A 13-year-old girl sustains a minor injury to the left side of her back in a school basketball game. On examination little is found except for asymmetric shoulder levels. While she bends over, the right posterior chest is elevated.
Which of the following are these findings most readily suggestive of?
Correct Answer D:
Scoliosis is lateral curvature of the spine. It can be detected in 2 to 3% of children aged 10 to 16 years; 60 to 80% are girls.
Scoliosis may first be suspected when one shoulder seems higher than the other or when clothes do not hang straight, but it is often detected during routine physical examination. Patients may initially report fatigue in the lumbar region after prolonged sitting or standing. Muscular backaches in areas of strain (eg, in the lumbosacral angle) may follow.
The curve is most pronounced when patients bend forward. Most curves are convex to the right in the thoracic area and to the left in the lumbar area, so that the right shoulder is higher than the left. X-ray examination should include standing anteroposterior and lateral views of the spine.
The greater the curve, the greater the likelihood that it will progress after the skeleton matures. Curves > 10° are considered significant. Prognosis depends on site and severity of the curve and age at symptom onset. Significant intervention is required in < 10% of patients.
A 10-year-old girl is referred to the clinic by the school nurse for evaluation of scoliosis. The girl's scoliosis was detected during a routine screening examination at the school, and it appears to be mild (curve less than 10 degrees). She is athletic and is otherwise in good health.
During the physical examination, particular attention should be given to which of the following?
Correct Answer E: The treatment of scoliosis is dependent on the age of the patient and curve progression. Premenarchal females have a greater chance of curve progression then females one to two years after menarche with similar curves. Curves of less than 25 degrees are observed and reevaluated every four to six months. The stage of pubertal development is important to note because a patient who has attained menarche will only have a small amount of additional growth; therefore, scoliosis will not progress.
A 2-year-old boy with visible abdominal distention is found to have a large left-sided flank mass.
Which one of the following is the most likely diagnosis?
Wilms tumor is an embryonal cancer of the kidney composed of blastemal, stromal, and epithelial elements. Genetic abnormalities have been implicated in the pathogenesis, but familial inheritance accounts for only 1 to 2% of cases.
Wilms' tumor usually presents in children younger than 5 years but occasionally in older children and rarely in adults. Wilms' tumor accounts for about 6% of cancers in children < 15 years.
The most frequent presentation is a painless, palpable abdominal mass. Less frequent findings include abdominal pain, hematuria, fever, anorexia, nausea, and vomiting.
Diagnosis is made by ultrasound and abdominal CT scan and confirmed by biopsy. Treatment may include surgical resection, chemotherapy, and radiation therapy.
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