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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...

correct answer c Tumor involving the hilum Pediatric hepatocellular carcinoma tumors should be considered and evaluated for transplantation if they are PRETEXT IV, multifocal in nature, have hilar involvement, and have major vascular involvement including the portal veins, IVC, and hepatic...

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...