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Pediatric surgery Flashcards

1
Q

Med to decrease burn hypermetabolic response

A

Propranolol

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2
Q

Open repair of pectus excavatum requires resection of

A

Short section of each depressed costal cartilage

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3
Q

Peutz-Jegher syndrome is characterized by

A

Polyposis of the intestinal tract (mostly small bowel), melanotic lesions around the mouth, in the rectum, and
other locations

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4
Q

Gardner syndrome is associated with

A

Desmoid tumors

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5
Q

Turcot syndrome is associated with

A

intracranial brain tumors

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6
Q

Peutz-Jeghers syndrome is associated with

A

pigmentation of the lips, buccal mucosa, hands, and feet

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7
Q

Cowden disease is associated with

A

hamartomas that affect all three germ layers. It is not associated with an increased risk of colon cancer.

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8
Q

Incidence of an empyema after pneumonia?

A

<1%
Empyema complicates 1:150

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9
Q

Imperforate hymen
Transverse septum
Longitudinal septum
Uterus didelphys with unilateral obstructed hemivagina

A

Bulging membrane with bluish discoloration
Transverse obstruction higher in the vagina
Patent hemivagina
Patent hemivagin

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10
Q

Gastroesophageal reflux in newborns and young infants is associated with

A

Excessive transient lower esophageal sphincter relaxations (TLESRs)

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11
Q

Newborn with cloacal exstrophy managed with loop ileostomy. At 3 months, the patient has failure to thrive and electrolyte abnormalities.

A

Absorption of urine via the colonic mucosa at the cecal plate leading to chronic acidosis

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12
Q

Most specific for appendicitis

A

Classic store…more than CT even. Wow

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13
Q

J pouch diarrhea

A

Diet first
Imodium

Biofeedback doesn’t work

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14
Q

Scrotal mass

A

Inguinal incision with radical resection to internal ring. If > 10 then node dissection up to renal vein.

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15
Q

Acute torticollis may be due

A

Atlantoaxial subluxation
-Trauma
-Tonsillectomy

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16
Q

Incidence of treatment failure for tPA fibrinolysis

A

16%

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17
Q

Ewing’s prognosis

A

Lung mets is worst
Pelvic worse than extremity
t(11;22) is diagnostic
Gender doesn’t matter

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18
Q

Most common ongoing source of morbidity in CDH

A

Gastrointestinal - affecting nearly two-thirds

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19
Q

Anemia and painless rectal bleeding best test

A

Meckel scan - 99mTc-pertechnetate radioisotope scan

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20
Q

3-month-old with torticollis and a mass in the right sternocleidomastoid muscle

A

Fibrosis - do nothing

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21
Q

Genes implicated in the etiology of Hirschsprung

A

RET, Endothelin-B receptor, SOX10, Neuturin

Not APC

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22
Q

Absolute contraindication to transplant for HCC

A

Any mets

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23
Q

Vent goals in CDH

A

PIP < 25
Preductal sat > 85%
pCO2 between 45-65
pH above 7.20
MIVF between 40-60 mL/kg/d

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24
Q

Branchial anomalies may be associated with

A

Branchio-oto-renal syndrome

Check kidneys

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25
Atresia types
Type I - mucosal atresia with intact bowel wall and no mesenteric defect. Type II - atretic bowel connected by a fibrous cord. Type IIIa - two segments separated by a V-shaped mesenteric defect. Type IIIb - apple-peel or Christmas-tree anomalies. Type IV - multiple atresias.
26
Chemo for rhabdomyosarcoma
Vincristine, actinomycin D, and cyclophosphamide
27
Osteosarcoma most important prognostic factor
Complete resection Others: unilateral, percent necrosis in resected lesion, disease free interval, single lung nodule
28
How to minimize bleeding on ECMO during CDH repair
Minimize anticoagulation (usually heparin) Initiating aminocaproic acid pre and postoperative (48-72 hours) Minimizing posterior diaphragmatic rim dissection Electrocautery, with additional hemostatic agents.
29
Cervical neuroblastoma most common postoperative complication
Horner’s syndrome related to damage to the oculosympathetic pathway
30
Most common secondary malignancy following therapy for Hodgkin lymphoma
Breast
31
Which best describes a -Congenital cystic adenomatoid malformation (CCAM) -Congenital lobar emphysema -Bronchopulmonary sequestration -Bronchogenic cyst -Polyalveolysis
-Terminal respiratory bronchioles forms cysts that can trap air but cannot participate in gas exchange - Mucosal proliferation and infolding within an affected bronchus permit inspiration, but limits expiration -Nonfunctioning lung tissue supplied by an anomalous systemic artery, with no bronchial connection to the tracheobronchial tree -White or pinkish thin-walled cysts lined with bronchial epithelium and filled with mucus -Total alveolar number is increased several fold, while arteries and airways are normal in number, size and structure
32
Cant find the testis, what next?
Laparoscopy - imaging no good
33
In children with congenital heart disease, the most important method of reducing the risk of developing subacute bacterial endocarditis (SBE)
Proper oral health and hygiene
34
Pull through complications -Duhamel -Soave
-Retained Duhamel spur (gets filled with stool) -Muscular cuff
35
Micronutrient deficiency results -Selenium -Chromium -Zinc -Copper -Lipid deficiency
Associated micronutrient deficiency -Cardiomyopathy -Diabetes (insulin resistance) -Diarrhea (can be caused by GI loss) -Pancytopenia -Essential fatty acids (scaly skin)
36
CAM Volume Ratio (CVR)
< 1.6 is good > 1.6 associated with hydrops. Twice weekly US and steroids.
37
Patients with branchial anomalies, the frequency of bilateral branchial lesions is
10% - Most arise from second cleft/pouch.
38
Esophageal balloon dilation, the safest technique
Generating a radial force over a localized area
39
CLOVES syndrome is characterized by
Congenital lipomatous overgrowth, vascular malformations, epidermal nevi, and skeletal anomalies
40
Parkes-Weber syndrome is characterized by
Arteriovenous malformation, bony overgrowth, capillary malformation
41
Sturge-Weber syndrome is characterized by
Capillary malformation, glaucoma, leptomeningeal angioma
42
PTEN Hamartoma-Tumor characterized by
Genital lentiginosis, hamartomas, macrocephaly
43
PHACES syndromes syndrome is characterized by
Arterial anomalies, cardiac defects, hemangiomas
44
Fetus with a cystic mass with other fetal anomalies (VACTERL)
Cloaca may be suspected. The pelvic mass is most likely a hydrocolpos (vagina filled with urine and mucus)
45
Surgery for torticollis
Less than 3% recurrence Divide both heads of the SCM Divide any tight fascia between SCM and trapezius
46
Choledochal cyst types -Ia -Ib -Ic -II -III
-Ia - cystic dilation of the entire common bile duct (CBD). -Ib - involve a segmental dilation of the CBD -Ic cysts are characterized by fusiform dilation. -Type II cysts are best described as a diverticulum. -Type III is a choledochocele typically localized to the distal CBD and can even be within the duodenal wall
47
Esophagoscopy after caustic ingestion is
To establish the presence of damage below the cricopharyngeus Don't advance scope past first evidence of damage
48
Post operative intussusception
Operate Segments in excess of 3.5 cm, with wall thickening, tend to require operative reduction Can happen after almost anything - classic is nephrectomy
49
Indications for lung transplant in CF
Usually based on a PaCO2 of more than 50 mm Hg
50
CDH oxygen saturation goals - pre and post ductal pCO2 goals pH goals
Pre: 85 - 95% (>70% in first two hours of life) Post: > 70% pCO2: 45 - 60 mmHg pH: pH > 7.2 if pCO2 < 65 and lactate < 5
51
Main risk for chylothorax after CDH
More severe disease, including patients who require preoperative attempted rescue high frequency oscillatory ventilation, those who need a patch repair and especially patients who require preoperative extracorporeal life support
52
First branchial lesion
Present as cysts, sinuses, or fistulae between the external auditory canal and the angle of the mandible. Parotid inflammation, otorrhea. Type 1 pass lateral to facial nerve Type 2 pass medial to facial nerve Consider branchiootorenal syndrome
53
Second branchial lesion
Cysts, sinuses, or fistulae anterior to the SCM Type 1 - superficial Type 2 - anterior and deep to SCM, pass anterior or posterior to carotid sheath Type 3 - Pass between internal and external carotids Type 4 - Medial and deep to carotid sheath, open into pharynx. Watch carotid, vagus, hypoglossal and glossopharyngeal nerves
54
Third and fourth branchial lesions
Recurrent neck infection or abscesses. Suppurative thyroiditis or thyroid cyst. Laryngoscopy to see opening at piriform sinus. Pass a catheter to identify. Watch recurrent laryngeal n. May need thyroid lobe. ENT can do endoscopic therapy
55
Histologic features is biliary atresia
Expanded portal tracts Bile duct proliferation Portal fibrosis Absence of sinusoidal fibrosis Canalicular and bile duct plugs
56
trisomy 21 the most likely type of anorectal malformation is an imperforate anus with
No fistula
57
Inadequate distal colostogram
poor distention, visible folds - indicating low pressure With adequate pressure, the rectal wall becomes rounded if no fistula is present (often seen with trisomy 21)
58
Most frequent complication of an ACE stoma
Stricture 8-40%
59
Cephalic fold defect
Pentalogy of Cantrell
60
Lateral fold defect
Omphalocele
61
Caudal fold defect
Cloacal extrophy

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