of other children and implementation of appropriate measures to prevent further spread of the head lice within the school environment. While important for public health, it is an action separate from the direct treatment and environmental control measures that parents should undertake at home.
Correct Answer is C
Explanation
Choice A rationale
Gastroenteritis typically presents with vomiting, diarrhea, and abdominal pain. While a sore throat can occur with some viral gastroenteritis, excessive drooling and refusal to eat are less common primary symptoms.
Choice B rationale
A viral infection causing a sore throat can lead to refusal to eat and some difficulty swallowing, potentially causing mild drooling. However, excessive drooling and the described level of distress are less typical of a simple viral sore throat.
Choice C rationale
Excessive drooling, coughing, distress, and refusal to eat in a young child are highly suggestive of foreign body ingestion causing airway obstruction or irritation of the esophagus or trachea. The body's attempt to expel the object and the difficulty swallowing saliva lead to drooling and coughing.
Choice D rationale
An allergic reaction can cause throat swelling and difficulty breathing, but excessive drooling is not a primary symptom. Hives, itching, or other systemic symptoms would also likely be present.
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