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Surgery NBME > Pediatric Surgery > Flashcards

Pediatric Surgery Flashcards

1
Q

What do you suspect in a newborn who presents with excessive salivation or choking spells during first feeding attempt?

A

Esophageal atresia- likely due to TE fistula

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2
Q

MC type of TE fistula

A

Proximal blind esophagus

Distal esophagus joins trachea

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3
Q

You insert a NGT in a baby and on XR it appears it has coiled back on itself in the upper chest…

A

Suspect TE fistula

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4
Q

You diagnose a baby with TE fistula, what are the first steps that need to be taken?

A

Rule out VACTERL abnormalities

  • vertebral, anal, cardiac, TE and renal/radial
  • once this has been R/O then you should proceed with surgery
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5
Q

A newborn baby is found to have an imperforate anus on PE- what is the next step?

A

Part of VACTERL group of abnormalities

Next step - XR while holding baby upside down and metal marker on anal dimple to assess level of blind pouch

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6
Q

Tx of imperforate anus

A

If fistula to vagina or perineum present, repair can be done later
If low blind pouch, repaired with simple operation
If high blind pouch, colostomy with reconstruction later

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7
Q

surgery for a baby with TE fistula must be delayed, what should be done in the meantime?

A

Gastrostomy to protect lungs from acid reflux

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8
Q

Newborn baby is tachypneic, cyanotic and grunting; bowel sounds are heard over the left chest - dx test? Dx?

A

Should do a chest XR: will show bowel in chest

- congenital diaphragmatic hernia

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9
Q

Tx of hypoplastic lung due to congenital diaphragmatic hernia

A

Surgery - but wait 36-48 hrs to allow transition from fetal circulation
In the meantime, intubation, low pressure hyperventilation, sedation and NGT suction

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10
Q

Bilious vomiting, ground glass appearance on abdominal XR and family history of CF

A

Meconium Ileus

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11
Q

3 week old baby with projectile vomiting following each feeding and on physical exam you see visible gastric persistaltic waves and a palpable olive mass

A

Hypertrophic pyloric stenosis

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12
Q

9 month old baby with intermittent colicky pain and currant jelly stool

A

Intussusception

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13
Q

Newborn with large abdominal wall defect to the right of the umbilicus - normal cord but protruding from the cord are edematous bowel loops

A

Gastroschisis

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14
Q

Newborn with shiny, thin membranous sac at the base of the umbilical cord; inside the sac you see part of the liver and loops of normal bowel

A

Omphalocele

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15
Q

Newborn with moist medallion of mucosa occupying the lower abdominal wall (above public and below umbilicus) that is constantly bathed in urine

A

Exstrophy of the urinary bladder

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16
Q

Tx of exstrophy of bladder

A

Emergent transfer to specialized institution

- requires rapid within 48 hrs

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17
Q

A baby with Down syndrome vomits green fluid. What study do you order?

A

X-ray

18
Q

What can the double bubble sign on XR mean?

A

Annular pancreas

Duodenal atresia

19
Q

What does a double bubble sign with no gas in the rest of the bowel mean?

A

Likely that complete obstruction is present and surgery is needed
- dx is most likely duodenal atresia in a new born with Downs

20
Q

What does a double bubble sign with air in the distal bowel mean? What test should you do next?

A 
Incomplete obstruction (duodenal stenosis, annular pancreas, malrotation)
- order barium enema
21
Q

A newborn baby has repeated episodes of green vomiting, it also didn’t pass meconium; XR shows multiple air fluid levels and distended loops of bowel

A

Intestinal atresia

- vascular accident in utero with loss of blood supply tons segment of bowel

22
Q

You had suspected intestinal atresia based on XR and clinical findings, but when you operate you find all the bowel is there…

A

Consider aganglionic megacolon with involvement of entire bowel
- do frozen sections on appendix

23
Q

What are the signs of sepsis in a newborn?

A

Rapidly dropping platelet count

24
Q

Premature baby develops feeding intolerance, abdominal distention and rapidly dropping platelet count; baby is 4 days old and was treated with indomethacin for PDA - what do you suspect?

A

Necrotising enterocolitis

25
Q

Tx for necrotizing enterocolitis

A

NPO, broad spec antibiotics, IVF/ nutrition

26
Q

What are indications for surgical intervention in a baby with necrotizing enterocolitis?

A

Abdominal wall erythema
Air in portal vein
Pneumo-peritoneum
Intestinal pneumatosis (gas in bowel wall)

27
Q

What is the next step when you have a baby with meconium Ileus? What can you see?

A

Gastrografin swallow - both diagnostic and therapeutic
Dx. See microcolon and inspissated pellets of meconium in terminal ileum
Tx. Gastrografic is hypertonic so it draws in fluid and dissolves the pellets

28
Q

A baby has had trouble feeding; he now has bilious vomiting. XR show double bubble sign with normal looking gas pattern in the rest of the bowel - dx?

A

Malrotation - emergency!

29
Q

You see signs of malrotation on XR (double bubble with air after), what is the next test you order?

A

Barium enema

30
Q

Once you suspect hypertrophic pyloric stenosis in a baby, what should you check next?

A

Electrolytes - hypokalemic, hypochloremic metabolic alkalosis
- correct and rehydrate

31
Q

Tx for hypertrophic pyloric stenosis

A

Ramstedt pyloromyotomy or balloon dilatation

32
Q

8 week old baby is brought in due to progressively increasing jaundice; bilirubin is sig.elevated, ESP CB - dx?

A

Biliary atresia

- baby is not born this way rather something destroys the biliary tree

33
Q

Best diagnostic test for biliary atresia

A

HIDA scan - after one week of phenobarbital treatment (stimulates liver to produce bile, then you do the scan and all the bile is within the liver )

34
Q

Tx. Biliary atresia

A

Surgical derivation but 2/3 of children will require liver transplant

35
Q

2 month old baby boy is brought in bc of chronic constipation and abdominal distention; XR show dilated loops of bowel throughout; DRE is followed by explosive expulsion of stool and flatus which relieves the distention

A

Hirschsprung disease

36
Q

What studies are diagnostic for Hirschsprungs dz?

A

Barium enema

Full thickness biopsy of rectal mucosa

37
Q

Tx. Hirschsprung’s disease

A

Ileostomy followed by reconstruction later

38
Q

9 month old boy has episode of colicky abdominal pain that make him double up and squat; the episodes last 1 min and then go away. On exam, there is a vague mass on right side of abdomen, empty lower right quadrant and currant jelly stools

A

Intussusception

39
Q

What test is both diagnostic and therapeutic for intussusception

A

Barium enema

- if does not help,proceed to surgery

40
Q

What are some signs of child abuse!

A

Subdural hematoma, retinal hemorrhage - shaken baby
Fractured humerus or fractures are various stages of healing
Second degree burns on both buttocks

41
Q

7 yo boy passes large bloody stool

A

Meckel’s diverticulum

42
Q

Diagnostic test for Meckel’s diverticulum

A

Radioisotope scan looking for gastric mucosa in the lower abdomen

Surgery NBME (16 decks)

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