peds

Question 1

When does pyloric stenosis typically develop?

Answer 1

first few weeks of life (2-12 weeks of age)

Question 2

Gold standard technique to diagnose pyloric stenosis

Answer 2

ultrasound

Question 3

Complications are known to occur to what systems of the body for CDH?

Answer 3

GI, pulmonary, neurodevelopmental complications

Question 4

Most common abnormality associated with gastroschisis

Answer 4

intestinal atresia

Question 5

Findings on ultrasound for pyloric stenosis:

Answer 5

pylorus/pyloric channel length usually 16mm or greater

Question 6

Diagnostic test for Meckel’s diverticulum:

Answer 6

99m Tcpertechnetate radioisotope scan

Question 7

Males with this genetic disorder are known to sometimes have absence of bilateral vas deferens

Answer 7

cystic fibrosis

Question 8

What treatments/interventions are associated with development of necrotizing enterocolitis?

Answer 8

antibiotic use and formula feeding

Question 9

What lateral sacral ratio is considered normal in anorectal malformations that signifies likely fecal continence?

Answer 9

sacral ratio >0.7

Question 10

True or false. Direct hyperbilirubinemia is always found in infants with biliary atresia

Answer 10

True

Question 11

What type of neuroblastoma is associated with subcutaneous metastases and positive bone marrow for small, round blue cells, and massive hepatomegaly from hepatic metastases?

Answer 11

4S disease neuroblastoma; usually spontaneously regresses

Question 12

In esophageal atresia, primary repair can be achieved when the length (gap) is _____

Answer 12

2 vertebral bodies or less

Question 13

procedure used to resect a thyroglossal duct cyst:

Answer 13

Sistrunk procedure; involves excising the tract, cyst, and hyoid bone 1 cm to the left and right of midline up to the level of foramen cecum

Question 14

Which types of neuroblastoma tend to regress over time and do not require operation?

Answer 14

infantile cystic and 4S disease neuroblastoma

Question 15

Which is more common after NEC, small intestinal strictures or large intestinal strictures?

Answer 15

large intestinal strictures

Question 16

True or false. About a quarter of infants with duodenal atresia have congenital heart disease

Answer 16

True

Question 17

Perforation in the intestine in utero resulting in meconium accumulation in the peritoneal cavity:

Answer 17

meconium pseudocyst; tx with ex lap and ostomy or peritoneal drains

Question 18

Appearance of meconium pseudocyst on imaging:

Answer 18

calcified walls surrounding meconium (large cyst with air fluid levels and eggshell calcifications)

Question 19

Study of choice for children suspected of having malrotation or intermittent midgut volvulus

Answer 19

upper GI contrast study

Question 20

Treatment of prepubescent males with undescended testis

Answer 20

orchiopexy

Question 21

Initial cancer risk for undescended testis and long term risk for undescended testis:

Answer 21

initial: gonadoblastoma

long term: seminoma

Question 22

Most common solid organ intraabdominal malignancy in children:

Answer 22

neuroblastoma

Question 23

Histology of neuroblastoma

Answer 23

small round blue cells in rosette formations

Question 24

treatment of duodenal atresia

Answer 24

diamond duodenoduodenostomy

Question 25

treatment of pectus carinatum:

Answer 25

removal of affected costal cartilages and sternal osteostomy with sternal reconstruction (Ravitch procedure)

Question 26

Through what incision are most H type TE fistulas approached?

Answer 26

right neck incision; most are located at the level of the thoracic inlet

Question 27

resuscitation regimen for infants:

Answer 27

5% dextrose in 0.45% saline with 20mEq/L

Question 28

True or false. Gastroschisis defects usually occur to the right of the umbilicus

Answer 28

true

Question 29

True or false. Omphalocele occurs to the right of the umbilicus.

Answer 29

false. occurs through the umbilicus

Question 30

most common incision for repair of CDH

Answer 30

subcostal

Question 31

Management of midgut volvulus is decompression by rotating the bowel ______

Answer 31

counterclockwise

Question 32

Management of violation of duodenal mucosa during pyloromyotomy:

Answer 32

repair mucosal defect and place omental patch; alternatively, close the mucosa and the muscle, rotate pylorus 180 degrees and perform a new pyloromyotomy

Question 33

True or false. R0 resection is not mandatory for neuroblastoma

Answer 33

true

Question 34

Operative principles of Wilm's tumor:

Answer 34

must palpate renal artery for tumor thrombus; tumor rupture should be avoided as it upstages disease and leads to recurrences; requires lymph node staging; acquired von Willebrand disease can lead to intraop bleeding

Question 35

True or false. Recent evidence suggests there is equivalent risk of rebleeding or continued bleeding for either limited segmental resection or simple diverticulectomy in tx of Meckel's diverticulum in children

Answer 35

true

Question 36

True or false. Abnormal intestinal rotation is seen in all patients with gastroschisis or omphalocele

Answer 36

True

Question 37

Electrolyte abnormalities of pyloric stenosis:

Answer 37

hypokalemic, hypochloremic metabolic alkalosis

Question 38

How is the pyloromyotomy made for pyloric stenosis?

Answer 38

longitudinal incision from serosa/extramucosal of pylorus just proximal to the hypertrophied muscle to just proximal to the pyloric vein; extend onto antrum of stomach

Question 39

What abnormality is associated with difficulty in getting ECMO access in CDH patients?

Answer 39

vascular (IJ & carotid) hypoplasia

Question 40

What structure is at risk of injury during high ligation of an inguinal hernia in females?

Answer 40

fallopian tube

Question 41

Primary modality of treatment for 3rd and 4th branchial anomaly fistula that can be visualized

Answer 41

endoscopic cautery or chemical ablation

Question 42

What amplification in neuroblastoma is associated with a good prognosis?

Answer 42

MYCN

Question 43

What amplification in neuroblastoma is associated with a bad prognosis?

Answer 43

TrkA

Question 44

What is secondary to failure of closure of the pleuroperitoneal canal?

Answer 44

congenital diaphragmatic hernia posterolateral - Bochdalek type (most common) anteromedial - Morgagni type; less common

Question 45

Nonfunctional pulmonary tissue fed by an anomalous systemic arterial supply with no connection to the tracheobronchial tree:

Answer 45

bronchopulmonary sequestration

Question 46

Abnormality due to poorly developed alveoli structure resulting in recurrent infections and respiratory compromise:

Answer 46

congenital cystic adenomatoid malformation

Question 47

Failure in development of bronchus cartilage resulting in air trapping with expiration

Answer 47

congenital lobar emphysema

Question 48

True or false. Hirschsprung disease can present in later childhood with chronic constipation after weaning from breastmilk in short segment disease

Answer 48

true

Question 49

treatment of hepatoblastoma:

Answer 49

surgical resection upfront is mainstay followed by chemo; if unresectable/metastatic, give chemo upfront to decrease size

Question 50

Most undescended testes resolve spontaneously in the first ____ of life

Answer 50

6 months

Question 51

where do lymph nodes need to be biopsied for Wilm's tumor:

Answer 51

renal hilum, vena cava, and aorta

Question 52

Drug of choice for PDA

Answer 52

indomethacin

Question 53

Standard operation for biliary atresia:

Answer 53

Roux en Y hepatic portoenterostomy (Kasai procedure)

Question 54

most common location for undescended testes

Answer 54

superficial inguinal ring

Question 55

temporizing measures for infants born with transposition of great vessels:

Answer 55

IV prostaglandin E1 to maintain PDA and then balloon atrial septostomy

Question 56

incomplete recanalization of the duodenum during 8-10 weeks gestation resulting in persistent membranous structure in the lumen of the duodenum that appears like a windsock

Answer 56

duodenal web

Question 57

Diagnosis and tx of duodenal web

Answer 57

UGI with barium; tx with duodenotomy and excision of web

Question 58

complete failure of duodenum to recanalize

Answer 58

duodenal atresia; bilious atresia, double bubble on radiograph

Question 59

True or false. There is no consensus on the indications for lap chole in children with biliary dyskinesia

Answer 59

true

Question 60

True or false. All button battery ingestions should be removed (even gastric)

Answer 60

true

Question 61

True or false. Incidentally discovered malrotation must be surgically managed.

Answer 61

true

Question 62

Steps of Ladd's procedure:

Answer 62

``` untwisting of volvulized bowel release of cecal bands broaden the small bowel mesentery incidental appy place small bowel to right and colon to the left ```