Pediatrics Flashcards by Sarah Assaf

What can cause CDH?

1) Vitamin A deficiency
2) Thalidomide
3) Anticonvulsants
4) Quinines

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Most common type of CDH?

Postero-Lateral (left side)

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Bad prognostic factors in CDH?

1) Associated malformations
2) Right-sided defects
3) Liver herniation
4) Fetal lung volume
5) Lung area to head circumference ratio (LHR)

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Mortality and morbidity in CDH are related mainly to?

1) Severity of lung hypoplasia
2) Pulmonary hypertension
3) Associated anomalies
4) Prematurity

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Associated anomalies with EA and TEF?

1) Vertebral
2) Anorectal
3) Cardiac
4) TracheoEsophageal
5) Renal
6) Limb

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Two nonspecific signs for EA and TEF?

1) Polyhydramnios (GI obstruction)
2) Absent or small stomach bubble

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Postnatal diagnosis of EA and TEF?

1) Excessive salivation
2) Coiled feeding tube in the blind upper pouch around T2–T4 on chest x-ray

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Operative repair depends on?

The gap between esophageal ends (on xray)

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Gap between esophageal ends is <2 vertebrae:

Primary anastomosis

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Gap between esophageal ends is 2-6 vertebrae:

Gastrostomy + delayed primary anastomosis

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Gap between esophageal ends is >6 vertebrae:

Gastrostomy + esophagostomy +
esophageal replacement later on

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Which side more common inguinal hernia?

Right

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Posterior wall of the inguinal canal?

1) Transversalis fascia
2) The ‘conjoint’ tendon

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Superior wall of the inguinal canal?

1) Internal oblique
2) Transversus abdominis muscles

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Inferior wall of the inguinal canal?

1) Inguinal ligament
2) Lacunar ligament (medial third)
3) Iliopubic tract (lateral third)

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Anterior wall of the inguinal canal?

External oblique aponeurosis

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Contents of inguinal canal include:

Males: ilioinguinal nerve + spermatic cord

Females: ilioinguinal nerve + round ligament

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Spermatic cord structures:

1) Cremasteric muscle
2) Testicular artery
3) Banbiniform plexus
4) Lymphatic channels
5) Vas
6) Genital branch of Genitofemoral nerve
7) Processus vaginalis

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Descent of the testes depends on:

1) The gubernaculum
2) Hormones

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Processus vaginalis forms?

The tunica vaginalis around the testis

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The female analogue of the processus vaginalis is:

The canal of Nuck

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Surgical treatment of hydroceles?

1) Evacuation
2) High ligation of PV or PPV

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Open exploration of the clinically-free contralateral side is justified in:

1) Prematurity
2) Younger age
3) Female gender
4) Left-sided unilateral hernia

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Don’t attempt inguinal hernia reduction if:

1) Signs of peritonitis
2) Septic shock

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Non-palpable undescended testis means:

1) Testicular agenesis 2) Intra-abdominal UDT 3) Peeping testis (when inside the abdomen) 4) Ectopic testis (non-palpable in the inguinoscrotal area) 5) Vanished testis (atrophied due to prev. vascular insult as perinatal torsion, trauma, or iatrogenic) 6) Small testis 7) Obese child 8) Non-experienced examiner

Palpable undescended testis means:

1) Inguinal UDT (high or low) 2) Retractile testis (cremasteric overactivity) 3) Ascending testis (acquired UDT) 4) Peeping testis (when inside the inguinal canal) 5) Ectopic testis (could be palpable in the ectopic areas; inguinal outside the canal, femoral, perineal, penopubic, or contralateral hemiscrotum)

Most SERIOUS cause of acute scrotum?

Torsion of the testis

Most COMMON cause of acute scrotum?

Torsion of the appendix testis/epididymis

Intravaginal torsion (more common) of testes is also called:

Bell-clapper

Where is the blue dot sign seen?

In torsion of the appendix testis/epididymis

What do we look for in testicular trauma?

Ruptured tunica albuginea

Most common site of origin for neuroblastoma?

Adrenal medulla

What is the most common intestinal atresia?

Jejunoileal

Where is the apple peel or christmas tree formation found?

Intestinal atresia

Clinical features of intestinal atresia?

Antenatal US: a) Polyhydramnios (↑ with the more proximal atresias). b) “Double bubble” (duodenal) c) Dilated proximal loops d) Echogenic bowel Postnatally: a) Bile-vomiting b) Varying degrees of distension (depending on level of obstruction)

CAUSES OF NEC IN INFANTS?

1) Immaturity of the preterm gut 2) Early enteral feeding 3) Splanchnic hypoperfusion

Which Bell's stage includes abdominal mass + GI bleeding

Stage 2

Most important imaging in NEC?

Supine AP X-ray

Early sign of NEC?

Abdominal distension

Late signs of NEC?

1) Pneumatosis (linear radiolucent bands/bubbles parallel to the bowel wall) 2) Portal venous gas 3) Extravisceral free air (air under diaphragm or “football sign”) 4) Ground-glass appearance

What do we do to assess onset of complications (as perforation) in NEC?

Serial radiography

Which Bell's stage (NEC) is surgery indicated?

Stage 3

X-ray findings in Meconium ileus?

1) Dilated proximal bowel loops 2) “Soap-bubble” appearance or "Neuhauser’s sign" (in the loops filled with meconium) 3) Calcification (in meconium peritonitis)

Management of meconium ileus?

Water-soluble contrast enema (success 60–70% in simple MI) = gastrografin

What is usually affected in Hirschsprung disease?

Distal colon

What is the most common anomaly associated with Hirschsprung disease?

Down syndrome

Which gene mutation is associated with Hirschsprung disease?

RET oncogene

Pathology of Hirschsprung disease?

1) Lack of progression of peristaltic wave into the aganglionic segment of intestine 2) Absent or abnormal internal anal sphincter relaxation

Clinical features of Hirschsprung disease?

1) Neonatal bowel obstruction: a) Delayed passage of meconium b) Abdominal distension c) Bile vomiting d) ± Enterocolitis 2) Chronic constipation (no encopresis/soiling): a) ± Enterocolitis b) Failure to thrive 3) Explosive discharge of liquid fecal matter after DRE

Which reflex is diminished in Hirschsprung disease?

Recto-anal inhibitory reflex

Management of Hirschsprung disease?

1) Decompress the obstructed bowel 2) Daily rectal washouts by parents 3) Colostomy (if unstable) 4) Pull-through procedure

Most common type of anorectal malformation in males?

Recto-bulbar urethral fistula

Most common type of anorectal malformation in females?

Recto-vestibular fistula

Three main areas of esophageal narrowing:

1) Cricopharyngeus sling (70%) 2) Level of the aortic arch in the mid-esophagus (15%) 3) Lower esophageal sphincter (GE junction) (15%)

X-ray sign to differentiate a coin from a button battery?

Double contour rim

Swallowed magnets may attach to each other and cause:

1) Obstruction 2) Volvulus 3) Perforation 4) Fistula

Anatomical differences in the airway of young children compared with older children:

1) Shorter airway, smaller in caliber 2) Anteriorly positioned larynx (increases difficulty with oral intubation) 3) Subglottic region is the narrowest part

FBs tend to find the ___ (left/right) main stem bronchus. Why?

1) Larger in diameter 2) Airflow is generally greater 3) Smaller angle of divergence from the trachea

X-ray sign for airway FB?

"Air trapping" = Hyperinflated lung on expiration

Definitive diagnosis for airway FB?

Bronchioscopy