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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...

A baby with a giant omphalocele is born at 33 weeks gestation with a birth weight of 1800 gm. They have respiratory distress requiring intubation and mechanical ventilation. What is the most likely cause of respiratory morbidity in this baby with giant omphalocele? a pneumonia and sepsis b...

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A 12 hour old baby has not urinated over 12 hrs. The nursing team noted swelling below the umbilical clamp and removed the clamp. You were called to look at the umbilicus. What is the best next step in management of this patient? a Laparoscopy b Ultrasound c Umbilical exploration d...

A 2-day-old infant is in the newborn nursery with persistent nonbilious emesis and intolerance of feeds. A chest radiograph was obtained which is shown below. Based upon this imaging an upper GI study was obtained showing no progression of contrast beyond the stomach after 1 hour (below). What...

correct answer a Chemotherapy Patients with Beckwith-Weidemann syndrome are at risk for developing Wilms tumor and should undergo screening ultrasound every 3 months until 5 years of age. Due to their high risk for developing metachronous tumors, nephron-sparing nephrectomy is appropriate when...

An 18-month-old child with Beckwith-Weidemann syndrome is found on screening imaging to have a left renal mass that is 50% of the left renal volume. There is no tumor thrombus or right sided renal mass. The most appropriate next step in management is: a Chemotherapy b Tumor biopsy c Left...

correct answer e resolution of paradoxical motion of abdominal wall muscles during deep respiration. Literature has continued to focus on the cardiopulmonary effects of minimally invasive repair of pectus excavatum (MIRPE) otherwise known as the Nuss procedure. Children are typically not...

A 15-year old boy is in your clinic for evaluation of pectus excavatum. The patient confesses that the deformity bothers him from a cosmetic and social viewpoint. However, he and his parents are mostly concerned that he feels shortness of breath with moderate exercise and are focused on how...

You explore a 3.6 kg, 36 week old male infant with concern for intestinal atresia. At the time of the operation, you discover a Type IIIb jejunal atresia as noted in the below picture. There is only 30 cm of well-perfused bowel proximal dilated bowel prior to the atretic segment. This proximal...

A 4-year-old child who underwent a Yancey-Soave pull through for Hirschsprung disease as a newborn continues to have infrequent stools and abdominal distension. There is no twist, stricture, or retained cuff. There are circumferential ganglion cells at the anastomosis. What is the next best step...

correct answer c No packed red blood cell transfusion A red blood cell transfusion would not be appropriate in this scenario. While blood transfusions can be necessary and lifesaving in oncologic operations with bleeding, they are associated with long-term risks for inflammation and...

You are doing a nephrectomy and retroperitoneal lymph node sampling for a 3-year-old child with a large renal tumor. The preoperative hemoglobin was 8.2 g/dL and there has been minimal bleeding during the operation. The patient has been hemodynamically stable with a urine output of 1.8 ml/kg/hr...