ABSITE ch 43 pediatric surg.txt

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ABSITE ch 43 pediatric surg.txt
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ABSITE ch 43 peds surg
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  1. foregut structures
    lungs, esophagus, stomach, pancreas, liver, gallbladder, bile duct, proximal duodenum
  2. midgut structures
    duodenum distal to ampulla, small bowel, large bowel to distal 1/3 of transverse colon
  3. hindgut structures
    distal 1/3 of transverse colon to anal canal
  4. definition of low birth weight
    <2500g
  5. definition of premature
    <37 weeks
  6. #1 cause of childhood death
    trauma
  7. pediatric trauma bolus
    20cc/kg X2
  8. best indicator of shock in pediatric patients
    tachycardia
  9. umbilical vessels
    3 (two arteries and one vein)
  10. rule of maintenance IVF in pediatrics
    4cc/kg for 1st 10kg, 2cc/kg for next 10kg, 1cc/kg for every add'l kg
  11. lung tissue with systemic arterial supply and either systemic venous or pulmonary vein drainage
    pulmonary sequestration
  12. intralobar pulmonary sequestration: more typical venous drainage pattern is:
    pulmonary veins
  13. extralobar pulmonary sequestration: more typical venous drainage pattern is:
    systemic veins
  14. disease where cartilage fails to develop in bronchi, leading to air trapping with expiration
    congenital lobar overinflation (emphysema)
  15. lobes most commonly affected by congenital lobar emphysema (2)
    RML, LUL
  16. Structure that communicates with airway, and has poorly-developed alveolar structures
    Congenital cystic adenoid malformation
  17. Extrapulmonary cysts formed from bronchial tissue and cartilage wall
    Bronchiogenic cyst
  18. Treatment of congenital cystic adenoid malformation
    Lobectomy
  19. Treatment of bronchiogenic cyst
    Resect cyst
  20. Most common mediastinal tumor in children
    Neurogenic tumors (neurofibroma, neuroganglioma, neuroblastoma)
  21. Symptoms of mediastinal masses
    Respiratory symptoms, dysphagia
  22. Most common anterior mediastinal tumors (4)
    T cell lymphoma, teratoma, thymoma, thyroid cancer
  23. Most common middle mediastinal tumors (3)
    T cell lymphoma, teratoma, cyst (cardiogenic or bronchogenic)
  24. Most common posterior mediastinal tumors (3)
    T cell lymphoma, neuroblastoma, neurogenic tumor
  25. Risks of choledochal cysts (4)
    Cholangiocarcinoma, pancreatitis, cholangitis, obstructive jaundice
  26. Fusiform dilation of entire CBD, mildly dilated common hepatic duct, normal intrahepatic ducts
    Type I choledochal cyst
  27. Treatment of Type I choledochal cyst
    Resection, hepaticojejunostomy
  28. A true diverticulum off of the CBD
    Type II choledochal cyst
  29. Treatment of Type II choledochal cyst
    Resection, hepaticojejunostomy prn
  30. Dilation of distal intramural CBD involving sphincter of Oddi
    Type III choledochal cyst
  31. Treatment of type III choledochal cyst
    Resection, choledochojejunostomy
  32. Multiple cysts, both intrahepatic and extrahepatic
    Type IV choledochal cyst
  33. Treatment of type IV choledochal cyst
    Resection, possible lobectomy
  34. Intrahepatic cysts with hepatic fibrosis; aka Caroli's disease
    Resection, may need lobectomy or transplant
  35. Most common reason for lymphadenopathy in children
    Acute supperative adenitis
  36. Causes of chronic lymphadenopathy in children (2)
    Cat scratch fever, atypical mycoplasma
  37. Lymphangioma in lateral cervical and submandibular regions in neck predisposed to infection
    Cystic hygroma
  38. Which side is more likely to have congenital diaphragmatic hernia
    Left
  39. Morbidity of CDH
    Pulmonary HTN, respiratory compromise
  40. Most common CDH, located posteriorly on the left
    Bochladek's hernia
  41. Rare CDH located anteriorly
    Morgagni's hernia
  42. Failure of diaphragm to fuse
    Eventration
  43. Internal caving of the sternum, repaired if causing respiratory symptoms for emotional distress
    Pectus excavatum
  44. Pigeon chest deformity; repaired for emotional distress
    Pectus carinatum
  45. Cyst near angle of mandible; may connect with externial auditory canal and often associated with facial nerve
    1st branchial cleft cyst
  46. cyst on anterior border of SCM muscle; goes through carotid bifurcation into tonsillar pillar
    2nd branchial cleft cyst
  47. most common branchial cleft cyst
    2nd
  48. cyst on lateral neck
    3rd branchial cleft cyst
  49. treament of branchial cleft cyst
    resection
  50. remnant of descent of thyroid gland from foramen cecum
    thyroglossal duct cyst
  51. midline cervical mass that moves with swallowing
    thyroglossal duct cyst
  52. treatment of thyroglossal duct cyst
    excision of cyst, tract and hyoid bone
  53. treatment of hemangiomas
    observation, steroids or laser if uncontrollable growth or persistence after age 8
  54. most common solid abdominal malignancy in children
    neuroblastoma
  55. most common location of neuroblastoma
    adrenal glands
  56. diagnostic studies for neuroblastoma
    increased catecholamines, VMA, HVA, and metanephrines
  57. tumor derived from neural crest cells that is common in the abdomen in children
    neuroblastoma
  58. potential metastases of neuroblastoma and Wilms tumor (2)
    lung, bone
  59. treatment of neuroblastoma
    resection , preoperative chemo if needed for clear margins
  60. stage III neuroblastoma
    crosses midline +/- regional nodes
  61. stage II neuroblastoma
    complete excision, does not cross midline
  62. typically asymptomatic mass that can also present with hematuria or HTN
    Wilms tumor
  63. Main prognostic factor for Wilms tumor
    Grade
  64. Hemihypertrophy, cryptorchidism, Drash syndrome and aniridia
    Beckwith-Wiedemann syndrome
  65. Treatment of Wilms tumor
    Nephrectomy, chemotherapy(for stage II +), XRT (for stage III +)
  66. Stage I Wilms tumor
    Limited to kidney, completely excised
  67. Stage II Wilms tumor
    Beyond kidney, completely excised
  68. Stage III Wilms tumor
    Residual nonhematogenous tumor
  69. Stage IV Wilms tumor
    Hematogenous mets
  70. Stage V Wilms tumor
    Bilateral renal involvement
  71. Most common pediatric malignant liver tumor
    Hepatoblastoma
  72. Tumor marker for hepatoblastoma
    AFP
  73. Histology of hepatoblastoma with best prognosis
    Prefetal histology
  74. Treatment of hepatoblastoma
    Resection, downsizing with doxorubicin and cisplatin
  75. Most common overall children's malignancy
    Leukemia (ALL)
  76. Most common class of solid tumor in children
    CNS tumors
  77. Most common general surgery tumor in children
    Neuroblastoma
  78. Most common general surgery tumor in children under 2
    Wilms tumor
  79. Most common cause of duodenal obstruction in newborns
    Duodenal atresia
  80. Most common cause of duodenal obstruction after the newborn period
    Malrotation
  81. Most common cause of colonic obstruction in children
    Hirschprung's
  82. Most common lung tumor in children
    Carcinoid
  83. Most common cause of painful lower GI bleed in children
    Anal fissures
  84. Most common cause of painless lower GI bleed in children
    Meckel's
  85. Most common cause of upper GI bleed in children <1year (2)
    Gastritis, esophagitis
  86. Most common cause of upper GI bleed in children >1 year to adult (2)
    Esophageal varices, esophagitis
  87. Structure that is a persistant remnant of the vitelline duct
    Meckel's diverticulum
  88. 3-12 week old male with projectile vomiting and olive mass: diagnosis?
    Pyloric stenosis
  89. Metabolic derangement in pyloric stenosis
    Hypochloremic hypokalemic metabolic alkalosis
  90. Currant jelly stools and sausage mass in 3month-3 year old: diagnosis?
    Intussusception
  91. Common intussusception lead points in children (3)
    Peyer's patches, lymphoma, Meckel's
  92. Initial treatment for intussusception
    Air-contrast enema
  93. Max pressure with air-contrast enema (or column height)
    120mmHg (column height 1 meter)
  94. newborn with bilious emesis, distension, and lack of meconium: diagnosis?
    Intestinal atresia
  95. Cause of intestinal atresia
    Intrauterine vascular accidents
  96. % of patients with duodenal atresia who also have Down's syndrome
    20
  97. double bubble sign on xray: diagnosis
    duodenal atresia
  98. treatment of duodenal atresia
    duodenoduodenostomy or duodenojejunostomy
  99. proximal esophageal atresia (blind pouch) with distal TE fistula
    Type C TEF
  100. Most common type of TEF
    Type C
  101. Esophageal atresia with no fistula
    Type A
  102. TEF not associated with atresia; most likely to present in adulthood
    Type E
  103. VACTERL: define
    Vertebral, anorectal (imperforate anus), cardiac, TE fistula, radius/renal, and limb anomalies
  104. Treatment of TE fistula
    Right extrapleural thoracotomy and primary repair
  105. Complications of TE fistula repair (5)
    GERD, leak, empyema, stricture, fistula
  106. Sudden onset of bilious vomiting in child: diagnosis?
    Malrotation
  107. Failure of normal counterclockwise 270 degree rotation of small bowel, predisposing to infarction
    Malrotation
  108. Diagnostic finding in UGI for malrotation
    Duodenum does not cross midline
  109. Treatment of malrotation
    Resection of Ladd's bands, counterclockwise rotation, cecopexy, duodenum to RUQ, appendectomy
  110. Symptoms of type C TE fistula (4)
    Spitting up feeds, excessive drooling, respiratory symptoms with feeding, unable to place NGT in stomach
  111. Distal ileal obstruction at birth, causing abdominal distension, bilious vomiting and distended bowel loops. Common in CF
    Meconium ileus
  112. Initial treatment of meconium ileus
    Gastrograffin enema or N-acetylcysteine enema
  113. Bloody stool after first feeding in premature infant: diagnosis?
    Necrotizing enterocolitis (NEC)
  114. Risk factors for NEC (6)
    Prematurity, hypoxia, hypotension, anemia, polycythemia, sepsis
  115. Xray findings in NEC (3)
    Pneumatosis, free air, or portal venous air
  116. Mortality of NEC
    10%
  117. congenital anomaly presenting with meconium in urine or vagina
    imperforate anus
  118. imperforate anus above levators, with meconium in urine or vagina
    high imperforate anus
  119. imperforate anus below levators
    low imperforate anus
  120. morbidity associated with imperforate anus
    constipation, stricture
  121. congenital anomaly occurring when there is intrauterine rupture of umbilical vein
    gastroschisis
  122. treatment of gastroschisis and omphalocele
    resuscitation, place saline-soaked gauzes, repair when stable
  123. congenital anomaly with bowel exposed to amniotic fluid/air with no sac
    gastroschisis
  124. failure of embryonal development, causing a midline defect
    omphalocele
  125. Cantrell pentalogy of defects
    Cardiac, pericardium, sternal cleft, diaphragmatic, omphalocele
  126. More often associated with congenital anomalies: gastroschisis or omphalocele
    Omphalocele
  127. Most common presenting sign for Hirschprung's
    Infants fail to pass meconium in first 24 hours
  128. Diagnostic test for Hirschprung's
    Rectal biopsy
  129. Failure of neural crest cells to progress in craniocaudal fashion in the bowel
    Hirschprung's
  130. Surgical treatment of Hirschprungs
    Soave, Dulhamel, coloanal anastamosis
  131. Failure of closure of linea alba
    Umbilical hernia
  132. Persistent processus vaginalis
    Inguinal hernia
  133. Most common side for pediatric hernia
    Right
  134. Occurrence of bilateral inguinal hernias in pediatric population
    10%
  135. most common cause of neonatal jaundice requiring surgery
    biliary atresia
  136. histologic findings of biliary atresia
    periportal fibrosis, bile plugging, cirrhosis (late)
  137. surgical treatment for biliary atresia
    Kasai, liver transplant
  138. Time frame within which Kasai must be performed to avoid irreversible liver damage
    3 months
  139. tumor markers for teratoma
    AFP, beta-hcg
  140. Most common location for teratoma in neonates
    Sacrococcygeal
  141. Treatment of neonatal teratoma
    Coccygectomy
  142. Treatment for undescended testes
    Orchiopexy through inguinal incision
  143. Hypoplasia of abdominal wall, urinary tract abnormalities, bilateral cryptorchidism
    Prune belly syndrome
  144. Most common cause of airway obstruction in infants
    Laryngomalacia
  145. Symptoms of laryngomalacia
    Intermittent respiratory distress, stridor exacerbation in supine position
  146. Obstruction of choanal opening by bone or mucus membrane
    Choanal atresia
  147. Treatment of choanal atresia
    Surgical correction
  148. Most common tumor of the pediatric larynx
    Laryngeal papilloma
  149. Probable cause of laryngeal papilloma
    HPV passed to infant while in birth canal

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