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ABSITE Flashcards > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Choledochal cysts tx

A

Always excise
25% risk of cancer
30% risk of pancreatitis

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2
Q

Type I choledochal cyst tx

A

whole CBD involved

tx: excise and do hepatico-j

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3
Q

Type II choledochal cyst tx

A

diverticulum that hangs off CBD

tx: do diverticulectomy

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4
Q

Type III choledochal cyst tx

A

distal dilation involving sphincter of Oddi

tx: resection or marsupialization

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5
Q

Type IV choledochal cyst tx

A

intra- and extrahepatic cysts

tx: resection, lobectomy, transplant

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6
Q

Type V choledochal cyst tx

A 
intrahepatic cysts (Caroli's disease)
tx: resection, lobectomy, transplant
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7
Q

congenital lobar emphysema

A

massive hyperinflation of a single lobe (usually upper/middle)
1/3 have respiratory distress at birth
CXR: radioluceny of affected lobe, compression of other lobe
M:F ratio is 2:1
tx: severely symptomatic - lobectomy, good prognosis

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8
Q 
cystic hygroma (lymphangioma) tx
#1 complication?
A 
resect
#1 complication = infection
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9
Q

1st sign of CHF in children?

A

hepatomegaly

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10
Q

Strawberry hemangioma

A

appear in 1st few weeks of life. leave alone, most involute by age 7.

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11
Q

Neuroblastoma

  • markers its associated with?
  • origin cells?
A

MC solid peds malignancy

  • high VMA, high HVA associated with worse prognosis, N-myc
  • neural creast cells
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12
Q

1 peds malignancy overall

A

Leukemia

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13
Q

Wilms tumor

A

nephroblastoma

80% cure with nephrectomy

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14
Q

Biliary atresia tx

A 
Kasi procedure (before 3 months age)
hepatoportoenterostomy
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15
Q

Meckel’s diverticulum

A 
on anti-mesenteric border
2ft from ileocecal valve
2% population
2% symptomatic
2 types of tissue: pancreatic, gastric
2 common presentations: diverticulitis, GIB
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16
Q

1 cause of GIB in children

A

Meckel’s diverticulum - persistent omphalomesenteric duct

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17
Q

Intussusception tx

A

reduce with air/contrast enema
IV glucagon can help (relaxes smooth muscle)
Usually presents in < 3 yo

peritonitis = ex lap
(if adult, automatically go to OR due to high risk of malignancy)

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18
Q

Intestinal atresia caused by

A

Intra-uterine vascular events

10% atresias are multiple

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19
Q

Duodenal atresia sx

A

Bilious vomiting
Double bubble sign
#1 cause of neonatal duodenal obstruction
associated w/ trisomy 21, 1/3 have cardiac defects

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20
Q

TE fistulas MC type and sx

A

90% are type C (most “common”): blind esophagus, distal TEF

spits up feeds and NG tube won’t pass

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21
Q

Type A TE fistula

A

Blind esophagus, no fistula

No air seen in entire GI tract

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22
Q

VATER

A 
Vertebral
Anorectal (imperforate anus)
TEF
Radial
Renal anomalies
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23
Q

Ladd’s procedure

A

For malrotation - appendectomy, take down bands, counterclockwise rotation

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24
Q

Meconium ileus dx and rx

A

associated with cystic fibrosis

Dx and rx: gastrografin enema

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25
Q

1 cause of colon obstruction

A

Hirschsprung’s
no BM in 1st 24hrs
dx: rectal biopsy

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26
Q

necrotizing enterocolitis sx and tx

A

presents AFTER initiating feeds in neonate with blood in stool
tx: peritonitic, free air - OR for resection with ostomy
do contrast eval weeks later to evaluate for stenosis before reconnecting bowel

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27
Q

Imperforate anus tx

A

if high, need colostomy

28
Q

Gastroschisis

A

Intrauterine rupture of umbilical cord
No associated defects, lateral defect, no sac
associated w/esophageal atresia

29
Q

Omphalocele

A

Midline defect, may contain liver or other non-bowel contents
Frequently associated with other anomalies - cardiac, pericardium, sternum, diaphragm, has peritoneal sac covering

30
Q

Process vaginalis

A

Present at 12 weeks gestation - peritoneal diverticulum that extends as testis descends in the 7th/8th month of gestation

Patent process vaginalis causes inguinal hernia

31
Q

Inguinal hernia risk of incarceration in infants

A

exceeds 60% in 1st 6 months

Repair should be performed before infant discharge

32
Q

MC tumor that develops from undescended testis

A

Nonseminomatous germ cell tumor

33
Q

Lymphadenitis

A

enlarged LN in the neck

Can progress to suppurative lymphadenitis - requires I&D

34
Q

Peritonsillar abscess

A

Complication of tonsillitis, pharyngitis or dental infection
Sx: hoarse voice, medial displacement of tonsils, edematous deviated uvula, inflamed soft palate, fever, chills
Tx: abscess present - I&D
Cause: MC pathogen is beta-hemolytic Strep

35
Q

Thyroglosal duct abnormalities

A

midline fluctuant cystic mass superior to thyroid - mobile and painless, moves with swallowing

tx: surgical excision

36
Q

Branchial cleft anomalies

A

presents as cysts, sinuses, or cartilaginous nests in lateral neck
tx: excision

37
Q

Torticollis

A

Hard mass in SCM in first 2-4 weeks of life
a/w breech delivery, vertebral anomalies
tx: surgical division of SCM and fascia

38
Q

Trachea foreign body removal tx?

A

Rigid bronch with forceps retrieval of foreign body

39
Q

MC levels of foreign body lodgement in esophagus?

A

Sites of esophageal narrowing:

  1. cricopharyngeal muscle
  2. arch of aorta (level of carina)
  3. GEJ
40
Q

Esophagus foreign body removal tx?

A
  1. level of cricopharyngeus and carina: rigid or flexible esophagoscopy with mechanical retrieval by forceps
  2. GEJ: obs
41
Q

Risks of esophageal foreign body removal?

A
  1. esophageal perf

2. aspiration - prevent by placing patient prone

42
Q

Diaphragm eventration

A

lack of normal muscular component of the diaphragm

intact, yet elevated diaphragm

43
Q

Causes of diaphragm eventration

A

Congenital

Acquired: phrenic nerve injury

44
Q

Sx of diaphragm eventration

A

Asymptomatic

Respiratory distress, especially infants

45
Q

Tx of diaphragm eventration

A

asymptomatic - nothing

symptomatic - plication and stabilization of the diaphragm in the expiratory position

46
Q

Surgical management of intussusception

A

Should be managed surgically if there are signs of necrotic bowel, incomplete reduction, or after 2+ recurrences

Bowel reduced by squeezing mass distal to proximal, if resection is necessary ileocectomy can be done with primary anastomosis

47
Q

Immunity at birth from

A

IgA - breastmilk

IgG - crosses the placenta

48
Q

Umbilical vessels

A

2 arteries

1 vein

49
Q

pulmonary sequestration cause

A

lung tissue has anomalous systemic arterial supply that does not communicate with tracheobronchial tree
MC - thoracic aorta or abdominal aorta through inferior pulmonary ligament

50
Q

extra-lobar vs intra-lobar pulmonary sequestration

A

extra lobar: more likely to have systemic venous drainage

intra lobar: more likely to have pulmonary vein drainage

51
Q

pulmonary sequestration treatment

A

ligate arterial supply first, then lobectomy

52
Q

bronchiogenic cyst

A

most common cyst of mediastinum

tx: resect cyst

53
Q

Most common mediastinal tumor in children

A

neuorgenic tumors - neurofibroma, neuroganglioma, neuroblastoma

54
Q

anterior mediastinum mass differential

A

T-cell lymphoma
teratoma
thyroid cancer

55
Q

middle mediastinum mass differential

A

T-cell lymphoma
teratoma
cyst (cardiogenic or bronchiogenic)

56
Q

posterior mediastinum mass differential

A

T-cell lymphoma
neuroblastoma
neurogenic tumor

57
Q

diaphragmatic hernia treatment

A

stabilize these patients before operating on them
need to reduce bowel and repair defect +/- mesh
run the bowel and look for visceral abnormalities

58
Q

Bochdalek’s hernia

A

MC, located posteriorly

59
Q

Morgagni’s hernia

A

rare, located anteriorly

60
Q

Pectus excavatum

A

sinks in
sternal osteotomy, need strut
performed if causing respiratory symptoms

61
Q

Pectus carinatum

A

chest juts out

strut not necessary, repair for cosmetic reasons if wanted

62
Q

Wilms tumor treatment

A

nephrectomy
tumor thrombus from vein can be extracted
frequent mets to bone/lung

63
Q

Hepatoblastoma

A

MC malignant liver tumor in children
Elevated AFP in 90% of cases
Tx: resection is optimal option, or downstage with chemo until resectable
Fetal histology has best prognosis

64
Q

Ultrasound findings for pyloric stenosis

A

> 4 mm thick

>14 mm long

65
Q

Bilious vomiting in infant - first study

A

UGI to rule out malrotation

ABSITE Flashcards (19 decks)

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