A clinical feature seen in Wilm's tumor?

Appeared in: NORCET-7 Mains-2024

Explanation

The most common initial sign of Wilms' tumor is an asymptomatic, palpable abdominal mass.
This mass is typically firm, smooth, non-tender, and located on one side of the abdomen (unilateral).
It is often discovered incidentally by parents or during a routine physical examination.
Other associated signs can include hypertension, hematuria (blood in urine), and abdominal pain, but the mass is the most frequent presenting feature.

Option B: Wilms' tumor is a cancer of the kidney, which is an abdominal organ, not a thoracic (chest) organ.
Option C: The tumor originates in the kidney, located in the upper abdomen or flank area, not the pelvis.
Option D: This option is incorrect because a palpable abdominal mass is a well-established and the most common clinical feature of Wilms' tumor.

Clinical Relevance

Nursing practice connection: Knowing Clinical presentation of Wilms' tumor (nephroblastoma) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The single most important nursing consideration for a child with a known or suspected Wilms' tumor is to avoid palpating the abdomen. A sign stating 'DO NOT PALPATE ABDOMEN' should be prominently displayed at the child's bedside to prevent accidental rupture of the tumor capsule and seeding of cancer cells.
Nurses must closely monitor the child's blood pressure, as tumor-induced renin secretion can cause significant hypertension.
What if? If a child with an abdominal mass also presents with aniridia (absence of the iris), hemihypertrophy (one side of the body is larger than the other), and genitourinary anomalies, the nurse should have a high index of suspicion for WAGR syndrome, which is strongly associated with Wilms' tumor.

How to Approach the Question

First, identify the core subject of the question, which is 'Wilm's tumor'.
Next, analyze the specific detail requested: a 'clinical feature'. This requires recalling the signs and symptoms of the disease.
Evaluate each option based on your knowledge of Wilms' tumor pathophysiology and location.
Recall that Wilms' tumor is a kidney tumor. The kidneys are located in the abdomen. This helps eliminate options related to the thorax or pelvis.
Remember the classic presentation: a parent often discovers a lump in the child's belly. This points directly to a 'palpable abdominal mass' as the key feature.

Concept Tested & Keywords

QU9IcP84lxC1fBkjexu5hK

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 936-938

Practise the full NORCET-7 Mains-2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.