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Paediatrics Flashcards

1
Q

Inguinal hernia mx in infant

A

Surgery over next few days

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2
Q

Neonate with decreased air entry on the left side of his chest and a displaced apex beat. Abdominal examination demonstrates a scaphoid abdomen

A

Congenital diaphragmatic hernia

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3
Q

Neonate with episodes of choking, cyanosis, hx of polyhyradminos

A

Oesophageal atresia

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4
Q

Mx of oesophageal atresia

A

Replogle tube which can be used to remove the oesophageal secretions, pending surgery.

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5
Q

Movement limited in SUFE

A

Internal rotation

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6
Q

Cherry red lesion, rectal bleeding

A

Juvenile polyp

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7
Q

Hyhpospadius symtoms

A

Urethra opens on ventral side of penis
Def of foreskin there
Skin tethering to hypoplastic urethra
Splayed columns of spongiosum tissue distal to the meatus

10% crytporchidism

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8
Q

Mx of hypospadias

A

Urethroplasty
Penile reconstruction

May not be needed in very distal disease

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9
Q

Usual diagnosis with meconium ileus and mx

A

Majority have cystic fibrosis

Infants who do not respond to PR contrast and NG N-acetyl cysteine will require surgery to remove the plugs

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10
Q

Mx of biliary atresia

A

Kasai at 8w
Roux-en Y portojejunostomy

45% who have kasai will require a transplantation

Overall survival 80%

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11
Q

Which is an ectopic teste
Canalicular or superficial inguinal pouch

A

Superficial inguinal pouch

Canalicular- between internal and external ring

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12
Q

Associated conditions and features with oesophageal atresia

A

Polyhydraminos
Imperforate anus
Absent gastric fluid on US
Sporadic risk
Distal fistula most common

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13
Q

Mx of NEC

A

Treatment is with total gut rest and TPN, babies with perforations will require laparotomy

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14
Q

Factors favouring septic arthritis

A

WCC > 12
ESR >40
Inability to weight bear
Fever >38.5

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15
Q

Swollen, erythematous umbilicus with septic neonate

A

Omphalaitis

Risk of portal pyaemia, and portal vein thrombosis

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16
Q

Mass above hyoid, multiloculated, heterogeneous

A

Dermoid cyst

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17
Q

Recurrent infections, slow loss of vision, Multiple x-rays show brittle bones with no differentiation between the cortex and the medulla

A

Osteopetrosis

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18
Q

No vas deferens, with recurrent chest infections

A

Cystic fibrosis

Sperm harvesting

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19
Q

Baby with undescended testicles mx

A

Review at 6-8w
Then 3m
Then will need referral to surgeon before 6m

Orchidopexy at 6- 18 months of age.

he operation usually consists of inguinal exploration, mobilisation of the testis and implantation into a dartos pouch.

Intra-abdominal testis should be evaluated laparoscopically and mobilised. Whether this is a single stage or two stage procedure depends upon the exact location.

After the age of 2 years in untreated individuals the Sertoli cells will degrade and those presenting late in teenage years may be better served by orchidectomy than to try and salvage a non functioning testis with an increased risk of malignancy.

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20
Q

Maintenance fluids in children

A

First 10kg- 100ml
Next 10- 50ml
After- 20ml/kg

E.g 21kg
1000+500+20= 1520ml/day

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21
Q

Maintenance fluid in neonates

A

From birth to day 1: 50-60 ml/kg/day.
Day 2: 70-80 ml/kg/day.
Day 3: 80-100 ml/kg/day.
Day 4: 100-120 ml/kg/day.
Days 5-8: 120-150 ml/kg/day.

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22
Q

Buckle vs greenstick fracture

A

Greenstick- unilateral cortisol breach only

Buckle - incomplete cortical disruption- resulting in periosteal haematoma only

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23
Q

Choanal atresia

A

Congenital disorder in which the nasal choanae, (i.e., paired openings that connect the nasal cavity with the nasopharynx), are occluded by soft tissue

episodes of cyanosis are usually worst during feeding. Improvement may be seen when the baby cries as the oropharyngeal airway is used.

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24
Q

Ix after bilious vomitting

A

Upper GI contrast study

Contrast should be seen to exit the stomach and the location of the DJ flexure is noted (it lies to the left of the midline). If this is not the case, or the study is inconclusive, a laparotomy is performed.

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25
Mx of uncomplicated umbilical hernia
After 3 years of age
26
Ix if perches disease does not show on X ray
MRI
27
Painful bright red defecation
Anal fissure
28
Breech presentation with Barlow and ortolani normal, what next
Hip USS
29
Cause of unilateral cleft lip
Incomplete fusion of nasolabial muscle ring
30
Ix for DDH
Initially no obvious change on plain films and USS gives best resolution until 3 months of age. On plain films Shentons line should form a smooth arc
31
Painful area at umbilicus, with clear yellow fluid draining
Patent urachus
32
Billious vomiting, DJ flexure is displaced to the right - what mx
Malrotation Ladds procedure- Laparotomy and division of adhesional bands
33
Umbilicus providing diffuse foul smelling brown fluid with granulation tissue
Peristent vitello intestinal ducts Small bowel content to umbilicus meant to obliterate at 5w when yolk sac no longer required for nutrition
34
Features of Rickets
Failure to thrive Bowing Large head Deformity of chest walll- thickening of costochondral junction (rickettary rosary) Transverse sulcus in the chest caused by the pull of the diaphragm (Harrison's sulcus). X- Rays show widening and cupping of the epiphysis of the long bones, most readily apparent in the wrist.
35
A 3 day old baby develops dyspneoa. A chest x-ray is performed and shows a radio-opaque shadow with an air-fluid level in the chest
Bronchogenic cyst Foregut-derived cystic malformations of the respiratory tract
36
Ix and tx of bronchogenic cyst
Many cases are diagnosed on antenatal ultrasound. Others may be detected on conventional chest radiography as a midline spherical mass or cystic structure. Once the diagnosis is suspected a CT scan should be performed. Mx- thorascopic resection after 6w
37
Mx of FB in external auditory meatus not easily removed
Removal under GA in next operative list
38
Smooth mass anterior triangle, near mandible
Brachial cyst Derived from second brachial cleft
39
Delayed meconium ix
Full thickness rectal biopsy
40
Mx of Hirschsprungs
Washout Definitive surgery
41
Projective non billions vomiting
Pyloric stenosis
42
Ix and mx of pyloric stenosis
Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting Diagnosis is most commonly made by ultrasound or test feed Management is with Ramstedt pyloromyotomy
43
Single palmar crease and prominent epicanthic folds of the eyes, with projectile vomiting
Duodenal atresia
44
Fluids for replacement of high output ileostomy
0.9% NaCL with K added Do not give glucose/Na outside neonates
45
Testes that come out in bath but otherwise aren't there and mx
Retractile testes If the examining clinician notes the testis to return rapidly into the inguinal canal when released then surgery is probably indicated.
46
Impalpable testes in scrotum or inguinal region 13m
Laparoscopy US not very useful
47
Jaundice ix
Present <24hrs- haemolytic anaemia, sepsis Measure direct(conjugated) serum BR + blood film 2d-2w can be normal- physiological, breastfeeding, breastmilk jaundice Transcutaneous BR + blood film >2w- can be normal or biliary atresia Direct and indirect serum BR prolonged physiological jaundice or breast milk jaundice will cause a rise in unconjugated bilirubin, whereas those with obstructive liver disease will have a rise in conjugated bilirubin)
48
VACTERL sx
Vertebral, Ano-rectal, Cardiac, Tracheo-oesophageal, Renal and Radial limb anomalies Intolerant of feeds, pan systolic murmur, forearms not developed properly
49
Pellet lodged in liver, patient is well mx?
Do not operate and review several weeks later Airgun pellets (and glass) lodged in the soft tissues are usually notoriously difficult to localise and extract
50
Gastroschisis vs omphalocele
Gastroschisis: Isolated abnormality, bowel lies outside abdominal wall through defect located to right of umbilicus. Other anomalies rare- intestinal atresia in 10% Exomphalos: Central umbilical Peritoneal sac Other anomalies present- heart
51
most common abdominal emergency in children under 1 year of age?
Intussesception
52
Mx of NEC
NG decompression Laparotomy should be undertaken in patients do not who progress despite conservative management or in whom compelling indications for surgery exist (eg free air).
53
Exophalmus and diaphragmatic hernia, now has biliary stained vomit
Intestinal malrotation
54
Feature of talipes equinovarus
Adducted and inverted calcaneus Wedge shaped head of talus and distal calcaneal articular surface Severe Tibio-talar plantar flexion Medial Talar neck inclination Displacement of the cuboid and navicular (medially) Bilateral in 50%
55
Features of perthes disease
Hyperactivity Short Hip pain- may be reared to knee 5-12 Bilateral in 20%
56
Cause of expanding head in NAI
Hydrocephalus
57
Ix of SUFE
Hip X ray
58
If suspicious of Perthes and nothing from 2 x ray what next
Hip MRI
59
Scaphoid abdomen and hypoxic at birth dx
Bochdalek hernia- Associated with pulmonary hypoplasia Poor prognosis Morgani- have little effect on lungs
60
Incision for laparotomy in children
Transverse supra umbilical abdominal
61
Where does spinal cord end in neonates
L3
62
Young girl, facial oedema, distended abdo, fever low Bp
Nephrotic syndrome now SBP
63
Patient had open abdo surgery, now erythema of wound and distention what ix
USS
64
Mx of ileo-ileal intussescpetion
Laparotomy
65
Tetralolgy of Fallot
VSD RVH Right ventricular tract obstruction- Pul Stenosis Overriding aorta Right to left shunt
66
Conditions causing intusseption
Peyers patches inflammed CF Meckels Mucosal polyps
67
Calculating fluid bolus
kg x 10 10 if arrest
68
Presentation of biliary atresia
Jaundice in infants > 14 days in term infants (>21 days in pre term infants) Pale stool, yellow urine (colourless in babies) Associated with cardiac malformations, polysplenia, situs inversus
69
Ix of biliary atresia
Conjugated bilirubin (prolonged physiological jaundice or breast milk jaundice will cause a rise in unconjugated bilirubin, whereas those with obstructive liver disease will have a rise in conjugated bilirubin) Ultrasound of the liver (excludes extrahepatic causes, in biliary atresia infant may have tiny or invisible gallbladder) Hepato-iminodiacetic acid radionuclide scan (good uptake but no excretion usually seen)
70
Ix of duodenal atresia
AXR shows 'double bubble sign, contrast study may confirm
71
Features of NEC
Premature Second week of life Dilated bowel loops on AXR, pneumatosis and portal venous air
72
Types of cleft palate
The primary palate consists of all anatomical structures anterior to the incisive foramen. The secondary palate lies more posteriorly and is sub divided into the hard and soft palate. Cleft palate occurs as a result of non fusion of the two palatine shelves.
73
What are those with cryptorchidism more likely to develop
Seminoma
74
Intrabominal teste mx
Laparoscopy and mobilised
75
>2 yrs non descended teste mx
After the age of 2 years in untreated individuals the Sertoli cells will degrade and those presenting late in teenage years may be better served by orchidectomy than to try and salvage a non functioning testis with an increased risk of malignancy.
76
Tx of inguinal hernia in children
Inguinal herniotomy - cut open then tie off patent TV In females offer bilateral As common The younger the child the higher the risks of strangulation and most neonatal inguinal hernias are repaired on the next available list.
77
Ix of malrotation
Bowel viability depends of mesentery containing MSA Abdominal ultrasound scan to determine the relationship between the superior mesenteric artery and vein (normally SMA lies to the left of the SMV). This test is complemented with an upper GI contrast series and this aims to establish that the DJ flexure is correctly sited to the left of the vertebral bodies
78
What happens in malrotation
Malrotation occurs when the rotational process described is incomplete. Typically the duodenal loop lies to the left of the caecum and therefore lacks 90 o of its 270o rotation. It becomes fixed in this position with peritoneal attachments (Ladds bands).
79
Formation of cystic hygroma
Cystic hygroma result from occlusion of lymphatic channels
80
Infantile haemangioma features
Grow rapidly initially and then will often spontaneously regress Plain x-rays will show a mass lesion, usually containing calcified phlebolith
81
Dermoid features
Derived from pleuripotent stem cells and are located in the midline Most commonly in a suprahyoid location They have heterogeneous appearances on imaging and contain variable amounts of calcium and fat
82
Where does Wilms tumour mets to
Lung
83
Toddler fracture
Oblique tibial fracture in infants
84
Plastic deformity
Stress on bone resulting in deformity without cortical disruption Bends
85
Central abdominal pain and URTI, dx and mx
Mesenteric adeninitis - conservative
86
Post op care of inguinal hernia
Most cases are performed as day cases, neonates and premature infants are kept in hospital overnight as there is a recognised increased risk of post operative apnoea.
87
Features of Congenital talipes equinovarus.
Equinus of the hindfoot Adduction and varus of the midfoot High arch
88
Mx of Congenital talipes equinovarus.
Conservative first, the Ponseti method is best described and gives comparable results to surgery. It consists of serial casting to mold the foot into correct shape. Following casting around 90% will require a Achilles tenotomy. This is then followed by a phase of walking braces to maintain the correction. Surgical correction is reserved for those cases that fail to respond to conservative measures. The procedures involve multiple tenotomies and lengthening procedures. In patients who fail to respond surgically an Ilizarov frame reconstruction may be attempted and gives good results.
89
Grade of VUR
1- reflux into ureter no dilation 2- renal pelvis no dilation 3- mild dilation od ureter, renal pelvis and calyces 4- dilatation with moderate ureteral tortuosity 5- gross dilation dn with ureteral tortuosity
90
Ladd procedure steps
Usually rotates 270 Anticlockwise DJ normally to left This doesn't occur Urgent laparotomy Rotate volvulus anticlockwise Return small bowel to right and caecum and colon to left and perform appendectomy
91
Most common cause of obstruction in paeds
Intusseption
92
What conditions are associated with intussusception
Haemangiomas, lymphomas, HSP, Haemophilia
93
Urinary pH in pyloric stenosis
Low
94
Locations of hypospadias
70% glandular 20% scrotal 10% penile
95
Pneumatosis intestianlis and postral venous gas
Severe NEC
96
Dose of IO vs IV
Same
97
Mx of rectal prolapse
Conservative
98
When should NAC be given
If above treatment line or delayed presentation >8 hrs
99
Child with congenital hypothyroid and what hernia
Umbilical
100
Positive Barlow test, when to US hip
4-6w
101
Normal urine output under 2
>2ml/kg/hr
102
Pass meconium, bilious aspirates, not opened bowel since, distended small bowel
Small bowel atresia
103
Most common cause of intussepetion
Hypertrophic peyeres
104
Purpose of brown fat in children and location
Thermogenesis Scpaulas, mediastinum, kidneys, adrenal
105
Feeding neonates post major bowel surgery
Often can't tolerate gastric feeds Parenteral nutrition
106
Condition associated with myelomenignocele
Hydrocephalus
107
Hypothermia effects
Decreased platelet activity Increased anaesthetic duration Acidosis due to resp Depression
108
Tumour of all 3 cell layers
Teratoma
109
Dose of IV morphine
0.1mg/kg
110
Most common ectopic teste location
Superficial inguinal pouch
111
If failed IV 2x
IO in tibia
112
Hormones levels post surgery
Catecholamines evaluated immediately Cortisol- stays high for shorter period than adults <24hrs
113
Term vs pre term IV fluid requirements
Pre term required more <26 80-150ml/kg Term- 60-80 per day
114
When should meconium be passed
By 48hrs
115
Persistent bilious vomiting after birth
Duodenal atresia
116
Most common cause of delayed passage of meconium and Ix
CF Guthrie test- spot test Sweat chloride - 2-5x more Cl
117
Na in pyloric stenosis
Low
118
What is CO most dependent on in paeds
HR
119
Edwards
Trisomy 18 Heart defect Omphalocele Oesophageal atresia Microcepahly Cleft lip
120
Paracetamol dose for <50kg
15mg/kg per dose
121
Important mechanism in heat conservation in newborns
Noradrenergic symp stimulation
122
Glucose and lactate in hypothermia
Glucose decrease lactate increase- anaerobic
123
Main cause of heat loss in surgery
Radiation
124
Rostral vs caudal
Rostral - nose Caudal- posterior head
125
Mx of malrotation with regards to amount of viable bowel
If <50cm- untwist, return- perform second look lap >50cm- excise ischaemic bowel
126

eMRCS questions (45 decks)

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