Surgery MCQs Q3

An 18-month-old infant is brought to the Accident & Emergency department by his mother. She reports failure to thrive, intermittent fever, and occasional blood in the diaper. On examination, a palpable renal mass is noted.

What is the most likely diagnosis?

A. Angioma of the renal artery

B. Nephroblastoma (Wilms tumor)

C. Transitional cell tumor of the ureter

D. Transitional cell tumor of the bladder

E. Adenocarcinoma of the kidney

✅ Correct Answer:

B. Nephroblastoma (Wilms tumor).

🔍 Decoding the Stem

• 💡 CLUE 1: Age – 18 months → Most Wilms tumors occur between 1–5 years of age.
• 💡 CLUE 2: Clinical features → Failure to thrive + Fever + Hematuria (blood in nappy).
• 💡 CLUE 3: Physical Exam → Palpable renal mass in a child is a classic presentation.

Why Nephroblastoma is Correct

Nephroblastoma is the most common renal malignancy in children. It typically presents as a unilateral, firm, smooth, non-tender abdominal mass. It may be associated with hypertension (renin secretion) and syndromes like WAGR or Beckwith-Wiedemann.

Why Other Options Are Incorrect

A, C, D: All are extremely rare in the pediatric population. Bladder/Ureter tumors usually present with obstructive symptoms rather than a large renal mass.

E. Adenocarcinoma: This is primarily an adult tumor (Renal Cell Carcinoma).

🧠 High-Yield Points

Most common renal tumor < 5 yrs → Wilms tumor
Classic Triad → Abdominal mass, hematuria, fever
Syndromes → WAGR, Beckwith-Wiedemann, Denys-Drash

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💡 Quick Clinical Challenge:

A physical exam finding shows absence of the iris in this child.

Your Challenge:

1. What is the name of this iris finding?
2. What acronym is used for the associated syndrome?

Show Answer

✅ Answer:

1. Aniridia (absence of the iris).
2. WAGR syndrome (Wilms, Aniridia, Genitourinary, Retardation).