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Fiser's ABSITE Ryan SHORT > Chapter 43 - Pediatrics I > Flashcards

Chapter 43 - Pediatrics I Flashcards

1
Q

What makes up the foregut?

A

Lungs, esophagus –> duodenum to ampulla + pancreas, liver, gallbladder

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2
Q

What makes up the midgut?

A

Duodenum from ampulla –> distal 1/3 of transverse colon

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3
Q

What makes up the hindgut?

A

Distal 2/3 transverse colon –> anal canal

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4
Q

Which way/how far does the midgut rotate?

A

270 degrees counterclockwise

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5
Q

What defines low birth weight? Premature?

A

<2,500g, <37wks

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6
Q

What makes up infant’s immunity at birth?

A

IgA from milk, IgM synthesized in child

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7
Q

What is the #1 cause of childhood death?

A

Trauma

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8
Q

What makes up a trauma bolus for kids?

A

20cc/kg x2; then give blood 10cc/kg

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9
Q

What is the best indicator of shock in peds?

A

Tachycardia Neonate: 150+ < 1 yo: 120+ > 1yo: 100+

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10
Q

What is the normal UOP for ped?

A

2-4cc/kg/hr

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11
Q

What % GFR capacity do kids have compared to adults?

A

25%; poor concentrating ability

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12
Q

What makes up the umbilical vessels?

A

2 arteries and 1 vein

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13
Q

What are maintenance IV fluids

A

4cc/kg/hr for the 1st 10 kg

2cc/kg/hr for the 2nd 10 kg

1cc/kg/hr for everything after that

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14
Q

What is pulmonary sequestration?

A

nonfunctioning mass of normal lung tissue that lacks normal communication with the tracheobronchial tree, and that receives its arterial blood supply from the systemic circulation.

  • Arterial supply MC from thoracic aorta or abdominal aorta through inferior pulmonary ligament.
  • Extra lobar: systemic venuous drainage via azygous system
  • Intra Lobar: pulmonary vein drainage
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15
Q

What is the most common presentation of pulmonary sequestration? Treatment?

A

Infection, respiratory compromise, abnormal CXR

Tx: Ligate arterial supply first (risk of severe hemorrhage) then lobectomy

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16
Q

What is congenital lobar overinflation (emphysema)?

A

Cartilage fails to develop in bronchus leading to air trapping with expiration

  • normal vascular suply
  • normal lobes
  • LUL most commonly affected
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17
Q

Presentation of congenial lobar overinflation? Treatment?

A

Can get vascular compromise (same mechanism as tension pneumo) or respiratory insufficiency

Tx: Lobectomy

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18
Q

What is congenital cystic adenoid malformation? (CCAM)

A

Alveolar structure not well developed although lung tissue is present, connects with airway

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19
Q

Presentation of congenital cystic adenoid malformation? Treatment?

A

Resp compromise and recurrent infection

Tx: Lobectomy

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20
Q

What is a bronchiogenic cyst?

A

Extrapulmonary cysts formed from bronchial tissue and cartilage wall

  • MC cyst of the mediastinum, usually posterior to the carina.
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21
Q

Presentation of bronchiogenic cyst? Treatment?

A

Presents as mediastinal mass filled with milky fluid, can compress adjacent structures or become infected

Tx: Cyst resection

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22
Q

What is the most common mediastinal mass in children?

A

Neurogenic tumors (neurofibroma, neuroganglionoma, neuroblastoma)

  • Usually located posterior
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23
Q

What symptoms are common to all mediastina masses regardless of location?

A

Respiratory symptoms, dysphagia

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24
Q

What are anterior mediastinal masses?

A

T cell lymphoma, teratoma (and other germ cell tumors), thymoma, thyroid ca

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25
Q

What are middle mediastinal masses?

A

T cel lymphoma, teratoma, cyst (cardiogenic, bronchiogenic)

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26
Q

What are posterior mediastinal masses?

A

T cell lymphoma, neuroblastoma, neurogenic tumors

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27
Q

What is the treatment for choledochal cysts?

Etiology?

A

All need resection do to risk of cholangiocarcinoma, pancreatitis, cholangitis, obstructive jaundice

Etiology: Reflux of pancreatic enzymes into biliary system in utero

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28
Q

What is a type I choledochal cyst?

%?

A

Fusiform dilation of entire common bile duct, mildly dilated CHD, normal intrahepatic ducts

85%

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29
Q

What is a type II choledochal cyst?

%?

A

True diverticulum that hangs off the common bile duct

3%

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30
Q

What is a type III choledochal cyst?

%?

A

Dilation of distal intramural common bile duct, involves sphincter of Oddi

1%

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31
Q

What is a type IV choledochal cyst? %?

A

Multiple cysts, both intra and extrahepatic 10%

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32
Q

What is type V choledochal cyst? Other name?

%?

A

Caroli’s disease Intrahepatic cysts, get hepatic fibrosis, may be associated with congenital hepatic fibrosis and medullary sponge kidney

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33
Q

What is lymphadenopathy most likely caused by?

A

Acute suppurative adenitis associated with URI or pharyngitis

34
Q

Workup for fluctuant lymphadenophathy? Asymptomatic?

A

Fluctuant: FNA, culture and sensitivity, abx; may need I&D

Asymptomatic: abx for 10d –>excisional biopsy if no improvement (lymphoma until proven otherwise)

35
Q

What causes chronic fluctuant lymphadenopathy?

A

Cat scratch fever, atypical mycoplasma

36
Q

What is cystic hygroma? Treatment?

A

Lymphangioma Found in lateral cervical and submandibular regions in neck, gets infected

Tx: Resection

37
Q

Overall survival of diaphragmatic hernias?

A

50%

38
Q

What % of diaphragmatic hernias have associated anomalies? What are they?

A

80% Cardiac and neural tube defects, malrotation

39
Q

Diaphragmatic hernias are increased on which side?

A

Left

40
Q

Treatment for diaphragmatic hernias?

A

High-frequency ventilation, ECMO, prostacyclin (pulmonary vasodilator); stabilize before operating, reduce bowel, repair +/- mesh, look for visceral anomalies (run the bowel)

41
Q

What is Bochdalek’s hernia?

A

Most common diaphragmatic hernia Posterior

42
Q

What is Morgagni’s hernia?

A

Rare diaphragmatic hernia Anterior

43
Q

What is eventration?

A

Failure of diaphragm to fuse

44
Q

Treatment for pectus excavatum?

A

(Sinks in) Sternal osteotomy, need strut Performed if causing respiratory symptoms or emotional distress

45
Q

Treatment for pectus craniatum?

A

(Pigeon chest) Strut not necessary Repair for emotional distress

46
Q

Branchial cleft cyst causes what?

A

Cysts, sinuses, fistulas

47
Q

Where is a 1st branchial cleft cyst? Associated with which nerve?

A

Angle of mandible, may connect with external auditory canal Facial nerve

48
Q

Where is a 2nd branchial cleft cyst?

A

On anterior border of SCM muscle, goes through carotid bifurcation into tonsillar pillar

49
Q

Where is a 3rd branchial cleft cyst?

A

Lateral neck

50
Q

What is the treatment for branchial cleft cysts? Which is most common?

A

Resection 2nd branchial cleft cyst most common

51
Q

Where is a thyroglossal duct cyst? Presentation?

A

From descent of thyroid gland from foramen cecum, goes through hyoid Presents as midline cervical mass

52
Q

Treatment for thyroglossal duct cyst?

A

Resection of cyst, tract, and hyoid bone

53
Q

Characteristics of hemangioma?

A

Appears at birth or shortly after Rapid growth between 6-12mo, then begins to involute

54
Q

Treatment of hemangioma?

A

Observation Steroids, laser/surgery if uncontrollable growth, impairs function (eyelid/ear canal), persistent after age 8

55
Q

What is the #1 solid abdominal malignancy in children?

A

Nueroblastoma

56
Q

How do neuroblastomas usually present?

A

Asymptomatic mass Can have secretory diarrhea, raccoon eyes (orbital mets), HTN, opsomy oclonus syndrome (unsteady gait)

57
Q

What is the most common location of neuroblastomas?

A

Adrenals; can occur anywhere on sympathetic chain

58
Q

Most common lab findings with neuroblastoma?

A

Elevated catecholamines, VMA, HVA, metanephrines

59
Q

Abd xray findings of neuroblastoma?

A

Stippled calcifications in tumor

60
Q

What is elevated in all patients with neuroblastoma mets?

A

Elevated NSE

61
Q

Treatment for neuroblastoma?

A

Resection (30-40% cured), chemo if initially unresectable

62
Q

Presentation of Wilms tumor?

A

Usually as asymptomatic mass Hematuria, HTN, 10% bilateral

63
Q

What is prognosis of Wilms tumor based on?

A

Tumor grade Anaplastic and sarcomatous variations with worst prognosis

64
Q

Where do mets from Wilms tumor go?

A

Bone and lung; can resect lung mets

65
Q

What syndromes are Wilms tumors associated with?

A

Beckwith-Widermann (hemihypertrophy, cryptorchidism, Drash syndrome, aniridia)

66
Q

What are CT findings with Wilms tumors?

A

Replacement of renal parenchyma NOT displacement as seen with neuroblastoma

67
Q

Treatment for Wilms tumor?

A

Nephrectomy (80-90% cured) Examine contralateral side for implants Avoid rupture of tumor Actinomycin and vincristine (except for stage I <500g)

68
Q

What is the most common malignant tumor in children?

A

Hepatoblastoma

69
Q

What lab value is elevated in hepatoblastoma? Presentation?

A

Elevated AFP in 90% Fractures, precocious puberty (from beta-HCG release)

70
Q

Hepatoblastomas are associated with what syndrome?

A

Beckwith-Wiedemann syndrome

71
Q

Treatment for hepatoblastoma?

A

Resection; otherwise doxorubicin-cisplatin based chemo

72
Q

What is the #1 children’s malignancy overall?

A

ALL

73
Q

What is the #1 solid tumor class?

A

CNS tumors

74
Q

What is the #1 general surgery tumor in child 2?

A

2y: Wilms tumor

75
Q

What is the #1 cause of duodenal obstruction in newborns?

A

Duodenal atresia

76
Q

What is the #1 cause of duodenal obstruction after newborn period and overall?

A

Malrotation

77
Q

Wat is the #1 cause of colon obstruction?

A

Hirschsprung’s disease

78
Q

What is the #1 liver tumor in children?

A

Hepatoblastoma

79
Q

What is the #1 lung tumor in children?

A

Carcinoid

80
Q

What is the #1 cause of painful lower GI bleeding?

A

Benign anorectal lesion (fissure, etc.)

81
Q

What is the #1 cause of painless lower GI bleeding?

A

Meckel’s diverticulum

82
Q

What are the causes of upper GI bleeding in children 0-1? 1-adults?

A

0-1y: gastritis, esophagitis 1-adult: esophageal varices, esophagitis

Fiser's ABSITE Ryan SHORT (50 decks)

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