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A 6-month-old child presents with a perianal abscess at the 3 o’clock position that has recurred six times. What is the next best step in management? a Needle Aspiration b Warm soaks and local care c Fistulotomy d Incision and drainage (I&D)

correct answer b Meso-Rex bypass Extrahepatic portal venous thrombosis is most frequently idiopathic, but in Western countries more than half of cases are due to complications of umbilical venous catheterization. Recurrent variceal bleeding that is refractory to banding is an absolute...

A 3-year-old child had three episodes of severe esophageal variceal bleeding in the last year. An ultrasound demonstrates extrahepatic portal venous thrombosis with cavernous transformation. This wedged hepatic vein portogram was obtained. The most appropriate next step is: a Distal...

correct answer e DICER 1 It is estimated that anywhere from 10% of children’s cancers are a manifestation of predisposition syndromes with germ line mutations. DICER1 gene is located on chromosome 14. Its protein is a ribonuclease III endoribonuclease which is essential for the production of...

A 22-month old boy presents with a large left sided abdominal mass. Ultrasound show a large cystic tumor of left kidney, confirmed by CT scan. After removal, pathology came back as cystic nephroma, with no lymph node involvement. The child should be tested for which cancer predisposition gene...

correct answer e Water-soluble contrast enema study The first step in successful bowel management is starting with a clean colon. This can be achieved with a water-soluble contrast enema, which not only kick starts clean-out of the colon, but also provides anatomical data regarding focal...

A 4-year-old with a history of perineal anoplasty for a recto-perineal fistula presents with longstanding constipation. The anoplasty is well situated within the sphincter complex without a stricture. X-rays demonstrate copious stool throughout the colon. The most appropriate first step in bowel...

correct answer d Faster time to achieve balanced resuscitation The study by McLoughlin et al. (2024) found that whole blood (WB) significantly improved the time to balanced resuscitation in critically injured preadolescent children compared to component therapy (CT). In trauma situations...

A 13-year-old adolescent is a pedestrian struck by a motor vehicle. He presents to the trauma bay and transfusion therapy is initiated. When comparing whole blood therapy over component therapy what is the main benefit in balanced resuscitation? a Reduced need for surgical b Improved...

correct answer d Discharge on PO cefdinir/metronidazole for 7 days This patient had improvement in their symptoms with 12 hours of IV antibiotics, a low-grade fever and no fecalith, so they satisfy the criteria for published non-operative management (NOM) protocols for appendicitis. Because the...

You are asked to assess a 12-year-old child with appendicitis. The appendix is 10mm in diameter on CT with no fecalith. There is a low-grade fever and the WBC = 13,000/uL. After 12 hours of IV ceftriaxone and metronidazole the pain has improved. The patient and their parents have expressed a...

correct answer c Partial nephrectomy This clinical scenario is most suggestive of recurrent disease in a child with previous bilateral Wilms tumors. In the initial setting of bilateral renal tumors suspected to be Wilms, according to the current Children’s Oncology Group (COG) guidelines...

A four-year-old girl is currently eighteen months off therapy for bilateral Wilms tumor. Previously she received neoadjuvant chemotherapy, bilateral partial nephrectomies and lymph node sampling, and bilateral flank radiation for positive lymph nodes. Her current off therapy scan reveals a 2 cm...

correct answer e bilateral infraclavicular incisions Treatment for severe subcutaneous emphysema requires urgently addressing the underlying air leak, such as usually via chest tube placement for pneumothoraces while simultaneously decompressing the subcutaneous tissue to prevent airway...

A 4-year-old was admitted to the PICU in ARDS. Ventilator settings include 100% FiO2, PRVC with TV of 5.5 ml/kg, RR 28, PEEP 12mmHg. Arterial blood gas showed: pH 7.42, pCO2 53, pO2 75, HCO3 34, base excess 8. You were called to help manage this finding on her CXR. It was interpreted as...

correct answer b Hybrid Ravitch/Nuss procedure This patient has pectus arcuatum. The pathoanatomy of this chest wall deformity involves premature obliteration of the sternal sutures or congenital non-segmentation of the sternum, which results in angulation of the bone. This is distinct from...

A 14-year-old boy presents with a chest wall deformity, pictured below. His mother says his chest looked abnormal at 7-years-old. He has chest pain and exercise intolerance. He and his parents want to improve the appearance of his chest. After chest CT and echocardiogram, which of the following...

correct answer d fetal urine flow Anhydramnios is a lack of amniotic fluid surrounding the developing fetus defined as the deepest pocket of amniotic fluid measuring two cm or less in the second trimester. Anhydramnios due to fetal renal or urinary tract anomalies may result in severe pulmonary...

A 21-year-old woman, G2P1001, who is now 20 weeks pregnant, arrives at your clinic for a prenatal consultation. A recent fetal ultrasound revealed anhydramnios with an amniotic fluid index (AFI) of 2 cm (normal, 8 to 20 cm) and small echogenic kidneys. No other fetal anomaly is present. A cell...