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Pediatrics Flashcards

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1
Q

Choledochal cysts tx

A

Always excise
25% risk of cancer
30% risk of pancreatitis

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2
Q

Type I choledochal cyst tx

A

whole CBD involved

tx: excise and do hepatico-j

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3
Q

Type II choledochal cyst tx

A

diverticulum that hangs off CBD

tx: do diverticulectomy

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4
Q

Type III choledochal cyst tx

A

distal dilation involving sphincter of Oddi

tx: resection or marsupialization

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5
Q

Type IV choledochal cyst tx

A

intra- and extrahepatic cysts

tx: resection, lobectomy, transplant

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6
Q

Type V choledochal cyst tx

A 
intrahepatic cysts (Caroli's disease)
tx: resection, lobectomy, transplant
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7
Q

congenital lobar emphysema

A

massive hyperinflation of a single lobe (usually upper/middle)
1/3 have respiratory distress at birth
CXR: radioluceny of affected lobe, compression of other lobe
M:F ratio is 2:1
tx: severely symptomatic - lobectomy, good prognosis

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8
Q 
cystic hygroma (lymphangioma) tx
#1 complication?
A 
resect
#1 complication = infection
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9
Q

1st sign of CHF in children?

A

hepatomegaly

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10
Q

Strawberry hemangioma

A

appear in 1st few weeks of life. leave alone, most involute by age 7.

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11
Q

Neuroblastoma

  • markers its associated with?
  • origin cells?
A

MC solid peds malignancy

  • high VMA, high HVA associated with worse prognosis, N-myc
  • neural creast cells
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12
Q

1 peds malignancy overall

A

Leukemia

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13
Q

Wilms tumor

A

nephroblastoma

80% cure with nephrectomy

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14
Q

Biliary atresia tx

A 
Kasi procedure (before 3 months age)
hepatoportoenterostomy
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15
Q

Meckel’s diverticulum

A 
on anti-mesenteric border
2ft from ileocecal valve
2% population
2% symptomatic
2 types of tissue: pancreatic, gastric
2 common presentations: diverticulitis, GIB
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16
Q

1 cause of GIB in children

A

Meckel’s diverticulum - persistent omphalomesenteric duct

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17
Q

Intussusception tx

A

reduce with air/contrast enema
IV glucagon can help (relaxes smooth muscle)
Usually presents in < 3 yo

peritonitis = ex lap
(if adult, automatically go to OR due to high risk of malignancy)

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18
Q

Intestinal atresia caused by

A

Intra-uterine vascular events

10% atresias are multiple

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19
Q

Duodenal atresia sx

A

Bilious vomiting
Double bubble sign
#1 cause of neonatal duodenal obstruction
associated w/ trisomy 21, 1/3 have cardiac defects

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20
Q

TE fistulas MC type and sx

A

90% are type C (most “common”): blind esophagus, distal TEF

spits up feeds and NG tube won’t pass

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21
Q

Type A TE fistula

A

Blind esophagus, no fistula

No air seen in entire GI tract

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22
Q

VATER

A 
Vertebral
Anorectal (imperforate anus)
TEF
Radial
Renal anomalies
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23
Q

Ladd’s procedure

A

For malrotation - appendectomy, take down bands, counterclockwise rotation

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24
Q

Meconium ileus dx and rx

A

associated with cystic fibrosis

Dx and rx: gastrografin enema

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25
#1 cause of colon obstruction
Hirschsprung's no BM in 1st 24hrs dx: rectal biopsy
26
necrotizing enterocolitis sx and tx
presents AFTER initiating feeds in neonate with blood in stool tx: peritonitic, free air - OR for resection with ostomy do contrast eval weeks later to evaluate for stenosis before reconnecting bowel
27
Imperforate anus tx
if high, need colostomy
28
Gastroschisis
Intrauterine rupture of umbilical cord No associated defects, lateral defect, no sac associated w/esophageal atresia
29
Omphalocele
Midline defect, may contain liver or other non-bowel contents Frequently associated with other anomalies - cardiac, pericardium, sternum, diaphragm, has peritoneal sac covering
30
Process vaginalis
Present at 12 weeks gestation - peritoneal diverticulum that extends as testis descends in the 7th/8th month of gestation Patent process vaginalis causes inguinal hernia
31
Inguinal hernia risk of incarceration in infants
exceeds 60% in 1st 6 months | Repair should be performed before infant discharge
32
MC tumor that develops from undescended testis
Nonseminomatous germ cell tumor
33
Lymphadenitis
enlarged LN in the neck | Can progress to suppurative lymphadenitis - requires I&D
34
Peritonsillar abscess
Complication of tonsillitis, pharyngitis or dental infection Sx: hoarse voice, medial displacement of tonsils, edematous deviated uvula, inflamed soft palate, fever, chills Tx: abscess present - I&D Cause: MC pathogen is beta-hemolytic Strep
35
Thyroglosal duct abnormalities
midline fluctuant cystic mass superior to thyroid - mobile and painless, moves with swallowing tx: surgical excision
36
Branchial cleft anomalies
presents as cysts, sinuses, or cartilaginous nests in lateral neck tx: excision
37
Torticollis
Hard mass in SCM in first 2-4 weeks of life a/w breech delivery, vertebral anomalies tx: surgical division of SCM and fascia
38
Trachea foreign body removal tx?
Rigid bronch with forceps retrieval of foreign body
39
MC levels of foreign body lodgement in esophagus?
Sites of esophageal narrowing: 1. cricopharyngeal muscle 2. arch of aorta (level of carina) 3. GEJ
40
Esophagus foreign body removal tx?
1. level of cricopharyngeus and carina: rigid or flexible esophagoscopy with mechanical retrieval by forceps 2. GEJ: obs
41
Risks of esophageal foreign body removal?
1. esophageal perf | 2. aspiration - prevent by placing patient prone
42
Diaphragm eventration
lack of normal muscular component of the diaphragm | intact, yet elevated diaphragm
43
Causes of diaphragm eventration
Congenital | Acquired: phrenic nerve injury
44
Sx of diaphragm eventration
Asymptomatic | Respiratory distress, especially infants
45
Tx of diaphragm eventration
asymptomatic - nothing | symptomatic - plication and stabilization of the diaphragm in the expiratory position
46
Surgical management of intussusception
Should be managed surgically if there are signs of necrotic bowel, incomplete reduction, or after 2+ recurrences Bowel reduced by squeezing mass distal to proximal, if resection is necessary ileocectomy can be done with primary anastomosis
47
Immunity at birth from
IgA - breastmilk | IgG - crosses the placenta
48
Umbilical vessels
2 arteries | 1 vein
49
pulmonary sequestration cause
lung tissue has anomalous systemic arterial supply that does not communicate with tracheobronchial tree MC - thoracic aorta or abdominal aorta through inferior pulmonary ligament
50
extra-lobar vs intra-lobar pulmonary sequestration
extra lobar: more likely to have systemic venous drainage | intra lobar: more likely to have pulmonary vein drainage
51
pulmonary sequestration treatment
ligate arterial supply first, then lobectomy
52
bronchiogenic cyst
most common cyst of mediastinum | tx: resect cyst
53
Most common mediastinal tumor in children
neuorgenic tumors - neurofibroma, neuroganglioma, neuroblastoma
54
anterior mediastinum mass differential
T-cell lymphoma teratoma thyroid cancer
55
middle mediastinum mass differential
T-cell lymphoma teratoma cyst (cardiogenic or bronchiogenic)
56
posterior mediastinum mass differential
T-cell lymphoma neuroblastoma neurogenic tumor
57
diaphragmatic hernia treatment
stabilize these patients before operating on them need to reduce bowel and repair defect +/- mesh run the bowel and look for visceral abnormalities
58
Bochdalek's hernia
MC, located posteriorly
59
Morgagni's hernia
rare, located anteriorly
60
Pectus excavatum
sinks in sternal osteotomy, need strut performed if causing respiratory symptoms
61
Pectus carinatum
chest juts out | strut not necessary, repair for cosmetic reasons if wanted
62
Wilms tumor treatment
nephrectomy tumor thrombus from vein can be extracted frequent mets to bone/lung
63
Hepatoblastoma
MC malignant liver tumor in children Elevated AFP in 90% of cases Tx: resection is optimal option, or downstage with chemo until resectable Fetal histology has best prognosis
64
Ultrasound findings for pyloric stenosis
>4 mm thick | >14 mm long
65
Bilious vomiting in infant - first study
UGI to rule out malrotation

ABSITE Flashcards (19 decks)

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