Pediatrics Flashcards
typical length of pylorus channel in infant with pyloric stenosis
16 mm
which drug has a “black box” for administration after tonsillectomy and/or adenoidectomy
Coedine, for respiratory depression
before you do a pull through for Hirschsprung disease, what do you need to establish
level of disease, you need level biopsies
where is the defect in gastroschisis?
to the right of the umbilicus
where is the defect in an omphalocele?
through umbilicus
features of gastrochisis
- no sac
- no amnion
- cardiac and chromosomal abnormalities are rare
- defect to the right of umbilicus
child born with a defect through abdominal wall with sac covering contents, what is it?
omphalocele
what are kids born with gastrochisis at higher risk for?
necrotizing enterocolitis
Patient with pectus carinatum does not tolerate compression bracing, what option do you have left?
Ravitch procedure
Removal of cartilage causing defect
VACTERL
Vertebral
Anorectal
Cardiac
Tracheal
Esophageal
Renal
Limb deformities
how long after a pyloromyotomy would continued vomiting warrant re-evaluation
if vomiting persist for a week post-op you should re-eval for incomplete myotomy
when should a child with the RET protoncogene have his prophylactic thyroidectomy?
by age 1
2 year old boy undergoing laparoscopic bilateral inguinal hernia repair, you cannot find vas deferens…what should kid be tested for?
cystic fibrosis
when would you administer corticosteroids for a surgery on a pregnant woman?
gestation weeks 24-34 for intra-abdominal surgeries with possible infectious etiology
what kind of tissue would you expect from a Meckel Diverticulum?
- gastric
- pancreatic
typical age range for intussusception
3 months to 3 years of age
ultrasound findings for intussusception
- target sign
- pseudo kidney sign longitudinally
examining a 4 year old boy for undescended testicles and in clinic you are able to bring the testicles down into the scrotum…what is this phenomenon called
retractile testis
Treatment for retractile testis
yearly examinations till puberty
how are pediatric umbilical hernias repaired
primarily with slowly absorbable sutures
Allows for repair to grow with child as they age
what metabolic derangement would you expect from pyloric stenosis
hypochloremixc, hypokalemic metabolic alkalosis
32 year old female 4 weeks postpartum presents with erythema and tenderness to periareolar left breast. Initial therapy
continue breast feeding
- likely lactational mastitis
steps to a Sistrunk Procedure
- Excise the cyst
- excise the tract
- resect the hyoid bone 1 cm to left and right of midline to level of foramen cecum
3 year old boy with an empty scrotum with diagnosis of non-palpable testis. next step
- diagnostic laparoscopy to assess its location
What is the Ravtich procedure?
- removal of cartilage wedged between the ribs and sternum
- reshapes and reposition the freed-up sternum
Which chest deformity can you use the ravtich procedure on?
both pectus carinatum and excavatum
long term complication pattern of diaphragmatic repair survivors
gastrointestinal
neurodevelopmental
pulmonary
diagnostic approach for 12 year old girl with painless blood per rectum…and why
- 99m Tc-pertechnetate radio-isotope scan
- this is a Meckel scan and you’re suspecting a Meckel Diverticulum with gastric mucosa
neonate with an imperforate anus and a bucket handle deformity, what do you do next?
perform primary anoplasty
what is a hydrocolpos?
dilated vagina
what is cloaca?
single orifice for both excretory and genital products
most common incision used to repair a congenital diaphragmatic hernia
subcostal incision, approximately two finger breadths below the subcostal margin
what should infants who had an omphalocele or gastroschisis closed be monitored for?
- abdominal compartment syndrome
- done by monitor UOP and ventilation requirements
What are branchial anomalies associated with
branchial-oto-renal syndrome
- ear and kidney issues (should image kidneys)
when would you do a segmental resection of small bowel for a Mekel’s diverticulum?
- base greater than 2 cm
- active inflammation at the base
When would it be appropriate to use intra-operative fetal heart tracing if operating on a gravid woman?
at viability ~ 24 weeks of gestation
what is the most common abnormality associated with gastrochisis
intestinal atresia
child with a midline neck mass that moves up and down with swallowing
thyroglossal duct cyst
most common etiology for ileocolic intussusception
hypertrophic lymphoid patches in the terminal ileum
what would an US 3 weeks post-op from a pyloromyotomy show in an asx patient?
hypertrophied pylorus even if myotomy was complete
what are the treatment options for infants presenting with omphalocele
- primary repair
- staged repair
- paint and wait technique
what is the most common congenital hemostasis mutation?
Von Willebrand’s disease
how do you test for Von Willebrand Disease
plasma Von Willebrand Disease antigen test
first step in a new born with gastrochisis?
placement of a bowel bag up to the midchest
A Meckel’s diverticulum is a remnant of what fetal structure
Vitellin duct
most common solid extra-cranial tumor in children
Neuroblastomas
- 85% of abdominal tumors, most present before the age of 2
what is the silk glove sign
thickening of the spermatic cord on the side of a hernia, in infants
what are indications to delay a surgery in a neonate
- low weight (< 2kg)
- major cardiac defect
- extreme prematurity
benefit of laparoscopic approach to hernia repair in children
easier to identify femoral hernias
- length of stay and post op the same between lap and open hernia repairs
What would be the next step in a child presenting with a white reflex in their eye
fundus examination, rule out retinoblastoma
What lab measure monitors a deficiency in Factor IX
PTT
when performing cannulation for ECMO in a kid with CDH, what should the surgeon be aware of
hypoplasia of internal jugular and carotid vessels (pertains to cervical cannulation)
what is the maximum pressure used to reduce intussusception with air
120 mmHg
Most common reason for incontinence in children after pull-through for Hirschsprung disease
Chronic constipation with overflow of stool
how long of a gap would warrant delayed repair in esophageal atresia
1-2 vertebral spaces
- most kids will grow enough to bridge that gap in 1-3 months
how long of a gap would warrant traction sutures in esophageal atresia
greater than 2 vertebral spaces
in which direction do you twist bowel to undo a midgut volvulus
counterclockwise
infant with bilious emesis, KUB shows dilated loops of bowel and air fluid levels. Contrast enema shows micro-colon with reflux of contrast into dilated terminal ileum…what does the newborn have
meconium ileus
how do you treat meconium ileus in a newborn
- water soluble contrast enemas
- resuscitation
- successful 2/3 of the time
infant with abnormally high direct bilirubin and HIDA scan showing failure of excretion of contrast. What is the next step
Percutaneous needly biopsy of the liver
- Could be biliary atresia OR Alagille syndrome
What does the 99m-technetium pertechnetate scan have an affinity for?
Gastric mucosa
What is involved in a Ladd’s procedure
Lysis of adhesions, counterclockwise reduction of volvulois, appendectomy, widening of mesentery, small bowel on left, colon on right
lateral neck mass in a child that expresses fluid, what is the most likely diagnosis
second branchial sinus
Type 1 jejunoileal atresia
intact bowel wall and mesentery with a mucosal atresia
Type 2 jujunoileal atresia
blind ends separated by a fibrous cord, but with intact mesentery
Type 3a jujunoileal atresia
blind end atresia with a V-shaped mesentery defect
Type 3b jujunoileal atresia
blind end atresia with large mesentery defect
Type 4 jujnoileal atresia
multiple atresias
which service should you consult for a child younger than 5 who sustained head trauma
ophthalmology for possible retinal damage
Most common cause of significant GI bleed in children
Meckel’s diverticulum
Most common cause of self limited GI bleed in children
intestinal polyps
after laparoscopically reducing intussusception in a 2 year old the bowel looks dusky, what do you do
wait 10-15 minutes to see if bowel appearance improves to avoid resection and anastomosis
