Pestana Pediatric Surgery Flashcards

1
Q

A newborn who begins excessively salivating gets choking spells during first feeding? Tests? Complications? Treatment?

A

Esophogeal atresia. NG tube and x ray. Blind puch in upper esophagus and fistula between lower esophagus and trachea/bronchus. Surgical repair - gastrostomy if surgery is delayed.

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2
Q

What is the major constellation of congential anomalies seen in the first 24 hours?

A

VACTER: Vertebral, Tracheal, Esophogeal, Radial: xray, Anal: visual inspection, Cardiac: echo,

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3
Q

Treatment for imperforate anus? Timeline?

A

Colostomy (for high rectal pouch) and surgical repair. Level of pouch found by upside down x rays. Fix before toilet training.

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4
Q

Congential diaphragmatic hernias. Where does it present? When is the surgery preformed? Treatment if severe?

A

Left side, with bowel in the chest. Delay 3-4 day for maturation of pulmonary system. Endotracheal intubation, low pressure ventilation, NG, and ECMO if really severe.

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5
Q

Presentation difference between gastroschisis and omphalocele? Treatment?

A

G: exposed reddened intestines with normal cord. O: normal looking bowel (encased in the cord) exposed. Closed with silastic silo and pushing contents back into the abdomen. Gastroschisis require TPN for 1 month.

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6
Q

Etiology of bladder exstrophy? Timeline for treatment?

A

Protrusion of the bladder through the unfused pubic symphysis. Fix surgically within 48 hours.

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7
Q

A newborn has green vomit. Which conditions will also show double bubble on xray? Which have multiple air bubbles?

A

Duodenal Atresia, annular pancreas, and malrotation. Malrotation and intestinal atresia.

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8
Q

Where are the air bubbles found In “double bubble”?

A

Stomach and first portion of duodenum.

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9
Q

A 2 week old infant presents with crying, severe abdominal pain, green vomit, and acid reflux? Tests? Treatment

A

Malrotation. X rays (double bubble, additional bubbles = worse prognosis). Constrast enema (diagnostic). Surgical repair.

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10
Q

A newborn premature infant is intolerant to feeding during his first feeding and develops abdominal distension and rapid thrombocyopenia? Treatment? Complications?

A

Necrotizing enterocolitis. Stop feeding. Broad spectrum antibiotic. IV fluids, IV nutrition. Abdominal wall erythema, intestinal pneumatosis, pneumoperitoneum - correct surgically.

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11
Q

A baby with cystic fibrosis develops feeding intolerance and bilous vomiting? Tests and signs? Treatment?

A

Meconium ileus. X rays (dilated loops in small intestine and ground glass appearing lower abdomen). Gastrografin enema is both diagnostic and theraputic.

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12
Q

A 3 week old boy develops nonbilious projectile vomiting after feeding? What is found on physical exam? What could he have past exposure to? Metabolic state? Tests? Treatment?

A

Hypertrophic pyloric stenosis. Eryth/Azythromycin. Palpable olive sized mass in RUQ, signs of dehydration. Hypochloremic, hypokalemic, metabolic alkalosis. Sonogram. Rehydration, correction of alkalosis, and Remstedt pyloromyomoty/balloon dilation.

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13
Q

A 7 week old baby presents with progressively increasing jaundice? Tests? Rule of 1/3s?

A

Biliary atresia. Check serologies and sweat test. Preform HIDA scan after 1 week of phenobarbitol - if no bile comes out, surgical exploration. 1/3 can get long last surgical derivation, 1/3 need liver transplant after derivation, 1/3 need liver transplant asap

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14
Q

A young girl has a history of chronic constipation, and recently has developed fecal soiling? Tests?

A

Hirschsprung disease. X rays - distended proximal colon. Full thickness biopsy of rectal mucosa (diagnostic) - will be aganglionic.

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15
Q

A chubby 10 month old healthy child has transient (1 minute) colicky abdominal pain. He has his knees drawn up, and has currant jelly stool? Tests? Clinical Sign? Treatment?

A

Intussusception. Barium enema is diagnostic and theraputic. “empty” RLQ = Dance sign. Surgery if it recurs.

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16
Q

An infant presents with the subdural hematoma and retinal hemorrhages?

A

Shaken baby syndrome.

17
Q

A child is blue. What are the 5 T’s?

A

Truncus Arteriosus, Transposition of the Great Arteries (TGA), Tricuspid Atresia, Tetrology of Falot, Total Anomalous Pulmonary Venous Connection.