PGICH Noida NO-2025
Child Health Nursing (Pediatrics)
Hard
All of the following are high-risk prognostic features in acute lymphoblastic leukaemia (ALL), EXCEPT:
Appeared in: PGICH Noida NO-2025
Explanation
- The correct option identifies a patient profile with favorable prognostic features for Acute Lymphoblastic Leukemia (ALL).
- Being a 'Female toddler' combines two key standard-risk factors: female sex and an age between 1 and 9 years.
- According to risk stratification guidelines, patients in the 1-9 year age group have the best prognosis.
- Female patients generally have a better prognosis compared to male patients in childhood ALL.
- Therefore, this profile is associated with a standard or low risk, not a high risk.
Why Other Options Were Wrong
- Option A: A 'Male infant' represents two distinct high-risk factors. Age below 1 year (infancy) and male sex are both independently associated with a poorer prognosis in ALL.
- Option B: The presence of lymphadenopathy (enlarged lymph nodes) indicates extramedullary disease, meaning the leukemia has spread outside the bone marrow. This is a sign of a higher tumor burden and is considered a high-risk feature.
- Option C: The presence of hepatosplenomegaly (enlarged liver and spleen) is also a sign of extramedullary disease and a high tumor burden. It is classified as a high-risk prognostic feature.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Prognostic factors in Acute Lymphoblastic Leukemia (ALL) as background academic context rather than a clinical decision trigger.
- Understanding risk stratification in ALL is critical for nurses in oncology. It determines the intensity of the chemotherapy regimen the patient will receive.
- High-risk patients receive more intensive and potentially more toxic therapy to combat the aggressive nature of their disease, requiring vigilant nursing monitoring for side effects.
- Nurses play a key role in educating families about the patient's risk category and what it means for their treatment plan and prognosis.
How to Approach the Question
- First, identify the core concept of the question, which is 'high-risk prognostic features in ALL'.
- Note the keyword 'EXCEPT'. This means you are looking for the option that is NOT a high-risk feature, i.e., a low-risk or favorable feature.
- Evaluate each option against the criteria for ALL risk stratification.
- Option A (Male infant): Male sex is high-risk, and age <1 year is high-risk. This is a high-risk feature.
- Option B (Lymphadenopathy): This indicates extramedullary disease, which is a high-risk feature.
- Option C (Hepatosplenomegaly): This also indicates extramedullary disease and is a high-risk feature.
Concept Tested & Keywords
- Concept Tested: Prognostic factors in Acute Lymphoblastic Leukemia (ALL)
- Stem keywords: acute lymphoblastic leukaemia, ALL, high-risk prognostic features
- Lead-in keywords: EXCEPT
- Negative lead-in flag: The question asks for the factor that is NOT high-risk, requiring you to identify the favorable prognostic feature among the options.
Question ID
Qww_2LFwnKnoMD2LUoAMiM
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 900-902
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 599-601
Practise the full PGICH Noida NO-2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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