What are the indications for pediatric umbilical hernia repair?
- incarceration
- strangulation
- recurrent pain
- constipation
- progressive feeding intolerance
Describe an AKA.
- apply a sterile tourniquet
- fish mouth incision with anterior and posterior soft tissue flaps
- division of soft tissue to bone, dissecting out and ligating the femoral vasculature
- division of femur 12cm proximal to joint
- closure
Describe a BKA.
- happy a sterile tourniquet
- fish mouth incision with anterior and posterior soft tissue flaps
- identification of peroneal and tibial vessels with ligation and division
- sharp division of nerves on traction to allow for retraction
- division of the tibia and tibia 10-15cm distal from the tibial tubercle
- smooth out the surfaces of the bone
- close the soft tissue
What are the reversible causes of cardiac arrest?
- hypovolemia (bleeding)
- hypoxia
- hypo/hyperkalemia
- hypotheramia
- acidosis
- tension pneumothorax
- tamponade
- thrombosis
- toxins
What is the appropriate initial response to a cardiac arrest?
- organize your team and call for help
- initiate ACLS and compressions
- intubate and connect to end tidal monitor
- ensure IV access
- connect to telemetry/AED
- send labs
Describe ECMO cannulation.
- organize team and equipment
- select sites for cannulation using US and identify appropriately sized cannulas
- heparinize the patient
- cannulate with venous cannula to just below RA and arterial to the descending aorta
- initiate flow
- later place a limb perfusion cannula once stabilized
Describe ECMO maintenance and weaning.
- continuous hep gtt with Xa levels
- hourly CMS checks
- wean pressors, flow, and sweep
- daily echos
- decannulate once there was improved cardiac function with primary repair of cannulation sites
What are markers of good chest compressions?
- EtCO2 > 10
- BPM 100-120
- with 2cm of chest compression and complete relaxation
How thick should your dermatome be set to?
0.011 inches
What is the metastatic workup for breast cancer?
CT C/A/P and bone scan
How should you resect a 15mm sessile polyp?
refer to GI for endoscopic resection or dissection
Which polyps should you tattoo during routine colonoscopy?
those > 1cm
How long should you watch IBD on steroids or immunotherapy prior to calling it failed?
- 3 days of steroids
- 5-7 days of infliximab
How quickly should you move through the three stages of an IPAA?
6 months to second stage
3 months to third stage if no leak
If a pediatric patient is found to have a new polyp during an intussusception workup, what is the appropriate management?
resect the segment and refer them to GI for endoscopic evaluation
GIST need what for staging?
CT C/A/P
What is standard imatinib dosing? What is high dose imatinib?
- standard is 400/day
- high dose is 800/day
- high dose used for KIT exon 9 mutations
Describe a low dose dex suppression test.
- 1mg of dexamethasone at 10pm
- measure AM cortisol
- less than 1.8 is appropriate
- less than 5 requires further workup
How should you handle a JJ with intussusception?
- resect and reconstruct
- measure all limbs
- anastomose roux and common channels
- plug in BP limb 30cm proximal or distal
Describe a lateral internal sphincterotomy.
2cm radial incision in the groove in the right lateral groove, isolation of the internal sphincter muscle, divide the length of the fissure and then close the skin with chromic
What is unique about anal fissures in the setting of diarrhea and incontinence?
- likely a low pressure fissure
- diagnose with anorectal manometry
- treat with stool bulk, bowel habits, topical lidocaine
- all other treatments are contraindicated
What is the recommended screening and surveillance for those with MEN1?
- pituitary MRI every 3-5 years
- serum calcium, PTH annually
- CT C/A/P every 1-3 years
What is the recommended screening and surveillance for those with MEN2?
- calcitonin, CEA, neck US
- serum calcium and PTH
- plasma free metanephrines
Describe the following for anapestic thyroid cancer:
- histology
- workup
- treatment
- undifferentiated cells, sarcomatoid or spindle cell morphology
- TSH, neck US, FNA with genetic testing, CT head/neck/chest/abdomen/pelvis, laryngoscopy, PET
- total thyroidectomy with therapeutic lymphadenectomy
- adjuvant chemoradiation
