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Section III Subspecialty Surgery P517 > Pediatric Surgery, C67 P517-572 > Flashcards

Pediatric Surgery, C67 P517-572 Flashcards

1
Q

What is the motto of
pediatric surgery?
P517

A

“Children are NOT little adults!”

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2
Q 
What is a simple way to
distract a pediatric patient
when examining the
abdomen for tenderness?
P517
A

Listen to the abdomen with the
stethoscope and then push down on the
abdomen with the stethoscope to check
for tenderness

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3
Q

PEDIATRIC IV FLUIDS AND NUTRITION
What is the estimated blood
volume of infants and children?
P517

A

≈8% of body weight or ≈80 cc/kg

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4
Q

PEDIATRIC IV FLUIDS AND NUTRITION
What is the maintenance IV
fluid for children?
P517

A

D5 1/4 NS + 20 mEq KCl

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5
Q

PEDIATRIC IV FLUIDS AND NUTRITION
Why 1/4 NS?
P517

A

Children (especially those younger than
4 years of age) cannot concentrate their
urine and cannot clear excess sodium

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6
Q

PEDIATRIC IV FLUIDS AND NUTRITION
How are maintenance fluid
rates calculated in children?
P517

A

4, 2, 1 per hour:
4 cc/kg for the first 10 kg of body
weight
2 cc/kg for the second 10 kg of
body weight
1 cc/kg for every kilogram over
the first 20 (e.g., the rate for a
child weighing 25 kg is 4 x 10 = 40
plus 2 x 10 = 20 plus 1 x 5 = 5,
for an IVF rate of 65 cc/hr)

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7
Q

PEDIATRIC IV FLUIDS AND NUTRITION
What is the minimal urine
output for children?
P517

A

From 1 to 2 mL/kg/hr

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8
Q 
PEDIATRIC IV FLUIDS AND NUTRITION
What is the best way to
present urine output
measurements on rounds?
P518
A

Urine output total per shift, THEN cc/kg/hr

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9
Q 
PEDIATRIC IV FLUIDS AND NUTRITION
What is the major difference
between adult and pediatric
nutritional needs?
P518
A

Premature infants/infants/children need

more calories and protein/kg/day

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10
Q

PEDIATRIC IV FLUIDS AND NUTRITION
What are the caloric requirements by age for the following patients:
Premature infants?
P518

A

80 Kcal/kg/day and then go up

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11
Q 
PEDIATRIC IV FLUIDS AND NUTRITION
What are the caloric requirements by age for the following patients:
Children younger than
1 year?
P518
A

≈100 Kcal/kg/day (90–120)

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12
Q

PEDIATRIC IV FLUIDS AND NUTRITION
What are the caloric requirements by age for the following patients:
Children ages 1 to 7?
P518

A

≈85 Kcal/kg/day (75–90)

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13
Q

PEDIATRIC IV FLUIDS AND NUTRITION
What are the caloric requirements by age for the following patients:
Children ages 7 to 12?
P518

A

≈70 Kcal/kg/day (60–75)

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14
Q

PEDIATRIC IV FLUIDS AND NUTRITION
What are the caloric requirements by age for the following patients:
Youths ages 12 to 18
P518

A

≈40 Kcal/kg/day (30–60)

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15
Q 
PEDIATRIC IV FLUIDS AND NUTRITION
What are the protein requirements by age for the
following patients:
Children younger than 1 year?
P518
A

3 g/kg/day (2–3.5)

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16
Q 
PEDIATRIC IV FLUIDS AND NUTRITION
What are the protein requirements by age for the
following patients:
Children ages 1 to 7?
P518
A

2 g/kg/day (2–2.5)

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17
Q 
PEDIATRIC IV FLUIDS AND NUTRITION
What are the protein requirements by age for the
following patients:
Children ages 7 to 12?
P518
A

2 g/kg/day

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18
Q 
PEDIATRIC IV FLUIDS AND NUTRITION
What are the protein requirements by age for the
following patients:
Youths ages 12 to 18?
P518
A

1.5 grams/kg/day

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19
Q

PEDIATRIC IV FLUIDS AND NUTRITION
How many calories are in
breast milk?
P518

A

20 Kcal/30 cc (same as most formulas)

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20
Q 
PEDIATRIC IV FLUIDS AND NUTRITION
PEDIATRIC BLOOD VOLUMES
Give blood volume per kilogram:
Newborn infant?
P518
A

85 cc

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21
Q

PEDIATRIC IV FLUIDS AND NUTRITION
Infant 1–3 months of age?
P518

A

75 cc

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22
Q

PEDIATRIC IV FLUIDS AND NUTRITION
Child?
P518

A

70 cc

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23
Q

FETAL CIRCULATIONFETAL CIRCULATION
What is the number of
umbilical veins?
P519

A

1 (usually)

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24
Q

FETAL CIRCULATIONFETAL CIRCULATION
What is the number of
umbilical arteries?
P519

A

2

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25
Q

FETAL CIRCULATIONFETAL CIRCULATION
Which umbilical vessel
carries oxygenated blood?
P519

A

Umbilical vein

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26
Q 
FETAL CIRCULATIONFETAL CIRCULATION
The oxygenated blood travels
through the liver to the IVC
through which structure?
P519
A

Ductus venosus

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27
Q 
FETAL CIRCULATIONFETAL CIRCULATION
Oxygenated blood passes
from the right atrium to the
left atrium through which
structure?
P519
A

Foramen ovale

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28
Q 
FETAL CIRCULATIONFETAL CIRCULATION
Unsaturated blood goes
from the right ventricle to
the descending aorta
through which structure?
P519
A

Ductus arteriosum

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29
Q

FETAL CIRCULATIONFETAL CIRCULATION
Define the overall fetal circulation.
P519 (picture)

A

(see Picture)

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30
Q 
FETAL CIRCULATIONFETAL CIRCULATION
What are the ADULT structures of the following
fetal structures:
Ductus venosus?
P520
A

Ligamentum venosum

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31
Q 
FETAL CIRCULATIONFETAL CIRCULATION
What are the ADULT structures of the following
fetal structures:
Umbilical vein?
P520
A

Ligamentum teres

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32
Q 
FETAL CIRCULATIONFETAL CIRCULATION
What are the ADULT structures of the following
fetal structures:
Umbilical artery?
P520
A

Medial umbilical ligament

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33
Q 
FETAL CIRCULATIONFETAL CIRCULATION
What are the ADULT structures of the following
fetal structures:
Ductus arteriosus?
P520
A

Ligamentum arteriosum

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34
Q 
FETAL CIRCULATIONFETAL CIRCULATION
What are the ADULT structures of the following
fetal structures:
Urachus?
P520
A

Median umbilical ligament

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35
Q 
FETAL CIRCULATIONFETAL CIRCULATION
What are the ADULT structures of the following
fetal structures:
Tongue remnant of
thyroid’s descent?
P520
A

Foramen cecum

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36
Q 
FETAL CIRCULATIONFETAL CIRCULATION
What are the ADULT structures of the following
fetal structures:
Persistent remnant of
vitelline duct?
P520
A

Meckel’s diverticulum

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37
Q

ECMO
What is ECMO?
P520

A

ExtraCorporeal Membrane Oxygenation:
chronic cardiopulmonary bypass—for
complete respiratory support

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38
Q

ECMO
What are the types of
ECMO?
P520

A

Venovenous: Blood from vein →
oxygenated → back to vein
Venoarterial: Blood from vein (IJ) →
oxygenated → back to artery (carotid)

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39
Q

ECMO
What are the indications?
P520

A

Severe hypoxia, usually from congenital
diaphragmatic hernia, meconium
aspiration, persistent pulmonary
hypertension, sepsis

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40
Q

ECMO
What are the
contraindications?
P520

A

Weight <2 kg, IVH (IntraVentricular
Hemorrhage in brain contraindicated
because of heparin in line)

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41
Q 
NECK
What is the major
differential diagnosis of a
pediatric neck mass?
P521
A 
Thyroglossal duct cyst (midline), branchial
cleft cyst (lateral), lymphadenopathy,
abscess, cystic hygroma, hemangioma,
teratoma/dermoid cyst, thyroid nodule,
lymphoma/leukemia (also parathyroid
tumors, neuroblastoma, histiocytosis X,
rhabdomyosarcoma, salivary gland tumors,
neurofibroma)
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42
Q

THYROGLOSSAL DUCT CYST
What is it?
P521

A 
Remnant of the diverticulum formed
by migration of thyroid tissue; normal
development involves migration of
thyroid tissue from the foramen cecum at
the base of the tongue through the hyoid
bone to its final position around the
tracheal cartilage
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43
Q

THYROGLOSSAL DUCT CYST
What is the average age at
diagnosis?
P521

A

Usually presents around 5 years of age

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44
Q

THYROGLOSSAL DUCT CYST
How is the diagnosis made?
P521

A

Ultrasound

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45
Q

THYROGLOSSAL DUCT CYST
What are the complications?
P521

A 
Enlargement, infection, and fistula
formation between oropharynx or
salivary gland; aberrant thyroid tissue
may masquerade as thyroglossal duct
cyst, and if it is not cystic, deserves a
thyroid scan
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46
Q

THYROGLOSSAL DUCT CYST
What is the anatomic
location?
P522

A

Almost always in the midline

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47
Q 
THYROGLOSSAL DUCT CYST
How can one remember the
position of the thyroglossal
duct cyst?
P522 (picture)
A

Think: thyroGLOSSAL = TONGUE

midline sticking out

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48
Q

THYROGLOSSAL DUCT CYST
What is the treatment?
P522

A

Antibiotics if infection is present, then
excision, which must include the midportion
of the hyoid bone and entire tract to
foramen cecum (Sistrunk procedure)

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49
Q

BRANCHIAL CLEFT ANOMALIES
What is it?
P522

A

Remnant of the primitive branchial clefts
in which epithelium forms a sinus tract
between the pharynx (second cleft), or
the external auditory canal (first cleft),
and the skin of the anterior neck; if the
sinus ends blindly, a cyst may form

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50
Q

BRANCHIAL CLEFT ANOMALIES
What is the common
presentation?
P522

A

Infection because of communication

between pharynx and external ear canal

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51
Q

BRANCHIAL CLEFT ANOMALIES
What is the anatomic
position?
P522

A 
Second cleft anomaly—lateral to the
    midline along anterior border of the
    sternocleidomastoid, anywhere from
    angle of jaw to clavicle
First cleft anomaly—less common than
    second cleft anomalies; tend to be
    located higher under the mandible
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52
Q

BRANCHIAL CLEFT ANOMALIES
What is the most common
cleft remnant?
P523

A

Second; thus, these are found most often
laterally versus thyroglossal cysts, which are
found centrally (Think: Second = Superior)

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53
Q

BRANCHIAL CLEFT ANOMALIES
What is the treatment?
P523

A

Antibiotics if infection is present, then
surgical excision of cyst and tract once
inflammation is resolved

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54
Q 
BRANCHIAL CLEFT ANOMALIES
What is the major anatomic
difference between
thyroglossal cyst and
branchial cleft cyst?
P523
A

Thyroglossal cyst = midline
Branchial cleft cyst = lateral
(Think: brAnchial = lAteral)

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55
Q

STRIDOR
What is stridor?
P523

A

Harsh, high-pitched sound heard on
breathing caused by obstruction of the
trachea or larynx

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56
Q

STRIDOR
What are the signs/
symptoms?
P523

A

Dyspnea, cyanosis, difficulty with

feedings

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57
Q

STRIDOR
What is the differential
diagnosis?
P523

A 
Laryngomalacia—leading cause of stridor
    in infants; results from inadequate
    development of supporting laryngeal
    structures; usually self-limited and
    treatment is expectant unless
    respiratory compromise is present
Tracheobronchomalacia—similar to
    laryngomalacia, but involves the entire
    trachea
Vascular rings and slings—abnormal
    development or placement of thoracic
    large vessels resulting in obstruction
    of trachea/bronchus
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58
Q

STRIDOR
What are the symptoms of
vascular rings?
P523

A

Stridor, dyspnea on exertion, or dysphagia

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59
Q

STRIDOR
How is the diagnosis of
vascular rings made?
P523

A

Barium swallow revealing typical
configuration of esophageal
compression
Echo/arteriogram

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60
Q

STRIDOR
What is the treatment of
vascular rings?
P523

A

Surgical division of the ring, if the patient

is symptomatic

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61
Q

CYSTIC HYGROMA
What is it?
P524

A

Congenital abnormality of lymph sac

resulting in lymphangioma

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62
Q

CYSTIC HYGROMA
What is the anatomic
location?
P524

A 
Occurs in sites of primitive lymphatic
lakes and can occur virtually anywhere in
the body, most commonly in the floor of
mouth, under the jaw, or in the neck,
axilla, or thorax
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63
Q

CYSTIC HYGROMA
What is the treatment?
P524

A

Early total surgical removal because they
tend to enlarge; sclerosis may be needed
if the lesion is unresectable

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64
Q

CYSTIC HYGROMA
What are the possible
complications?
P524

A 
Enlargement in critical regions, such as
the floor of the mouth or paratracheal
region, may cause airway obstruction;
also, they tend to insinuate onto major
structures (although not malignant),
making excision difficult and hazardous
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65
Q 
ASPIRATED FOREIGN BODY (FB)
Which bronchus do FBs go
into more commonly (left or
right)?
P524
A 
Younger than age 4—50/50
Age 4 and older—most go into right
bronchus because it develops into a
straight shot (less of an angle)
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66
Q

ASPIRATED FOREIGN BODY (FB)
What is the most commonly
aspirated object?
P524

A

Peanut

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67
Q

ASPIRATED FOREIGN BODY (FB)
What is the associated risk
with peanut aspiration?
P524

A

Lipoid pneumonia

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68
Q

ASPIRATED FOREIGN BODY (FB)
How can an FB result in “air
trapping and hyperinflation”?
P524

A

By forming a “ball valve” (i.e., air in, no
air out) as seen on CXR as a hyperinflated
lung on expiratory film

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69
Q 
ASPIRATED FOREIGN BODY (FB)
How can you tell on
A-P CXR if a coin is in the
esophagus or the trachea?
P524
A

Coin in esophagus results in the coin lying
“en face” with face of the coin viewed as
a round object because of compression
by anterior and posterior structures
If coin is in the trachea, it is viewed as a
side projection due to the U-shaped
cartilage with membrane posteriorly

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70
Q

ASPIRATED FOREIGN BODY (FB)
What is the treatment of
tracheal or esophageal FB?
P525

A

Remove FB with rigid bronchoscope or

rigid esophagoscope

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71
Q

CHEST
What is the differential
diagnosis of a lung mass?
P525

A 
Bronchial adenoma (carcinoid is most
common), pulmonary sequestration,
pulmonary blastoma, rhabdomyosarcoma,
chondroma, hamartoma, leiomyoma,
mucus gland adenoma, metastasis
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72
Q 
CHEST
What is the differential
diagnosis of mediastinal
tumor/mass?
P525
A 
1. Neurogenic tumor (ganglioneuromas,
    neurofibromas)
2. Teratoma
3. Lymphoma
4. Thymoma
(Classic “four T’s”: Teratoma, Terrible
    lymphoma, Thymoma, Thyroid tumor)
Rare: pheochromocytoma, hemangioma,
    rhabdomyosarcoma, osteochondroma
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73
Q 
PECTUS DEFORMITY
What heart abnormality
is associated with pectus
abnormality?
P525
A

Mitral valve prolapse (many patients

receive preoperative echocardiogram)

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74
Q

PECTUS EXCAVATUM
What is it?
P525 (picture)

A

Chest wall deformity with sternum caving

inward (Think: exCAVatum = CAVE)

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75
Q

PECTUS EXCAVATUM
What is the cause?
P526

A

Abnormal, unequal overgrowth of rib

cartilage

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76
Q

PECTUS EXCAVATUM
What are the signs/
symptoms?
P526

A

Often asymptomatic; mental distress,

dyspnea on exertion, chest pain

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77
Q

PECTUS EXCAVATUM
What is the treatment?
P526

A

Open perichondrium, remove abnormal
cartilage, place substernal strut; new
cartilage grows back in the perichondrium
in normal position; remove strut 6 months
later

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78
Q

PECTUS EXCAVATUM
What is the NUSS
procedure?
P526

A

Placement of metal strut to elevate

sternum without removing cartilage

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79
Q

PECTUS CARINATUM
What is it?
P526 (picture)

A

Chest wall deformity with sternum outward
(pectus = chest, carinatum = pigeon);
much less common than pectus excavatum

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80
Q

PECTUS CARINATUM
What is the cause?
P526

A

Abnormal, unequal overgrowth of rib

cartilage

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81
Q

PECTUS CARINATUM
What is the treatment?
P526

A 
Open perichondrium and remove
    abnormal cartilage
Place substernal strut
New cartilage grows into normal position
Remove strut 6 months later
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82
Q

ESOPHAGEAL ATRESIA WITHOUT TRACHEOESOPHAGEAL (TE) FISTULA
What is it?
P527

A

Blind-ending esophagus from atresia

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83
Q

ESOPHAGEAL ATRESIA WITHOUT TRACHEOESOPHAGEAL (TE) FISTULA
What are the signs?
P527

A

Excessive oral secretions and inability to

keep food down

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84
Q

ESOPHAGEAL ATRESIA WITHOUT TRACHEOESOPHAGEAL (TE) FISTULA
How is the diagnosis made?
P527

A

Inability to pass NG tube; plain x-ray
shows tube coiled in upper esophagus
and no gas in abdomen

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85
Q

ESOPHAGEAL ATRESIA WITHOUT TRACHEOESOPHAGEAL (TE) FISTULA
What is the primary
treatment?
P527

A

Suction blind pouch, IVFs, (gastrostomy to
drain stomach if prolonged preoperative
esophageal stretching is planned)

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86
Q

ESOPHAGEAL ATRESIA WITHOUT TRACHEOESOPHAGEAL (TE) FISTULA
What is the definitive
treatment?
P527

A 
Surgical with 1 anastomosis, often
with preoperative stretching of blind
pouch (other options include colonic or
jejunal interposition graft or gastric tube
formation if esophageal gap is long)
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87
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What is it?
P527

A

Esophageal atresia occurring with a
fistula to the trachea; occurs in >90% of
cases of esophageal atresia

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88
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What is the incidence?
P527

A

One in 1500 to 3000 births

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89
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
Define the following types of fistulas/atresias:
Type A
P527 (picture)

A

Esophageal atresia without TE fistula (8%)

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90
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
Define the following types of fistulas/atresias:
Type B
P528 (picture)

A 
Proximal esophageal atresia with proximal
TE fistula (1%)
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91
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
Define the following types of fistulas/atresias:
Type C
P528 (picture)

A 
Proximal esophageal atresia with distal
TE fistula (85%); most common type
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92
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
Define the following types of fistulas/atresias:
Type D
P528 (picture)

A

Proximal esophageal atresia with both
proximal and distal TE fistulas (2%)
(Think: D = Double connection to
trachea)

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93
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
Define the following types of fistulas/atresias:
Type E
P529 (picture)

A

“H-type” TE fistula without esophageal

atresia (4%)

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94
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
How do you remember
which type is most common?
P529

A

Simple: Most Common type is type C

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95
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What are the symptoms?
P529

A

Excessive secretions caused by an
accumulation of saliva (may not occur
with type E)

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96
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What are the signs?
P529

A 
Obvious respiratory compromise,
aspiration pneumonia, postprandial
regurgitation, gastric distention as air
enters the stomach directly from the
trachea
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97
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
How is the diagnosis made?
P529

A

Failure to pass an NG tube (although this
will not be seen with type E); plain film
demonstrates tube coiled in the upper
esophagus; “pouchogram” (contrast in
esophageal pouch); gas on AXR
(tracheoesophageal fistula)

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98
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What is the initial
treatment?
P529

A 
Directed toward minimizing
complications from aspiration:
    1. Suction blind pouch (NPO/TPN)
    2. Upright position of child
    3. Prophylactic antibiotics (Amp/gent)
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99
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What is the definitive
treatment?
P529

A

Surgical correction via a thoracotomy,
usually through the right chest with
division of fistula and end-to-end
esophageal anastomosis, if possible

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100
Q 
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What can be done to
lengthen the proximal
esophageal pouch?
P530
A

Delayed repair: with or without G-tube

and daily stretching of proximal pouch

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101
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
Which type should be fixed
via a right neck incision?
P530

A

“H-Type” (type E) is high in the thorax
and can most often be approached via a
right neck incision

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102
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What is the workup of a
patient with a TE fistula?
P530

A

To evaluate the TE fistula and associated
anomalies: CXR, AXR, U/S of kidneys,
cardiac echo (rest of workup directed by
physical exam)

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103
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What are the associated
anomalies?
P530

A 
VACTERL cluster (present in about 10%
of cases):
    Vertebral or vascular, Anorectal, Cardiac,
       TE fistula, Esophageal atresia
    Radial limb and renal abnormalities,
       Lumbar and limb
    Previously known as VATER:
       Vertebral, Anus, TE fistula, Radial
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104
Q

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL (TE) FISTULA
What is the significance of
a “gasless” abdomen on AXR?
P530

A

No air to the stomach and, thus, no

tracheoesophageal fistula

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105
Q

CONGENITAL DIAPHRAGMATIC HERNIA
What is it?
P530

A

Failure of complete formation of the
diaphragm, leading to a defect through
which abdominal organs are herniated

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106
Q

CONGENITAL DIAPHRAGMATIC HERNIA
What is the incidence?
P530

A

One in 2100 live births; males are more

commonly affected

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107
Q

CONGENITAL DIAPHRAGMATIC HERNIA
What are the types of
hernias?
P530

A

Bochdalek and Morgagni

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108
Q

CONGENITAL DIAPHRAGMATIC HERNIA
What are the associated
positions?
P530

A

Bochdalek—posterolateral with L > R
Morgagni—anterior parasternal hernia,
relatively uncommon

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109
Q 
CONGENITAL DIAPHRAGMATIC HERNIA
How to remember the
position of the Bochdalek
hernia?
P531 (picture)
A

Think: BOCH DA LEK = “BACK TO

THE LEFT”

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110
Q

CONGENITAL DIAPHRAGMATIC HERNIA
What are the signs?
P531

A

Respiratory distress, dyspnea, tachypnea,
retractions, and cyanosis; bowel sounds in
the chest; rarely, maximal heart sounds
on the right; ipsilateral chest dullness to
percussion

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111
Q

CONGENITAL DIAPHRAGMATIC HERNIA
What are the effects on the
lungs?
P531

A
  1. Pulmonary hypoplasia

2. Pulmonary hypertension

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112
Q

CONGENITAL DIAPHRAGMATIC HERNIA
What inhaled agent is often
used?
P531

A

Inhaled nitric oxide (pulmonary
vasodilator), which decreases the shunt
and decreases pulmonary hypertension

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113
Q

CONGENITAL DIAPHRAGMATIC HERNIA
What is the treatment?
P531

A

NG tube, ET tube, stabilization, and if
patient is stable, surgical repair; if patient
is unstable: nitric oxide +/– ECMO then
to the O.R. when feasible

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114
Q

PULMONARY SEQUESTRATION
What is it?
P531

A

Abnormal benign lung tissue with
separate blood supply that DOES NOT
communicate with the normal
tracheobronchial airway

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115
Q

PULMONARY SEQUESTRATION
Define the following terms:
Interlobar
P531

A

Sequestration in the normal lung tissue

covered by normal visceral pleura

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116
Q

PULMONARY SEQUESTRATION
Define the following terms:
Extralobar
P532

A

Sequestration not in the normal lung

covered by its own pleura

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117
Q

PULMONARY SEQUESTRATION
What are the signs/
symptoms?
P532

A

Asymptomatic, recurrent pneumonia

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118
Q

PULMONARY SEQUESTRATION
How is the diagnosis made?
P532

A

CXR, chest CT, A-gram, U/S with

Doppler flow to ascertain blood supply

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119
Q

PULMONARY SEQUESTRATION
What is the treatment of each type:
Extralobar?
P532

A

Surgical resection

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120
Q

PULMONARY SEQUESTRATION
What is the treatment of each type:
Intralobar?
P532

A

Lobectomy

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121
Q 
PULMONARY SEQUESTRATION
What is the major risk
during operation for
sequestration?
P532
A 
Anomalous blood supply from below the
diaphragm (can be cut and retracted into
the abdomen and result in exsanguination!);
always document blood supply by A-gram
or U/S with Doppler flow
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122
Q 
ABDOMEN
What is the differential
diagnosis of pediatric upper
GI bleeding?
P532
A

Gastritis, esophagitis, gastric ulcer,
duodenal ulcer, esophageal varices,
foreign body, epistaxis, coagulopathy,
vascular malformation, duplication cyst

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123
Q 
ABDOMEN
What is the differential
diagnosis of pediatric lower
GI bleeding?
P532
A 
Upper GI bleeding, anal fissures, NEC
(premature infants), midgut volvulus
(usually children younger than 1 year),
strangulated hernia, intussusception,
Meckel’s diverticulum, infectious
diarrhea, polyps, IBD, hemolytic uremic
syndrome, Henoch-Schönlein purpura,
vascular malformation, coagulopathy
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124
Q 
ABDOMEN
What is the differential
diagnosis of neonatal bowel
obstruction?
P532
A 
Malrotation with volvulus, intestinal
atresia, duodenal web, annular pancreas,
imperforate anus, Hirschsprung’s
disease, NEC, intussusception (rare),
Meckel’s diverticulum, incarcerated
hernia, meconium ileus, meconium plug,
maternal narcotic abuse (ileus), maternal
hypermagnesemia (ileus), sepsis (ileus)
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125
Q 
ABDOMEN
What is the differential
diagnosis of infant
constipation?
P533
A

Hirschsprung’s disease, CF (cystic fibrosis),

anteriorly displaced anus, polyps

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126
Q 
INGUINAL HERNIA
What is the most commonly
performed procedure by
U.S. pediatric surgeons?
P533
A

Indirect inguinal hernia repair

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127
Q

INGUINAL HERNIA
What is the most common
inguinal hernia in children?
P533

A

Indirect

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128
Q

INGUINAL HERNIA
What is an indirect inguinal
hernia?
P533

A 
Hernia lateral to Hesselbach’s triangle
into the internal inguinal ring and down
the inguinal canal (Think: through the
abdominal wall indirectly into the internal
ring and out through the external
inguinal ring)
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129
Q

INGUINAL HERNIA
What is Hesselbach’s
triangle?
P533

A

Triangle formed by:

1. Epigastric vessels
2. Inguinal ligament
3. Lateral border of the rectus sheath
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130
Q 
INGUINAL HERNIA
What type of hernia goes
through Hesselbach’s
triangle?
P533
A

Direct hernia from a weak abdominal
floor; rare in children (0.5% of all
inguinal hernias)

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131
Q 
INGUINAL HERNIA
What is the incidence of
indirect inguinal hernia in
all children?
P533
A

≈3%

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132
Q

INGUINAL HERNIA
What is the incidence in
premature infants?
P533

A

Up to 30%

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133
Q

INGUINAL HERNIA
What is the male to female
ratio?
P533

A

6:1

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134
Q

INGUINAL HERNIA
What are the risk factors for
an indirect inguinal hernia?
P533

A 
Male gender, ascites, V-P shunt,
prematurity, family history, meconium
ileus, abdominal wall defect elsewhere,
hypo/epispadias, connective tissue disease,
bladder exstrophy, undescended testicle,
CF
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135
Q

INGUINAL HERNIA
Which side is affected more
commonly?
P534

A

Right ( ≈60%)

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136
Q

INGUINAL HERNIA
What percentage are
bilateral?
P534

A

≈15%

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137
Q 
INGUINAL HERNIA
What percentage have a
family history of indirect
hernias?
P534
A

≈10%

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138
Q

INGUINAL HERNIA
What are the signs/
symptoms?
P534

A

Groin bulge, scrotal mass, thickened

cord, silk glove sign

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139
Q

INGUINAL HERNIA
What is the silk glove sign?
P534

A

Hernia sac rolls under the finger like the

finger of a silk glove

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140
Q

INGUINAL HERNIA
Why should it be repaired?
P534

A

Risk of incarcerated/strangulated bowel

or ovary; will not go away on its own

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141
Q

INGUINAL HERNIA
How is a pediatric inguinal
hernia repaired?
P534

A 
High ligation of hernia sac (no repair of
the abdominal wall floor, which is a big
difference between the procedure in
children vs. adults; high refers to high
position on the sac neck next to the
peritoneal cavity)
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142
Q 
INGUINAL HERNIA
Which infants need overnight
apnea monitoring/
observation?
P534
A

Premature infants; infants younger than 3

months of age

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143
Q 
INGUINAL HERNIA
What is the risk of
recurrence after high
ligation of an indirect
pediatric hernia?
P534
A

≈1%

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144
Q 
INGUINAL HERNIA
Describe the steps in the
repair of an indirect inguinal
hernia from skin to skin.
P534
A

Cut skin, then fat, then Scarpa’s fascia,
then external oblique fascia through the
external inguinal ring; find hernia sac
anteriomedially and bluntly separate
from the other cord structures; ligate sac
high at the neck at the internal inguinal
ring; resect sac and allow sac stump to
retract into the peritoneal cavity; close
external oblique; close Scarpa’s fascia;
close skin

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145
Q

INGUINAL HERNIA
Define the following terms:
Cryptorchidism
P535

A

Failure of the testicle to descend into the

scrotum

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146
Q

INGUINAL HERNIA
Define the following terms:
Hydrocele
P535

A

Fluid-filled sac (i.e., fluid in a patent
processus vaginalis or in the tunica
vaginalis around the testicle)

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147
Q 
INGUINAL HERNIA
Define the following terms:
Communicating
hydrocele
P535
A

Hydrocele that communicates with the
peritoneal cavity and thus fills and drains
peritoneal fluid or gets bigger, then
smaller

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148
Q 
INGUINAL HERNIA
Define the following terms:
Noncommunicating
hydrocele
P535
A

Hydrocele that does not communicate
with the peritoneal cavity; stays about the
same size

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149
Q 
INGUINAL HERNIA
Define the following terms:
Can a hernia be ruled
out if an inguinal mass
transilluminates?
P535
A

NO; baby bowel is very thin and will

often transilluminate

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150
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
From what abdominal
muscle layer is the cremaster
muscle derived?
P535
A

Internal oblique muscle

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151
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
From what abdominal
muscle layer is the inguinal
ligament (a.k.a. Poupart’s
ligament) derived?
P535
A

External oblique

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152
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What nerve travels with the
spermatic cord?
P535
A

Ilioinguinal nerve

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153
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
Name the 5 structures in the
spermatic cord.
P535
A
  1. Cremasteric muscle fibers
  2. Vas deferens
  3. Testicular artery
  4. Testicular pampiniform venous plexus
  5. With or without hernia sac
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154
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What is the hernia sac made
of?
P535
A

Basically peritoneum or a patent

processus vaginalis

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155
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What is the name of the
fossa between the testicle
and epididymis?
P536
A

Fossa of Geraldi

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156
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What attaches the testicle to
the scrotum?
P536
A

Gubernaculum

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157
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
How can the opposite side
be assessed for a hernia
intraoperatively?
P536
A 
Many surgeons operatively explore the
    opposite side when they repair the
    affected side
Laparoscope is placed into the
    abdomen via the hernia sac and the
    opposite side internal inguinal ring
    is examined
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158
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
Name the remnant of the
processus vaginalis around
the testicle.
P536
A

Tunica vaginalis

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159
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What is a Littre’s inguinal
hernia?
P536
A

Hernia with a Meckel’s diverticulum in

the hernia sac

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160
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What may a yellow/orange
tissue that is not fat be on
the spermatic cord/testicle?
P536
A

Adrenal rest

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161
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What is the most common
organ in an inguinal hernia
sac in boys?
P536
A

Small intestine

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162
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What is the most common
organ in an inguinal hernia
sac in girls?
P536
A

Ovary/fallopian tube

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163
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What lies in the inguinal canal
in girls instead of the vas?
P536
A

Round ligament

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164
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
Where in the inguinal canal
does the hernia sac lie in relation
to the other structures?
P536
A

Anteriomedially

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165
Q

CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What is a “cord lipoma”?
P536

A

Preperitoneal fat on the cord structures
(pushed in by the hernia sac); not a
real lipoma
Should be removed surgically, if feasible

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166
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
Within the spermatic cord,
do the vessels or the vas lie
medially?
P537
A

Vas is medial to the testicular vessels

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167
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What is a small outpouching
of testicular tissue off of the
testicle?
P537
A

Testicular appendage (a.k.a. the appendix
testes); should be removed with
electrocautery

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168
Q

CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What is a “blue dot sign”?
P537

A

Blue dot on the scrotal skin from a

twisted testicular appendage

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169
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
How is a transected vas
treated?
P537
A

Repair with primary anastomosis

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170
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
How do you treat a
transected ilioinguinal
nerve?
P537
A

Should not be repaired; many surgeons

ligate it to inhibit neuroma formation

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171
Q 
CLASSIC INTRAOPERATIVE QUESTIONS DURING REPAIR
OF AN INDIRECT INGUINAL HERNIA
What happens if you cut the
ilioinguinal nerve?
P537
A

Loss of sensation to the medial aspect of
the inner thigh and scrotum/labia; loss of
cremasteric reflex

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172
Q

UMBILICAL HERNIA
What is it?
P537

A

Fascial defect at the umbilical ring

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173
Q

UMBILICAL HERNIA
What are the risk factors?
P537

A
  1. African American infant

2. Premature infant

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174
Q

UMBILICAL HERNIA
What are the indications for
surgical repair?
P537

A
  1. > 1.5 cm defect
  2. Bowel incarceration
  3. > 4 years of age
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175
Q

GERD
What is it?
P537

A

GastroEsophageal Reflux Disease

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176
Q

GERD
What are the causes?
P537

A

LES malfunction/malposition, hiatal hernia,
gastric outlet obstruction, partial bowel
obstruction, common in cerebral palsy

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177
Q

GERD
What are the signs/
symptoms?
P538

A

Spitting up, emesis, URTI, pneumonia,
laryngospasm from aspiration of gastric
contents into the tracheobronchial tree,
failure to thrive

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178
Q

GERD
How is the diagnosis made?
P538

A

24-hour pH probe, bronchoscopy, UGI

manometry, EGD, U/S

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179
Q 
GERD
What cytologic aspirate
finding on bronchoscopy can
diagnose aspiration of
gastric contents?
P538
A

Lipid-laden macrophages (from

phagocytosis of fat)

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180
Q

GERD
What is the medical/
conservative treatment?
P538

A

H(2) blockers
Small meals/rice cereal
Elevation of head

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181
Q

GERD
What are the indications for
surgery?
P538

A 
“SAFE”:
    Stricture
    Aspiration, pneumonia/asthma
    Failure to thrive
    Esophagitis
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182
Q

GERD
What is the surgical
treatment?
P538

A

Nissen 360 fundoplication, with or

without G tube

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183
Q

CONGENITAL PYLORIC STENOSIS
What is it?
P538 (picture)

A

Hypertrophy of smooth muscle of pylorus,

resulting in obstruction of outflow

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184
Q

CONGENITAL PYLORIC STENOSIS
What are the associated
risks?
P538

A

Family history, firstborn males are affected
most commonly, decreased incidence in
African American population

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185
Q

CONGENITAL PYLORIC STENOSIS
What is the incidence?
P539

A

1 in 750 births, M:F ratio = 4:1

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186
Q

CONGENITAL PYLORIC STENOSIS
What is the average age at
onset?
P539

A 
Usually from 2 weeks after birth to about
2 months (“2 to 2”)
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187
Q

CONGENITAL PYLORIC STENOSIS
What are the symptoms?
P539

A

Increasing frequency of regurgitation,
leading to eventual nonbilious projectile
vomiting

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188
Q

CONGENITAL PYLORIC STENOSIS
Why is the vomiting
nonbilious?
P539

A

Obstruction is proximal to the ampulla of

Vater

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189
Q

CONGENITAL PYLORIC STENOSIS
What are the signs?
P539

A 
Abdominal mass or “olive” in epigastric
region (85%), hypokalemic hypochloremic
metabolic alkalosis, icterus (10%), visible
gastric peristalsis, paradoxic aciduria,
hematemesis ( <10%)
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190
Q

CONGENITAL PYLORIC STENOSIS
What is the differential
diagnosis?
P539

A 
Pylorospasm, milk allergy, increased
ICP, hiatal hernia, GERD, adrenal
insufficiency, uremia, malrotation,
duodenal atresia, annular pancreas,
duodenal web
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191
Q

CONGENITAL PYLORIC STENOSIS
How is the diagnosis made?
P539

A 
Usually by history and physical exam
    alone
U/S—demonstrates elongated ( >15 mm)
    pyloric channel and thickened muscle
    wall ( >3.5 mm)
If U/S is nondiagnostic, then barium
    swallow—shows “string sign” or
    “double railroad track sign”
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192
Q

CONGENITAL PYLORIC STENOSIS
What is the initial treatment?
P539

A

Hydration and correction of alkalosis
with D10 NS plus 20 mEq of KCl
(Note: the infant’s liver glycogen stores
are very small; therefore, use D10; Cl
and hydration will correct the alkalosis)

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193
Q

CONGENITAL PYLORIC STENOSIS
What is the definitive
treatment?
P539

A

Surgical, via Fredet-Ramstedt
pyloromyotomy (division of circular
muscle fibers without entering the
lumen/mucosa)

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194
Q

CONGENITAL PYLORIC STENOSIS
What are the postoperative
complications?
P540

A

Unrecognized incision through the
duodenal mucosa, bleeding, wound
infection, aspiration pneumonia

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195
Q

CONGENITAL PYLORIC STENOSIS
What is the appropriate
postoperative feeding?
P540

A

Start feeding with Pedialyte® at 6 to 12
hours postoperatively; advance to
full-strength formula over 24 hours

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196
Q

CONGENITAL PYLORIC STENOSIS
Which vein crosses the
pylorus?
P540

A

Vein of Mayo

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197
Q

DUODENAL ATRESIA
What is it?
P540

A

Complete obstruction or stenosis of
duodenum caused by an ischemic
insult during development or failure of
recanalization

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198
Q

DUODENAL ATRESIA
What is the anatomic
location?
P540

A

85% are distal to the ampulla of Vater,
15% are proximal to the ampulla of Vater
(these present with nonbilious vomiting)

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199
Q

DUODENAL ATRESIA
What are the signs?
P540

A 
Bilious vomiting (if distal to the ampulla),
epigastric distention
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200
Q

DUODENAL ATRESIA
What is the differential
diagnosis?
P540

A

Malrotation with Ladd’s bands, annular

pancreas

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201
Q

DUODENAL ATRESIA
How is the diagnosis made?
P540

A

Plain abdominal film revealing “double
bubble,” with one air bubble in the
stomach and the other in the duodenum

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202
Q

DUODENAL ATRESIA
What is the treatment?
P540

A

Duodenoduodenostomy or

duodenojejunostomy

203
Q

DUODENAL ATRESIA
What are the associated
abnormalities?
P540

A

50% to 70% have cardiac, renal, or other
gastrointestinal defects; 30% have
trisomy 21

204
Q

MECONIUM ILEUS
What is it?
P540

A

Intestinal obstruction from solid

meconium concretions

205
Q

MECONIUM ILEUS
What is the incidence?
P540

A

Occurs in ≈15% of infants with CF

206
Q 
MECONIUM ILEUS
What percentage of patients
with meconium ileus have
CF (cystic fibrosis)?
P541
A

> 95%

207
Q

MECONIUM ILEUS
What are the signs/symptoms
of meconium ileus?
P541

A

Bilious vomiting, abdominal distention,
failure to pass meconium, Neuhauser’s
sign, peritoneal calcifications

208
Q

MECONIUM ILEUS
What is Neuhauser’s sign?
P541

A

A.k.a. “soap bubble” sign: ground glass
appearance in the RLQ on AXR from
viscous meconium mixing with air

209
Q

MECONIUM ILEUS
How is the diagnosis made?
P541

A 
Family history of CF, plain abdominal
films showing significant dilation of
similar-sized bowel loops, but few if any
air-fluid levels, BE may demonstrate
“microcolon” and inspissated meconium
pellets in the terminal ileum
210
Q

MECONIUM ILEUS
What is the treatment?
P541

A 
70% nonoperative clearance of
meconium using gastrografin enema,
+/-- acetylcysteine, which is hypertonic
and therefore draws fluid into lumen,
separating meconium pellets from bowel
wall (60% success rate)
211
Q

MECONIUM ILEUS
What is the surgical
treatment?
P541

A 
If enema is unsuccessful, then enterotomy
with intraoperative catheter irrigation
using acetylcysteine (Mucomyst®)
212
Q

MECONIUM ILEUS
What should you remove
during all operative cases?
P541

A

Appendix

213
Q

MECONIUM ILEUS
What is the long-term
medical treatment?
P541

A

Pancreatic enzyme replacement

214
Q

MECONIUM ILEUS
What is cystic fibrosis (CF)?
P541

A

Inherited disorder of epithelial Cl
transport defect affecting sweat glands,
airways, and GI tract (pancreas, intestine);
diagnosed by sweat test (elevated levels of
NaCl 60 mEq/liter) and genetic testing

215
Q

MECONIUM ILEUS
What is DIOS?
P541

A

Distal Intestinal Obstruction Syndrome:
intestinal obstruction in older patients with
CF from inspissated luminal contents

216
Q

MECONIUM PERITONITIS
What is it?
P542

A

Sign of intrauterine bowel perforation;
sterile meconium leads to an intense
local inflammatory reaction with eventual
formation of calcifications

217
Q

MECONIUM PERITONITIS
What are the signs?
P542

A

Calcifications on plain films

218
Q

MECONIUM PLUG SYNDROME
What is it?
P542

A

Colonic obstruction from unknown
factors that dehydrate meconium,
forming a “plug”

219
Q

MECONIUM PLUG SYNDROME
What is it also known as?
P542

A

Neonatal small left colon syndrome

220
Q

MECONIUM PLUG SYNDROME
What are the signs/
symptoms?
P542

A

Abdominal distention and failure to pass
meconium within first 24 hours of
life; plain films demonstrate many loops
of distended bowel and air-fluid levels

221
Q

MECONIUM PLUG SYNDROME
What is the nonoperative
treatment?
P542

A

Contrast enema is both diagnostic and
therapeutic; it demonstrates “microcolon”
to the point of dilated colon (usually in
transverse colon) and reveals copious
intraluminal material

222
Q

MECONIUM PLUG SYNDROME
What is the major
differential diagnosis?
P542

A

Hirschsprung’s disease

223
Q

MECONIUM PLUG SYNDROME
Is meconium plug highly
associated with CF?
P542

A

No; <5% of patients have CF, in contrast
to meconium ileus, in which nearly all
have CF (95%)

224
Q

ANORECTAL MALFORMATIONS
What are they?
P542

A

Malformations of the distal GI tract in
the general categories of anal atresia,
imperforate anus, and rectal atresia

225
Q

ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
What is it?
P542

A

Congenital absence of normal anus

complete absence or fistula

226
Q

ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
Define a “high” imperforate anus.
P543

A

Rectum patent to level above

puborectalis sling

227
Q

ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
Define “low” imperforate anus.
P543

A

Rectum patent to below puborectalis

sling

228
Q 
ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
Which type is much more
common in women?
P543
A

Low

229
Q 
ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
What are the associated
anomalies?
P543
A

Vertebral abnormalities, Anal abnormalities,
Cardiac, TE fistulas, Esophageal Atresia,
Radial/Renal abnormalities, Lumbar
abnormalities (VACTERL; most
commonly TE fistula)

230
Q 
ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
What are the signs/
symptoms?
P543
A

No anus, fistula to anal skin or bladder,
UTI, fistula to vagina or urethra, bowel
obstruction, distended abdomen,
hyperchloremic acidosis

231
Q

ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
How is the diagnosis made?
P543

A

Physical exam, the classic Cross table
“invertogram” plain x-ray to see level of
rectal gas (not very accurate), perineal
ultrasound

232
Q 
ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
What is the treatment of the following conditions:
Low imperforate anus with anal fistula?
P543
A

Dilatation of anal fistula and subsequent

anoplasty

233
Q 
ANORECTAL MALFORMATIONS
IMPERFORATE ANUS
What is the treatment of the following conditions:
High imperforate anus?
P543
A

Diverting colostomy and mucous fistula;

neoanus is usually made at 1 year of age

234
Q

HIRSCHSPRUNG’S DISEASE
What is it also known as?
P543

A

Aganglionic megacolon

235
Q

HIRSCHSPRUNG’S DISEASE
What is it?
P543

A 
Neurogenic form of intestinal obstruction
in which obstruction results from
inadequate relaxation and peristalsis;
absence of normal ganglion cells of the
rectum and colon
236
Q

HIRSCHSPRUNG’S DISEASE
What are the associated
risks?
P543

A

Family history; 5% chance of having a

second child with the affliction

237
Q

HIRSCHSPRUNG’S DISEASE
What is the male to female
ratio?
P544

A

What is the male to female

ratio?

238
Q

HIRSCHSPRUNG’S DISEASE
What is the anatomic
location?
P544

A

Aganglionosis begins at the anorectal line
and involves rectosigmoid in 80% of cases
(10% have involvement to splenic flexure,
and 10% have involvement of entire colon)

239
Q

HIRSCHSPRUNG’S DISEASE
What are the signs/
symptoms?
P544

A

Abdominal distention and bilious vomiting;
>95% present with failure to pass
meconium in the first 24 hours; may also
present later with constipation, diarrhea,
and decreased growth

240
Q

HIRSCHSPRUNG’S DISEASE
What is the classic history?
P544

A

Failure to pass meconium in the first

24 hours of life

241
Q

HIRSCHSPRUNG’S DISEASE
What is the differential
diagnosis?
P544

A 
Meconium plug syndrome, meconium
ileus, sepsis with adynamic ileus, colonic
neuronal dysplasia, hypothyroidism,
maternal narcotic abuse, maternal
hypermagnesemia (tocolysis)
242
Q

HIRSCHSPRUNG’S DISEASE
What imaging studies should
be ordered?
P544

A

AXR: reveals dilated colon
Unprepared barium enema: reveals
constricted aganglionic segment
with dilated proximal segment, but
this picture may not develop for 3 to
6 weeks; BE will also demonstrate
retention of barium for 24 to 48 hours
(normal evacuation = 10 to 18 hours)

243
Q

HIRSCHSPRUNG’S DISEASE
What is needed for
definitive diagnosis?
P544

A 
Rectal biopsy: for definitive diagnosis,
submucosal suction biopsy is adequate in
90% of cases; otherwise, full-thickness
biopsy should be performed to evaluate
Auerbach’s plexus
244
Q

HIRSCHSPRUNG’S DISEASE
What is the “colonic
transition zone”?
P544

A

Transition (taper) from aganglionic small
colon into the large dilated normal colon
seen on BE

245
Q

HIRSCHSPRUNG’S DISEASE
What is the initial
treatment?
P544

A

In neonates, a colostomy proximal to the
transition zone prior to correction, to allow
for pelvic growth and dilated bowel to
return to normal size

246
Q

HIRSCHSPRUNG’S DISEASE
What is a “leveling”
colostomy?
P545

A

Colostomy performed for Hirschsprung’s
disease at the level of normally innervated
ganglion cells as ascertained on frozen
section intraoperatively

247
Q

HIRSCHSPRUNG’S DISEASE
Describe the following procedures:
Swenson
P545 (picture)

A

Primary anastomosis between the anal

canal and healthy bowel (rectum removed)

248
Q

HIRSCHSPRUNG’S DISEASE
Describe the following procedures:
Duhamel
P545 (picture)

A

Anterior, aganglionic region of the
rectum is preserved and anastomosed to
a posterior portion of healthy bowel; a
functional rectal pouch is thereby created
(Think: duha = dual barrels side by side)

249
Q

HIRSCHSPRUNG’S DISEASE
Describe the following procedures:
Soave
P546 (picture)

A

A.k.a. endorectal pull-through; this procedure
involves bringing proximal normal
colon through the aganglionic rectum,
which has been stripped of its mucosa but
otherwise present (Think: SOAVE =
SAVE the rectum, lose the mucosa)

250
Q 
HIRSCHSPRUNG’S DISEASE
What is the new trend in
surgery for Hirschsprung’s
disease?
P546
A

No colostomy; remove aganglionic colon
(as confirmed on frozen section) and
perform pull-through anastomosis at the
same time (Boley modification)

251
Q

HIRSCHSPRUNG’S DISEASE
What is the prognosis?
P546

A

Overall survival rate >90%; >96%
of patients continent; postoperative
symptoms improve with age

252
Q

MALROTATION AND MIDGUT VOLVULUS
What is it?
P546

A

Failure of the normal bowel rotation,
with resultant abnormal intestinal
attachments and anatomic positions

253
Q

MALROTATION AND MIDGUT VOLVULUS
Where is the cecum?
P546

A

With malrotation, the cecum usually ends

up in the RUQ

254
Q

MALROTATION AND MIDGUT VOLVULUS
What are Ladd’s bands?
P547 (picture)

A

Fibrous bands that extend from the
abnormally placed cecum in the RUQ,
often crossing over the duodenum and
causing obstruction

255
Q

MALROTATION AND MIDGUT VOLVULUS
What is the usual age at
onset?
P547

A

33% are present by 1 week of age, 75%

by 1 month, and 90% by 1 year

256
Q

MALROTATION AND MIDGUT VOLVULUS
What is the usual
presentation?
P547

A

Sudden onset of bilious vomiting (bilious
vomiting in an infant is malrotation
until proven otherwise!)

257
Q

MALROTATION AND MIDGUT VOLVULUS
Why is the vomiting bilious?
P547

A

“Twist” is distal to the ampulla of Vater

258
Q

MALROTATION AND MIDGUT VOLVULUS
How is the diagnosis made?
P547

A

Upper GI contrast study showing cutoff
in duodenum; BE showing abnormal
position of cecum in the upper abdomen

259
Q

MALROTATION AND MIDGUT VOLVULUS
What are the possible
complications?
P547

A

Volvulus with midgut infarction, leading to
death or necessitating massive enterectomy
(rapid diagnosis is essential!)

260
Q

MALROTATION AND MIDGUT VOLVULUS
What is the treatment?
P547

A

IV antibiotics and fluid resuscitation with
LR, followed by emergent laparotomy with
Ladd’s procedure; second-look laparotomy
if bowel is severely ischemic in 24 hours to
determine if remaining bowel is viable

261
Q

MALROTATION AND MIDGUT VOLVULUS
What is the Ladd’s
procedure?
P548

A 
1. Counterclockwise reduction of
    midgut volvulus
2. Splitting of Ladd’s bands
3. Division of peritoneal attachments to
    the cecum, ascending colon
4. Appendectomy
262
Q 
MALROTATION AND MIDGUT VOLVULUS
In what direction is the
volvulus reduced—clockwise
or counterclockwise?
P548
A

Rotation of the bowel in a

counterclockwise direction

263
Q

MALROTATION AND MIDGUT VOLVULUS
Where is the cecum after
reduction?
P548

A

LLQ

264
Q 
MALROTATION AND MIDGUT VOLVULUS
What is the cause of bilious
vomiting in an infant until
proven otherwise?
P548
A

Malrotation with midgut volvulus

265
Q

OMPHALOCELE
What is it?
P548

A

Defect of abdominal wall at umbilical

ring; sac covers extruded viscera

266
Q

OMPHALOCELE
How is it diagnosed
prenatally?
P548

A

May be seen on fetal U/S after 13 weeks’

gestation, with elevated maternal AFP

267
Q

OMPHALOCELE
What comprises the “sac”?
P548

A

Peritoneum and amnion

268
Q 
OMPHALOCELE
What organ is often
found protruding from
an omphalocele, but is
almost never found with a
gastroschisis?
P548
A

The liver

269
Q

OMPHALOCELE
What is the incidence?
P548

A

≈1 in 5000 births

270
Q

OMPHALOCELE
How is the diagnosis made?
P548

A

Prenatal U/S

271
Q

OMPHALOCELE
What are the possible
complications?
P548

A

Malrotation of the gut, anomalies

272
Q

OMPHALOCELE
What is the treatment?
P548

A
  1. NG tube for decompression
  2. IV fluids
  3. Prophylactic antibiotics
  4. Surgical repair of the defect
273
Q

OMPHALOCELE
What is the treatment of a
small defect ( <2 cm)?
P549

A

Closure of abdominal wall

274
Q

OMPHALOCELE
What is the treatment of a
medium defect (2–10 cm)?
P549 (picture)

A

Removal of outer membrane and placement
of a silicone patch to form a “silo,” temporarily
housing abdominal contents; the
silo is then slowly decreased in size over 4
to 7 days, as the abdomen accommodates
the viscera; then the defect is closed

275
Q

OMPHALOCELE
What is the treatment of
“giant” defects ( >10 cm)?
P549

A

Skin flaps or treatment with Betadine®
spray, mercurochrome, or silver sulfadiazine
(Silvadene®) over defect; this allows an
eschar to form, which epithelializes over
time, allowing opportunity for future
repair months to years later

276
Q

OMPHALOCELE
What are the associated
abnormalities?
P550

A 
50% of cases occur with
abnormalities of the GI tract,
cardiovascular system, GU tract,
musculoskeletal system, CNS, and
chromosomes
277
Q

OMPHALOCELE
Of what “pentalogy” is
omphalocele a part?
P550

A

Pentalogy of Cantrell

278
Q

OMPHALOCELE
What is the pentalogy of
Cantrell?
P550

A 
“D COPS”:
    Diaphragmatic defect (hernia)
Cardiac abnormality
Omphalocele
Pericardium malformation/absence
Sternal cleft
279
Q

GASTROSCHISIS
What is it?
P550

A

Defect of abdominal wall; sac does not

cover extruded viscera

280
Q

GASTROSCHISIS
How is it diagnosed
prenatally?
P550

A

Possible at fetal ultrasound after 13 weeks’

gestation, elevated maternal AFP

281
Q

GASTROSCHISIS
Where is the defect?
P550

A

Lateral to the umbilicus

Think: gAstrochisis = lAteral

282
Q 
GASTROSCHISIS
On what side of the
umbilicus is the defect
most commonly found?
P550
A

Right

283
Q

GASTROSCHISIS
What is the usual size of the
defect?
P550

A

2 to 4 cm

284
Q

GASTROSCHISIS
What are the possible
complications?
P550

A 
Thick edematous peritoneum from
    exposure to amnionic fluid;
    malrotation of the gut
Other complications include hypothermia;
    hypovolemia from third-spacing; sepsis;
    and metabolic acidosis from hypovolemia
    and poor perfusion, NEC, prolonged
    ileus
285
Q

GASTROSCHISIS
How is the diagnosis made?
P550

A

Prenatal U/S

286
Q

GASTROSCHISIS
What is the treatment?
P551

A 
Primary—NG tube decompression, IV
    fluids (D10 LR), and IV antibiotics
Definitive—surgical reduction of viscera
    and abdominal closure; may require
    staged closure with silo
287
Q

GASTROSCHISIS
What is a “silo”?
P551

A

Silastic silo is a temporary housing for
external abdominal contents; silo is slowly
tightened over time

288
Q

GASTROSCHISIS
What is the prognosis?
P551

A

>90% survival rate

289
Q

GASTROSCHISIS
What are the associated
anomalies?
P551

A

Unlike omphalocele, relatively uncommon
except for intestinal atresia, which occurs
in 10% to 15% of cases

290
Q 
GASTROSCHISIS
What are the major
differences compared with
omphalocele?
P551
A

No membrane coverings
Uncommon associated abnormalities
Lateral to umbilicus—not on umbilicus

291
Q 
GASTROSCHISIS
How can you remember the
position of omphalocele vs.
gastroschisis?
P551
A

Think: OMphalocele = ON the

umbilicus

292
Q 
GASTROSCHISIS
How do you remember that
omphalocele is associated
with abnormalities in 50% of
cases?
P551
A

Think: Omphalocele = “Oh no, lots of

abnormalities”

293
Q 
POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
What are the differences
between omphalocele and
gastroschisis in terms of the
following characteristics:
Anomalies?
P551
A

Common in omphalocele (50%),

uncommon in gastroschisis

294
Q 
POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
What are the differences
between omphalocele and
gastroschisis in terms of the
following characteristics:
Peritoneal/amnion
covering (sac)?
P551
A

Always with omphalocele—never with

gastroschisis

295
Q 
POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
What are the differences
between omphalocele and
gastroschisis in terms of the
following characteristics:
Position of umbilical
cord?
P551
A

On the sac with omphalocele, from skin

to the left of the gastroschisis defect

296
Q 
POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
What are the differences
between omphalocele and
gastroschisis in terms of the
following characteristics:
Thick bowel?
P552
A

Common with gastroschisis, rare with

omphalocele (unless sac ruptures)

297
Q 
POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
What are the differences
between omphalocele and
gastroschisis in terms of the
following characteristics:
Protrusion of liver?
P552
A

Common with omphalocele, almost never

with gastroschisis

298
Q 
POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
What are the differences
between omphalocele and
gastroschisis in terms of the
following characteristics:
Large defect?
P552
A

Omphalocele

299
Q

APPENDICITIS
What is it?
P552

A 
Obstruction of the appendiceal lumen
(fecalith, lymphoid hyperplasia),
producing a closed loop with resultant
inflammation that can lead to necrosis
and perforation
300
Q

APPENDICITIS
What is its claim to fame?
P552

A

Most common surgical disease requiring

emergency surgery in children

301
Q

APPENDICITIS
What is the affected age?
P552

A

Very rare before 3 years of age

302
Q

APPENDICITIS
What is the usual
presentation?
P552

A 
Onset of referred or periumbilical pain
    followed by anorexia, nausea, and
    vomiting (Note: Unlike gastroenteritis,
    pain precedes vomiting, then
    migrates to the RLQ, where it
    intensifies from local peritoneal
    irritation)
If the patient is hungry and can eat,
    seriously question the diagnosis of
    appendicitis
303
Q

APPENDICITIS
How is the diagnosis made?
P552

A

History and physical exam

304
Q

APPENDICITIS
What are the signs/
symptoms?
P552

A 
Signs of peritoneal irritation may be
present—guarding, muscle spasm, rebound
tenderness, obturator and Psoas signs;
low-grade fever rising to high grade if
perforation occurs
305
Q

APPENDICITIS
What is the differential
diagnosis?
P552

A 
Intussusception, volvulus, Meckel’s
diverticulum, Crohn’s disease, ovarian
torsion, cyst, tumor, perforated ulcer,
pancreatitis, PID, ruptured ectopic
pregnancy, mesenteric lymphadenitis
306
Q 
APPENDICITIS
What is the common
bacterial cause of mesenteric
lymphadenitis?
P553
A

Yersinia enterocolitica

307
Q

APPENDICITIS
What are the associated lab
findings with appendicitis?
P553

A 
Increased WBC ( >10,000 per mm in
>90% of cases, with a left shift in most)
308
Q

APPENDICITIS
What is the role of
urinalysis?
P553

A

To evaluate for possible pyelonephritis or
renal calculus, but mild hematuria and
pyuria are common in appendicitis
because of ureteral inflammation

309
Q

APPENDICITIS
What is the “hamburger”
sign?
P553

A

Ask patients with suspected appendicitis
if they would like a hamburger or favorite
food; if they can eat, seriously question
the diagnosis

310
Q

APPENDICITIS
What radiographic studies
may be performed?
P553

A

Often none; CXR to rule out RML or
RLL pneumonia; abdominal films are
usually nonspecific, but calcified fecalith
is present in 5% of cases; U/S to evaluate
for ovarian/gynecologic pathology

311
Q

APPENDICITIS
What is the treatment?
P553

A 
Nonperforated—prompt appendectomy
    and cefoxitin to avoid perforation
Perforated—triple antibiotics,
    fluid resuscitation, and prompt
    appendectomy; all pus is drained and
    cultures obtained, with postoperative
    antibiotics continued for 5 to 7 days,
    ± drain
312
Q 
APPENDICITIS
How long should antibiotics
be administered if
nonperforated?
P553
A

24 hours

313
Q

APPENDICITIS
How long if perforated?
P553

A

Usually 5 to 7 days or until WBCs are

normal and patient is afebrile

314
Q 
APPENDICITIS
If a normal appendix is
found upon exploration,
what must be examined/
ruled out?
P553
A

Meckel’s diverticulum, Crohn’s disease,

intussusception, gynecologic disease

315
Q

APPENDICITIS
What is the approximate risk
of perforation?
P554

A

≈25% after 24 hours from onset of
symptoms
≈50% by 36 hours
≈75% by 48 hours

316
Q

INTUSSUSCEPTION
What is it?
P554

A

Obstruction caused by bowel telescoping
into the lumen of adjacent distal bowel;
may result when peristalsis carries a
“leadpoint” downstream

317
Q

INTUSSUSCEPTION
What is its claim to fame?
P554

A

Most common cause of small bowel

obstruction in toddlers ( <2 years old)

318
Q

INTUSSUSCEPTION
What is the usual age at
presentation?
P554

A

Disease of infancy; 60% present from 4 to

12 months of age, 80% by 2 years of age

319
Q

INTUSSUSCEPTION
What is the most common
site?
P554

A

Terminal ileum involving ileocecal valve

and extending into ascending colon

320
Q

INTUSSUSCEPTION
What is the most common
cause?
P554

A

Hypertrophic Peyer’s patches, which act
as a lead point; many patients have prior
viral illness

321
Q

INTUSSUSCEPTION
What are the signs/
symptoms?
P554

A

Alternating lethargy and irritability (colic),
bilious vomiting, “currant jelly” stools,
RLQ mass on plain abdominal film,
empty RLQ on palpation (Dance’s sign)

322
Q

INTUSSUSCEPTION
What is the intussuscipiens?
P554

A

Recipient segment of bowel (Think:

recipiens = intussuscipiens)

323
Q

INTUSSUSCEPTION
What is the intussusceptum?
P554

A

Leading point or bowel that enters the

intussuscipiens

324
Q

INTUSSUSCEPTION
Identify locations 1 and 2 on
the following illustration:
P554 (picture)

A
  1. Intussuscipiens

2. Intussusceptum

325
Q 
INTUSSUSCEPTION
How can the spelling
of intussusception be
remembered?
P555
A

Imagine a navy ship named The

U.S.S. U.S.—INTUSSUSCEPTION

326
Q

INTUSSUSCEPTION
What is the treatment?
P555

A 
Air or barium enema; 85% reduce
with hydrostatic pressure (i.e., barium
= meter elevation air = maximum
of 120 mm Hg); if unsuccessful, then
laparotomy and reduction by “milking”
the ileum from the colon should be
performed
327
Q 
INTUSSUSCEPTION
What are the causes of
intussusception in older
patients?
P555
A

Meckel’s diverticulum, polyps, and
tumors, all of which act as a lead
point

328
Q

MECKEL’S DIVERTICULUM
What is it?
P556

A

Remnant of the omphalomesenteric
duct/vitelline duct, which connects the
yolk sac with the primitive midgut in the
embryo

329
Q

MECKEL’S DIVERTICULUM
What is the usual location?
P556

A

Between 45 and 90 cm proximal to the
ileocecal valve on the antimesenteric
border of the bowel

330
Q

MECKEL’S DIVERTICULUM
What is the major differential
diagnosis?
P556

A

Appendicitis

331
Q

MECKEL’S DIVERTICULUM
Is it a true diverticulum?
P556

A

Yes; all layers of the intestine are found

in the wall

332
Q

MECKEL’S DIVERTICULUM
What is the incidence?
P556

A

2% of the population at autopsy, but

>90% of these are asymptomatic

333
Q

MECKEL’S DIVERTICULUM
What is the gender ratio?
P556

A

2 to 3x more common in males

334
Q

MECKEL’S DIVERTICULUM
What is the usual age at
onset of symptoms?
P556

A

Most frequently in the first 2 years of life,

but can occur at any age

335
Q

MECKEL’S DIVERTICULUM
What are the possible
complications?
556

A 
Intestinal hemorrhage (painless)—50%
    Accounts for 50% of all lower GI
       bleeding in patients younger than
       2 years; bleeding results from
       ectopic gastric mucosa secreting
       acid → ulcer → bleeding
Intestinal obstruction—25%
    Most common complication in
       adults; includes volvulus and
        intussusception
Inflammation ( ± perforation)—20%
336
Q

MECKEL’S DIVERTICULUM
What percentage of cases
have heterotopic tissue?
556

A

>50%; usually gastric mucosa (85%), but
duodenal, pancreatic, and colonic mucosa
have been described

337
Q 
MECKEL’S DIVERTICULUM
What is the most common
ectopic tissue in a Meckel’s
diverticulum?
556
A

Gastric mucosa

338
Q 
MECKEL’S DIVERTICULUM
What other pediatric disease
entity can also present with
GI bleeding secondary to
ectopic gastric mucosa?
556
A

Enteric duplications

339
Q 
MECKEL’S DIVERTICULUM
What is the most common
cause of lower GI bleeding
in children?
556
A

Meckel’s diverticulum with ectopic

gastric mucosa

340
Q

MECKEL’S DIVERTICULUM
What is the “rule of 2s”?
556

A 
2% are symptomatic
Found ≈2 feet from ileocecal valve
Found in 2% of the population
Most symptoms occur before age 2
One of 2 will have ectopic tissue
Most diverticula are about 2 inches long
Male:female ratio = 2:1
341
Q

MECKEL’S DIVERTICULUM
What is a Meckel’s scan?
556

A

Scan for ectopic gastric mucosa in
Meckel’s diverticulum; uses technetium
Tc 99m pertechnetate IV, which is
preferentially taken up by gastric mucosa

342
Q

NECROTIZING ENTEROCOLITIS
What is it also known as?
P57

A

NEC

343
Q

NECROTIZING ENTEROCOLITIS
What is it?
P57

A

Necrosis of intestinal mucosa, often with
bleeding; may progress to transmural
intestinal necrosis, shock/sepsis, and death

344
Q

NECROTIZING ENTEROCOLITIS
What are the predisposing
conditions?
P57

A 
PREMATURITY
Stress: shock, hypoxia, RDS, apneic
    episodes, sepsis, exchange transfusions,
    PDA and cyanotic heart disease,
    hyperosmolar feedings, polycythemia,
    indomethacin
345
Q

NECROTIZING ENTEROCOLITIS
What is the pathophysiologic
mechanism?
P57

A

Probable splanchnic vasoconstriction with
decreased perfusion, mucosal injury, and
probable bacterial invasion

346
Q

NECROTIZING ENTEROCOLITIS
What is its claim to fame?
P57

A

Most common cause of emergent

laparotomy in the neonate

347
Q

NECROTIZING ENTEROCOLITIS
What are the signs/
symptoms?
P57

A 
Abdominal distention, vomiting, heme
positive or gross rectal bleeding, fever or
hypothermia, jaundice, abdominal wall
erythema (consistent with perforation
and abscess formation)
348
Q

NECROTIZING ENTEROCOLITIS
What are the radiographic
findings?
P57

A

Fixed, dilated intestinal loops; pneumatosis
intestinalis (air in the bowel wall); free
air; and portal vein air (sign of advanced
disease)

349
Q

NECROTIZING ENTEROCOLITIS
What are the lab findings?
P57

A

Low hematocrit, glucose, and platelets

350
Q

NECROTIZING ENTEROCOLITIS
What is the treatment?
P57

A

Most are managed medically:

1. Cessation of feedings
2. OG tube
3. IV fluids
4. IV antibiotics
5. Ventilator support, as needed
351
Q

NECROTIZING ENTEROCOLITIS
What are the surgical
indications?
P57

A

Free air in abdomen revealing
perforation, and positive peritoneal tap
revealing transmural bowel necrosis

352
Q

NECROTIZING ENTEROCOLITIS
Operation?
P58

A
  1. Resect

2. Stoma

353
Q 
NECROTIZING ENTEROCOLITIS
What is an option for bowel
perforation in 1000 gram
NEC patients?
P58
A

Placement of percutaneous drain

without laparotomy!

354
Q 
NECROTIZING ENTEROCOLITIS
Is portal vein gas or
pneumatosis intestinalis
alone an indication for
operation with NEC?
P58
A

No

355
Q

NECROTIZING ENTEROCOLITIS
What are the indications for
peritoneal tap?
P58

A

Severe thrombocytopenia, distended
abdomen, abdominal wall erythema,
unexplained clinical downturn

356
Q

NECROTIZING ENTEROCOLITIS
What are the possible
complications?
P58

A

Bowel necrosis, gram-negative sepsis,
DIC, wound infection, cholestasis, short
bowel syndrome, strictures, SBO

357
Q

NECROTIZING ENTEROCOLITIS
What is the prognosis?
P58

A

>80% overall survival rate

358
Q

BILIARY TRACT
What is “physiologic
jaundice”?
P558

A

Hyperbilirubinemia in the first 2 weeks
of life from inadequate conjugation of
bilirubin

359
Q

BILIARY TRACT
What enzyme is responsible
for conjugation of bilirubin?
P558

A

Glucuronyl transferase

360
Q 
BILIARY TRACT
How is hyperbilirubinemia
from “physiologic jaundice”
treated?
P558
A

UV light

361
Q

BILIARY TRACT
What is Gilbert’s syndrome?
P558

A

Partial deficiency of glucuronyl
transferase, leading to intermittent
asymptomatic jaundice in the second or
third decade of life

362
Q

BILIARY TRACT
What is Crigler-Najjar
syndrome?
P558

A

Rare genetic absence of glucuronyl
transferase activity, causing unconjugated
hyperbilirubinemia, jaundice, and death
from kernicterus (usually within the first
year)

363
Q

BILIARY ATRESIA
What is it?
P559

A

Obliteration of extrahepatic biliary tree

364
Q

BILIARY ATRESIA
What is the incidence?
P559

A

One in 16,000 births

365
Q

BILIARY ATRESIA
What are the signs/
symptoms?
P559

A 
Persistent jaundice (normal physiologic
jaundice resolves in <2 weeks),
hepatomegaly, splenomegaly, ascites
and other signs of portal hypertension,
acholic stools, biliuria
366
Q

BILIARY ATRESIA
What are the lab findings?
P559

A

Mixed jaundice is always present (i.e.,
both direct and indirect bilirubin
increased), with an elevated serum
alkaline phosphatase level

367
Q 
BILIARY ATRESIA
What is the classic
“rule of 5s” of indirect
bilirubinemia?
P559
A 
Bizarre: with progressive
hyperbilirubinemia, jaundice progresses
by levels of 5 from the head to toes:
5 mg/dL = jaundice of head, 10 mg/
dL = jaundice of trunk, 15 mg/dL =
jaundice of leg/feet
368
Q

BILIARY ATRESIA
What is the differential
diagnosis?
P559

A 
Neonatal hepatitis (TORCH); biliary
hypoplasia
369
Q

BILIARY ATRESIA
How is the diagnosis made?
P559

A 
1. U/S to rule out choledochal cyst and
    to examine extrahepatic bile ducts and
    gallbladder
2. HIDA scan—shows no excretion into
    the GI tract (with phenobarbital
    preparation)
3. Operative cholangiogram and liver
    biopsy
370
Q

BILIARY ATRESIA
What is the treatment?
P559

A

Early laparotomy by 2 months of age
with a modified form of the Kasai
hepatoportoenterostomy

371
Q

BILIARY ATRESIA
How does a Kasai work?
P559

A

Anastomosis of the porta hepatis and the
small bowel allows drainage of bile via
many microscopic bile ducts in the
fibrous structure of the porta hepatis

372
Q

BILIARY ATRESIA
What if the Kasai fails?
P560

A

Revise or liver transplantation

373
Q

BILIARY ATRESIA
What are the possible
postoperative complications?
P560

A 
Cholangitis (manifested as decreased
bile secretion, fever, leukocytosis,
and recurrence of jaundice),
progressive cirrhosis (manifested as
portal hypertension with bleeding
varices, ascites, hypoalbuminemia,
hypothrombinemia, and fat-soluble
vitamin K, A, D, E deficiencies)
374
Q

BILIARY ATRESIA
What are the associated
abnormalities?
P560

A

Between 25% and 30% have other
anomalies, including annular pancreas,
duodenal atresia, malrotation, polysplenic
syndrome, situs inversus, and preduodenal
portal vein; 15% have congenital heart
defects

375
Q

CHOLEDOCHAL CYST
What is it?
P560

A

Cystic enlargement of bile ducts; most
commonly arises in extrahepatic ducts, but
can also arise in intrahepatic ducts

376
Q

CHOLEDOCHAL CYST
What is the usual
presentation?
P560

A

50% present with intermittent jaundice,
RUQ mass, and abdominal pain; may also
present with pancreatitis

377
Q

CHOLEDOCHAL CYST
What are the possible
complications?
P560

A

Cholelithiasis, cirrhosis, carcinoma, and

portal HTN

378
Q 
CHOLEDOCHAL CYST
What are the anatomic
variants:
I?
P560 (picture)
A

Dilation of common hepatic and common
bile duct, with cystic duct entering the
cyst; most common type (90%)

379
Q 
CHOLEDOCHAL CYST
What are the anatomic
variants:
II?
P561 (picture)
A

Lateral saccular cystic dilation

380
Q 
CHOLEDOCHAL CYST
What are the anatomic
variants:
III?
P561 (picture)
A

Choledochocele represented by an

intraduodenal cyst

381
Q 
CHOLEDOCHAL CYST
What are the anatomic
variants:
IV?
P561 (picture)
A

Multiple extrahepatic cysts, intrahepatic

cysts, or both

382
Q 
CHOLEDOCHAL CYST
What are the anatomic
variants:
V?
P561 (picture)
A

Single or multiple intrahepatic cysts

383
Q

CHOLEDOCHAL CYST
How is the diagnosis made?
P562

A

U/S

384
Q

CHOLEDOCHAL CYST
What is the treatment?
P562

A 
Operative cholangiogram to clarify
pathologic process and delineate the
pancreatic duct, followed by complete
resection of the cyst and a Roux-en-Y
hepatojejunostomy
385
Q 
CHOLEDOCHAL CYST
What condition are these
patients at increased risk
of developing?
P562
A

Cholangiocarcinoma often arises in
the cyst; therefore, treat by complete
prophylactic resection of the cyst

386
Q

CHOLELITHIASIS
What is it?
P562

A

Formation of gallstones

387
Q

CHOLELITHIASIS
What are the common
causes in children?
P562

A 
Etiology differs somewhat from that
of adults; the most common cause is
cholesterol stones, but there is an
increased percentage of pigmented
stones from hemolytic disorders
388
Q

CHOLELITHIASIS
What is the differential
diagnosis?
P562

A

Hereditary spherocytosis, thalassemia,
pyruvate kinase deficiency, sickle-cell
disease, cystic fibrosis, long-term
parenteral nutrition, idiopathic

389
Q

CHOLELITHIASIS
What are the associated
risks?
P562

A

Use of oral contraceptives, teenage,

positive family history

390
Q

CHOLELITHIASIS
What is the treatment?
P562

A

Cholecystectomy is recommended for all

children with gallstones

391
Q 
ANNULAR PANCREAS
What is an annular
pancreas?
What is an annular
pancreas?
P562
A

Congenital pancreatic abnormality with
complete encirclement of the duodenum
by the pancreas

392
Q

ANNULAR PANCREAS
What are the symptoms?
P562

A

Duodenal obstruction

393
Q

ANNULAR PANCREAS
What is the treatment?
P562

A

Duodenoduodenostomy bypass of

obstruction (do not resect the pancreas!)

394
Q 
TUMORS
What is the differential
diagnosis of pediatric
abdominal mass?
P563
A 
Wilms’ tumor, neuroblastoma, hernia,
intussusception, malrotation with volvulus,
mesenteric cyst, duplication cyst, liver
tumor (hepatoblastoma/hemangioma),
rhabdomyosarcoma, teratoma
395
Q

TUMORS
WILMS’ TUMOR
What is it?
P563

A

Embryonal tumor of renal origin

396
Q

TUMORS
WILMS’ TUMOR
What is the incidence?
P563

A

Very rare: 500 new cases in the United

States per year

397
Q 
TUMORS
WILMS’ TUMOR
What is the average age at
diagnosis?
P563
A

Usually between 1 and 5 years of age

398
Q

TUMORS
WILMS’ TUMOR
What are the symptoms?
P563

A

Usually asymptomatic except for
abdominal mass; 20% of patients present
with minimal blunt trauma to mass

399
Q

TUMORS
WILMS’ TUMOR
What is the classic history?
P563

A

Found during dressing or bathing

400
Q

TUMORS
WILMS’ TUMOR
What are the signs?
P563

A 
Abdominal mass (most do not cross the
midline); hematuria (10%–15%); HTN in
20% of cases, related to compression of
juxtaglomerular apparatus; signs of
Beckwith-Wiedemann syndrome
401
Q 
TUMORS
WILMS’ TUMOR
What are the diagnostic
radiologic tests?
P563
A

Abdominal and chest CT

402
Q 
TUMORS
WILMS’ TUMOR
Define the stages:
Stage I
P563
A

Limited to kidney and completely resected

403
Q 
TUMORS
WILMS’ TUMOR
Define the stages:
Stage II
P563
A

Extends beyond kidney, but completely
resected; capsule invasion and perirenal
tissues may be involved

404
Q 
TUMORS
WILMS’ TUMOR
Define the stages:
Stage III
P563
A

Residual nonhematogenous tumor after

resection

405
Q 
TUMORS
WILMS’ TUMOR
Define the stages:
Stage IV
P563
A 
Hematogenous metastases (lung, distal
lymph nodes, and brain)
406
Q 
TUMORS
WILMS’ TUMOR
Define the stages:
Stage V
P563
A

Bilateral renal involvement

407
Q 
TUMORS
WILMS’ TUMOR
What are the best indicators
of survival?
P564
A

Stage and histologic subtype of tumor; 85%
of patients have favorable histology (FH);
15% have unfavorable histology (UH);
overall survival for FH is 85% for all stages

408
Q

TUMORS
WILMS’ TUMOR
What is the treatment?
P564

A

Radical resection of affected kidney
with evaluation for staging, followed by
chemotherapy (low stages) and radiation
(higher stages)

409
Q 
TUMORS
WILMS’ TUMOR
What is the neoadjuvant
treatment?
P564
A

Large tumors may be shrunk with
chemotherapy/XRT to allow for surgical
resection

410
Q 
TUMORS
WILMS’ TUMOR
What are the associated
abnormalities?
P564
A

Aniridia, hemihypertrophy,
Beckwith-Wiedemann syndrome,
neurofibromatosis, horseshoe kidney

411
Q 
TUMORS
WILMS’ TUMOR
What is the Beckwith-
Wiedemann syndrome?
P564
A 
Syndrome of:
1. Umbilical defect
2. Macroglossia (big tongue)
3. Gigantism
4. Visceromegaly (big organs) (Think:
Wilms’ = Beckwith-Wiedemann)
412
Q

TUMORS
NEUROBLASTOMA
What is it?
P564

A

Embryonal tumor of neural crest origin

413
Q 
TUMORS
NEUROBLASTOMA
What are the anatomic
locations?
P564
A 
Adrenal medulla—50%
Paraaortic abdominal paraspinal
ganglia—25%
Posterior mediastinum—20%
Neck—3%
Pelvis—3%
414
Q 
TUMORS
NEUROBLASTOMA
With which types of tumor
does a patient with Horner’s
syndrome present?
P564
A

Neck, superior mediastinal tumors

415
Q

TUMORS
NEUROBLASTOMA
What is the incidence?
P564

A

One in 7000 to 10,000 live births; most
common solid malignant tumor of
infancy; most common solid tumor in
children outside the CNS

416
Q 
TUMORS
NEUROBLASTOMA
What is the average age at
diagnosis?
P564
A

≈50% are diagnosed by 2 years of age

≈90% are diagnosed by 8 years of age

417
Q

TUMORS
NEUROBLASTOMA
What are the symptoms?
P565

A

Vary by tumor location—anemia, failure
to thrive, weight loss, and poor nutritional
status with advanced disease

418
Q

TUMORS
NEUROBLASTOMA
What are the signs?
P565

A 
Asymptomatic abdominal mass (palpable
in 50% of cases), respiratory distress
(mediastinal tumors), Horner’s syndrome
(upper chest or neck tumors), proptosis
(with orbital metastases), subcutaneous
tumor nodules, HTN (20%–35%)
419
Q

TUMORS
NEUROBLASTOMA
LABS?
P565

A

24-hour urine to measure VMA, HVA,
and metanephrines (elevated in 85%);
neuron-specific enolase, N-myc oncogene,
DNA ploidy

420
Q 
TUMORS
NEUROBLASTOMA
What are the diagnostic
radiologic tests?
P565
A

CT scan, MRI, I-MIBG, somatostatin

receptor scan

421
Q 
TUMORS
NEUROBLASTOMA
What is the classic abdominal
plain x-ray finding?
P565
A

Calcifications ( ≈50%)

422
Q 
TUMORS
NEUROBLASTOMA
How do you access bone
marrow involvement?
P565
A

Bone marrow aspirate

423
Q 
TUMORS
NEUROBLASTOMA
What is the difference in
position of tumors in
neuroblastoma versus
Wilms’ tumors?
P565 (picture)
A

Neuroblastoma may cross the midline,

but Wilms’ tumors do so only rarely

424
Q

TUMORS
NEUROBLASTOMA
What is the treatment?
P565

A

Depends on staging

425
Q 
TUMORS
NEUROBLASTOMA
Define the stages:
Stage I
P566
A

Tumor is confined to organ of origin

426
Q 
TUMORS
NEUROBLASTOMA
Define the stages:
Stage II
P566
A

Tumor extends beyond organ of origin

but not across the midline

427
Q 
TUMORS
NEUROBLASTOMA
Define the stages:
Stage III
P566
A

Tumor extends across the midline

428
Q 
TUMORS
NEUROBLASTOMA
Define the stages:
Stage IV
P566
A

Metastatic disease

429
Q 
TUMORS
NEUROBLASTOMA
Define the stages:
Stage IVS
P566
A

Infants: Localized primary tumor does
not cross the midline, but remote
disease is confined to the liver,
subcutaneous/skin, and bone marrow

430
Q 
TUMORS
NEUROBLASTOMA
What is the treatment of each stage:
Stage I
P566
A

Surgical resection

431
Q 
TUMORS
NEUROBLASTOMA
What is the treatment of each stage:
Stage II
P566
A

Resection and chemotherapy +/– XRT

432
Q 
TUMORS
NEUROBLASTOMA
What is the treatment of each stage:
Stage III
P566
A

Resection and chemotherapy/XRT

433
Q 
TUMORS
NEUROBLASTOMA
What is the treatment of each stage:
Stage IV
P566
A

Chemotherapy/XRT → resection

434
Q 
TUMORS
NEUROBLASTOMA
What is the treatment of each stage:
Stage IVS
P566
A

In the infant with small tumor and
asymptomatic = observe as many will
regress “spontaneously”

435
Q 
TUMORS
NEUROBLASTOMA
What is the survival rate of
each stage:
Stage I?
P566
A

≈90%

436
Q 
TUMORS
NEUROBLASTOMA
What is the survival rate of
each stage:
Stage II?
P566
A

≈80%

437
Q 
TUMORS
NEUROBLASTOMA
What is the survival rate of
each stage:
Stage III?
P566
A

≈40%

438
Q 
TUMORS
NEUROBLASTOMA
What is the survival rate of
each stage:
Stage IV?
P566
A

≈15%

439
Q 
TUMORS
NEUROBLASTOMA
What is the survival rate of
each stage:
Stage IVS?
P566
A

Survival rate is >80%! Note: these tumors
are basically stage I or II with metastasis to
liver, subcutaneous tissue, or bone marrow;
most of these patients, if younger than
1 year of age, have a spontaneous cure
(Think: Stage IVS = Special condition)

440
Q 
TUMORS
NEUROBLASTOMA
What are the laboratory
prognosticators?
P567
A

Aneuploidy is favorable! The lower the
number of N-myc oncogene copies, the
better the prognosis

441
Q 
TUMORS
NEUROBLASTOMA
Which oncogene is associated
with neuroblastoma?
P567
A

N-myc oncogene

Think: N-myc = Neuroblastoma

442
Q

TUMORS
RHABDOMYOSARCOMA
What is it?
P567

A

Highly malignant striated muscle sarcoma

443
Q

TUMORS
RHABDOMYOSARCOMA
What is its claim to fame?
P567

A

Most common sarcoma in children

444
Q

TUMORS
RHABDOMYOSARCOMA
What is the age distribution?
P567

A

Bimodal:

1. 2–5 years
2. 15–19 years
445
Q 
TUMORS
RHABDOMYOSARCOMA
What are the most common
sites?
P567
A
  1. Head and neck (40%)
  2. GU tract (20%)
  3. Extremities (20%)
446
Q 
TUMORS
RHABDOMYOSARCOMA
What are the signs/
symptoms?
P567
A

Mass

447
Q

TUMORS
RHABDOMYOSARCOMA
How is the diagnosis made?
P567

A

Tissue biopsy, CT scan, MRI, bone marrow

448
Q 
TUMORS
RHABDOMYOSARCOMA
What is the treatment:
Resectable?
P567
A

Surgical excision, +/– chemotherapy and

radiation therapy

449
Q 
TUMORS
RHABDOMYOSARCOMA
What is the treatment:
Unresectable?
P567
A

Neoadjuvant chemo/XRT, then surgical

excision

450
Q

TUMORS
HEPATOBLASTOMA
What is it?
P567

A

Malignant tumor of the liver (derived

from embryonic liver cells)

451
Q 
TUMORS
HEPATOBLASTOMA
What is the average age at
diagnosis?
P567
A

Presents in the first 3 years of life

452
Q 
TUMORS
HEPATOBLASTOMA
What is the male to female
ratio?
P567
A

2:1

453
Q

TUMORS
HEPATOBLASTOMA
How is the diagnosis made?
P568

A 
Physical exam—abdominal distention;
    RUQ mass that moves with
    respiration
Elevated serum -fetoprotein and ferritin
    (can be used as tumor markers)
CT scan of abdomen, which often
    predicts resectability
454
Q 
TUMORS
HEPATOBLASTOMA
What percentage will have
an elevated -fetoprotein
level?
P568
A

≈90%

455
Q

TUMORS
HEPATOBLASTOMA
What is the treatment?
P568

A 
Resection by lobectomy or trisegmentectomy
is the treatment of choice
(plus postoperative chemotherapy);
large tumors may require preoperative
chemotherapy and subsequent hepatic
resection
456
Q 
TUMORS
HEPATOBLASTOMA
What is the overall survival
rate?
P568
A

≈50%

457
Q 
TUMORS
HEPATOBLASTOMA
What is the major difference
in age presentation
between hepatoma and
hepatoblastoma?
P568
A

Hepatoblastoma presents at younger
than 3 years of age; hepatoma presents
at older than 3 years of age and in
adolescents

458
Q

PEDIATRIC TRAUMA
What is the leading cause of
death in pediatric patients?
P568

A

Trauma

459
Q 
PEDIATRIC TRAUMA
How are the vast majority
of splenic and liver injuries
treated in children?
P568
A

Observation (i.e., nonoperatively)

460
Q 
PEDIATRIC TRAUMA
What is a common simulator
of peritoneal signs in the
blunt pediatric trauma
victim?
P568
A

Gastric distention (place an NG tube)

461
Q 
PEDIATRIC TRAUMA
How do you estimate normal
systolic blood pressure (SBP)
in a child?
P568
A

80 + 2 x age (e.g., a 5-year-old child

should have an SBP of about 90)

462
Q 
PEDIATRIC TRAUMA
What is the 20–20–10 rule
for fluid resuscitation of the
unstable pediatric trauma
patient?
P569
A

First give a 20-cc/kg LR bolus followed
by a second bolus of 20-cc/kg LR bolus
if needed; if the patient is still unstable
after the second LR bolus, then administer
a 10-cc/kg bolus of blood

463
Q

PEDIATRIC TRAUMA
What CT scan findings
suggest small bowel injury?
P569

A

Free fluid with no evidence of liver
or spleen injury; free air, contrast leak,
bowel thickening, mesentery streaking

464
Q

PEDIATRIC TRAUMA
What is the treatment for
duodenal hematoma?
P569

A

Observation with NGT and TPN

465
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is bilious vomiting in
an infant?
P569

A

Malrotation, until proven otherwise!
(About 90% of patients with malrotation
present before the first year of life)

466
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What does TORCHES stand
for?
P569

A

Nonbacterial fetal and neonatal infections:
TOxoplasmosis, Rubella, Cytomegalovirus
(CMV), HErpes, Syphilis

467
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the common
pediatric sedative?
P569

A

Chloral hydrate

468
Q 
OTHER PEDIATRIC SURGERY QUESTIONS
What are the
contraindications to
circumcision?
P569
A

Hypospadias, etc., because the foreskin
might be needed for future repair of the
abnormality

469
Q

OTHER PEDIATRIC SURGERY QUESTIONS
When should an umbilical
hernia be repaired?
P569

A

>1.5 cm, after 4 years of age;
otherwise observe, because most close
spontaneously; repair before school age
if it persists

470
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the cancer risk in
the cryptorchid testicle?
P569

A

> 10x the normal testicular cancer rate

471
Q

OTHER PEDIATRIC SURGERY QUESTIONS
When should orchidopexy
be performed?
P569

A

All patients with undescended testicle

undergo orchidopexy after 1 year of age

472
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What are some signs of child
abuse?
P570

A

Cigarette burns, rope burns, scald to
posterior thighs and buttocks, multiple
fractures/old fractures, genital trauma,
delay in accessing health care system

473
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the treatment of
child abuse?
P570

A

Admit the patient to the hospital

474
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is Dance’s sign?
P570

A

Empty RLQ in patients with ileocecal

intussusception

475
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the treatment of
hemangioma?
P570

A

Observation, because most regress

spontaneously

476
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What are the indications for
operation in hemangiomas?
P570

A

Severe thrombocytopenia, congestive
heart failure, functional impairment
(vision, breathing)

477
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What are treatment options
for hemangiomas?
P570

A

Steroids, radiation, surgical resection,

angiographic embolization

478
Q 
OTHER PEDIATRIC SURGERY QUESTIONS
What is the most common
benign liver tumor in
children?
P570
A

Hemangioma

479
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is Eagle-Barrett’s
syndrome?
P570

A 
A.k.a. prune belly; congenital inadequate
abdominal musculature (very lax and thin)
480
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the Pierre-Robin
syndrome?
P570

A

Classic triad:

1. Big, protruding tongue (glossoptosis)
2. Small mandible (micrognathia)
3. Cleft palate
481
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the major concern
with Pierre-Robin syndrome?
P570

A

Airway obstruction by the tongue!

482
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What are the most common
cancers in children?
P570

A
  1. Leukemia
  2. CNS tumors
  3. Lymphomas
483
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the most common
solid neoplasm in infants?
P570

A

Neuroblastoma

484
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the most common
solid tumor in children?
P570

A

CNS tumors

485
Q 
OTHER PEDIATRIC SURGERY QUESTIONS
What syndrome must you
consider in the patient with
abdominal pain, hematuria,
history of joint pain, and a
purpuric rash?
P571
A

Henoch-Schönlein syndrome; patient
may also have melena (50%) or at least
guaiac-positive stools (75%)

486
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is Apley’s law?
P571

A

The further a chronically recurrent
abdominal pain is from the umbilicus, the
greater the likelihood of an organic cause
for the pain

487
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the most common
cause of SBO in children?
P571

A

Hernias

488
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is a patent urachus?
P571

A

Persistence of the urachus, a
communication between the bladder and
umbilicus; presents with urine out of the
umbilicus and recurrent UTIs

489
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is a “Replogle tube”?
P571

A

10 French sump pump NG tube for
babies (originally designed by Dr. Replogle
for suction of the esophageal blind
pouch of esophageal atresia)

490
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What are “A’s and B’s”?
P571

A

Apnea and Bradycardia episodes in

babies

491
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is the “double bubble”
sign on AXR?
P571

A

Gastric bubble and duodenal bubble
on AXR; seen with duodenal obstruction
(web, annular pancreas, malrotation with
volvulus, duodenal atresia, etc.)

492
Q

OTHER PEDIATRIC SURGERY QUESTIONS
What is Poland’s syndrome?
P571

A 
Absence of pectoralis major muscle
Absence of pectoralis minor muscle
Often associated with ipsilateral hand
    malformation
Nipple/breast/right-breast hypoplasia
493
Q 
OTHER PEDIATRIC SURGERY QUESTIONS
What is the treatment of
ATYPICAL mycobacterial
lymph node infection?
P571
A

Surgical removal of the node

494
Q 
OTHER PEDIATRIC SURGERY QUESTIONS
What is the most common
cause of rectal bleeding in
infants?
P571
A

Anal fissure

495
Q 
OTHER PEDIATRIC SURGERY QUESTIONS
What chromosomal
abnormality is associated
with duodenal web/atresia/
stenosis?
P572
A

Trisomy 21

496
Q 
OTHER PEDIATRIC SURGERY QUESTIONS
Which foreign body past the
pylorus must be surgically
removed?
P572
A

Batteries!

497
Q 
POWER REVIEW
What is the usual age at
presentation of the following
conditions:
Pyloric stenosis?
P572
A

2 weeks to 2 months

498
Q 
POWER REVIEW
What is the usual age at
presentation of the following
conditions:
Intussusception?
P572
A

4 months to 2 years ( >80%)

499
Q 
POWER REVIEW
What is the usual age at
presentation of the following
conditions:
Intussusception?
P572
A

1 to 5 years

500
Q 
POWER REVIEW
What is the usual age at
presentation of the following
conditions:
Malrotation?
P572
A

Birth to 1 year ( >85%)

501
Q 
POWER REVIEW
What is the usual age at
presentation of the following
conditions:
Neuroblastoma?
P572
A

≈50% present by 2 years;

>80% present by 8 years

502
Q 
POWER REVIEW
What is the usual age at
presentation of the following
conditions:
Hepatoblastoma?
P572
A

Younger than 3 years

503
Q 
POWER REVIEW
What is the usual age at
presentation of the following
conditions:
Appendicitis?
P572
A

Older than 3 years (but must be

considered at any age!)

Section III Subspecialty Surgery P517 (11 decks)

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