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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...

correct answer c Minimally invasive excision of the pits and sinuses Minimally invasive approaches that achieve excision of the pits and underlying hair and inflammatory tissue have low rates of recurrence and wound complications. These include the Gips procedure, in which pits are cored out...

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...

Correct answer d Release of ligament with celiac plexus neurolysis Median arcuate ligament syndrome (MALS), or celiac artery compression syndrome, was first described in 1917 and again in 1963. It is a rare condition that typically occurs in young women and presents with post-prandial...

A 16-year-old female is found to have celiac artery compression from median arcuate ligament syndrome on CT angiogram. She is active in volleyball and has chronic pain following eating and after exercise. She has lost 30 lbs over the last 6 months. She has been seen by a multi-disciplinary team...

correct answer e CT Abdomen/Pelvis This patient presents with abdominal distention with imaging showing a large centrally located abdominal mass with calcifications. Further imaging is warranted to better evaluate the mass. Ultrasound may be of use but due to the large size of the mass may make...

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...

correct answer c total thyroidectomy MEN 2 is caused by activating germline missense variants in the RET proto-oncogene,[1] and the definitive diagnosis is made by RET sequencing (positive in 98 % of cases). A complete curation of close to 200 RET germline variants reported (up to 2022 and...

An 11-month-old asymptomatic boy presents for evaluation. He has been seen by genetics and endocrinology due to a diagnosis of multiple endocrine neoplasia, type 2A. His calcitonin level was normal and a neck ultrasound is normal. He has a ’highest risk" category RET oncogene variant (M918T)...

correct answer a Injection of botulinum toxin into the internal sphincter. Botulinum toxin works by temporarily inhibiting acetylcholine release at the neuromuscular junction, resulting in chemical denervation and relaxation of the internal anal sphincter. In children with Hirschsprung disease...

A 5-year-old child underwent a Yancey-Soave pull through for Hirschsprung disease as a newborn. They present to your office due to concerns about infrequent stools and abdominal distension. A thorough workup reveals no twist, stricture, or retained cuff. There are circumferential ganglion cells...

correct answer c intraoperative cholangiogram Indocyanine green (ICG) is a water-soluble fluorescent dye that is rapidly taken up by the liver and excreted into the bile ducts within minutes of application. Fluorescence of the liver and bile ducts may continue up to six hours after injection...

A three-week-old infant presents with direct hyperbilirubinemia, acholic stools and jaundice. Indocyanine green is administered intravenously but it was not detected in the child’s diaper even after 48 hours. What is the best next step in this child’s management? a magnetic resonance cholangio...

correct answer d complete, margin negative resection of the tumor. Current recommendations for PRETEXT 1 and 2 liver lesions, VFEPR negative is liver resection done without biopsy independent of suspected cell type if the resection can be accomplished with segmentectomy or hemi-hepatectomy with...

A 14-year-old boy presents with a liver lesion in segments 2-4 (PRETEXT 2) VFEPR (-) tumor. AFP is elevated. No metastasis is found. The best next step for this patient is a neoadjuvant chemotherapy b open liver biopsy c early transplantation. d complete, margin negative resection of the tumor...

correct answer c Reduced time to definitive closure The management challenge in giant omphalocele (GO) is the protection of the herniated contents by preventing amnion breakdown, and to encourage coverage of the defect. A staged repair is often required for GO and many different techniques have...

A term infant weighing 2.5kg is born with a giant omphalocele measuring 6cm in diameter and containing 65% of the total liver volume. Other than a small muscular ventricular septal defect, there are no other associated anomalies. The amnion is still intact, but the defect is too large to be...

correct answer c Urine drug screen This patient presents with cannabinoid hyperemesis syndrome (CHS). This syndrome is characterized by cyclic vomiting due to chronic cannabis use. Due to multiple reasons, including legislative changes and increased medical indications for cannabis, the use of...

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...

correct answer b Continue drain to gravity This drain study shows a connection of the abscess cavity to the cecum. Since the patient is clinically well with adequate source control, a second drain or surgical intervention are not indicated. This patient’s care should be focused on eventual safe...