Pediatrics

Question 1

What is the number one cause of death in children?

Answer 1

trauma

Question 2

What is the best indicator of shock in pediatric patients?

Answer 2

tachycardia

Question 3

What is considered tachycardia for the following age groups:

• neonates
• 1-6 years old
• 6-12 years old
• 13 years or older

Answer 3

• neonates: > 150 bpm
• 1-6 years old: > 120 bpm
• 6-12 years old: > 110 bpm
• 13 years or older: > 90

Question 4

What is the appropriate volume for boluses in children of crystalloid and blood?

Answer 4

• crystalloid: 20cc/kg

- blood: 10cc/kg

Question 5

When should blood be transfused in pediatric trauma patients?

Answer 5

if still hypotensive after two crystalloid boluses

Question 6

What is considered adequate urine output in neonates, infants, and toddlers?

Answer 6

• neonates: 2-3 mL/kg/hr
• infants: 2-3 mL/kg/hr
• toddlers: 1 mL/kg/hr

Question 7

What is the appropriate size and type of ETT in children less than 10 years old?

Answer 7

• they always get an uncuffed tube

- use a tube with same diameter as patient’s pinkie or use Breslow tape to decide

Question 8

Describe the presentation, diagnosis, and treatment of pyloric stenosis.

Answer 8

• presents with projective, non-bilious emesis and an olive-like mass palpable in the epigastrium
• labs reveal hypochloremic, hypokalemic, metabolic alkalosis
• US shows a pylorus > 3mm thick and > 14mm long
• treat with resuscitation (NS) then dextrose-containing mIVF and take to the OR for pyloromyotomy

Question 9

What is the most common type of tracheoesophageal fistula?

Answer 9

a blind ending of the esophagus with distal TE fistula

Question 10

What are the VACTERL syndrome components?

Answer 10

• Vertebral anomalies
• Anorectal (imperforate anus)
• Cardiac
• TE fistula
• Renal
• Limb anomalies

Question 11

In addition to the workup and treatment of a TE fistula, what other diagnostic studies are required to work up the VACTERL syndrome?

Answer 11

• vertebral anomalies: sacral US
• anorectal: digital exam for imperforate anus
• cardiac: TTE
• TE fistula: AXR
• renal: ultasound
• limb anomalies: exam

Question 12

How is TE fistula treated?

Answer 12

primary repair through a right extra pleural thoracotomy plus a G-tube

Question 13

What are the five types of TE fistula?

Answer 13

• A: isolated esophageal atresia
• B: esophageal atresia with proximal fistula
• C: esophageal atresia with distal fistula
• D: esophageal atresia with double fistula
• E: isolated fistula

Question 14

What are the most common etiologies for intussusception in children?

Answer 14

1) inflamed peers patches after viral illness
2) lymphoma
3) Meckel’s diverticulum

Question 15

How is ileocolonic intussusception managed in children? Adults?

Answer 15

• begin with air-contrast enema
• repeat enema if it recurs
• operate if unable to reduce with enema, they are peritonitis, or they are obstructed
• always operate for adults since malignant lead point is much more common

Question 16

What is the etiology for malrotation with midgut volvulus?

Answer 16

• malrotation secondary to failure of normal 270-degree rotation during intestinal development
• volvulus secondary to Ladd’s bands (adhesions to right retroperitoneum)

Question 17

Describe the presentation, etiology, diagnosis, associations, and treatment of malrotation with mid-gut volvulus.

Answer 17

• presents with bilious emesis, typically before one year of age
• malrotation (asymptomatic) is due to failure of 270-degree rotation while volvulus (symptomatic) is due to Ladd’s bands (adhesions to right RP)
• diagnosed with an upper GI series, which will show that the duodenum does not cross the midline
• associated with congenital diaphragmatic hernia and omphalocele
• treat with resection of Ladd’s bands, counterclockwise detorsion to place the small intestine on the right and large intestine on the left, and appendectomy

Question 18

What is the treatment for malrotation with volvulus?

Answer 18

• resection of Ladd’s bands
• counterclockwise detorsion, placing the small bowel on the right and large bowel on the left (think “turn back time” for counterclockwise)
• appendectomy to prevent later diagnostic confusion

Question 19

Malrotation with midgut volvulus is associated with what two other anomalies?

Answer 19

• congenital diaphragmatic hernia

- omphalocele

Question 20

How is duodenal atresia diagnosed?

Answer 20

• AXR showing double bubble sign is usually first

- follow with an upper GI series

Question 21

What causes small bowel atresia?

Answer 21

• duodenal atresia is failure of re-canalization

- other intestinal atresias are due to intrauterine vascular accidents (usually jejunum)

Question 22

Give the etiology, diagnostic workup, and treatment for duodenal atresia.

Answer 22

• due to failure of re-canalization
• diagnosed with AXR and UGI series
• treated with primary reconnection

Question 23

Describe the presentation, associations, diagnosis, and treatment of meconium ileum.

Answer 23

• presents with failure to pass meconium in the first 24hrs of life
• diagnosed with AXR showing dilated small bowel without air fluid level and a positive sweat chloride test given the high association with cystic fibrosis
• treated with gastrhogafin enema or N-acetylcysteine enema
• operate for perforation or ostomy creation for anterograde NAC enemas

Question 24

What is the most common cause of colonic obstruction in neonates?

Answer 24

Hirschsprung’s disease

Question 25

How is Hirschsprung’s disease diagnosed?

Answer 25

with suction rectal biopsy showing an absence of ganglion cells in the myenteric plexus

Question 26

What is the treatment for Hirschsprung’s disease?

Answer 26

resection of affected rectum and colon with delayed anastomosis

Question 27

What is the treatment for Hirschsprung’s colitis?

Answer 27

rectal irrigations, may require emergent colectomy