外科：小兒

47 flashcards · Other · by Wanying Koh

1. endotracheal intubation of children/baby - 容易進入bronchus because

   trachea too short

2. endotracheal tube size calculation for children

   (4 + patient age in years) / 4

3. blood volume / kg in children

   70-75ml/kg

4. cricothyroidotomy contraindicated in children? what age?

   children below 12 y/o

5. thyroglossal duct cyst: complete resection to prevent recurrence includes?

   duct cyst 管道 hyoid bone 中央 hyoid bone 以上到 tongue base

6. torticollis accompanied by what joint dysfunction

   hip developmental dysplasia

7. which is a neck central mass thyroglossal duct cyst branchial cleft cyst cystic hygraoma torticollis

   thyroglossal duct cyst (其他都 lateral)

8. honeymoon period in what disease

   congenital diaphragmatic hernia 剛出生數小時 無症狀 因 pulm HTN 還不足以造成 R to L shunt 的呼吸窘迫

9. diaphragmatic hernia 不能用什麼處置

   mask and ambu bagging 會導致空氣進到腸胃 --> worsen condition

10. s/s: neonate 一出生便呼吸窘迫 dx?

    congenital diaphragmatic hernia

11. esophageal atresia w distal tracheoesophageal fistula surgical tx: 剝離 proximal or distal esophagus 較好？why？

    切除 proximal esophagus 因為血管豐富。 避免切除/移動 distal - 血管不健全

12. most common complication after tx of esophageal atresia

    GERD

13. intestinal atresia s/s

    polyhydraminos 羊水過多 abd bloating billous emesis no meconium passing 稀疏胎便 (KUB: double bubble sign ----- 特別指的是 duuodenal)

14. intestinal atresia associated w what disease

    down syndrome

15. Diagnosis

    Volvulus (Corkscrew sign)

16. Ladd's procedure used to treat what dz

    midgut malrotation

17. Ladd's procedure includes what steps (x3)

    把扭轉的腸子轉回去 分離 Ladd's band mesentery widening - to prevent recurrence => 小腸： R side ，大腸：L side

18. necrotizing enterocolitis surgical indications: pneumatosis intestinalis acidosis pH<7.2 after fluid resuscitation intraperitoneal free air hepatoportal venous gas

    acidosis pH<7.2 after fluid resuscitation intraperitoneal free air hepatoportal venous gas (pneumatosis intestinalis 不是)

19. hirschsprung disease dx

    rectal biopsy - gold std anorectal manometry (check anus 鬆緊度) lower GI barium contrast *問胎便排出時間 - 未排出

20. hirschsprung disease most commonly affected 腸子 area

    rectum sigmoid colon

21. urine 帶有 feces dx tx

    middle/high type (中高位) imperforate anus colostomy

22. best diagnostic tool for biliary atresia

    liver biopsy

23. choledochal cyst triad

    jaundice RUQ abd mass abd pain

24. anomalous junction of pancreatic duct & CBD 會造成什麼

    choledochal cyst

25. which type of inguinal hernia most common in children

    indirect hernia

26. inguinal hernia vs hydrocele tx

    inguinal hernia: heniorrhaphy < 1y hydrocele: obs until 1 y/o, hydrocelectomy

27. incarcerated inguinal hernia tx

    manual reduction (trendelenburg position) + sedation 不行才 emergent surgery

28. most common liver malignancy in children

    hepatoblastoma

29. most common abdominal malignancy in children

    neuroblastoma

30. neuroblastoma: <1y/o child with meta to liver staging?

    stage 4s (good prognosis)

31. beckwith-wiedemann syndrome comorbid with what dz

    rhabdomyosarcoma neuroblastoma wilm's tumor hepatoblastoma

32. beckwith-wiedemann syndrome s/s

    omphalocele 臍膨出 macroglossia 巨舌 visceromegaly 巨內臟 hyperinsulinemia + hypoglycemia

33. hemangioma 是 vascular malformation or vascular tumor

    vascular tumor

34. timing for craniosynotosis surgery

    close to 6mo of age

35. double bubble sign dx

    duodenal atresia

36. intussusception rx

    mostly conservative: N/S or gas 灌腸 (80-90% pts resolve) recurrence 10% 10% need surgery

37. 新生兒 teratoma 好發在？ which gender more common

    sacrococcygeal region females (sacrococcygeal 45% > ovary 27% > mediastinal 6% > testis 5% = CNS 5%)

38. necrotizing enterocolitis tx

    conservative tx (7-10d): 50% resolve NG decompression IV fluid NPO broad spectrum ABx surgery if: 惡化 / no improvements KUB: free air = perforated gut

39. similarities/differences: ASD VSD PDA

    ASD, VSD, PDA 皆 non-cyanotic, L-to-R shunt VSD - symptomatic since birth, HSM murmur ASD - no symptoms during childhood, MSM murmur PDA - continuous murmur

40. Blalock-Taussig shunt which bv connected together

    ipsilateral subclavian a. & pulm. a.

41. large VSD tx

    PA banding (at younger age) dec PA bloodflow -> dec pulm HTN, HF ---> total correction of VSD (when pt older)

42. if untreated VSD, 演變成 eisenmenger's syndrome 原因

    L-to-R shunt --> pulm edema / pulm HTN in the long term, pulmonary blood vessels 硬化 -> blood vessels resistance inc. -> remodelling -> 最後變成 R-to-L shunt

43. eisenmenger's syndrome tx

    heart transplant

44. 什麼時候用 VCUG (voiding cystourethrography) IVP (intravenous pyelography)

    VCUG --> suspect any anatomy structural problems or vesicoureteral reflux (: 小兒 recurrent UTI) IVP --> suspect stones, tumor, obstruction

45. most common esophageal atresia 問題 which type

    Gross Type C - esophageal atresia with distal TEF (86%)

46. omphalocele .. gastroschisis location size 膜 comorbidities

    location: central // right side size: 大 // 小 膜: 有 // 無 comorbidities: common >50% // 10-15% 較少

47. most common extracranial tumor in childhood

    neuroblastoma 8-10% nephroblastoma - 6%