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pediatric Flashcards

1
Q

what Ig in milk vs placenta

A

IgA milk
IgG placenta cross

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2
Q

child bolus

A

20 cc/kg

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3
Q

child transfusion

A

10 cc/kg

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4
Q

tachycardia in child

A

neonate > 150
1 yr > 120
otherwise > 100

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5
Q

UOP child goal

A

2-4 cc/kg/hrc

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6
Q

congenital cystic disease of lung causes

A
  1. pulmonary sequestration from anomalous systemic arterial supply (aorta via pulmonary ligament) and drainage thru azygous vs pulmonary vein… need to ligate arterial supply then lobectomy (can bleed)
  2. lobar overinflation/emphysema from cartilage failure in bronchus (air trap) (can cause tPTX) mostly LUL… lobectomy
  3. cystic adenoid malformation CCAM communciated with airway causing resp compromise/infection… lobectomy
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7
Q

bronchiogenic cyst mgmt

A

resect, malignant potential

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8
Q

bronchiogenic cyst location

A

mediastinum; posterior to carina; filled with milky

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9
Q

LAD unknown

A

10 days antibiotics suspect from infection
then excisional bx (to r/o lymphoma)

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10
Q

cystic hygroma LYMPHANGIOMA

A

found in lateral cervical POSTERIOR regions in neck; gets infected & multiloculated…… lateral to the SCM muscle

can connect to IJ

RESECT!

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11
Q

congenital diaphragmatic hernia

A

sx: both lungs dysf(x)l, hypoplastic and pulm HTN

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12
Q

mgmt diaph hernia

A

high freq ventilation, inhaled NO, ECMO
look for anomalies (cardiac, neural tube defects, malro)

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13
Q

bochdalek’s hernia

A

mC diaph hernia… located posteriorly

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14
Q

morgagni hernia

A

rare diaph hernia… located anteriorly

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15
Q

pectus excavatum

A

sinks in…
mgmt: sternal osteotomy with strut= Nuss or Ravitch procedure

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16
Q

pectus carinatum

A

pushes out…
mgmt: repair if emotional stress

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17
Q

1st branchial cyst

A

angle of mandible; poss connect to external auditory canal
ass’d with facial nerve

tx: resect

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18
Q

2nd branchial cyst MCMCMCMCMCMCM

A

MC**
anterior border of mid-SCM muscle
thru carotid bifurc into tonsillar pillar

tx: resect

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19
Q

3rd branchial cyst

A

lower neck, MEDIAL to/lower SCM to the piriform sinus

tx: resect

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20
Q

thyroglossal duct cyst

A

MIDLINE.
goes thru hyoid bone;descends thru foramen cecum

mgmt: excise cyst, tract, hyoid (at least central portion) = SISTRUNK POCEDURE

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21
Q

hemangiomas in kids

A

usually involte after 1YO… resolve at 7-8 YO

can resect after steroids if uncontrollable growth/impairs function

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22
Q

sx of neuroblastoma (MC abd malignancy solid in children)

A

secretory diarrhea, raccoon eyes (orbital met), HTN, opsomy-oclonus syndrome (unstead)

usually < 2 YO (Wilms older)

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23
Q

mgmt neuroblastoma

A

resect adrenal and kidney
if uresectable, doxorubicin chemo…need tissue dx first (n-myc vs no mutation) will change chemo

poor Px: neuron specific enolase, LDH, HVA, diploid, MYCN amplification

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24
Q

neuroblastoma staging

A

I: excised
II: incomplete excision does not cross midline
III: crosses midline +/- nodes
IV distant mets

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25
Q

wilms tumor = nephroblastoma

A

3 YO dx

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26
Q

prognosis wilms tumor based on?

A

GRADE LIKE SARCOMAS

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27
Q

wilms met to?

A

bone. &. LUNG (whole lung XRT)

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28
Q

sx wilms

A

asx&raquo_space;» hematuria, HTN (mostly unilateral

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29
Q

mgmt wilms

A

nephrectomy withotu rupture
pull tumor out of renal vein

and LN SAMPLING*

stage II+ (not fully resected) needs actinomycin and vincristine

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30
Q

wilms staging

A

I; limited to kidney, excised
II: beyodn kidney but excied
III: residual nonhematogenous tumor
IV: heme mets
V: b/l renal involvement (needs nephron sparing surgery)

bone & lung mets need RADIATION

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31
Q

hepatoblastoma

A

AFP**
b-hCG release: fractures, precocious puberty
<3 YO

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32
Q

beckwith wiedemann syndrome

A

ass’d with hepatoblastoma and Wilms

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33
Q

mgmt hepatoblastoma

A

resect
doxorubicin if unresectable
plastinum chemotherapy if positive margin and then watch & wait

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34
Q

best prognosis for hepatoblastoma

A

FETAL HISTOLOGY

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35
Q

MC chid malignancy overall

A

ALL

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36
Q

MC solid tumor classs

A

CNS tumors

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37
Q

MC cause of duo obstruction <1wk old

A

duodenal atresia

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38
Q

MC duo obstructuion >1wk old

A

malrotation

39
Q

MC cause LBO

A

Hirschsprungs

40
Q

MC lung tumor child

A

carcinoid

41
Q

MC painless lower GI bleed

A

Meckels

42
Q

meckels location

A

antimesenteric border of small bowel

43
Q

meckels path

A

persistent vitelline duct

44
Q

mgmt meckels

A

resect if sx (gastric tissue = bleeding)….

if >1/3 size of bowel OR IF diverticulitis (panc tissue) at base, need to SBR

45
Q

pyloric stenosis metabolic derangement

A

hypochloremic hypokalemic metaboic alkalosis

46
Q

US pyloric stenosis

A

muscle is >3 mm thick
muscle is >14 mm long
3.14 PIloric stenosis

47
Q

mgmt pyloric stenosis

A

Ramstedt pyloromyotomy; proximal extent should be circular mm of stomach
need to visualize mucosa

48
Q

intussusceptionage

A

3 mo to 3 yr

49
Q

mgmt intussusception

A

air contrast enema 120 mm Hg (max pressure)
OR if fails
PUSH on distal limb (don’t pull on proximal)
don’t rly need to resect in kids (adults = ca)

repeat air enema if it keeps working

4 hours obs, PO challenge, and DC

50
Q

intussuscipiencs
intussusceptum

A

intussusceptum goes INTO intussuscipiens

51
Q

duodenal atresia

A

MC obstruction in newborn

due to failure of recanalization unlike jejunal

distal to ampulla (bilious)

ass’d polyhydramnios, cardiac/renal/GI anomalies/Down syndrome

dx: double bubble

mgmt: DD or DJ

r/o volvulus with UGI series (crosses midline)

52
Q

intestinal atresia (nonD)

A

usually jejunum
from vascular accidents in utero

mgmt: resect after r/o Hirschsprungs

53
Q

type C TEF **MC

A

blind proximal esophageal atresia and distal TEF

spits food, drools, can’t NGT

XR: huge gas bubble

mgmt: R thoracotomy, primary repair, G tube, divide azygous

54
Q

type A TEF

A

esophageal atresia no fistula

same sx but no gas in abdomen

55
Q

VACTERL

A

vertebral
anorectal imperforate
cardiac
TE fistulaa
radius/renal
limb anomalies

56
Q

malrotation

A

sudden bilious emesis from Ladd’s bands (causing obstruction)

can cause SMA compromise… infarction

failed 270 degree counterclockwise rotation by right RP ladds bands

dx: upper GI emergently; duo does not cross midline; DJ junction on the right.

mgmt: resect Ladd’sbands, coutnerclokwise place cecum in LLQ with cecopexy, place duo in RUQ and appy.

57
Q

abnormalities associated with midgut volvulus?

A

diaphragmatic hernia 20%
omphalocele
gastroschisis

58
Q

meconium ileus dx

A

see on XR: feculent small bowel without air fluid levels
do PCR for Cl channel defect, sweat chloride test

59
Q

meconium ileus mgmt

A

gastrografin enema (dx and tx), vs NAC enema

or OR decompression, plus vent for antegrade enema

60
Q

NEC necrotiszing enterocolitis

A

bloody stool after 1st feeding premies <37
+thrombocytopenia (=sepsis in infants)
XR: pneumoatosis, free/portal air (on lat film)

61
Q

mgmt NEC

A

resusc, NPO, abx, TPN, OGT, and POSSIBLY PERC DECOMPRESSION IF FREE AIR (SCORE)

OR if peritonitis/free air/abdominal wall erythema… resect & ostomy

when reconnect, get fluoro study first (make sure no distal stenosis)

62
Q

imperforate anus HIGH above levator mgmt

A

fistulizes to vag/bladder so need:
1. colostomy
2. eventual anal recon with posterior sagittal anoplasty

63
Q

imperforate anus LOW below levators mgmt

A

fistulizes to perineal skin so need:
posterior sagittal anorectoplasty PSARP no colostomy with postop anal dilation

64
Q

gastroschisis pathophys

A

intrauterine rupture of umbilicla vein; NO SAC

65
Q

gastroschisis association

A

intestinal atresia (cuz vascular accident!)

66
Q

gastroschisis gross

A

RIGHT of midline; no sac; stiff bowel from amniotic fluid

67
Q

gastroschisis mgmt

A

saline soaked gauze, resuscitation, TPN, NPO repair when stable

place bowel back in, silastic mesh silo if needed (squeeze over time)
primary after silo is done

68
Q

gastroschisis association

A

1: intestinal atresia > midgut volvulus

69
Q

omphalocele pathophys

A

embryonal development with SAC and cord attached
MIDLINE MIDLINE MIDLINE

70
Q

omphalocele associations

A

Down
malrotation
Cantrell pentalogy: cardiac, pericardium defect, sternal cleft/absent sternum, diaph septum trasnversum absence, omphalocele

Beckwith Wiedemann, Trisome 13 18 and 21

71
Q

mgmt omphalocele

A

saline soaked gauze and resusciation, TPn, NPO, repair when stable

OR: place back in if needed, silo and delayed closure if needed

72
Q

extrophy of urinary bladder

A

mucosa thru walld efect over pubis (not fused)

mgmt: close defect and repair bladder

73
Q

hirschsprung pathophys and dx

A

absence of ganglion cells in myenteric plexus; faiure of crest cells ganglion cells to progress in caudad direction

must dx with full thickness rectal bx

RET+ (think MEN2A)

74
Q

mgmt hirschsprung

A

leveling biopsies (larparoscopic): resect rectum and colon until proximal to where ganglion cells appear
Soave or Duhamel procedure (connect colon to anus after colostomy possibly)
endorectal pullup without ostomy (SCORE)

emergent colectomy and rectal irrigation if COLITIS (can cause sepsis)

75
Q

umbilical hernia repair

A

close by 5 (earlier if incarcerated or VP shunt)

76
Q

indirect inguinal hernia repair

A

M>F

R>L>b/L

elective with high ligation <1 YO AT THE INTERNAL RING(earlier if sx; witin 24 hr of reduction)

explore other side if female, < 1 YO, or lef sided

77
Q

hydrocele

A

transilluminate…
OR at 1 YO (resect and ligate processus vaginalis)

78
Q

duplication cyst

A

mostly ILEUM; on MESENTERIC border

mgmt: resect

79
Q

biliary atresia

A

@ wks after birth… progressive jaundice

MC cause of neonatla jaundice requiring surgery & liver txp

dx: bx (fibrosis, bile plug, cirrhsois, ductal proliferation)

mgmt: kasai hepaticoportojejunostomy1/3 improve) before 3 mo old otherwise irreversible

80
Q

teratoma presenation in neonates

A

sacrococcygeal

high AFP and bHCG

if >2 mo persist, need coccygectomy and surveillance

81
Q

undescended testicle

A

wait 6 mos to treat
risk for SEMINOMA even if u treat it
if b/l, chromosomal studies

mgmt: bring it down yourself, no OR
if can’t bring down, orchiopexy thru inguinal incision may need to divide spermatic vessels (vas def blood supply will collateralize) to bring it down

82
Q

tracheomalacia dx

A

wheezing… see bronch: elliptical fragmented tracheal rings instead of C shaped

83
Q

tracheomalacia mgmt

A

indication: dying spell (MC), ventilator prolonged, many infection

mgmt: aortopexy (aorta to the sternum (open trachea)

84
Q

laryngomalacia

A

MC airway obstruction in infants

sx: stridor /intermittent distress in supine

= immature epiglottis cartilage

mgmt: trach if doesn’t improve by 1 YO (it may)

85
Q

choanal atresia

A

unilateral bone/membrane obstructing nasal passage

sx: can’t suckle/can’t breathe

86
Q

mgmt choanal atresia

A

reconstrcut

87
Q

larygneal papillomatosis

A

MC tumor of larynx in kids.. .goes away at puberty

HPV from mom

88
Q

mgmt layngeal papillomatosis

A

endoscopic/laser but will probably come back

89
Q

pyloric stenosis surgical technique

A

fredet ramstedt pyloromyotomy
dividespyloric muscle until mucosa is visualized; 1-2 mm prox to duo and extending to nonhypertrophied antrum

90
Q

pyloric stenosis abnormality

A

hypoK hypoCl met ALKALOSIS

91
Q

meckel scan

A

tech-99m pertechnitate scintigraphy for GASTRIC mucosa

92
Q

Wilms vs neuroblastoma on CT scan

A

Wilms replaces parenchyma; neuroblastoma displaces it

93
Q

how to find testicle in EMPTY SCROTUM?

A

laparoscopy to find

94
Q
A

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