Esophageal atresia & TOF

[size=20px]A four-year old boy ingests lye and develops a long, severe esophageal stricture that is refractory to multiple dilations. You decide to recommend esophagectomy and esophageal replacement. Which technique for esophageal replacement leads to the best outcome? A gastric transposition B gastric tube C colon interposition D jejunal interpositions E the technique most familiar to the surgeon[/size]

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[size=20px]A 3 year-old child with a history of esophageal atresia repaired at birth comes to your office as a new referral after moving from another state. The child is eating well, has no respiratory issues and is developmentally normal. The child has not taken antacids in several months. What is the next best step in this patient’s management? A The child should resume antacid medication ​ B The child should have a surveillance endoscopy with biopsies to evaluate for asymptomatic esophagitis C The child does not require antacids or further follow-up​ D The child should get an esophagogram[/size]

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[size=20px]An infant with esophageal atresia with distal tracheoesophageal fistula (EATEF) is transferred to your service. Your preoperative evaluation demonstrates a cardiac ventriculoseptal defect, a hemivertebra and normal appearing kidneys on bedside screening ultrasound. Head and spine ultrasounds are normal. After repair of EATEF and recovery, additional early testing should include A head computerized tomography (CT) scan. B spinal magnetic resonance imaging (MRI). C voiding cystourethrogram. D cardiac catheterization. E extremity radiographs.[/size]

[size=20px]A newborn infant presents with pure esophageal atresia. A gastrostomy is performed and a contrast study reveals a five vertebral body distance between the proximal and distal esophageal pouches. Which of the following approaches will result in the shortest time to definitive anastomosis for patients with long gap esophageal atresia? A delayed primary repair B the application of traction sutures (Foker technique) C gastric pull up D colon interposition E serial extrathoracic proximal esophageal advancement (Kimura technique)[/size]

[size=20px]A 13-year old female had Type C tracheoesophageal fistula and esophageal atresia (TEF/EA) repair as a child. On her annual visit, she complains of occasional heartburn. At this point, this teenager with a history of EA/TEF should undergo A no diagnostic procedures. B esophagram. C pH probe. D esophageal motility and manometry studies. E esophagogastroduodenoscopy.[/size]

[size=20px]A 25-day old infant girl had intermittent coughing with feeding. An esophageal contrast study was inconclusive and a bronchoscopy showed no evidence of laryngoesophageal cleft but revealed an H type tracheoesophageal fistula. She undergoes repair via a right cervical incision. Five days postoperatively, she is offered oral feeding, but exhibits coughing and aspiration with every feed. The next best step in management of this patient with an H type fistula is A bedside flexible laryngoscopy. B esophagogram. C video fluoroscopic swallowing study. D rigid bronchoscopy. E neck ultrasound.[/size]

[size=20px]Three months after repair of esophageal atresia with a blind proximal pouch and distal tracheoesophageal fistula, a full term infant returns for postoperative follow-up. His mother describes worsening inspiratory stridor - particularly with feeding, agitation or crying. The infant has generally been feeding and growing without emesis or other respiratory distress. The most appropriate diagnostic test for this esophageal atresia patient with inspiratory stridor is A fiberoptic laryngobronchoscopy. B direct laryngoscopy. C modified barium swallow. D contrast esophagogram. E airway computerized tomography scan.[/size]

[size=20px]During attempted thoracoscopic repair of an isolated esophageal atresia in an otherwise healthy full term infant, there is still a three cm gap between the two ends of the esophagus after aggressive surgical mobilization. You proceed to place traction sutures on both ends of the esophagus (i.e. Foker technique). The expectation that you will be able to achieve a primary esophageal anastomosis at subsequent thoracoscopy or thoracotomy is A 0.5 percent. B 1 percent. C 25 percent. D 50 percent. E 80 percent.[/size]

[size=20px]You are planning to operate on a 2.5-kg full term infant with esophageal atresia and distal tracheoesophageal fistula. If you use three to five mmHg CO2 insufflation pressure during thoracoscopic repair, compared to open repair, you would expect to A decrease in mean arterial blood pressure. B increase in paCO2. C decrease in pH. D decrease in regional cerebral oxygen saturation. E maintain similar pH and paCO2.[/size]

[size=20px]A four-kg baby with type C esophageal atresia and tracheoesophageal atresia has sputtering associated with significant desaturation and occasional apnea wirth each oral feeding. He has an intact anastomosis and minimal penetration of contrast into the airway on his postoperative esophagram. On bronchoscopy, he has mild tracheomalacia and a type II laryngotracheal cleft. There is no vocal cord paralysis. The next best step for this baby with a laryngotracheal cleft is A fundoplication. B tracheopexy. C tracheostomy. D endoscopic repair of the cleft. E sternotomy with laryngotracheal reconstruction.[/size]

[size=20px]A newborn undergoes an extrapleural repair of an esophageal atresia with distal tracheoesophageal fistula. On the second postoperative day he requires reintubation and there is a continuous air leak from the drainage tube. A subsequent chest radiograph reveals a large right pneumothorax. Which of the following is true regarding this patient with esophageal atresia and a large air leak. A bronchoscopy will identify the leak B use of an transanastomotic feeding tube increases the rate of anastomotic stricture C reoperation is the best next step D an esophagram is likely to identify the source of the pneumothorax E extensive esophageal anastomoti…