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correct answer b Discontinue cervical spine precautions The currently accepted management of children who are obtunded due to blunt trauma includes MRI of the cervical spine. Although the sensitivity of CT for significant cervical spine injury in adults is 98.5%, the elevated risk for...

An 8-year-old child was struck by a car yesterday and has a GCS of 7 with bilateral intraparenchymal hemorrhages on head CT. A concurrent cervical spine CT showed no evidence of injury. The most appropriate next step in management of the cervical spine is: a Flexion-extension imaging b...

correct answer a 26 to 50%. Mohinudin reviewed 163 neonates over a four year period who were transferred to a regional center. They found that 46% had a surgical diagnosis and 14.1% required an emergent operation. An abnormal plain film of the abdomen was considered to be important with a...

You receive a call from a referring neonatologist regarding a full term newborn with bilious emesis and an abnormal abdominal radiograph. She would like advice about doing further diagnostic studies at her institution. You suggest immediate transfer as the incidence of surgical pathology in term...

correct answer b Reduced post-op PRBC transfusions Traditionally, many surgeons have steered away from performing muscle flap repairs for patients on ECMO given that assumption that this technique would increase the risk of hemorrhage. However, recent data has seems to argue that this is not...

You are performing a repair of a large congenital diaphragmatic hernia on an infant who is on ECMO. The hernia is not amenable to a primary repair, so you opt to perform a muscle-flap repair. When compared to patch repairs performed while on ECMO, you would expect which of the following...

correct answer b Irrigation of wounds Dog bites represent most animal bites seen in the pediatric population. Multiple studies continue to evaluate the most appropriate management of the patient who has sustained a bite wound. These studies look at multiple issues including whether to close the...

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...