Surgery and Urology

Question 1

What is the symptomatic triad of appendicitis?

Answer 1

Murphy's:
Pain
Vomiting
Fever
McBurney's point - one-third of the distance from the anterior superior iliac spine to the umbilicus

Question 2

How is appendicitis treated?

Answer 2

Surgical removal

Question 3

What are the complications of appendicitis?

Answer 3

Abscess
Mass
Peritonitis

Question 4

What is malrotation?

Answer 4

When the intestine doesn’t form properly

Question 5

What are the signs of malrotation?

Answer 5

Bilious vomiting

Question 6

What investigations would be done if malrotation was suspected?

Answer 6

Upper GI contrast study

Question 7

How is malrotation treated?

Answer 7

Laparotomy

Question 8

What are the complications of malrotation?

Answer 8

Volvulus - loop of intestine twists around itself causing bowel obstruction

Question 9

What age group is malrotation common in?

Answer 9

First few weeks - first few months

Question 10

What is the pathology of intussusception?

Answer 10

Bowel invaginate into itself

Leads to obstruction of faeces through the bowel

Question 11

What are the signs of intussusception?

Answer 11

Preceding viral illness
Severe, colicky abdominal pain
Palpable mass - RUQ, sausage shaped
Pallor
Lethargic
Stool - redcurrent jelly (late)
Vomiting

Question 12

What investigation would be done if intussusception was suspected?

Answer 12

Ultrasound - looks like a target

Question 13

How is intussusception treated?

Answer 13

Pneumostatic air reduction (air enema)

Laparotomy

Question 14

What are the complications of intussusception?

Answer 14

Obstruction
Gangrenous bowel
Perforation

Question 15

What age group is intussusception more common in?

Answer 15

Infants 6 months to 2 years

Question 16

What is the pathology of a hernia?

Answer 16

Direct - caused by weakness in the posterior muscular wall of the inguinal canal
Indirect - contents pass through the canal and exit through the superficial inguinal ring

Question 17

What is a major risk factor for a hernia?

Answer 17

Increased risk with prematurity

Question 18

What are the signs of a hernia?

Answer 18

Groin swelling

Question 19

How are hernia’s treated?

Answer 19

<1 year - urgent referral, repair
>1 year - elective referral and repair
Incarcerated - reduce and repair on the same admission

Question 20

What are the complications of hernia’s?

Answer 20

Incarcerated - bowel obstruction

Question 21

What type of hernias are most common and in which sex?

Answer 21

99% indirect

Boys 9:1

Question 22

What is a hydrocele?

Answer 22

Fluid filled sac around the testes

Question 23

What are the signs of a hydrocele?

Answer 23

Bluish scrotal swelling

Painless - increases with crying, straining

Question 24

What investigations would be done if a hydrocele was suspected?

Answer 24

Ultrasound

Trans illuminate with light

Question 25

How are hydroceles treated?

Answer 25

Conservative until 5yrs of age

Question 26

What is the pathology of cryptorchidism?

Answer 26

When the testes don't descent from the abdomen into the scrotum (mostly inguinal)

Question 27

How is cryptorchidism treated?

Answer 27

Newborns - watch and wait (most descent in first 3-6 months) Refer to paediatric urologist if not descended by 6 months Orchiodexopathy

Question 28

What are the complications of cryptorchidism?

Answer 28

If left untreated - testicular cancer

Question 29

What is the pathology of vesicle-uterine reflux?

Answer 29

Urine flows back into the ureters/kidneys away from the bladder

Question 30

How is vesicle-uterine reflux treated?

Answer 30

Conservative - voiding advice

Question 31

What is the WHO pain ladder for children?

Answer 31

Paracetamol – 20mg/kg 4-6hrly Ibuprofen – 10mg/kg 8hrly Weak opioid – codeine not recommended <12 years Strong opioid

Question 32

Fluid resuscitation

Answer 32

20ml/kg bolus 0.9 NaCl

Question 33

Fluid maintenance

Answer 33

0.9% NaCl/5% Dextrose +/- 0.15% KCl 4ml/kg 1st 10kg 2ml/kg 2nd 10kg 1ml/kg every kg thereafter

Question 34

What are the features of non-specific abdominal pain?

Answer 34

``` Short duration Central Constant Not made worse by movement No GIT disturbance No temperature Site and severity of tenderness varies ```