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Flashcards in Paediatrics II Deck (10):

A 4-month-old boy turns up at the clinic after his mother has discovered a lump in the scrotum.
On examination the child is well, the lump is smooth and non-tender and the testis is part of the swelling.
Which of the following is correct?
(Please select 1 option)
He is at risk of epididymo-orchitis
Surgery is indicated soon
The child has a testicular tumour
The lump is likely to be transilluminable
The lump is unlikely to resolve spontaneously

The lump is likely to be transilluminable

This scenario describes a hydrocele in a well 4-month-old child. This is an accumulation of fluid around the testicle within the tunica vaginalis.

Most hydroceles resolve spontaneously and therefore do not require surgery.

Patients are usually asymptomatic.

The swelling is uniformly smooth and fluctuant.

The testis cannot be felt separately and transillumination confirms the diagnosis.


Which of the following is true of the inguinal hernia?
(Please select 1 option)
Herniotomy should be delayed until the child is over 2 years
Incarcerated hernia can cause infarction of the testis in the very young
Is more common on the left in the female
Is more common on the left in the male
The most common presenting age is between 1-2 years

Incarcerated hernia can cause infarction of the testis in the very young

Inguinal hernias are the most common surgical condition encountered in childhood. Male to female ratio is 9: 1.

Incidence is increased in premature and low birth weight babies.

70% of hernias are right sided
25% of hernias are left sided
5% are bilateral
30% present within the first year
75% of incarcerated hernias present less than 1 year of age
and therefore require urgent surgical correction.

Incarcerated hernias cause infarction of the testes in the young.


Which of the following is correct regarding intussusception?
(Please select 1 option)
Always presents with intestinal obstruction
Bleeding per rectum is the most common presenting symptom
Is more common between the age of 3-18 months
Is more common in girls
Should always have a barium enema to see if it can be reduced by this means

Is more common between the age of 3-18 months

Intussusception is a condition which is more common in boys.

It tends to affect the 3 month - 2 age group mainly although can occur in older children with risk factors such as Henoch-Schönlein purpura (HSP), tumours etc.

Symptoms include abdominal pain which is sudden and colicky in nature. Vomiting is also a presenting complaint as well as circulatory collapse and shock. The passage of blood per rectum is a late and serious feature.

Physical examination may reveal a sausage shaped mass in the right upper quadrant. Clinical suspicion is usually confirmed by ultrasonography.

Reduction is usually achieved by hydrostatic enema, and if unsuccessful surgical intervention must be performed.


Which of the following is correct of intussusception?
(Please select 1 option)
Can be diagnosed by an air contrast enema
Has a peak incidence in infants aged 6-9 weeks
Has an identifiable underlying cause in the majority of children
Results in the early rectal passage of blood stained mucus
Typically results in continuous abdominal pain

Can be diagnosed by an air contrast enema

Intussusception occurs when a segment of bowel is telescoped into another segment of bowel just distal to it.

It is the commonest cause of intestinal obstruction in the 3 month to 6 year age group and is more common in males.

Symptoms include sudden onset of paroxysmal colicky abdominal pain and vomiting that may progress to shock. The passage of bloody red currant jelly stool is a late feature. This is due to gut wall haemorrhage and oedema.

Diagnosis may be achieved by an air-contrast enema, in which the coiled spring appearance of the intussusception may be seen. This can also be therapeutic. Barium can cause problems if it leaks.

Intussusceptions tend to occur in areas in which a peristaltic intestine abuts an aperistaltic segment. The latter are frequently found in

Areas of enlarged Peyer patches
Meckel's diverticulum
Tumours and complications of Henoch-Schönlein purpura (HSP).
In the majority of cases it is not possible to identify the cause.


Umbilical hernia in children:
(Please select 1 option)
Causes pain and vomiting
Clears spontaneously
Requires surgical treatment because of incarceration
Requires surgical treatment because of psychological problems
Should be strapped

Clears spontaneously

Umbilical hernia are common especially in low birth weight and black infants They are also more common in certain conditions such as Down's syndrome and Beckwith Wiedemann. They appear as a soft swelling and become more obvious with crying or coughing. They are easily reducible. Most appear before the age of 6 months and they resolve spontaneously. 95% by the age of 2 years. Surgery is not required unless the hernia is very large or if it causes symptoms. Strangulation is rare.


Which of the following is correct regarding pyloric stenosis?:
(Please select 1 option)
Bile-stained vomitus is an important symptom
Can be misdiagnosed as a duodenal atresia
Reluctance to feed is a common feature
Usually presents at the age of 3-6 months
Weight loss is an important feature

Weight loss is an important feature This is the correct answerThis is the correct answer
Pyloric stenosis is a congenital obstruction of the stomach. It more commonly affects boys than girls.

Vomiting usually starts in the 2nd or 3rd week of life and patients usually present by 6 weeks. Babies vomit and therefore lose weight but remain hungry and so feed enthusiastically. Differential diagnosis for pyloric stenosis are reflux and overfeeding.

The vomitus is not bile stained as it may be in duodenal atresia (depending on the site of obstruction).

In pyloric stenosis gastric peristaltic waves may be visible and a small 'olive' may be palpable. These features would not be present in duodenal atresia.

Abdominal x rays in patients with duodenal atresia may show the characteristic double bubble sign which is as a result of distension of the stomach and duodenum with a constricting pylorus between them.

Ultrasound is the standard investigation of pyloric stenosis. This should demonstrate the pyloric 'tumour' and confirm the clinical diagnosis.


Which of the following is true of a Meckel's diverticulum?
(Please select 1 option)
Is a vestigial remnant of the urachus
Is situated on the mesenteric surface of the gut
May contain ectopic gastric, pancreatic or colonic mucosa
May form the apex of an ileo-ileal intussusception
Most frequently presents with haematemesis in children over 2 years

May contain ectopic gastric, pancreatic or colonic mucosa

Meckel's diverticulum occurs in 2-3% of the population and is usually about 60 cm proximal to the ileocaecal junction on the anti-mesenteric surface of the gut.

This remnant of the vitello-intestinal duct most frequently presents with painless rectal bleeding with a peak incidence of symptoms in the first 2 years of life.

The mucosal lining is the same as the adjacent ileum but more than 35% have ectopic gastric, pancreatic or colonic mucosa at the tip.

Presentation is either with painless rectal bleeding or abdominal pain resulting from diverticulitis or an intussusception.


Umbilical hernia in early childhood is often associated with which of the following?
(Please select 1 option)
Asperger's syndrome
Down syndrome
Simple obesity
Type 1 diabetes mellitus

Down syndrome

Umbilical hernia is most common in infants of Afro-Caribbean origin and in prematurity.

It is also associated with

Hurler's syndrome and
Down syndrome.


Which of the following is true regarding intussusception?
(Please select 1 option)
Commonly occurs during adolescence
Is associated with haemophilia
Is more common in girls
Is not associated with any signs on per abdominal examination
Leads to haematemesis

Is associated with haemophilia

Intussusception occurs when a segment of bowel invaginates into its adjoining lower segment.

It is more common in boys. About 60% are under 1-year-old and 80%-90% under 2 years old. It is rare after the age of 6.

Intussusception is associated with

Henoch-Schönlein purpura
Haemangiomas, and
GI lymphomas.
Clinical features include severe colicky abdominal pain and vomiting.Between attacks the infant may appear in good health.

The infant may pass 'redcurrant jelly' stools and a sausage shaped mass is palpable on abdominal examination.

Rectal examination may reveal blood in the majority of cases and occasionally the apex of the intussusception is palpable.


Which condition requires surgical management in the newborn period?
(Please select 1 option)
Cavernous haemangioma
Hirschsprung's disease
Non-retractile prepuce
Tongue tie
Umbilical hernia

Hirschsprung's disease

The foreskin is non-retractile in the immediate newborn period and traumatic forced retraction may predispose to later phimosis by causing scarring.

Cavernous haemangiomas (strawberry naevi) are common and only very rarely require treatment with surgery. Most enlarge over the next few months and then subsequently regress.

Hirschsprung's disease presenting in the neonatal period requires surgical management with either resection of the aganglionic segment or formation of a colostomy proximal to the affected segment. Surgery may be delayed if the gut can be kept decompressed by regular rectal washouts or rectal stimulation.

Umbilical hernias usually resolve by about 2 years of age and only require surgery for cosmetic reasons if they persist for longer.

Tongue tie or short frenulum only requires surgical treatment in the most extreme cases and otherwise parental reassurance is all that is required.