GI

Question 1

Most common type of tracheo esophageal fistula

Answer 1

Esophageal atresia with fistula between trachea and distal esophagus( Type 1a and 3 depending on classifn system)

Question 2

Reason for enlarged gastric bubble in TEF

Answer 2

Fistula between trachea and distal esophagus leading to air entering stomach (not usually seen in types 1b and 1e)

Question 3

Syndrome associated with TEF

Answer 3

VACTERL

Verterbal
Ano-rectal malformations
Cardiac abnormalities
Tracheo
Esophageal fistula
Renal, Radial aplasia
Limb

Question 4

Investigation of choice for TEF

Answer 4

Flexible bronchoscopy looking
- presence of fistula to proximal segment
- presence of fistula to distal segment

Question 5

Incision for TEF

Answer 5

4th of 5th intercostal space

Question 6

Steps for TEF ligation and repair

Answer 6

Isolate azygos vein

Interrupted sutures
1. Posterior first
2. Then anterior

Check whether NGT is able to pass thru patent repair
- on POD5 inject dye to check for leak and whether feeds can be started

Place chest tube to drain saliva leak

Monitor in NICU

Question 7

What does double bubble sign with absent distal colonic and rectal suggest

Answer 7

Duodenal atresia or annular pancreas

Question 8

Part of pregnancy duodenal atresia usually occurs

Answer 8

1st trimester: Failure of recanalization

Question 9

Windsock appearance suggests?

Answer 9

Duodenal webs/intraluminal duodenal diverticulum

Question 10

syndrome associated with duodenal atresia

Answer 10

T21

Question 11

Suspicion in newborn with NBNB projectile vomiting

Answer 11

Hypertrophic pyloric stenosis

Question 12

First steps for newly diagnosed duodenal atresia

Answer 12

1. Order TTE tro cardiac abnormalities
2. Drip and suck the neonate

Question 13

Direction umbilical vein catheter usually goes in

Answer 13

Superiorly

Question 14

Why duodenal atresia usually p/w bilious vomiting

Answer 14

Usually distal to ampulla of vater

Question 15

How duodeno-duodenostomy is usually performed for duodenal atresia

Answer 15

side to side anastomosis b/w D1 and D3, D2 often too atretic

Question 16

Radiological invx to confirm small bowel atresia

Answer 16

Barium enema

Barium follow through would be too dilated

Question 17

Most common types of duodenal atresia and the etiology

Answer 17

Type 1 and 3a, usually due to vascular accident/ischemia

Question 18

Part of pregnancy where jejunal and ileal atresia tend to occur

Answer 18

2nd and 3rd trimester due to ischemia

Question 19

Risk factor for short gut syndrome

Answer 19

DJ flexure to ileocecal valve <60cm

Question 20

Options for jejunal and ileal atresia mx

Answer 20

1. Stoma
2. Bowel resection

Question 21

How suction rectal biopsy is done

Answer 21

3 biopsys starting 3cm from rectum, 3cm apart

Question 22

Mx of hirschsprung

Answer 22

Non surgical: rectal washout 2-3x a day

Surgical

1) Transverse colon colostomy as temporizing

2) Definitive is pull through eg Duhamel, Swensen

Question 23

Invx for hirschsprungs disease

Answer 23

1. Suction rectal biopsy to confirm diagnosis
2. Barium enema to delineate anatomical segment
3. XR to look for dilated bowel segments

Question 23

What to check for intraop in Pull through

Answer 23

intraop frozen section to check for ganglion cells present at dentate line via pull through

Question 24

Common cx of anorectal malformations in boys

Answer 24

Fistula to genito urinary system - check intra op if present, needs to be ligated

Question 25

Reason for double barrel stoma with division in ARM for boys

Answer 25

Reduce entry of fecal output into distal segment that may cause UTIs/ fecaluria

Question 26

Mx of Ano rectal malformations

Answer 26

LAARP/PSARP Laparoscopic/ Posterior sagittal AnoRecto Plasty

Question 27

Side of umbilical cord that gastroschisis usually comes out of

Answer 27

Almost always on the right side of the umbilical cord

Question 28

Syndromes predisposing to omphalocele/exomphalos

Answer 28

T13,18,21 edwards patau downs Beckwith Wiedemann syndrome

Question 29

Temporizing measure for closing large omphalocele

Answer 29

A silo sutured to the skin to help reduce heat and fluid loss

Question 30

Common organs involved in omphalocele

Answer 30

Stomach, small intestine, liver and spleen

Question 31

How to monitor for excessive intra abdominal pressure when replacing an omphalocele

Answer 31

1. Intra vesical pressure management 2. Looking for desaturation

Question 32

Types of congenital diaphragmatic hernia

Answer 32

1. 80% bochdalek foramen left posterolateral 2. 10% right sided 3. 5% morgagni foramen anterior

Question 33

Cx of Congenital diaphragmatic hernia

Answer 33

1. Pulmonary hypotension 2. Pulmonary hypoplasia 3.

Question 34

Acute medical Mx of CDH

Answer 34

Intubation and ventilatory support 1.High frequency oxygen ventilation 2. Nitric oxide to help with pulmonary vasodilation 3. extra corporeal membrane oxygenation for severe cases

Question 35

Signs and Sx of Hypertrophic Pyloric stenosis

Answer 35

Sx 1. NBNB projectile vomiting Signs 1. Olive shaped mass at the LUQ

Question 36

Invx for Hypertrophic Pyloric Stenosis

Answer 36

Biochemical 1. RP for electrolytes hypokalemia hypochloremia, low bicarb, BE less than -2 2. ABG for metabolic acidosis 3. Urine for paradoxical aciduria Imaging 1. Transabdominal US

Question 37

US finding for Hypertrophic Pyloric Stenosis

Answer 37

Hypertrophied muscles around pylorus Can include Dynamic study

Question 38

Mx of hypertrophic pyloric stenosis

Answer 38

Pyloromyotomy( open vs lap vs transumbilical) - Split pyloric muscles without entering the lumen trial of feeds 4hrs after

Question 39

Barium enema findings for Hirschsprungs disease

Answer 39

1. Transition zone with funneling 2. Reversal of rectosigmoid ratio

Question 40

Sign of HAEC

Answer 40

Hirschsprung associated enterocolitis Sawtooth appearance from mucosal edema

Question 41

Age group where intussusception is common

Answer 41

6 months to 6 years

Question 42

Most common cause of intussuception

Answer 42

Infection causing hypertrophy of Peyer Patches or lymphadenitis

Question 43

First line management of intussusception

Answer 43

Air enema

Question 44

What to consent for in open reduction of intussusception

Answer 44

Appendicectomy so RUQ pain won't lead to diagnostic dilemma

Question 45

Possible pathological lead points to expect in patients outside of 6m to 6y

Answer 45

1. Meckel 2. Polyps 3. Hamartoma 4. Masses eg lymphoma, GIST 5. IgA Vasculitis/HSP

Question 46

Number of air enema reductions before converting to open reduction

Answer 46

3-4 attempts with high pressures not >120mmHg

Question 47

Mx of intuss with suspected pathological lead point

Answer 47

Open reduction with exploration

Question 48

Mx of indirect inguinal hernia in neonate/infant

Answer 48

Surgical herniotomy due to high risk of cx( incarceration, obstruction, strangulation and perforation)

Question 49

Age where hydrocele is

Question 51

Radiological signs of Hirschsprungs

Answer 51

1. Transition point 2. Mosaic colonic pattern