EXAM #3: PEDIATRIC SURGICAL PROBLEMS

Question 1

What are the three etiologies of lymphadenopathy?

Answer 1

1) Infectious
2) Reactive
3) Malignancy

Question 2

What is the difference between acute and chronic lymphadenopathy?

Answer 2

• Less than 6 weeks= acute

- Greater than 6 weeks= chronic

Question 3

What is the surgical procedure to diagnose lymphadenopathy?

Answer 3

Biopsy

Question 4

What do you need to do for the proper diagnosis of a thryoglossal duct cyst?

Answer 4

US to ensure there is normal thyroid tissue

Question 5

What is the surgical procedure for a thyroglossal duct cyst?

Answer 5

Sistrunk procedure

A small incision is made over the cyst. The cyst and the entire tract are removed, as well as the middle portion of the hyoid bone

Question 6

When is surgery indicated for congenital torticollis?

Answer 6

Failure to resolve within a year with aggressive conservative therapy

Question 7

How is congenital torticollis treated surgically?

Answer 7

Division of the involved SCM

Question 8

What is the most common type of tracheo-esophageal fistula?

Answer 8

Proximal atresia with distal fistula

Question 9

What is the most common presenting symptom of a TE fistula?

Answer 9

Excessive salivation

Question 10

How is a TE fistula managed surgically?

Answer 10

Right toracotomy and exptrapleural repair

*May require gastrostomy

Question 11

What is the VATER association with TE fistula? Why is this important?

Answer 11

Vertebral 
Anorectal 
Cardiovascular 
Tracheal 
Esophageal 
Renal 
Limb

Any kid with a TE fistula will need to be associated for these issues as well.

Question 12

What is the eponym for the most common location of a diaphragmatic hernia?

Answer 12

Foramen of Bochdalek in the left pleuroperitoneal membrane

Question 13

When do you know if a chest wall deformity needs to be repaired?

Answer 13

At least 14 years of age–only intervene earlier if cardiopulmonary compromise

Question 14

What anomalies are associated with omphalocele?

Answer 14

1) Heart
2) Urinary Tract
3) Beckwith-Wiedeman

Question 15

What is the difference between major and minor omphalocele?

Answer 15

Minor= less than 4cm 
Major= greater than 4cm

Question 16

What is Bechwith-Wiedeman Syndrome?

Answer 16

This is an overgrowth disorder usually present at birth; it is characterized by an increased risk of childhood cancer and congenital anomalies, including:

1) macroglossia (large tongue),
2) macrosomia (above average birth weight and length),
3) midline abdominal wall defects (omphalocele/exomphalos, umbilical hernia, diastasis recti),
4) ear creases or ear pits, and
5) neonatal hypoglycemia

Question 17

What is Gastrochisis?

Answer 17

Abdominal wall defect right of the umbilicus

Question 18

What is worse, gastrochisis or omphalocele?

Answer 18

Omphalocele

Question 19

What are the complications of gastrochisis and omphalocele?

Answer 19

1) Heat loss–>warm
2) Third space heat loss
3) Infection–>antibiotics

Question 20

At birth, what should you remember about gastrochisis or omphalocele?

Answer 20

Leave the umbilical cord long

Question 21

What is the presentation with malrotation and volvulus?

Answer 21

Forceful often bilious emesis

Remember, bilious emesis is a red flag

Question 22

How do you diagnose malrotation/ volvulus?

Answer 22

Upper GI series

Question 23

What is the classic imaging for duodenal atresia?

Answer 23

“Double bubble sign”

Question 24

How is duodenal atresia repaired surgically?

Answer 24

Duodenoduodenostomy

Question 25

What causes midgut atresia?

Answer 25

In utero mesenteric vascular accident

Question 26

What is the rule of two’s for Meckel’s Diverticumlum?

Answer 26

• 2 feet from ileocecal valve
• 2% population
• Most before age of 2

Question 27

How does Meckel’s Diverticulum present?

Answer 27

Massive bleeding

Question 28

What is the first thing you need to do if you suspect Meckel’s Diverticulum?

Answer 28

1) Resuscitate

2) Meckel’s Scan

Question 29

How do you work-up Hirschsprung’s Disease?

Answer 29

1) Barium enema

2) Rectal biopsy* gold-standard

Question 30

On x-ray, what is suggestive of Hirschsprung’s Disease?

Answer 30

No gas in the rectum

Question 31

How do you treat Hirschsprung’s Disease with surgery?

Answer 31

1) Possible colostomy

2) Remove affected contracted region

Question 32

What is an imperforate anus?

Answer 32

Cloaca that does NOT separate rectum and urogenital sinus

Question 33

What is the typical age that you would repair an umbilical hernia?

Answer 33

3-5 years old

Question 34

What is the classic presentation of Intussception?

Answer 34

• Paroxysmal, crampy abdominal pain

- Currant jelly stool (late sign)

Question 35

How is Intusssception worked up?

Answer 35

1) US–> “target sign”

2) Barium enema

Question 36

What are the buzzwords for pyloric stenosis?

Answer 36

• Projectile non-bilious emesis
• Olive mass
• Hypochloremic hypokalemic alkalosis (emesis contains Cl- and K+)

Question 37

How does biliary atresia present?

Answer 37

Persistent direct hyperbilirubinemia

Question 38

What is the definitive treatment for biliary atresia?

Answer 38

Transplant (initial surgery, “Kasai” only buys time)

Question 39

What type of hernia is more common in kids?

Answer 39

Indirect

Question 40

What increases the risk of indirect hernia?

Answer 40

Premature

Question 41

What should you remember about pediatric inguinal hernias?

Answer 41

Should be fixed ASAP

Question 42

When do undescended testes need to be fixed?

Answer 42

By 1-year (may descend by six months)

Question 43

What is a horseshoe kidney?

Answer 43

Single kidney with fused poles