Surgical Problems in Pediatrics

Question 1

What is the treatment of Lymphadenopathy

Answer 1

Infectous- Abtx
Reactive- Observation and Follow up
Malignancy- Excisional or incisional biopsy

Question 2

What is the Tx of Thyroglossal duct cyst?

Answer 2

Remove with mid portion of Hyoid

Question 3

How is a Thyroglossal duct cyst IDed?

Answer 3

Midline Neck mass, moves with the tongue

Question 4

What is the Tx of COngenital Torticollis?

Answer 4

Physical Therapy, Stretching, Surgry if it doesn’t resolve

Question 5

What are causes of COngenital Torticollis?

Answer 5

Birth Trauma, Vertebral issues

Question 6

What is Pulmonary Sequestration?

Answer 6

Lungs dissconnecte from Bronchial tree. independant blood supply. Can be intralobar or extralobar.

Question 7

How is pulmonary sequestration Diagnosed?

Answer 7

CT of Chest

Question 8

What is the Tx Of esophageal Atresia?

Answer 8

Aspirate Prox pouch
Gastrotomy?
Right thoracotomy, Extrapleural repair

Question 9

How is Esophageal Atresia Identified in the clinic?

Answer 9

Excessive drooling/saliva

Chest x ray.

Question 10

What is the VACTERL Association?

Answer 10

Vertebral
Anorectal
Cardio
Tracheal
Esophageal
Renal 
Limb

Question 11

What is Diaphragmatic Hernia?

Answer 11

Stomach Herniates into the Thorax
Surgury after 24hrs
Hypoplastic Lung
Pulmonary Hypertension

Question 12

Chest wall Deformity

Answer 12

Pectus Excavatum, Pectus Carinatum, Sternal Cleft

Question 13

Chest wall Deformity Tx?

Answer 13

Surgery after physical maturity is reached. Remodel cartilige and sternum

Question 14

What is an omphalocele?

Answer 14

Midline abdominal defect with umbilical membrane covering. Beckwith Wiedman Syndrome

Question 15

What is Gastroschesis?

Answer 15

Abd. wall defect to right of umbilicus. Better outcome than omohalocele.

Question 16

Risks associated with Omphalocele and Gastroschisis?

Answer 16

No covering over intestines. Succeptible to infection.

Question 17

What is a malrotation and and volvulus?

Answer 17

Failure of gut to rotate and fix in abdomen. Midgut free to rotate around the SMA.
Forceful Billious vomiting
Ischemic pain
Can happen at any age’
Duodenum must cross the midline and rise to the level of the pylorus. If not it is a volvulus

Question 18

What imaging finding is associated with Duodenal Atresia?

Answer 18

Double Bubble

Question 19

What is Midgut atresia?

Answer 19

Mesenteric vascular accident causing abnormalities in formation.

Question 20

What is Meckel’s Diverticulum?

Answer 20

2 feet from the iliocecal valve

Can present as diverticulitis, Intusseseption, of bleeding

Question 21

What is Hirschprung’s disease?

Answer 21

Failure of Migtation of neural crest cells. Low peristalsis
Enterocolitis may be fatal (Toxic Megacolon)
Barium enema
Rectal manometry

Question 22

Where is the most common location of Hirschprung’s disease?

Answer 22

Rectosigmoidal segment. (81%)
Transverse(10%)
Iliocecal (9%)

Question 23

What is imperforate Anus?

Answer 23

Cloaca doesn’t separate into Rectum and urogenital sinus. No anal opening. Recto urogenital fistula.
also rectovaginal fistula.

Question 24

What is an umbilical hernia?

Answer 24

Outpouching of intestines into a pouch near the umbilicus. May act as a bowel obstruction. Usually a small hole. wait til 3-5yo to fix. otherwise recurrence is relatively high.

Question 25

What is intussuseption?

Answer 25

``` Telescoping of the Bowel. can cause ischemia Paroxismal Pain, Crampy Can be normal, or subdued between cramps Currant jelly stool. Blood, etc. Ultra SOund better than CT ```

Question 26

Tx for intussuseption?

Answer 26

Barium or air enema may be diagnostic or curative!

Question 27

What is Pyloric Stenosis?

Answer 27

``` Narrowin of the Pylorus Non-bilous vomiting. More common in males Can palpate "olive" stomach US is diagnostic. Tx is dividing Stenotic muscles. ```

Question 28

What is biliary Atresia?

Answer 28

Persistant direct hyperbili

Question 29

What is a choledochal Cyst?

Answer 29

...

Question 30

What is an indirect inguinal hernia?

Answer 30

Related to testicular descent. Intestines push through the abdominal wall and sometimes into the scrotum. Can compomise blood flow to the Testes or protruding bowel.

Question 31

What are undescended testes?

Answer 31

orchiopexy More common in preemies Retractile(undescended) vs ectopic testes Increased risk of cancer.

Question 32

How do you tell the difference between Retractile and ectopic testes?

Answer 32

US or scope to find in the abdomen | If you can palpate in the testicle in the Inguinal canal it is retractile.