June Week 2

Abdominal Masses in Children: Neuroblastoma, Wilms tumor, and other Considerations
by Armand E. Brodeur, MD MRd, LLD, FACR, FAAP and Garrett M. Brodeur, MD
Pediatrics in Review, Vol. 12, No. 7, January 1991, pages 196-206

1. Abdominal masses are more likely to be malignant in
A. older children than infants
B. infants

2. What is the differential diagnosis of masses in the RUQ?

3. What is the differential diagnosis of masses in the LUQ?

4. What is the differential diagnosis of masses in the RLQ?

5. If it’s not a mass of impacted stool, what is the likely origin of a mass in a girl’s LLQ?

6. What are the two most common malignant solid tumors in children?

7. You are the Sick Resident seeing kid after kid with diarrhea in an especially bad week. When sorting out the gastroenteritis from the overflow diarrhea, and the improperly mixed formula from the allergic enteritis, and the traveller’s diarrhea from the inflammatory bowel disease, you should keep Dr. Shad’s voice in the back of your head saying, “Don’t forget about…
A. vasoactive intestinal peptide-secreting neuroblastoma
C. Wilms tumor
D. irritable bowel syndrome

8. You are in CYAS listening to the astute GT3 present your patient upon whom you have yet to lay eyes. It’s a 3 year old boy there for a well child check, whose mother is concerned that he won’t eat his veggies and is refusing to poop on the toilet since his baby brother was born. When the GT3 tells you she thinks she can feel the mass of stool the mom is talking about, which additional physical exam finding will make you wonder if this is really poop everyone is feeling?
A. anirida
B. hemihypertrophy
C. both A & B

9. The median age at diagnosis of children with neuroblastoma is
A. 22 months
B. 6 months
C. 4 years
D. 10 years

10. Neuroblastoma has a propensity to involve the bones of the 
A. skull and orbit
B. hands
C. lower extremities

11. What are the two most important studies to be ordered by a general pediatrician on a patient who has an abdominal mass?
A. chest x-ray and abdominal ultrasound
B. chest x-ray and abdominal x-ray
C. abdominal x-ray and pelvic ultrasound
D. abdominal CT scan

12. Describe the staging system for Wilms tumor