Answer to Question 1
B
Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may be irritable or lethargic, feed poorly, and have increased head circumference with a bulging fontanel. Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor but would not be able to be verbalized by an infant. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor, but infants do not get themselves out of bed in the morning. Increased intracranial pressure resulting from a brain tumor is manifested as a headache but could not be verbalized by an infant.
Answer to Question 2
C
In TLS, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure. TLS is related to intracellular electrolytes overloading the kidney as a response to the rapid lysis of tumor cells. This does not affect the liver, the CNS, or the lungs and cause respiratory distress.
