Pediatrics

Question 1

Lowest risk pull-through for anastomosis in HD

Answer 1

Duhamel, end to side

Question 2

Pull through, end to end to cuff of aganglionic muscle

Answer 2

Soave

Question 3

Pull through, end to end to rectum

Answer 3

Swenson

Question 4

Recurrent intussusception in child, suspicious for

Answer 4

Meckel diverticulum

Question 5

Wilms tumor key surgical concepts

Answer 5

Ligate renal art before vein
Palpate renal vein for thrombus
Ligate ureter close to bladder
Renal hilar and axrtocaval nodes for staging

Question 6

Ladd procedure steps

Answer 6

Counterclockwise detorsion, division of Ladd bands, widening of root mesentery, appendectomy, cecum on left side

Question 7

Most common location of undescended testicle

Answer 7

superficial inguinal ring

Question 8

<5yo, horners, palpable neck mass; dx

Answer 8

Cervical neuroblastoma

Question 9

s/p successful enema reduction of intussusception in child; next step

Answer 9

Observe 4hrs and discharge

Question 10

Biggest risk factor for necrotizing enterocolitis

Answer 10

Premature birth

Question 11

Indication for surgical intervention with necrotizing enterocolitis, technique

Answer 11

Signs of perforation, resect all necrotic bowel with stoma creation

Question 12

Anastomotic leak TE fistula repair; tx

Answer 12

Retropleural chest tube, NPO, abx

Question 13

Most common type of TEF

Answer 13

Type C - Esophageal atresia with distal TEF

Question 14

Excessive drooling, inability to pass ngt, gasses abdomen on X-ray; dx

Answer 14

Type A TEF (pure atresia with no fistula)

Question 15

Most predictive of poor outcome with congenital daphragmatic hernia

Answer 15

Presence of a cardiac defect

Question 16

Painless lower GI bleed in child remnant of vitelline duct; dx modality

Answer 16

Meckels via technetium 99m scan

Question 17

Pyloric stenosis imaging findings and metabolic abnormality

Answer 17

Pyloric muscle thickness >3-4mm and longer than 15-18mm, hypokalemic, hypochloremic metabolic alkalosis with paradoxical aciduria

Question 18

Arises from first pharyngeal pouch

Answer 18

Eustachian tube and tympanic cavity

Question 19

Arises from second pharyngeal pouch

Answer 19

Palatine tonsil

Question 20

Arises from third pharyngeal pouch

Answer 20

Inferior parathyroids and thymus

Question 21

Arises from fourth pharyngeal pouches

Answer 21

Superior parathyroids

Question 22

Arises from first pharyngeal cleft

Answer 22

External auditory meatus

Question 23

Arises from second through fourth pharyngeal cleft

Answer 23

Cervical sinus

Question 24

Cryptorchidism at 6 months; next step

Answer 24

Orchiopexy

Question 25

Child with donut or bullseye sign on abdominal US without peritonitis; tx

Answer 25

Pneumatic reduction

Question 26

Type I choledocal cyst and tx

Answer 26

Fusiform dilation extra hepatic, hepatico-je

Question 27

Type II choledocal cyst and tx

Answer 27

Diverticulum CBD, cystectomy

Question 28

Type III choledochal cyst and tx

Answer 28

Distal duct dilation, transduodenal marsupialization

Question 29

Type IV choledochal cyst and tx

Answer 29

Intra and extra hepatic dilations, roux en y jejunostomy vs liver txp

Question 30

Type V choledochal cyst and tx

Answer 30

Caroli disease, dilation of intrahepatic ducts, liver transplant

Question 31

WAGR syndrome

Answer 31

Wilms tumor, Aniridia, GU anomalies, Retardation

Question 32

Child with abdominal pain, palpable RUQ mass and jaundice; dx

Answer 32

Choledochal cyst

Question 33

Treatment for severe congenital lobar emphysema

Answer 33

Lobectomy

Question 34

Double bubble right of midline, projectile vomiting; dx and tx

Answer 34

Duodenal atresia, end to side or side to side duo-duo

Question 35

Pediatric umbilical hernia; tx

Answer 35

Observe until age 5