Congenital diaphragmatic hernia

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A term infant is born with a left sided congenital diaphragmatic hernia (CDH). At exploration a large defect is encountered, which the surgeon determines is not amenable to primary repair. The repair technique for large CDH defects that is associated with the lowest recurrence risk is: A Surgisis™ (porcine small intestinal submucosa) B Gore-tex™ C Marlex™(monofilament polypropylene) D Muscle flap​

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[size=20px]A 38-week gestation, 2.9-kg infant is transferred to the NICU with the diagnosis of a left congenital diaphragmatic hernia (CDH). She is intubated and on 100% FiO2 with ventilator pressures of 28/6, IMV rate of 60/minute and a preductal ABG of pH 7.10, PaO2 75 and PaCO2 65. Head ultrasound is normal. However, her echocardiogram shows coarctation of the aorta with a large PDA and right to left flow to the aorta distal to the coarctation. The left ventricle does not appear small. Gentle ventilation is initiated, but the infant continues to deteriorate. Cardiology recommends prostaglandin E1 to maintain ductal flow. High frequency ventilation and nitric oxide are …

[size=20px]A 30-year-old G1P0 woman presents with a singleton pregnancy complicated by left-sided congenital diaphragmatic hernia (CDH). She is currently 29 weeksgestation. Fetal ultrasound demonstrated observed/expected lung-to-head ratio (O/E LHR) of 28%. No other structural abnormalities were identified on fetal ultrasound. Fetal MRI is not available. Karyotype was normal. Current recommendations for this patient include: A Transfer to a center for fetoscopicendoluminal tracheal occlusion (FETO) B Selective use of fetal echocardiogram C Delivery at a center with protocolized management and ECMO capabilities D Transfer to a center with fetal MRI​[/size]

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[size=20px]A term infant (39 weeks gestation) is born at a tertiary care facility with an antenatally diagnosed congenital diaphragmatic hernia. Her birth weight is 1350 grams, 1-minute APGAR is 7, and 5-minute APGAR is 8. Echocardiogram demonstrates increased pulmonary vascular resistance and increased right ventricular pressure. Her cardiac architecture is otherwise normal. Chromosomal testing is also normal. Based on the Congenital Diaphragmatic Hernia Study Group (CDHSG) clinical prediction model, what is this patient’s risk profile? A Low risk B Intermediate risk C High risk D Insufficient data to determine risk profile​[/size]

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[size=20px]You are seeing a mother carrying a fetus diagnosed with a left sided CDH. The O/E LHR using tracing method at 24 weeks is 28%. Follow-up measurement at 26 weeks is 32%. The parents conceived this baby after significant difficulty and are asking about the outcomes of fetal tracheal occlusion (FETO) therapy for their baby. You advise the parents that A Pregnancy should be terminated. B FETO is definitely recommended. C Delivery is safe at a community hospital. D Delivery should be at a hospital with ECMO resources.[/size]

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[size=20px]A 3 kg term newborn with antenatally diagnosed left congenital diaphragmatic hernia (CDH) is hemodynamically stable on conventional mechanical ventilation. Over several hours, the mean arterial pressure falls from the mid 40s to the low 30s, urine output decreases from 2 to 0.5 cc/kg/h and the serum lactate increases from 2mmol/l to 4 mmol/l. A 20 cc/kg normal saline bolus is given, and dopamine is started at 10 ug/kg/min. One hour later, there has been minimal improvement in the blood pressure or urine output, and the oxygenation index (OI) has increased from 12.5 to 30. The next step in management of this CDH infant is: A Repeat 20cc/kg NS bolus B Start…

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First one with correct answer with justification win. A 3 yo female with symptoms consistent with a viral pulmonary illness has a chest x-ray. The most appropriate next step is [center] [/center] [size=20px]A Observation B Upper GI series C CT Scan D Laparoscopic repair E Thoracoscopic repair[/size]

please write the answer and your justification, correct answer will be submitted after 48 hrs [size=20px]A newborn is found to have a sternal defect, diaphragmatic hernia, large ventricular septal defect, and a pericardial defect. Which of the following additional anomalies would be expected? A pyloric atresia B duodenal atresia C imperforate anus D esophageal atresia E omphalocele[/size]