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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...

A 6 year-old presented with 10-days of symptoms and perforated appendicitis with abscess. They underwent IR percutaneous drainage of abscess. Five days later, they are clinically improved with 20 mL/d brownish fluid out of the drain. A drain study was obtained. What is the best next step in this...

correct answer c External pelvic examination This patient has an absent uterus on examination which is pathognomic for Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH, i.e. Mullerian agenesis). This entity is defined anatomically as the absence of the uterus and upper vagina in an XX female...

A 6-year-old female presents with sudden oneset of right sided abdominal pain. Her mom notes the patient has a history of polycystic ovarian syndrome. US reveals an asymmetrically enlarged right ovary with adjacent right adnexal soft tissue swirling concerning for ovarian torsion. She is brought...

correct answer d posterior tracheopexy. Tracheomalacia (TM) refers to a weakening of the trachea caused by reduction of the longitudinal elastic fibers in the membranous trachea and/or impaired integrity of the cartilaginous rings that makes the airway susceptible to collapse during during...

A four-month old boy with a history of prior esophageal atresia and tracheoesophageal fistula repair has undergone previous aortopexy when he presented with a brief resolved unexplained event (BRUE). Postoperatively, he continues to have significant episodes of BRUE and intermittent hypoxic...

correct answer b total thyroidectomy. In 2015 the American Thyroid Association published management guidelines for children with thyroid cancer. Thyroid malignancies are more common in adolescents compared to younger children and there is a 5:1 female predominance in this age group. Ninety...

A 15-year old girl comes to clinic with a new neck mass. On palpation, there is a nodule in the left lobe of the thyroid gland. Thyroid stiluating hormone and T4 are normal. An ultrasound shows a 3.5 cm mass in the left lobe of the thyroid. There are no palpable nodes on physical exam. The fine...

correct answer e Mesoportal shunt (Rex shunt) Portal hypertension in children can arise due to various factors, which generally fall into prehepatic, intrahepatic, and posthepatic categories. The following table summarizes the causes of portal hypertension in children. This patient’s...

3-year-old boy has had 3 episodes of variceal bleeding in the past year. All were controlled endoscopically. His past medical history is significant for Tetralogy of Fallot repaired at birth. On exam, he has splenomegaly. Liver panel shows slightly elevated AST and ALT, and normal total and...

correct answer c Ovarian torsion Prompt interpretation of ultrasound imaging is crucial in diagnosing and guiding the therapy of patients with ovarian torsion. There are several features on ultrasound that increase the likelihood of torsion as diagnosis. These include a size discrepancy between...

A 14-year-old girl presents with sudden onset right lower quadrant pain, nausea, and vomiting. She has right lower quadrant tenderness and fullness in the suprapubic area. An ultrasound is obtained. The most likely diagnosis is a Ruptured appendicitis with abscess b Ruptured ovarian cyst c...

Correct answer B upper gastrointestinal series. as long as the child is hemodynamically stable & abdomen not surgical, upper gastrointestinal study should be done to confirm diagnosis. if child is shocked/septic surgical exploration should not be delayed waiting for imaging.

You are called by the emergency department to consult on a ten-day old full term male infant with bilious vomiting. The baby is hemodynamically stable and the abdominal exam is unremarkable. An abdominal ultrasound obtained by the emergency physician suggests that the superior mesenteric artery...

correct answer c administered without interruption of dosing This patient will undergo laparoscopic surgery with relatively low sirolimus levels. Sirolimus may be administered through the perioperative period. The mammalian target of rapamycin (mTOR) inhibitors block enzymes in the cell cycle...

A 6-month-old baby is being treated with sirolimus for a lymphatic malformation of the head and neck. Sirolimus levels are being maintained between 4-8 ng/mL. The child requires placement of a gastrostomy tube that is planned for the following week. In preparation for surgery, sirolimus should...

correct answer a ultrasound. Ultrasound (US) examination for nonradiolucent soft tissue foreign bodies such as wood is very accurate (sensitivity and specificity greater than 90%). In this case US revealed a single foreign body measuring 7 cm long and 0.5 cm wide which was successfully...

A 15-year old male presents with a six month history of an open non healing draining wound on his right lateral thigh (see below) since sustaining a laceration falling out of a tree. Plain films show no evidence of mass, foreign body or osteomyelitis. The white blood cell count is normal. The...

correct answer d Functional end-end anastomosis Apple-peel or type IIIb atresia is the rarest form of intestinal atresia occurring in less than 10% of infants with jejunoileal atresia. It is characterized by proximal atresia (often with a bulbous segment), absence of the superior mesenteric...

A 36-week gestational age baby was found to have intestinal atresia as pictured below. There is proximal jejunal atresia and approximately 60 cm of distal small intestine with an intact ileocecal valve. The most appropriate surgical management is: a End-side anastomosis b Delayed primary...