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ORAL BOARDS > PEDS > Flashcards

PEDS Flashcards

1
Q

Bolus for peds

A

20 cc/kg

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2
Q

Easy way to determine fluid status of baby (in history)

A

Ask about wet diapers

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3
Q

Special notes on laparoscopic surgery in kids

A

Bladder decompression
Lower pneumoperitoneum (8-10) and slowly insufflate abdomen
Shorter lap instruments
Enter via hassan

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4
Q

Air enema - what pressure for intussusception?

A

should not exceed 120 mmHg

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5
Q

Pre tx for pyloric stenosis

A 
20 mL/kg bolus NS 
d5 1/2 NS + 20K
1.5 X maintenance (4:2:1)
UOP >1.5 cc/kg/hr
pediatric ICU
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6
Q

Electrolyte goals in pyloric stenosis

A

Bicarb <30
Cl <100
K+ normal

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7
Q

Inguinal hernia repair in peds

A

R inguinal dissection
Locate hernia sac on anteromedial side of spermatic cord
Separate sac from cord contents (ID and preserve ilioinguinal nerve, vas deferens and testicular vessels)
Separate sac from cord structures and free it all the way to external inguinal ring
Perform double high ligation of sac with silk suture
Finally remove any excess sac from distal cord including any non communicating hydroceles

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8
Q

During inguinal hernia repair in child, find testicle is very mobile

A

Orchiopexy

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9
Q

During inguinal hernia repair in child, inadvertently divide vas deferens

A

Intraop urology consult to help with repair

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10
Q

Reduction of groin hernia in pediatrics

A

Intranasal fentanyl

Firm constant pressure in groin - part of this pressure includes elongation of herniated bowel

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11
Q

Repair of strangulated inguinal hernia (pediatrics)

A

Open skin overlying incarcerated bowel and dissect down to ext inguinal ring
Release ext fascial ring to free bowel - if appears necrotic, convert to transverse laparotomy and perform bowel resection + primary anastomosis vs discontinuity & open abdomen
If not necrotic, high ligation of sac and possible suture repair of inguinal floor if defect is particularly large

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12
Q

Intussuception (peds) - OR

A

ID intussusception and reduce it by gently pushing on large bowel and pulling on small bowel
Look carefully for pathologic lead point
If unable to reduce, resect and perform primary anastomosis

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13
Q

Intussusception in adolescent - recurrent

A

More concerned about pathologic lead point

Proceed to OR for reduction and ID of lead point

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14
Q

Henonch Schonlein Purpura

A

Small bowel intussusception

Purpura on extremities

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15
Q

Biliary emesis in an infant - critical fail if this is NOT considered

A

malrotation

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16
Q

Malrotation - OR

A

Detorse bowel by turning counterclockwise and ensure reperfuses nicely
ID any Ladds bands or scar tissue holding colon over duodenum or causing duo to twist in RUQ
Take down all those bands in order to fully mobilize colon and straighten duodenum
Make mesentery as wide as possible by leaving small bowel in right abdomen and large bowel in left abdomen
Appendectomyngui

17
Q

Meckels diverticulum - description

A

True diverticulum

Arises from antimesenteric surface of distal ileum

18
Q

Rule of 2s for meckels

A 
Male:female 2:1
2 in in length
2 feet from ileocecal valve 
2% of population
2% of chances of complications over lifetime
19
Q

Gastric mucosa is present in how many of meckels

A

25%

20
Q

Bleeding meckels - OR

A

Small periumbilical incision
Extracorporalize small bowel
Run small bowel to verify no other lesions present
SBR removing meckels + adjacent ulcers

21
Q

Lap appy - appy appears normal but inflamed Meckels

A

Leave appy alone

Stapled excision of diverticulum if base appears healthy

22
Q

Lap appy - inflammed appendix + 6 cm non inflamed Meckels

A

Perform appy

D/w family re: Meckels and if they consent stapled diverticulectomy during same operation

23
Q

Lap pyloromyotomy - OR

A

Establish pneumoperitoneum
Longitudinal myotomy via seromuscular incision that runs across entire pylorus
Spread muscle to visualize submucosa and ensure complete myotomy
Look carefully for any injury to mucosa
Air leak test

24
Q

Lap pyloromyotomy - full thickness injury to submucosa

A

Convert to open
Close mucosal injury with absorbable suture
Close pyloric muscle over top of injury also w/absorbable
Flip pylorus over and perform new pyloromyotomy 180 degrees from original

25
Q

Post op blockage of pylorus s/p pyoloromyotomy

A

UGI

Worry about INCOMPLETE MYOTOMY and should return to OR

26
Q

Post op emesis s/p pyloromyotomy, UGI does not show obstruction

A

Low volume feeds
Gradually increase
Consult peds for food allergy

27
Q

Post op feeding s/p pyloromyotomy

A

4-6 hrs post op
Begin slowly with small volume of Pedialyte, increase as tolerated
Once tolerating 60-90 mL can resume breastfeeding

28
Q

Why paradoxical aciduria in pyloric stenosis

A

If the hypokalemia is severe, sodium exchange is preferentially substituted with hydrogen in the distal convoluted tubule, producing the “paradoxically” acidic urine

ORAL BOARDS (11 decks)

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