Pediatrics Flashcards
Electrolytes in pyloric stenosis?
Hypokalemia hypochloremic metabolic alkalosis with paradoxical aciduria
Most common solid abdominal malignancy in children
neuroblastoma
favorable/unfavorable factors for neuroblastoma?
children less than 1 have more advanced disease, N-myc oncogene have unfavorable prognosis
congenital lung lesion, presents with hemodynamic instability, hyperinflated lobe – dx/tx?
congenital lobar overinflation (emphysema) - cartilage failed to develop in bronchus, leads to air trapping with expiration – leads to HD instability (similar to tension PNX) – tx w/ lobectomy
lung tissue w/ abnormal arterial supply, presents w/ infection - dx/tx?
pulmonary sequestration (Extra vs intralobar – extra = azygos drainage, intra = pulmonary vein drainage), does not communicate with tracheobronchial tree, present w/ infection, tx w/ lobectomy (kids) segmentectomy (adults)
cystic lesion that communicates with airway, and poorly developed alveolar structure, recurrent infection - dx/tx?
congenital pulmonary adenoid malformation - tx w/ lobectomy
Which CPAM types are associated with malignancy?
CPAM 1 (most common type) and 4
what is a type 1 choledochal cyst? what is the treatment?
type 1 (most common ~85%)- fusiform dilation of the entire common bile duct – generally treat with resection and roux-en-Y hepaticojejunostomy
what is a type 2 choledochal cyst? what is the treatment?
type 2 - true diverticulum that hangs off the common bile duct – generally able to resect off of the common bile duct to avoid a hepaticojejunostomy
what is a type 3 choledochal cyst? what is the treatment?
type 3 - dilation of the intramural common bile duct, involving the sphincter of Oddi - generally treat if symptomatic or young – low malignant risk – possible endoscopic sphincterotomy, vs surgical transduodenal cyst excision
what is a type 4 choledochal cyst? what is the treatment?
type 4a is both intra and extahepatic cysts, type 4b with extrahepatic cysts only – if 4b usually resect CBD and treat with hepaticojejunostomy, if there are intrahepatic cysts like in 4a, would also need partial hepatectomy, if extensive intrahepatic disease / symptom would need txp
what is a type 5 choledochal cyst? what is the treatment?
type 5 is ‘caroli’s disease’, all intrahepatic cysts, get hepatic fibrosis, often need liver txp
tender neck mass just lateral to the SCM: dx / tx
cystic hygroma, resection
most common congenital diaphragm location?
posteriolateral most common (Bochladek), anteromedial is less common (Morgagni)
most common liver tumor in children
hepatoblastoma
most common lung tumor in children
carcinoid
most common cause of painless bleeding in children? preferred treatment?
bleeding Meckel’s diverticulum. segmental resection is preferred to diverticulectomy to ensure removal of ulcer
embryologic origin of Meckel’s diverticulum
persistent vitelline duct
what is the most common type of tracheo-esophageal fistula? second most common?
type C (85%)– 1) blind esophagus 2) distal TE fistula – cannot pass NG to stomach; type A (5%) – similar to type C – blind esophagus (esophageal atresia) but no fistula, no gas is observed in abdomen
explain VACTERL
vertebral anomalies, imperforate anus, cardiac abnormalities, TE fistula, radial/renal abnormalities, limb anomalies
explain the steps of a Ladd’s procedure
1) eviscerate and detorse counterclockwise if any volvulus is present 2) release Ladd’s cecal bands 3) broaden small bowel mesentery 4) appendectomy 5) place small bowel on right and colon on the left
what is cantrell’s pentalogy?
cardiac defects, pericardium defects, sternal cleft, diaphragmatic septum absence, omphalocele
gastroschisis vs omphalocele - how to differentiate
gastroschisis is usually off midline (to the right), has NO peritoneal sac covering – due to intrauterine rupture of umbilical vein; omphalocele is sac through cord
most significant physiologic abnormality in patients with CDH?
pulmonary hypertension
newborn with drooling, coughing, and cyanosis after first feeding – resolves quickly and spontaneously. What is the next step?
pass OG tube – if unable to pass, obtain CXR to confirm DX of esophageal atresia w/ or w/o TE fistula
explain paradoxical aciduria in pyloric stenosis
as vomiting continues, serum potassium drops, in an effort to conserve K+, kidney absorbs more Na+ and releases H+ into urine (which in turn leads to more K+ reabsorbed)
key factors in determining prognosis of neuroblastoma
age <1 year best prognosis, >3 copies of N-myc amplification have poor prognosis – these tumors are most commonly found in adrenal medulla, can produce catecholamines
fetal mesenteric vascular accidents lead to….
jejunal/ileal atresias
failure of recanalization of the bowel leads to…
esophageal/duodenal atresias
lack fo proper rotation of the bowel leads to…
midgut volvulus / malrotation
most common indication for ECMO in neonates
meconium aspiration
2 year old, abdominal mass – raccoon eyes, blueberry muffin skin lesions: dx
neuroblastoma (periortbital metastases - proptosis and ecchymosis), met to skin give blueberry muffin lesion)
2 year old, abdominal mass, aniridia, GU abnormalities, and mental retardation
WAGR - wilms, aniridia, GU abnormalities, mental retardation
most common cause of pathologic lead point for intussusception in children
Meckel’s diverticulum
during surgery for type 1 choledochal cyst, cyst found to be adherent to portal vein – best management?
excise anterior portion of cyst with mucosectomy of the posterior cyst to prevent malignant degeneration
