Chest wall, intra thoracic lesions, and airway

[size=6]A 4-year-old was admitted to the PICU in ARDS. Ventilator settings include 100% FiO2, PRVC with TV of 5.5 ml/kg, RR 28, PEEP 12mmHg. Arterial blood gas showed: pH 7.42, pCO2 53, pO2 75, HCO3 34, base excess 8. You were called to help manage this finding on her CXR. It was interpreted as “significant pneumomediastinum, no pneumothorax, and significant subcutaneous emphysema." On examination, patient has crepitus to the forehead and upper extremities to the wrist, back to iliac crests. Examination did not show any pharyngeal injury. Esophagoscopy and bronchoscopy demonstrated mucosal integrity. The next best step is a jet ventilation or high frequency oscil…

A 27-week neonate weighing 950g is born at an outside hospital. The neonate is in respiratory distress. The airway is secured after three attempts, There are also several attempts to pass an NG tube each of which meets resistance at 8 cm.The infant has stabilized after intubation and an umbilical venous catheter is inserted for vascular access. Vital signs are currently normal for gestational age.The neonate is being transferred to your center for suspected esophageal atresia and tracheo-esophageal fistula. Upon arrival, a chest radiograph to confirm endotracheal and nasogastric tube position is performed. Based on the accompanying image, what is the most likely diagnosis…

[size=20px]A 14-year-old girl presents to your clinic with a palpable, non-tender right breast mass noted for the past 3 weeks. She denies trauma, fever, or nipple discharge. On exam, the mass is firm, mobile, and measures approximately 4 cm in diameter. An ultrasound shows a solid, well-circumscribed lesion with features consistent with a fibroadenoma. She has no family history of breast cancer or known genetic syndromes. What is the most appropriate next step in management? a Core needle biopsy b Immediate excisional biopsy without a margin c Immediate excisional biopsy with a 1 cm margin d Observation with ultrasound surveillance at 6 and 12 months[/size]

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The breast tissue present in gynecomastia is most often tender, firm, and subareolar. One third of boys will present with unilateral gynecomastia. A mass in the breast that is not subareolar and is asymmetric should raise concern for other conditions. A testicular exam is a key component of the physical exam to rule out hypogonadism, suggestive of Klinefelter’s syndrome, a varicocele, or possible estrogen-secreting tumors of the testes, such as germ cell tumors, Sertoli cell tumors, or Leydig cell tumors."

You are consulted on a sixteen-year-old who is being evaluated for wheezing unresponsive to bronchodilators. A computerized tomography (CT) scan of the chest is obtained. The most likely diagnosis in this patient with wheezing is [size=20px]a congenital pulmonary airway malformation b intralobar pulmonary sequestration. c bronchial atresia. d extralobar pulmonary sequestration. e lobar emphysema.[/size]

.

see video link in second post

see video link in second post

A 14 year old boy presents with a 6 month history of a painless palpable mass on his chest wall. An MRI is shown below. The best next step in management is [size=20px]a primary excision of the lesion b arterial embolization c percutaneous sclerotherapy with polidocanol d systemic treatment with denosumab e local curettage with autologous bone grafting[/size]

[size=20px]A 17-year-old girl complains of 6 months of pain at her left costal margin when playing gymnastics. She notes that she feels a "click" with sudden shooting pain with certain movements. On physical exam, you can recreate a “click” sound and pain by hooking the lower rib cartilages with your finger as you feel it move. The best next step in management for this patient is A NSAIDS and activity restriction B Lower rib excision C Intercostal nerve block D Steroid injection E Lower disconnected rib chondrectomy[/size]

A 12-year-old girl presents with some chest discomfort after playing soccer with her friends. She denies any trauma. She is hemodynamically stable. A chest x ray is performed and reveals a moderate pneumomediastinum. The best next step in her management should be [center][/center] [size=20px]A Bronchoscopy B Esophagram C Chest CT D No further imaging​[/size]

In pediatric surgery clinic, you see a 2-year old girl referred for an asymptomatic left breast mass. No significant medical history. You palpate a firm, rubbery circular mass under the nipple. Remainder of physical exam is normal. What is your next step?

Download lecture from second post ​

.

see video link in second post

A five-week-old, former 25-week gestational age infant required high pressure mechanical ventilatory support during the first several weeks of life. The baby is now clinically improved and weaning from mechanical ventilation.The attached CXR was obtained. The best next step in management is: [center][/center] [size=20px]A observation B chest CT C segmental resection D lobectomy E tube thoracostomy[/size]

see video link in second post

see video link in second post

see Chart PDF link in second post

see video link in second post

see video link in second post

see video link in second post

see video link in second post

see video link in second post