Pediatrics

Question 1

Choledochal cysts:

Excise? ____ Has ___% cancer, ___% pancreatitis?

Answer 1

Must excise; leaving cyst = 25% cancer, 30% pancreatitis (Every year)

Question 2

type I choledochal cyst:

___% of all? What’s involved? What do you do?

Answer 2

> 90%; whole CBD involved. Excise, do hepatico-jejunostomy

Question 3

Type II Choledochal cyst:

What is it? What do you do?

Answer 3

diverticulum. Do diverticulectomy.

Question 4

Type III Choledochal cyst:

What is it? What do you do?

Answer 4

Choledochocele involving sphincter. Excise, sphincteroplasty.

Question 5

Type IV Choledochal cyst:

What is it? What do you do?

Answer 5

Intra- and extrahepatic cysts (Caroli’s disease). Transplant.

Question 6

Type V Choledochal cyst:

What is it? What do you do?

Answer 6

Intrahepatic cysts. Transplant.

Question 7

Pulmonary sequestration:
What is extralobar version? What is intralobar version?
Rx? Presentation?

Answer 7

Extralobar has systemic artery and vein; intralobar has aorta in and pulmonary vein out. Resection is treatment for both. #1 presentation= infection (not as respiratory distress in newborn)

Question 8

Congenital lobar emphysema: what is it? usually where?

___% have resp distress at birth, only ___% present after age 6 months

Answer 8

massive hyperinflation of a single lobe, usually upper/middle. 1/3 have resp distress at birth. Only 5% present after age 6 months

Question 9

Congenital lobar emphysema:
M:F ratio is _______
CXR: _________
Severly symptomatic rx? ____ Px? ____

Answer 9

M:F is 2:1; CXR radiolucency of affected lobe, compression of other lobe; severely symptomatic: lobectomy, excellent px

Question 10

Cystic hygroma= _______

Rx? _______. #1 complication is ________.

Answer 10

lymphangioma; Rx resect; infection is #1 complication

Question 11

Sistrunk procedure: __________

Answer 11

excision of thyroglossal duct cyst (midline) with hyoid bone

Question 12

1st sign of CHF in children is _____________

Answer 12

hepatomegaly

Question 13

Strawberry hemangioma:

When do they appear? What to do?

Answer 13

appear in 1st few weeks of life; leave alone since most involute by age 7

Question 14

Neuroblastoma: #1 _________;
___% have incr VMA; high HVA (homovanillic acid)= _____; From where? ___;
___% cure?; associated with ___

Answer 14

1 solid peds malignancy; 90% have inc VMA; high HVA = worse prognosis; from neural crest; only 30% cure; associated with N-myc

Question 15

1 pediatric malignancy overall

Answer 15

leukemia

Question 16

Wilm’s tumor= ___________.

Rx and cure rate?

Answer 16

nephroblastoma; 80% cure with nephrectomy

Question 17

Biliary atresia………… rx? when?

Answer 17

need Kasi procedure (before age 3 months) = hepatoportoenterostomy

Question 18

1 GIB in children cause

Answer 18

Meckel’s diverticulum

Question 19

Meckel’s diverticulum rule of 2’s (x 5)

Answer 19

on anti mesenteric border, 2 feet from ileocecal valve;

2% population; 2% symptomatic; 2 types of tissue (gastric, pancreatic; 2 presentations (diverticulitis, GIB)

Question 20

Meckel’s diverticulum embryology

Answer 20

persistent omphalomesenteric duct

Question 21

Intussusception:

Initial rx? can add? OR indications? Adults? when presents usually?

Answer 21

reduce with air/contrast enema. IV glucagon can help (relaxes smooth muscle). To OR if peritonitis, free air. Adult w intussecption goes to OR since high likelihood of malignancy at lead point. usually presents < 3 years old

Question 22

Intestinal atresias are secondary to ___________.
Mother may have ___________.
___% of atresias are multiple.

Answer 22

intra-uterine vascular events; polyhydramnios; 10%

Question 23

Duodenal atresia presents……….. imaging……….
Associated with………..
___% have cardiac defects

Answer 23

bilious vomiting, ‘double-bubble’;

assoc w/ trisomy 21 (Down’s); 1/3 have cardiac defects

Question 24

1 neonatal duodenal obstruction

Answer 24

Duodenal atresia

Question 25

TE fistulas:
___% are type C = _______, _________;
Symptoms? Findings?

Answer 25

90% are type C as in “Common”= blind esophagus, distal TEF.

Spits up feeds. NGT won’t pass.

Question 26

TE fistulas:
__% are type A= ______, __________
Air in GI tract?

Answer 26

5% are type A= blind esophagus, no fistula= no air in entire GI tract?

Question 27

VATER

Answer 27

vertebral, anorectal (imperforate anus in 10%), TEF, radial, renal anomalies

Question 28

Ladd’s procedure for malrotation:

____, _____, ____

Answer 28

appendectomy, take down bands, counterclockwise rotation

Question 29

Meconium Ileus:
associated with?
Dx and Tx with?

Answer 29

cystic fibrosis; try gastrograffin enema (dx and rx)

Question 30

1 cause of colon obstruction in baby; how to dx?

Answer 30

Hirschsprung’s (no BM in 1st 24hrs); dx with rectal bx

Question 31

________: presents after initaiting feeds in neonate (premie) with blood in stool.

Answer 31

NEC

Question 32

NEC OR indications:
___,___, ____, ____
operation?
Follow up studies? Why?

Answer 32

OR for free air, peritonitis, acidosis/thrombocytopenia/ clinical deterioration.
Resect, ostomies.
Must do contrast eval before reconnecting bowel weeks later (20% will have stenoses)

Question 33

Imperforate anus: If high, have…………. need………..

Answer 33

have meconium in urine (fistula to bladder, vagina or urethra); need colostomy

Question 34

Gastroschisis:

mech? associated defects? location? has sac?

Answer 34

intrauterine rupture of umbilical cord, no associated defects, lateral (right) defect, no sac

Question 35

Omphalocele:

location? associated defects? has sac?

Answer 35

midline defect, may contain liver or other non-bowel contents, frequent anomalies (cardiac, pericardium, sternum, diaphgram= cantell pentology). Has peritoneal sac