General Discussions

[center]PSC congratulate prof Sherif Emil for this great and beautiful achievement! see links to all 50 episodes in next posts (10 episode per post)[/center]

[center][/center] This Forum is dedicated to Pediatric surgery discussions only off topic discussions are not allowed in this section

[size=6]A 17-year-old presents to your clinic with a left lower extremity mass that has been present for the last year. The patient is a high-level dancer and travels nationally. He notes that the mass is more pronounced during activity and improves with rest. It does not cause him any pain or discomfort. On exam there is a 1 to 2cm mass palpable over the anterolateral calf. US shows a muscle herniation of the tibialis anterior through a fascial defect. What is the best next step in management of this patient? a Primary fascial closure b Repair with biologic mesh c Compression stockings d Fasciotomy e Observation[/size]

[size=6]A 21-year-old woman, G2P1001, who is now 20 weeks pregnant, arrives at your clinic for a prenatal consultation. A recent fetal ultrasound revealed anhydramnios with an amniotic fluid index (AFI) of 2 cm (normal, 8 to 20 cm) and small echogenic kidneys. No other fetal anomaly is present. A cell free DNA test is negative and the results of the amniocentesis are pending. Which of the following plays a role in amniotic fluid volume? a fetal hepatic function b fetal pulmonary blood flow c fetal movement d fetal urine flow[/size]

[size=6]An adolescent, who weighs 140 kg, sustained a complicated pelvic fracture in a motor vehicle crash. Their pain is not controlled with non-opioid medications. Dosing of morphine should be based on a Lean body weight b Ideal body weight c Actual body weight d Total body weight[/size]

[size=6]A 10-year-old presents to the emergency room after being bitten by a neighbor’s dog on his way to school. The child sustained multiple puncture wounds on the lower extremity. The neighbor has confirmed the dog’s rabies vaccination status. The child’s vaccines are up to date. What is the best next step in the management of this patient? a Primary closure of wounds b Irrigation of wounds c Tetanus vaccination d Intravenous antibiotics e Rabies vaccination[/size]

[size=5]A 15-year-old presents with a 1-year history of intermittent pain and drainage from the superior gluteal cleft treated with oral antibiotics. On exam, there are three midline pits with a small amount of seropurulent drainage, but no signs of infection. After instituting a shaving regimen and starting LASER hair removal, what is the best next step in management? a Wide excision with off-midline flap closure b Incision and drainage with curettage of the sinus tract c Minimally invasive excision of the pits and sinuses d Long-term suppressive oral antibiotics e Wide excision with healing by secondary intention[/size]

[size=6]A 9-year-old female presents to the emergency room with abdominal distention, early satiety and constipation. An abdominal radiograph is obtained as shown below. What is the best next step in her management? a Golyte bowel cleanout b UGI with SBFT c Reassurance d Contrast enema e CT Abdomen/Pelvis[/size]

[size=6]A 14-year-old presents to the emergency room with several months of nausea and vomiting. They have a significant weight loss of over 20 lbs during this time. Workup included a CT of the abdomen/pelvis which showed pneumomediastinum which was confirmed on chest radiograph. The remainder of the CT was unremarkable. They note that the only time they have improvement of their symptoms is with taking hot showers. What is the next best study to obtain in this patient? a Small bowel follow through b Esophagram c Urine drug screen d CT chest e Bronchoscopy[/size]

[size=6]A 15-year old male presents with a six month history of an open non healing draining wound on his right lateral thigh (see below) since sustaining a laceration falling out of a tree. Plain films show no evidence of mass, foreign body or osteomyelitis. The white blood cell count is normal. The next most appropriate test for this patient with a non healing wound is a ultrasound. b bone scan. c computerized tomography. d magnetic resonance imaging. e positron emission tomography.[/size]

[size=6]15 year old presents with back pain. Primary care physician obtains and MRI (image below). You send alpha-fetoprotein and beta-hCG both of which are normal. What is the best course of action for this child? a surgical resection b observation c sclerotherapy d physical therapy[/size]

[size=6]A term female infant born with APGARs of 2, 5, and 7 was apneic at delivery. After intubation, CXR demonstrated an abnormal mediastinum. Cardiac echo revealed a large mass in the pericardial space and a large pericardial effusion with decreased systemic venous return. What is the best next step in this infant’s management? a Obtain tumor markers b Thoracoscopic resection c Place pericardial drain d Obtain cross sectional imaging[/size]

[size=6]You are doing a nephrectomy and retroperitoneal lymph node sampling for a 3-year-old child with a large renal tumor. The preoperative hemoglobin was 8.2 g/dL and there has been minimal bleeding during the operation. The patient has been hemodynamically stable with a urine output of 1.8 ml/kg/hr. The anesthesiologist says the current hemoglobin is 6.9 g/dL. What would you recommend? a Transfuse 10 ml/kg of packed red blood cells b Administer erythropoietin postoperatively c No packed red blood cell transfusion d Transfuse 20 ml/kg of packed red blood cells[/size]

[b]“The Hungarian J. Veress developed the spring-loaded needle for performance of therapeutic pneumothorax to treat pulmonary tuberculosis in 1938; he then applied this technique to cases of pneumoperitoneum” — Endoscopic Surgery in Infants and Children by Klaas N.M.A. Bax, K.E. Georgeson, et al. [/b]

.

see video link in second post

A 4-month-old infant presents to clinic with a swollen, red left fourth toe (see images below). In addition to the swelling, the toe has an area of circumferential indentation (marked by arrow). His parents state that his toe was minimally swollen at birth, but it has continued to gradually worsen since then. What is this infant’s diagnosis? [size=20px]a Hair Tourniquet Syndrome b Klippel-Trenaunay Syndrome c Ingrown toenail d Milroy disease e Macrodactyly[/size]

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "A technique to prevent distal obstructions where the distal catheter is passed through the falciform and positioned above the liver with the tip pointed at the hepatic flexure has been described in adults [45]."

A 17 year old girl with a myelomeningocele has a long-standing VP shunt, which was last revised two years ago. Recently, the patient noticed VP shunt tubing extruding from her anus. On physical examination, she has no abdominal tenderness and the shunt tubing was not seen. Imaging including shunt series and CT scan of the abdomen shows that the shunt is intracolonic with the tip located in the distal sigmoid colon. In addition to IV antibiotics and externalizing the shunt, the best next step in the management of this patient is? [size=20px]A Sigmoidoscopy B Paracentesis C Diagnostic laparoscopy D Exploratory laparotomy E Remove entire shunt system[/si…

[size=20px]A two day old former 30 week premature 1.2 kg infant underwent resection and ileostomy for ileal atresia. Two hours after surgery, the HR is 140 and mean arterial pressure is 30-32 mm Hg. He is intubated on pressure support, FiO2 21% with oxygen saturation of 98%. Urine output is adequate. Hgb is 11g/dL and platelet count is 45,000/microliter. INR is 1.6 and PTT is 40 sec. There is no evidence of ongoing bleeding. The infant should receive a no blood products b red blood cells c platelets d plasma e platelets and plasma[/size]

[size=20px]A 13-year-old girl sustained a complicated pelvic fracture and had an external fixator placed. She is currently immobile. Her baseline body mass index (BMI) is 33 kg/m2 and she takes an oral contraceptive at baseline. Which of the following is the most appropriate strategy for VTE prophylaxis in this high-risk patient? a Daily lower extremity duplex ultrasound b Lower extremity sequential compression devices (SCDs) c Lovenox 0.5 mg/kg q12h d Placement of a removable IVC filter[/size]

.

.

A 15-year-old boy with neurofibromatosis 1 (NF1) presents with worsening scoliosis and abdominal pain. A CT scan of the abdomen and pelvis is obtained. The preferred treatment for this condition is: [center][/center] [size=20px]A Surgical debulking. B External beam radiation. C Treatment with an alkylating agent. D Treatment with a biologic agent. E Targeted immunotherapy.[/size]