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A 9-year-old patient with a new diagnosis of de novo pediatric hepatocellular carcinoma is referred to your pediatric surgery clinic. Which of the following features of the tumor would be an indication for evaluation for transplantation? a Tumor located in segment 4B b PRETEXT III tumor c...

correct answer a surgical resection This MRI shows a tailgut cyst. Features on the MRI suggesting a tailgut cyst include multicystic pattern with small cysts clustered around larger ones and a high signal intensity relative to muscle. The hyperintense signal is indicative of mucin. Tailgut...

15 year old presents with back pain. Primary care physician obtains and MRI (image below). You send alpha-fetoprotein and beta-hCG both of which are normal. What is the best course of action for this child? a surgical resection b observation c sclerotherapy d physical therapy

correct answer D giant ganglia within the submucosal plexus. Neuronal intestinal dysplasia (NID) is a controversial diagnosis based on clinical, manometric and histopathologic findings. The etiology is unknown and its pathogenesis poorly understood. Furthermore, symptoms may not correlate well...

A four-year old boy presents with chronic constipation and numerous failed attempts at medical management. A contrast enema shows a markedly dilated colon. He undergoes a full thickness rectal biopsy with findings consistent with neuronal intestinal dysplasia (NID). The histopathology of NID is...

correct answer a abnormal mediastinal silhouette Chest computerized tomography (CT) is frequently used as a screening tool in pediatric blunt thoracic trauma. No consensus exists regarding optimal utilization of chest CT for blunt pediatric trauma resulting in overuse, increased radiation...

A restrained six-year old is involved in a high speed motor vehicle collision. They present to your trauma center complaining of chest pain. On physical exam they have a Glasgow Coma Score of 15, age appropriate vital signs, bruising of the anterior chest, bilateral equal breath sounds and 99%...

correct answer d Bile lakes Bile lakes are intrahepatic bile collections that develop in about 6-24% of patients with biliary atresia. They may be simple, multiple, or have bead-like patterns. Bile lakes are thought to be an extension of the inflammatory nature of biliary atresia. Bile lakes...

An 11-month-old baby who underwent Kasai portoenterostomy as an 8-week old presents with her fourth episode of cholangitis. MRCP scan shows a 1.5 cm x 1 cm anechoic fluid collection close to the Roux limb (Figures below). A smaller fluid collection was also seen in the left lobe of the liver...

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correct answer a Intrapyloric botox injection The two main etiologic domains for failure of gastric function are gastroparesis (muscular, neurologic, or both) and anatomic gastric outlet obstruction. The most common causes of gastroparesis are idiopathic, post-viral, diabetes, neurologic...

An otherwise healthy 11-year old boy is diagnosed with severe gastroparesis manifested by nausea, vomiting, and weight loss. He has been unresponsive to dietary changes, medications and gastric electrical stimulation. His workup included an upper endoscopy and upper GI series that did not show...

correct answer c Place pericardial drain This infant is in urgent need of stabilization and placement of a pericardial drain will likely improve the baby’s hemodynamic status. The echo findings are concerning for a mediastinal teratoma or germ cell tumor. Once stabilized, investigation with...

A term female infant born with APGARs of 2, 5, and 7 was apneic at delivery. After intubation, CXR demonstrated an abnormal mediastinum. Cardiac echo revealed a large mass in the pericardial space and a large pericardial effusion with decreased systemic venous return. What is the best next step...

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correct answer c Intraosseous access In an infant with dehydration, obtaining timely peripheral access may not be possible. Intraosseous placement in the proximal tibia or the proximal humerus is the most expeditious means to gain vascular access. A saphenous vein catheter would likely require...

correct answer C necrotizing enterocolitis Intestinal failure or short bowel syndrome is the condition where there is either anatomic or functional loss of bowel absorptive capacity. These patients are dependent on parenteral nutrition at least initially, with the host of potential...

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A 5-week-old 3 kg infant is in the ED with bilious emesis. The infant is lethargic and dehydrated. The ED has not been able to obtain peripheral IV access. What is the best next step to secure urgent vascular access? a Saphenous vein catheter b Umbilical vein catheter c Intraosseous access d...

correct answer b pulmonary hypoplasia Babies born with giant omphalocele often have associated pulmonary hypoplasia which can cause respiratory distress at birth, complicate attempts to surgically repair the omphalocele and be an important determinant of long term outcome. The pulmonary...