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ABS > PEDIATRIC SURGERY > Flashcards

PEDIATRIC SURGERY Flashcards

1
Q

Congenital diaphragmatic hernia - what causes it?

A

Failrue of normal closure of pleuroperitoneal canal
Posterolateral - Bochdalek
Anteromedial - Morgagni

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2
Q

Majority of Bochdalek hernias are on?

A

Left side (80%) 10 % are bilateral

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3
Q

When should you fix CDH?

A

When pulm vascular resistance decreases - usually days to weeks

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4
Q

What pentalogy is associated with CDH (morgagni)

A 
Pentalogy of cantrell:
abdominal wall defect
absent pericardium
VSD
sternal cleft (ectopia cordis)
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5
Q

CDH associated with (4)

A

severe pulm HTN
cardiac and neural tube defects
malrotation

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6
Q

How are both lungs impacted by CDH?

A

Hernia side is hypoplastic

Contralateral side has pulmonary HTN

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7
Q

Tx for CDH

A

high frequency ventilation, inhaled NO, may need ECMO

Need to reduce bowel and repair defect with mesh maybe, look for visceral anomalies by running the bowel

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8
Q

pectus carinatum vs excavatum - which one do you NOT need to fix?

A

carinatum (pigeon chest) - can repair for emotional distress

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9
Q

Standard initial operation for biliary atresia

A

Kasai (roux en y hepatic portoenterostomy)
excision of entire extrahepatic biliary tree with transection of fibrous portal plate near hilum of the liver
bilioenteric continuity is then resstablished with a roux en Y limb

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10
Q

Order of ligation when performing radical nephroureterectomy in Wilm’s tumor?

A

renal artery –> renal vein –> ureter

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11
Q

Prognosis of Wilm’s tumor is based on what?

A

Tumor grade (ajnaplastic and sarcomatous variations have worse prognosis)

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12
Q

Where do wilms turor metastasize to?

A

Bone and lung

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13
Q

Abdominal CT of Wilms tumor shows

A

Replacement of renal parenchyma, NOT displacement

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14
Q

Actinomycin and vincristine should be given to all wilms tumor unless?

A

Stage I and <500 g tumor

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15
Q

Stage III wilm’s tumor

A

unilateral with regional LN involvement, tumor spillage or previous biopsy without resection

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16
Q

Stage V wilm’s tumor

A

bilateral disease

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17
Q

Wilm’s tumor with spillage or residual disease - what now

A

XRT

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18
Q

What to do if Wilms tumor impinging on vital structures or IVC involvement

A

preoperative chemo

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19
Q

What to do with bilateral Wilms tumor

A

conservative approach to save renal parenchyma; biopsy both kidneys followed by chemo and renal sparing partial nephrectomy

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20
Q

What is WAGR

A

Wilms + aniridia + GU malformation _ mental retardation

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21
Q

VSD that cause sx related to CHF can initially be treated with

A

Digoxin and diuretics

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22
Q

How often do VSD close spontaneously

A

About 50%

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23
Q

What is Eisenmenger’s syndrome

A

Long standing left to right shunt (usually due to VSD) causes pulmonary HTN and reversal into cyanotic right to left shunt

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24
Q

Most common esophageal substitute in kids

A

Colon

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25
Q

Goal of ventilatory support in CDH

A

PaO2 >60 and PaCO2 < 60

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26
Q

Pyloric muscle thickness and length in pyloric stenosis

A

Thickness 3-4 mm

Length 14-18 mm

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27
Q

IVF resuscitation (initial) for HPS

A

underlying metabolic alkalosis slowly corrected iwth normal saline
K is not given until intravasscular volume restored and normal UOP resumed

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28
Q

Reversed rectosigmoid junction

A

Hirschsprungs

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29
Q

MCC death in uncorrected Hirscsprungs

A

Enterocolitis

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30
Q

Waht stain can you use to diagnose hirschsprungs

A

Calretinin stain for nerve cells

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31
Q

Where should you do the rectal biopsy for hischsprungs

A

At least 2 cm ABOVE dentate

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32
Q

Duodenal atresia occurs due to?

A

Failure of recanalization of proximal small bowel

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33
Q

Adrenal mass + bony lesions

A

Neuroblastoma

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34
Q

MC extracranial solid tumor in children

A

Neuroblastoma

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35
Q

When diagnosis of neuroblastoma has been established, what is next step?

A

Tissue biopsy to determine n-myc amplification status. If amplified will be placed in “High risk” categorywhich impacts ultimate treatment

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36
Q

AXR shows stippled tumor calcification

A

Neuroblastoma

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37
Q

Tumor markers for neuroblastoma

A

VMA and HVA

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38
Q

Stage III neuroblastoma

A

Tumros extend beyond midline, bilateral LN may be involved

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39
Q

Stage IV-S neuroblastoma

A

Would be stage I or II; remote disease confined to liver, subcutaneous tissues and bone marrow (but not cortex) in child < one year

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40
Q

Presentation of neuroblastoma

A

USually asymptomatic but can have HTN, diarrhea, raccoon eyes from orbital mets or unsteady gait

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41
Q

Most common location of neuroblastoma

A

Adrenal

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42
Q

CT scan for neuroblastoma will show

A

renal displacement (vs Wilms which replaces parenchyma)

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43
Q

High risk/worse prognosis neuroblastomas

A 
NEuron-specific enolase
LDH
HVA
Diplooid tumor
N-myc amplification
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44
Q

Tx for unresectable neuroblastoma

A

NEoadjuvant doxorubicin

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45
Q

1 tumor in child <2 yaears

A

neuroblastoma

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46
Q

How much intra abdominal esophagus is needed during lap nissen

A

2-3 cm

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47
Q

Bleeding Meckel diverticulum is best treated with

A

Diveticulectomy alone

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48
Q

When is segmental ileal resection indicated for Meckel diverticulum

A

Neoplasms
Ischemic or injured bowel
Diverticulum has a wide/broad base

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49
Q

At waht age should you refer pt for orchiopexy with undescended testicles

A

6 months

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50
Q

Tx of mesenteric or omental cyst

A

Simple excision q

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51
Q

Ladd’s procedure - detorse volvulus in what direction

A

Counterclockwise

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52
Q

Which peritoneal attachments need lysed in Ladds procedure

A

abnormal peritoneal attachments (Ladd bands) between cecum and abdominal wall

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53
Q

What organ is removed during Ladd procedure

A

appendix

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54
Q

Where should the cecum and duodenum be placedi n Ladd procedure

A

Cecum in LLQ and duodenum in RUQ

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55
Q

What causes the respiratory distress inCDH

A

pulmonary hypoplasia

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56
Q

MC abnormalities of GU tract in WAGR

A

cryptorchidism and hypospadias in males and streak ovaries in females

57
Q

Deletion of what chormosome is responsible for development of WAGR syndrome

A

short arm of chromosome 11

58
Q

Neuroblastoma is assoc with which neurofibromatosis

A

Type 1

59
Q

KArtagener syndrome

A

immotile cilia syndrome/primary ciliary dyskinesia –> recurrent sinusitis

60
Q

Umbilical vessels

A

two arteries and one vein

61
Q

Wher edoes oxygenated blood from the placenta go ?

A

into the SINGLE umbilical vein into the IVC

62
Q

How does blood flow from right atrium to left atrium i nfetal circulation

A

Via foramen ovale

63
Q

Less oxygenated blood returned to placenta via?

A

two umbilical arteries

64
Q

Blood that is slightly less oxygenated flows from RA to RV and then into the PA. This blood is then largely shunted into ____ via the ductus arteriosus

A

Descending aorta

65
Q

Describe a V shaped diverticulectomy

A

Segmenta lresection to include diverticulum as well as ulcer (usually opposite the diverticulum) by performing V shaped diverticulectomy. Then you perform transverse closure of ileum

66
Q

Regardless of stage, all patients iwth hepatoblastoma should receive ..

A

chemotherapy

67
Q

Tx for children with unresectable or metastatic hepatoblastomas

A

Biopsy to fonfirm diagnosis followed by chemo to reduce size of tumor and control mets

68
Q

Incision for pyloromyotomy

A

Longitudinal serosal inciisson on anterosuperior aspect of pylorus begining 1-2 mm proximal t oduodenum and extending on the non hypertrophied antrum

69
Q

What layer of gastric all should be visualized to ensure pyloromyotomy success

A

submucosa

70
Q

MC presenting symptoms of ASD

A

dyspnea and SOB (CHF)

71
Q

HEart murmur in ASD

A

systolic murmur, fixed split S2

72
Q

MC TEF

A

TEF-EA which is TYpe C, proximal EA, distal TEF

73
Q

Prenatal US shows small or absent gastric bubble plus polyhydraminos

A

TEF

74
Q

VACTERL

A 
Vertebral defects
Anorectal anomalies
Cardiac defects
Esophageal anomalies
REnal defects
Limb anomalies
75
Q

CHARGE syndrome

A 
Coloboma
Heart defects
ATresia choanae (choanal atresia)
Retardation
Genital hypoplasia
Ear deformities (deafness)
76
Q

Which trisomy assoc with TEF

A

18

77
Q

TEF pre op should have what two studies

A 
Echo for cognenital heart defects and ascertain side of aortic arch
Renal ultrasound
ASSOC WITH VACTERL 
check sacral US (vertebral anomalies)
rectal exam (imperforate anus)
78
Q

Operative repair includes what 4 steps for EA-TEF

A

Right posterolateral thoracotomy, extrapleural approach
Division of azygous vein
Divison of fistula with primary anastomosis
Place chest tube or closed suction drain near anastomosis

79
Q

If large TEF with severe respiratory distress what is treatment

A

Fogarty in fistula and emergent surgical divsiion of fistula plus gastrostomy tube

80
Q

Repair of TEF

A

Repair via cervical approach after bronchoscopic stenting of fistula with asmall catheter

81
Q

Om[halocele occurs due to

A

Incomplete closure of anterior abdominal wall at umbilicus

82
Q

Persistent omphalomesenteric duct leads to

A

Meckel diverticulum

83
Q

Deficiency in what vitamin is seen in CDH infants

A

Vitamin A

84
Q

How to repair mucosal defect in pyloromyotomy

A

Single layer of absorbable sutures placed transversely at site of perforation with an omental patch. May perform second myootmy at 90-180 degrees if remiemains concern for continued obstructio nfo gastric outlet

85
Q

Which is most effective imaging for biliary atresia

A

DISIDA (technetium labeled compound diisopropyl iminodiacetic acid)

86
Q

If time allows, all jaundiced infants undergoing hepatobiliary scintigraphy should e pretreated with what before the study

A

phenobarbital (5 mg/kg/day) for 5 days

87
Q

Most accurate prenatal diagnostic stool for CDH

A

MRI

88
Q

MCC early death jejunoileal atresia

A

infection/sepsis

89
Q

normal lateral sacral ratio

A

> 0.7

90
Q

best indicator of shock in peds patient

A

tachycardia

91
Q

neonate tachycardia HR >

A

150 BPM

92
Q

tachycardia in age 1-6

A

> 120 BPM

93
Q

tachycardia in age 6-12

A

> 110 BPM

94
Q

targets for crystalloid fluid resuscitation

A

20 mL/kg

95
Q

targets for blood resuscitation

A

10 mL/kg (give after 2 fluid boluses in hypotensive)

96
Q

UOP goal in neonate/infant

A

2-3 mL/kg/hr

97
Q

UOP goal in toddlers and older

A

1 mL/kg/hr

98
Q

Type A TEF

A

2nd MC

only one without a TEF just esophageal atresia

99
Q

Type C TEF on AXR

A

gas + distended stomach

100
Q

Type A TEF on AXR

A

gasless abdomen

101
Q

Important in diagnostic workup of TEF

A

check for VACTERL

102
Q

top 3 etiologies for intussusception

A 
#1 inflamed Peyers patches after viral illness
#2 lymphoma
#3 meckels diverticulum
103
Q

etiology of malrotation

A

failure of normal 270 degree rotation during intestinal development

104
Q

what is volvulus due to

A

Ladds bands (adhesions from right retroperitoneum)

105
Q

1 on differential in pediatric bilious emesis

A

malrotation with midgut volvulus

106
Q

dx of malrotation

A

emergent upper GI (duodenum doesnt cross midline)

107
Q

2 major associations with malrotation

A

CDH in 20%, omphalocele

108
Q

1 cause of duodenal obstruction in neonates

A

duodenal atresia

109
Q

what will be seen on suction rectal biopsy in Hirschsprungs disease

A

absent galnglion cells in myenteric plexus (due to failure to progress caudad)

110
Q

what do you need to remember to do prior to taking down ostomies after surgery for NEC

A

barium enema to rule out stenotic distal obstruction

111
Q

etiology of gastroschisis

A

in utero rupture of umbilical vein

112
Q

gastroschesis is assoc with

A

intestinal atresia (MC), malrotation

113
Q

which (omphalocele vs gastroschisis) has worse prognosis

A

omphalocele

114
Q

when to explore contralateral side in inguinal hernia repair

A

left sided
female
<1 year old

115
Q

noncommunicating hydrocele usually resolve by

A

1 year

116
Q

when to perform surgery for hydrocele

A

if not resolved by 1 year old or communicating

117
Q

surgical tx of hydrocele

A

resect hydrocele ligate processus vaginalis

118
Q

can you divide spermatic vessels during orchiopexy?

A

yes! due to vas deferns collateral

119
Q

MC location neuroblastoma

A

adrenal

120
Q

tx of neuroblastoma

A

resection, can try neoadjuvant doxorubicin if unresectable

121
Q

tx of hepatoblastoma

A

resection, chemo if unresectable

122
Q

MC indication for pediatric liver transplant

A

biliary atresia

123
Q

liver biopsy showing periportal fibrosis, bile plug

A

biliary atresia

124
Q

if <3 months of age with biliary atresia, tx is?

A

transplant
1/3 improve
1/3 progress to transplant
1/3 die

125
Q

what is pulm sequestration

A

lung tissue that doesnt communicate with tracheobronchial tree with independent blood supply from aorta

126
Q

extra lobar pulm sequestration - venous drainage is?

A

systemic

127
Q

intra lobar pulm sequestration - venous drainage is

A

pulmonary

128
Q

tx of pulm sequestration

A

ligate arterial supply –> lobectomy

129
Q

what is the diff between congenital cystic adenoid malformation and pulm sequestration

A

CCAM communicates with tracheobronchial tree

130
Q

congenital lobar emphysema is due to

A

failure of cartilage development

131
Q

presentation of congenital lobar emphysema

A

similar to tension PTX BUT DONT PLACE A CHEST TUBE!

132
Q

tx of congenital lobar emphysema

A

lobectomy

133
Q

what is bronchogenic cyst

A

extrapulm cysts of bronchial tissue and cartilage, presents as mediastinal cystic mass

134
Q

where do branchial cleft cysts present

A

mc 2nd branchial cleft cysts which are middle of anterior SCM

135
Q

6 mo old with red lesions growing on face and scalp. Dx and tx?

A

hemangioma, will resolve by 8 years old otherwise steroids or laser

136
Q

1 mo old with elevated AFP and beta HCG. Diagnosis?

A

sacrococcygeal teratoma - usually malignant after 2 months old

137
Q

MC anterior mediastinal mass in kid

A

teratoma

138
Q

MC overall mediastinal mass in kid

A

neurogenic tumor (posterior mediastinum)

ABS (23 decks)

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