Surgery Flashcards
Which of the following is TRUE regarding pediatric appendicitis?
- The incidence of perforated appendicitis in children under 2 years of age is rare
- Routine imaging is recommended to confirm the diagnosis of appendicitis
- The peak incidence of appendicitis is 6-8 years of age
- Patients with perforated appendicitis may be treated with antibiotics alone
- Patients with perforated appendicitis may be treated with antibiotics alone
Which statement is TRUE regarding paradoxical aciduria observed in pyloric stenosis:
- It is only observed in infants with pyloric stenosis
- It is mediated by an aldosterone effect
- It is indicative of a total body HCO3 deficit
- It can be treated by providing hypotonic intravenous fluid
- It is mediated by an aldosterone effect
What is the MOST COMMON pathologic lead point seen with intussusception?
- Meckel’s diverticulum
- Appendix
- Malignant polyp
- Hematoma (e.g. Henoch-Schonlein purpura)
- Intestinal duplication cyst
- Meckel’s diverticulum
• A 2 year old boy presents with two large maroon colored stools. He has no abdominal pain. While waiting in the ER, he passes another large bloody stool.
• On exam, he is pale, cool and irritable.
• Vitals: HR 160 BP 80/40 RR 36 35.8oC
• No abdominal distension or pain
• Clots evident in diaper
Which of the following is the PRIORITY in this patient?
1. Blood work including cross match
2. Intravenous access and fluid bolus
3. Abdominal films
4. Insert NG tube and aspirate gastric content
- Intravenous access and fluid bolus
• A 2 year old boy presents with two large maroon colored stools. He has no abdominal pain. While waiting in the ER, he passes another large bloody stool.
• On exam, he is pale, cool and irritable.
• Vitals: HR 160 BP 80/40 RR 36 35.8oC
• No abdominal distension or pain
• Clots evident in diaper
The most likely diagnosis in this scenario is:
1. Bleeding esophageal varicies
2. Intussusception
3. Meckel’s diverticulum
4. Malignant polyp
- Meckel’s diverticulum
• A newborn has profound respiratory distress and cyanosis at birth requiring intubation.
• Apgar scores are 31 and 55.
• A blood gas confirms severe hypoxia and acidosis. A chest radiograph is taken and shows an intestinal air pattern in the left hemithorax.
Given the most likely diagnosis, which of the following is THE MOST APPROPRIATE next step?
1. Immediate placement of a nasal or oral gastric tube
2. Aggressive fluid resuscitation
3. Echocardiogram
4. Preparation of operating suite for urgent repair
5. Start inhaled nitric oxide
- Immediate placement of a nasal or oral gastric tube
Which of the following is TRUE regarding CDH?
- Ventilation strategies in CDH should utilize higher mean airway pressures to maintain oxygenation
- The prenatal diagnosis of CDH is associated with worse outcomes than those diagnosed post-natally
- Chromosomal anomalies are very rare in CDH
- Surgical repair should be performed as soon as possible after birth to allow more space for the affected lung to grow
- The prenatal diagnosis of CDH is associated with worse outcomes than those diagnosed post-natally
• 35 week infant male, 5 hours old, has a cyanotic spell and bradycardia after a first attempt at breast feeding.
• Born by SVD; polyhydramnios?
• Apgars 7 and 9.
• Requires oxygen and frequent suctioning for oral secretions
• Second attempt at feeding leads to another significant desaturation episode requiring intubation
• On examination
• Irritable with stable vital signs.
• H+N, resp and CVS exam normal
• Abdomen - mildly distended; no masses.
• GU – Normal genitalia. The infant has not voided yet.
• Rectal – anus is patent with a small drop of meconium
• A chest radiograph is taken due to repeated desaturations. An NGT is inserted prior. On the XR, the tip of the NG is high.
Given the clinical information and radiograph, what is the MOST LIKELY diagnosis?
1. Esophageal atresia
2. Esophageal atresia with tracheo-esophageal fistula
3. Largyngeal cleft
4. “H-type” tracheo-esohageal atresia
5. Respiratory distress syndrome
- Esophageal atresia with tracheo-esophageal fistula
The initial, most important, maneuver to confirm a diagnosis of EA-TEF is:
- Contrast esophagogram
- Urgent bronchoscopy
- Computed Tomography of chest
- Attempt insertion of NG tube
- Ultrasound of neck/chest
- Attempt insertion of NG tube
Which major anomaly occurs MOST frequently with EA-TEF?
- Skeletal
- Genitourinary
- Cardiovascular
- Neurologic
- Gastrointestinal
- Cardiovascular
• 1 week old infant with a 24-hour history of vomiting, decreased stooling and decreased urine output. Infant is lethargic. Vomitus is now yellow-green in color and mother noted some streaks of blood in diaper.
• Infant is dehydrated and lethargic. Abdomen is scaphoid and soft. Rectal exam confirms mucoid blood-tinged stool.
•Hb 142 WBC 16 PLT 350
•Na 135 Cl 98 K 3.8 HCO3 17
• The next MOST APPROPRIATE radiologic test for this patient is:
(a) Abdominal radiograph
(b) CT abdomen
(c) US abdomen
(d) Upper GI series (Repas baryté)
(e) Contrast enema
(d) Upper GI series (Repas baryté)
- 1 week old infant with a 24-hour history of vomiting, decreased stooling and decreased urine output. Infant is lethargic. Vomitus is now yellow-green in color and mother noted some streaks of blood in diaper.
- Infant is dehydrated and lethargic. Abdomen is scaphoid and soft. Rectal exam confirms mucoid blood-tinged stool.
- Hb 142 WBC 16 PLT 350
- Na 135 Cl 98 K 3.8 HCO3 17
The differential diagnosis of bilious vomiting in the neonate includes:
(a) Hirschsprung’s disease
(b) Malrotation +/- Midgut volvulus
(c) Intestinal atresia (small bowel)
(d) Ileus
(e) All of the above
(e) All of the above
3-day old term male infant presents to the ER. He was discharged after uneventful SVD at 24 hours. Fed well initially but is now distended and vomiting “yellow.” He has only passed a small amount of meconium today. He is alert, active and afebrile.
• On exam he is well. Normal cap refill. He is distended. DRE demonstrates an anus with normal location, tone and size. A large amount of gas and stool is passed following examination.
• The scenario MOST supports a diagnosis of:
a) Malrotation with midgut volvulus
b) Ileal atresia
c) Lower intestinal obstruction
d) Necrotizing enterocolitis
e) Milk protein intolerance
c) Lower intestinal obstruction
3-day old term male infant presents to the ER. He was discharged after uneventful SVD at 24 hours. Fed well initially but is now distended and vomiting “yellow.” He has only passed a small amount of meconium today. He is alert, active and afebrile.
• On exam he is well. Normal cap refill. He is distended. DRE demonstrates an anus with normal location, tone and size. A large amount of gas and stool is passed following examination.
A contrast enema is performed demonstrating a transition zone in the sigmoid colon. The next BEST step in the management of this infant includes:
a) Ultrasound
b) Upper gastrointestinal series
c) Rectal biopsy at bedside
d) Immediate pull-through procedure
e) Manometry
c) Rectal biopsy at bedside
Which of the following features BEST distinguishes omphalocele from gastroschisis:
- Location of the umbilical cord relative to the abdominal wall defect
- Co-existent intestinal obstruction
- Co-existent intestinal malrotation
- Prenatal diagnosis
- Location of the umbilical cord relative to the abdominal wall defect
