Pediatrics👶🏽

Question 1

Esophageal Atresia with Tracheoesophageal Fistula (EA/TEF): Pathophysiology

Answer 1

Failure of the primitive foregut to separate into the trachea and esophagus. Most common type (Type C): Blind-ending esophageal pouch with a distal tracheoesophageal fistula.

Question 2

EA/TEF: Presentation

Answer 2

Newborn with copious oral secretions, choking, coughing, and cyanosis after feeding. History of polyhydramnios during pregnancy.

Question 3

EA/TEF: Diagnosis

Answer 3

Inability to pass an NG tube beyond 10-15 cm. Chest X-ray shows coiled NG tube in the upper pouch and air in the GI tract (if fistula present).

Question 4

EA/TEF: Management - Preoperative Stabilization

Answer 4

Suction to clear secretions, upright positioning to reduce reflux, IV fluids, and antibiotics to prevent aspiration pneumonia.

Question 5

EA/TEF: Management - Surgical Repair

Answer 5

Primary anastomosis if feasible. Staged repair if there is a long gap between segments.

Question 6

Congenital Diaphragmatic Hernia (CDH): Pathophysiology

Answer 6

Incomplete formation of the diaphragm, usually through the posterolateral (Bochdalek) foramen, causing lung hypoplasia.

Question 7

CDH: Presentation

Answer 7

Respiratory distress at birth, scaphoid abdomen, and decreased breath sounds on the affected side.

Question 8

CDH: Diagnosis

Answer 8

Chest X-ray shows bowel loops in the thorax with mediastinal shift. Prenatal diagnosis via ultrasound or fetal MRI.

Question 9

CDH: Management

Answer 9

Immediate endotracheal intubation, gastric decompression with NG tube, and surgical repair after stabilization.

Question 10

Intussusception: Pathophysiology

Answer 10

A segment of the bowel telescopes into an adjacent segment, causing obstruction and ischemia.

Question 11

Intussusception: Presentation

Answer 11

Sudden onset of colicky abdominal pain, currant jelly stools, and a palpable sausage-shaped mass in the right upper quadrant.

Question 12

Intussusception: Diagnosis

Answer 12

Ultrasound shows target sign or doughnut sign. Air or contrast enema is both diagnostic and therapeutic.

Question 13

Intussusception: Management

Answer 13

Fluid resuscitation, electrolyte correction, and non-surgical reduction using air or barium enema.

Question 14

Pyloric Stenosis: Pathophysiology

Answer 14

Hypertrophy of the pyloric muscle causing gastric outlet obstruction, typically at 3-6 weeks of age.

Question 15

Pyloric Stenosis: Presentation

Answer 15

Projectile, non-bilious vomiting, palpable olive-shaped mass in the epigastrium, and hypokalemic, hypochloremic metabolic alkalosis.

Question 16

Pyloric Stenosis: Diagnosis

Answer 16

Ultrasound shows thickened pyloric muscle and elongated channel. Blood tests show electrolyte disturbances.

Question 17

Pyloric Stenosis: Management

Answer 17

IV fluid resuscitation, correction of electrolytes, and pyloromyotomy (Ramstedt procedure).

Question 18

Cryptorchidism: Pathophysiology

Answer 18

Failure of the testes to descend into the scrotum, most common in preterm infants.

Question 19

Cryptorchidism: Diagnosis

Answer 19

Physical exam reveals absence of testes in the scrotum. Imaging (ultrasound/MRI) if needed.

Question 20

Cryptorchidism: Management

Answer 20

Observation for spontaneous descent within 6 months. Orchidopexy recommended before 1 year of age.

Question 21

Necrotizing Enterocolitis (NEC): Pathophysiology

Answer 21

Ischemic and inflammatory necrosis of intestinal mucosa, commonly in preterm infants.

Question 22

NEC: Presentation

Answer 22

Feeding intolerance, abdominal distension, bloody stools, and signs of sepsis or shock.

Question 23

NEC: Diagnosis

Answer 23

Abdominal X-ray shows pneumatosis intestinalis, portal venous gas, or free air.

Question 24

NEC: Management

Answer 24

NPO, IV fluids, parenteral nutrition, broad-spectrum antibiotics. Surgery for perforation or severe cases.