GPS

Question 1

Foregut

Answer 1

lungs, esophagus, stomach, pancreas, liver, gallbladder, bile duct, and duodenum proximal to ampulla

Question 2

Midgut

Answer 2

duodenum distal to ampulla, small bowel, and large bowel to distal ⅓ of transverse colon

Question 3

Hindgut

Answer 3

distal ⅓ of transverse colon to anal canal

Question 4

Midgut rotates what degree normally? Clockwise?

Answer 4

Midgut rotates 270 degrees counterclockwise normally

Question 5

Low birth weight (number)

Answer 5

<2500 g

Question 6

Pre-term (weeks)

Answer 6

< 37 weeks

Question 7

Which Ig from mother’s milk? Which Ig crosses placenta?

Answer 7

IgA/milk; IgG/placenta

Question 8

1 cause of childhood death

Answer 8

Trauma

Question 9

Peds trauma bolus

Answer 9

20 cc/kg x 2; then blood 10 cc/kg

Question 10

Best indicator of shock in a pediatric patient?

Answer 10

Tachycardia (neonate > 150; < 1 year > 120; rest >100)

Question 11

Children < 6 months old have more/less GFR than adults?

Answer 11

Less; only about 25%; poor concentrating ability

Question 12

Why is ALP so high in peds?

Answer 12

Bone growth

Question 13

What are the components of a normal umbilical cord?

Answer 13

1 vein; 2 arteries

Question 14

Maintenance IVF calculation

Answer 14

4/2/1 (10; 10; 1)

Question 15

Pulmonary sequestration/Accessory lung

Answer 15

Aberrant formation of segmental lung tissue that has no connection with the bronchial tree or pulmonary arteries. It is a bronchopulmonary foregut malformation (BPFM).

Question 16

Anomalous arterial supply of accessory lung

Answer 16

Thoracic aorta (MC); abdominal aorta (inferior pulmonary ligament)

Question 17

Venous drainage of accessory lung (based on extra/intra-lobar)

Answer 17

Systemic venous (extra-lobar) or pulmonary venous drainage (intra-lobar)

Question 18

Pulmonary sequestration most often presents with…

Answer 18

Infection; can also p/w respiratory compromise or abnormal CXR

Question 19

Treatment of pulmonary sequestration

Answer 19

Ligate arterial supply (risk of severe hemorrhage); then lobectomy

Question 20

Most common mediastinal tumor in children

Answer 20

Neurogenic (neurofibroma, ganglionoma, neuroblastoma) ** usually located in the posterior mediastinum

Question 21

Symptoms common to all mediastinal masses regardless of location

Answer 21

Respiratory, dysphagia

Question 22

Anterior mediastinal masses in children

Answer 22

T’s: T cell lymphoma, teratoma (other germ cell tumors = MC), thyroid

Question 23

Middle mediastinal masses in children

Answer 23

T cell lymphoma, teratoma, cardio- or broncho-genic cysts

Question 24

Posterior medaistinal masses in children

Answer 24

Neuro!

Question 25

T/F Thymoma is rare in children

Answer 25

True

Question 26

Do you need to resect choledochal cysts?

Answer 26

Yes-- risk of cholangiocarcinoma, pancreatitis, cholangitis, obstructive jaundice caused by reflux of pancreatic enzymes into the biliary system in utero

Question 27

Etiology of choledochal cysts.

Answer 27

In utero reflux of pancreatic enzymes into the biliary system

Question 28

Types of choledochal cysts

Answer 28

1. Fusiform dilation entire CBD (HJ) 2. True divertic CBD (Rsxn) 3. Dilation of distal CBD/Sphincter of Oddi (Rsx) 4. Multiple cysts (intra+extra) Rsx/Lobe/Txp 5. Caroli's disease (intrahepatic cysts) Rsx/Lobe/Txp

Question 29

Lymphadenopathy in children is usually 2/2

Answer 29

Suppurative adenitis a/w URI or phayngitis

Question 30

Chronic causes of LAD in children

Answer 30

Cat scratch, aypical mycoplasma

Question 31

If fluctuant LAD in a child...

Answer 31

FNA, cx, Abx +/- I&D

Question 32

Asymptomatic LAD in a child...

Answer 32

Lymphoma until proven otherwise (10 days ABX followed by excisional biopsy)

Question 33

Cystic hygroma

Answer 33

Found in lateral cervical regions in neck; get infected and lateral to SCM

Question 34

Which side has greater CDH?

Answer 34

L (80%)

Question 35

Major cardiac consequence of CDH

Answer 35

Pulmonary HTN

Question 36

T/F 80% children with CDH have associated anomalies

Answer 36

True: cardiac, NTD, malro

Question 37

Are both lungs dysfunctional in CDH?

Answer 37

Yes

Question 38

Treatment CDH

Answer 38

High-frequency ventilation; iNO; ECMO (Stabalize before OR; reduce bowel, repair defect; run the bowel)

Question 39

Two types of CDH

Answer 39

1. Bochdalek-MC-posterior | 2. Morgagni: rare, anterior

Question 40

When to perform Nuss

Answer 40

Respiratory symptoms, emotional stress

Question 41

#1 solid abdominal malignancy in children

Answer 41

Neuroblastoma | - Asymp mass

Question 42

Some symptoms of neuroblastoma

Answer 42

Secretory diarrhea, raccoon eyes (orbial mets), HTN, opsomyoclonus syndrome (unsteady gait)

Question 43

Neuroblastoma is most often on which organ?

Answer 43

Adrenals; but anywhere on the sympathetic chain

Question 44

What are some lab markers of neuroblastoma?

Answer 44

Catecholamines, VMA, HVA, metanephrines

Question 45

From what cells are neuroblastomas derived?

Answer 45

Neural crest cells

Question 46

Stippled calcifications in a tumor in a child

Answer 46

Neuroblastoma

Question 47

What tumor marker is elevated in peds patients with neuroblastoma w/ mets?

Answer 47

NSE (LDH, HVA, diploic, N-myc)

Question 48

Resection for neuroblastoma

Answer 48

Adrenal & kidney taken

Question 49

What about neoadjuvant chemo for neuroblastoma?

Answer 49

Doxorubicin-based chemo

Question 50

Staging neuroblastoma

Answer 50

1. Localized, complete excision 2. Incomplete excision, does not cross midline 3. Crosses midline (+/- regional nodes) 4. Distant mets (nodes/solid organ)

Question 51

Common presentation of Wilms tumor

Answer 51

Asymptomatic; hematuria, hypertension; 10% bilateral

Question 52

Mean age diagnosis of Wilms; prognosis is based upon

Answer 52

3 year olds; tumor grade (anaplastic and sarcomatous have worst prognosis)

Question 53

In the case of pulmonary mets in Wilms tumor

Answer 53

Whole lung XRT

Question 54

Abdominal CT differentiating Wilms from neuroblastoma

Answer 54

Wilms: replaces renal parenchyma; Neuro: displaces

Question 55

Treatment of Wilms

Answer 55

Nephrectomy +/- resection from vein; examine contralateral kidney & look for peritoneal implants

Question 56

Staging of Wilms

Answer 56

1: Limited to kidney, completely excised 2. Beyond, completely excised 3. Residual non-heme 4. Heme mets 5. B/L renal invovlement