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You are called to the neonatal intensive care unit to evaluate a 16-hour-old girl with progressive abdominal distention and respiratory distress requiring 6L HFNC. On examination she has a distended abdomen with a palpable mass above the umbilicus. An abdominal radiograph demonstrates a rounded...

correct answer b Operative cholangiogram This 50-day old infant has persistent conjugated hyperbilirubinemia with acholic stool. The ultrasound suggests biliary atresia as the gallbladder is absent. At this age, further delay waiting for the results of the MMP-7 testing would potentially...

A 50-day-old infant has conjugated hyperbilirubinemia, mild transaminitis, and acholic stool. Ultrasonography demonstrated an absent gallbladder. A blood sample was sent out for MMP-7 yesterday and results are pending. What is the next best step in management? a Await MMP-7 results b Operative...

case of Dr. Usman, from Pakistan.

case of Dr. Usman, from Pakistan. a 19-month-old female patient. The parents noticed abdominal distension incidentally during routine care. An ultrasound was performed, which suggested a left renal unilocular cyst. They then repeated the ultrasound at another center, where it was reported as a...

Correct answer d Observation The presence of a large (>1.5mm) hemodynamically significant PDA, especially in extreme preterm infants, has been associated with increased mortality and morbidity such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and intraventricular...

A 26-week gestational age (GA) infant is noted to have a 2mm diameter patent ductus arteriosus (PDA) with left-to-right shunting. The best next step in the management of the PDA for this infant should be: a Ibuprofen b Acetaminophen c Thoracoscopic ligation d Observation e Percutaneous...

correct answer a Diagnostic laparoscopy/laparotomy The most appropriate management in this child with a Chance fracture, fevers, abdominal pain, and tachycardia is to take the child to the operating room due to concern for a hollow viscus injury. Chance fracture, a vertebral fracture involving...

A 10-year-old is involved in a high speed motor vehicle collision. They were appropriately restrained with a seatbelt. On physical exam, there is a visible seatbelt sign, mild lower abdominal pain and no neurologic deficits. Their CT scan (image included) shows a comminuted fracture of L2...

correct answer a Lean body weight In obese patients, opioid dosing should be based on lean body weight (LBW), which is total body weight (TBW)-fat weight. LBW may be determined based on several gender-specific formulas. LBW is substantially less than TBW in patients with significant obesity and...

An adolescent, who weighs 140 kg, sustained a complicated pelvic fracture in a motor vehicle crash. Their pain is not controlled with non-opioid medications. Dosing of morphine should be based on a Lean body weight b Ideal body weight c Actual body weight d Total body weight

correct answer d Hypotension requiring vasopressors Octreotide has been used in a number of clinical conditions in infants. Most commonly chylothorax, hypoglycemia and gastrointestinal hemorrhage. A 2015 study of 428 infants over 15 years at 333 neonatal ICUs demonstrated that laboratory...

A term infant is born with a congenital chylothorax. The neonatal team places a chest tube and begins an octreotide infusion. The parents inquire about the safety of this medication. The most common clinical adverse event in infants receiving an octreotide infusion is: a Intraventricular...

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...