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Paediatrics > Paediatric Surgery > Flashcards

Paediatric Surgery Flashcards

1
Q

What is the most common surgical cause of acute abdominal pain in children 3-12 months of age?

A

Intussusception

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2
Q

Which condition is associated with the passage of ‘red currant jelly’ stools in children?

A

Intussusception

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3
Q

What is the most useful investigation in the diagnosis of intussusception?

A

Barium enema to identify apex

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4
Q

What is Hirschsprung disease?

A

Congenital condition where part or all of the colon does not have ganglionic cells (and there is no regulation of colonic activity)

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5
Q

Why is a neonatal diaphragmatic hernia of concern?

A

Bowel can protrude into the thoracic cavity, impairing lung growth and respiratory function after birth

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6
Q

What is the difference between an omphalocele and gastroschsis?

A

Omphalocele = herniation of bowel and liver throgh defect at umbilicus, covered by sac of fused amniotic membrane and peritoneum

Gastroschisis = defect to the right of the umbilicus through which bowel and sometimes the gonads herniate (no covering sac)

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7
Q

What are the 2 major risk factors for neonatal necrotising enterocolitis?

A

Premature birth Perinatal stress

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8
Q

What is the most common type of paediatric hernia?

A

Indirect inguinal hernia

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9
Q

Failure of which embryological structure to obliterate can result in the formation of an inguinal hernia?

A

Processus vaginalis

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10
Q

What is the most common chest wall deformity?

A

Pectus excavatum

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11
Q

Give 3 differentials for a scrotal lump in a neonate.

A

Testicular torsion Indirect inguinal hernia Hydrocele

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12
Q

Which deformity is often responsible for neonatal testicular torsion?

A

Bell-Clapper Deformity

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13
Q

Give 2 long-term complications of undescended testes.

A
  1. Subfertility
  2. Increased risk of testicular cancer
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14
Q

How is % body surface area for burns calculated in children?

A

Using the Brund-Lowder chart

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15
Q

What condition presents with respiratory distress, a barrel chest and a scaphoid abdomen in a newborn?

A

Congenital posterolateral (Bochdalek) hernia

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16
Q

How does oesophageal atresia typically present?

A

Excessive drooling / salivation in a newborn

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17
Q

How is a diagnosis of oesophageal atresia confirmed?

A

By the inability to pass a 10 gauge catheter more than 10cm into the stomach

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18
Q

What is the triad of symptoms in neonatal bowel obstruction?

A
  1. Failure to pass meconium
  2. Bile-stained vomiting
  3. Abdominal distension
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19
Q

What is the classic abdominal x-ray finding in duodenal atresia?

A

The ‘double bubble’ sign

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20
Q

What is the most common cause of neonatal bowel obstruction?

A

Hirschsprung disease

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21
Q

What are three serious causes of acute abdominal pain in neonates?

A
  1. Midgut malrotation with volvulus
  2. Intussusception
  3. Irreducible / incarcerated inguinal hernia
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22
Q

What are the differential diagnoses for acute appendicitis in children?

A
  1. Mesenteric adenitis
  2. Gastroenteritis
  3. UTI
  4. Adnexal cause (e.g. ovarian torsion, menstrual pain)
  5. Testicular torsion
  6. Meckel’s diverticulitis
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23
Q

What generally precedes the onset of mesenteric adenitis?

A

URTI

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24
Q

Give three signs that should be elicited in a patient with suspected appendicitis.

A
  1. Psoas sign (painful hip flexion)
  2. Rosving’s sign (crossed tenderness)
  3. Obturator sign (painful hip rotation)
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25
Q

What is the immediate management for suspected appendicitis?

A
  1. Fluid resuscitation (10-20mL/kg bolus)
  2. Opioid analgesia
  3. Antibiotics (if proceeding to appendicectomy)
26
Q

What two pathologies can arise from a patent processus vaginalis?

A
  1. Hydrocele (opening is narrow and only allows peritoneal fluid into the tunica vaginalis)
  2. Indirect inguinal hernia (bowel +/- ovary passes into the inguinal canal through wide opening)
27
Q

Give 5 causes of acute paediatric scrotum.

A
  1. Testicular torsion
  2. Torsion of the testicular appendage
  3. Epididimo-orchitis
  4. Incarcerated inguinal hernia
  5. Other (e.g. benign idiopathic scrotal oedema, HSP)
28
Q

Give 5 differential diagnoses for acute neonatal vomiting.

A
  1. Gastroenteritis
  2. Hypertrophic pyloric stenosis
  3. Midgut volvulus
  4. GORD
  5. UTI
  6. Food allergy
  7. Other (e.g. raised ICP)
29
Q

What is the major concern with hypertrophic pyloric stenosis?

A

Electrolyte imbalance and dehydration due to frequent projectile vomiting

30
Q

In which condition may you find an olive-shaped mass in the RUQ of a neonate?

A

Hypertrophic pyloric stenosis

31
Q

What is the classic triad of intussusception?

A
  1. Red currant jelly stools
  2. Sausage-like mass in abdomen
  3. Colicky abdominal pain
32
Q

Which type of nephropathy is associated with hypertension in early adulthood and a childhood history of enuresis and febrile episodes?

A

Reflux nephropathy (febrile episodes being UTIs)

33
Q

What is the diagnosis?

A

Oesophageal atresia with gastroesophageal fistula (as there is gas in the stomach)

34
Q

What is the diagnosis?

A

Duodenal atresia (double-bubble sign)

35
Q

What is the diagnosis?

A

Slipped Capital Femoral Epiphysis

36
Q

What is the diagnosis?

A

Perthes Disease (avascular necrosis of head of femur)

37
Q

Give three risk factors for a slipped capital femoral epiphysis.

A
  1. Male
  2. Overweight
  3. Adolescence (soon after a growth spurt)
38
Q

Around which age do growth plates close in long bones?

A

Females: 13-15

Males: 15-17

39
Q

What is the diagnosis?

A

Talipes Equinovarus (club foot)

40
Q

What is the diagnosis?

A

DDH

41
Q

What is the diagnosis?

A

Scoliosis

42
Q

Give 2 complications of a growth plate fracture.

A
  1. Shortened bone (reduced growth of physis)
  2. Angulated bone (reduced growth of one side of physis)
43
Q

What classifcation system is used for physis fractures?

A

Salter-Harris Classification

44
Q

How is a supracondylar fracture of the humerus obtained?

A

Falling from a height (4-10 years)

45
Q

What are the 5 main differences between gastroschisis and an omphalocele?

A

With gastroschisis, there is a:

  1. Greater risk of hypothermia
  2. Smaller abdominal wall defect
  3. No covering sac
  4. Lower incidence of serious coexisting malformations
  5. Greater (but still small) risk of bowel atresias
46
Q

Give 5 differential diagnoses for hip pain in children.

A
  1. Trauma
  2. Bone or soft tissue tumour
  3. Transient synovitis
  4. Perthes disease
  5. Slipped capital femoral epipysis
  6. Juvenile chronic arthritis
  7. Bone or joint infection
47
Q

Give 3 differential diagnoses for this presentation.

A
  1. Osgood-Schlatter disease
  2. Normal separate ossification centres
  3. Avulsion fracture of tibial tuberosity
48
Q

What is this radiological sign and what are two differential diagnoses?

A

Codman’s Triangle

  1. Osteosarcoma
  2. Ewing’s Sarcoma
49
Q

What are the two most common bone tumours in children?

A
  1. Osteosarcoma
  2. Ewing’s Sarcoma
50
Q

What is the most common cause of Vaulkmann’s ischaemic contracture?

A

Supracondylar #humerus (causing compartment syndrome)

51
Q

What is the Salter-Harris Classification?

A
  • I - through the physis
  • II - through the metaphysis
  • III - through the epiphysis
  • IV - through the metaphysis and epiphysis
  • V - compression
52
Q

What is this fracture?

A

Monteggia Fracture

  • Fracture through proximal 1/3 ulna
  • Dislocation of radial head at elbow joint
53
Q

What is this diagnosis? Is it malignant?

A

Osteochondroma with <5% chance of developing into malignancy

54
Q

Which electrolyte abnormality occurs with hypertrophic pyloric stenosis?

A

Hypochloraemic, hypokalaemic metabolic alkalosis

  • Excessive loss of HCl from vomiting
  • Exchange of H+ for K+ in kidneys
55
Q

Which surgical procedure is used to treat pyloric stenosis?

A

Pyloromyotomy (Fredet-Ramstedt Procedure)

**Incision is made to the level of the mucosa**

56
Q

What are the 4 most common organisms causing otitis media?

A
  • Viruses (e.g. RSV, infleunza)
  • Strep pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
57
Q

List 5 complications of otitis media.

A
  1. Chronic otitis media with effusion (glue ear)
  2. Hearing impairment
  3. Suppurative complications (mastoiditis, abscess)
  4. Cholesteatoma
  5. Febrile convulsions
58
Q

Which surgical procedure is used to treat cryptorchidism?

A

Orchidopexy at 6-12 months

59
Q

Which investigations should be ordered in a case of suspected neuroblastoma?

A
  • Baseline CBE, EUC, LFTs
  • Urinary catecholamines
  • Tumour markers LDH, ferritin, NSE
  • Biopsy required for diagnosis
  • Staging with CT/MRI
60
Q

From which cell lineage do neuroblastomas arise?

A

Primordial neural crest cells that give rise to the adrenal medulla and sympathetic ganglia

Paediatrics (5 decks)

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