Pediatric Surgery review

Question 1

What drug can you give to keep ductus arteriosus patent in neonates?

Answer 1

• Prostaglandins

Question 2

What drug can you give in an attempt to pharmacologically close a patent ductus arteriosus?

Answer 2

• Indomethacin

Question 3

What procedure do you perform to close a patent ductus arteriosus in a neonate?

Answer 3

• left anterolateral thoracotomy, can be performed at bedside
• clip PDA

Question 4

describe a Duhamel proceudre

Answer 4

aganglionic rectal stump is left in place, ganglionic colon is brought posterior to stump and a common channel is made between the two

Question 5

what surgical options are available for Hirschsprung’s disease?

Answer 5

• Soave
• Duhamel
• Swenson

Question 6

Describe the Soave procedure

Answer 6

submucosal endorectal dissection, resection of aganalionic rectum with pull through of ganglionic colon and end to end anastomosis…a muscular layer from the aganglionic rectum is left surrounding the colon pulled through

Question 7

Describe the Swenson procedure

Answer 7

full thickness resection of aganglionic rectum and pull through of sigmoid colon to create end to end anastomosis with rectal stump

Question 8

Air filled stomach and air filled duodenum on plain film in a neonate…what is this called and what is it associated with?

Answer 8

• double bubble sign

- duodenal atresia or a duodenal web

Question 9

neonate with bilious emesis, plain film with double bubble sign and no distal air noted…next step?

Answer 9

• upper GI contrast study, will confirm Duodenal atresia but more importantly need to rule in or out midgut volvulus (lack of air distally)

Question 10

3 month old with inguinal hernia presents to ED, bowel noted to be in hernia…next step?

Answer 10

• attempt reduction, if successful admit for 1-2 days of observation then repair the hernia (allows for edema to subside)
• if reduction fails take to OR for open reduction and repair

Question 11

unable to pass an NGT in a neonate…what is first on the differential?

Answer 11

Esophageal atresia

Question 12

most common form of esophageal atresia?

Answer 12

atresia with a distal tracheoesophageal fistula (you’ll see gas in GI tract distally from inspired air

Question 13

VACTERRL syndrome

Answer 13

Vertebral
Anal
Cardiac
Trachea
Esophagus
Renal
Radial Bone
Limb

• defects that are associated with each other

Question 14

What is unicameral bone cyst?

Answer 14

• cyst in the bone filled with cytokines that cause bone resorption
• typically asx but can present with pathologic fracture

Question 15

how do you treat a fracture from a simple bone cyst?

Answer 15

• cast and see if it heals

- if this fails can do methylprednisolone injection

Question 16

Characteristics of a mesenteric Cyst?

Answer 16

• no solid component

- freely mobile and perpendicular to mesentery

Question 17

8 year old with 1 cm mass on lateral neck, mom said it comes and goes with some fluid drainage…next step?

Answer 17

• total surgical excision likely a brachial cleft anomaly

Question 18

Surgical treatment for thyroglossal duct cyst?

Answer 18

Sistrunk procedure

removal of cyst and its track as well as central portion of the hyoid bone

Question 19

Fetal structural abnormalities that are associated with increased amniotic fluid?

Answer 19

esophageal atresia
intestinal atresia
craniofacial abnormalities

Question 20

Cardiac abnormalities seen in Tertralogy of Fallot?

Answer 20

• pulmonary artery stenosis
• ventricular septal defect
• overriding aorta with deviation of origin to the right
• concentric right ventricular hypertrophy

Question 21

Type III choledochal cyst

Answer 21

intraduodenal or intrapancreatic dilations, distal to CBD

Question 22

treatment for Type III choledochal cyst

Answer 22

if < 3cm can get an ERCP and marsupialize the cyst

if > 3cm will need formal resection and reconstruction

Question 23

Type I choledochal cyst

Answer 23

extra hepatic biliary dilation(s)

• some argue Type I and IV are a spectrum of the same entity

Question 24

treatment for type I choledochal cyst

Answer 24

resection with roux-en-y hepaticpjejunostomy

Question 25

Type IV choledochal cyst

Answer 25

extra-hepatic and or intra-hepatic cyst

Question 26

treatment for type IVa and V choledochal cyst

Answer 26

orthotropic liver transplantation if diffuse, segmental resection if isolated

Question 27

Caroli Disease

Answer 27

multi-focal intrahepatic biliary dilation, can be segmental or diffuse

AKA type V choledochal cyst disease

Question 28

Type II choledochal cyst

Answer 28

singular diverticulum protruding from CBD

Question 29

treatment for Type II choledochal cyst

Answer 29

resection of diverticulum, reconstruction is normally not needed

Question 30

how much blood do you give in pediatric trauma

Answer 30

10 mL/kg

Question 31

how much fluid do you give in pediatric trauma, what is your bolus dose?

Answer 31

20 mL/kg

Question 32

child with multiple liver masses and elevated alpha-fetoprotein…what do they have?

Answer 32

hepatoblastoma

Question 33

how do you test adequacy of pyloromyotomy

Answer 33

• edges should be freely mobile, independent of each other

Question 34

most common intestinal atresia

Answer 34

jejunal atresia

Question 35

most common cause of jejunal atresia

Answer 35

intrauterine vascular accident

Question 36

new born male has an undescended testicle, with no other symptoms, when does this become a problem?

Answer 36

if it has not spontaneously descended in the first 4 months of life surgery will likely be needed

Question 37

when do kids present with pyloric stenosis typically

Answer 37

2-8 weeks of age