surgical

Question 1

ddx neonatal bilious vomiting

Answer 1

Surgical

a. Malrotation with midgut volvulus
b. Intestinal atresia
c. Meconium ileus
d. Necrotising enterocolitis
e. Hirschsprung’s disease

Non-surgical

a. Sepsis
b. Meningitis
c. Omphalitis
d. Reflux

Question 2

exomphalos vs gastroschisis

Answer 2

exomphalos:

• herniation through defect at base of umbi
• therefore protected by sac (membrane) continuous with umbi
• poor outcome 10% survival
• more associated with genetics - BW, T13, T18
• if liver in sac, less likely aneuploidy risk

gastroschisis:
- herniation through abdo wall defect, usually to right of umbi
- no protective sac
- better outcome 90% survival
- AFP high
- cord paraumbi

Question 3

consequences of CDH and long-term

Answer 3

pulmonary hypoplasia and pul HTN
malrotation
dextrocardia

long-term:
reflux, CLD, obstruction, recurrence of hernia

Question 4

treatment of CDH

Answer 4

supportive: NGT
ventilate: HFOV vs CV, ECMO
treat pul HTN: NO, open PDA
surgical

Question 5

what is diaphragmatic eventration

Answer 5

part of the diaphgram didnt muscularise good -> moves paradoxically
most is whatever, doesnt need repair

Question 6

which TOF kind most common

Answer 6

type C = oesophageal atresia with distal TOF

Question 7

types of TOF

Answer 7

A = atresia only
B = atresia + prox TOF
C = atresia + distal TOF
D = atresia + both TOF
E = h type = TOF no atresia

Question 8

presence of air in stomach/bowel with a TOF must mean what type?

Answer 8

distal fistula present

Question 9

how may TOFs present

Answer 9

US scan - polyhydramnios cant swallow fluid

birth - cant feed, vomiting/coughing, resp distress, infections, frothy mucous

Question 10

which TOF type can present later?

Answer 10

H - no atresia, so stuff could go down to GI (or resp)

Question 11

which type of TOF has worst prognosis?

Answer 11

A - pure atresia

Question 12

pyloric stenosis

• age
• biochemical finding

Answer 12

• 2-6 weeks

- hypokalaemic hypochloraemic met alkalosis (vomit up Cl and H2O, kidneys conserve Na/H2O and kick out H/K)

Question 13

exam thoughts: pyloric atresia = what condition?

Answer 13

= EB

Question 14

when does malrotation present?

Answer 14

most within first year

most in D1-D3 of life

Question 15

most common type of intestinal atresia

Answer 15

duodenal

Question 16

duodenal atresia radiological finding

Answer 16

double bubble

Question 17

duodenal atresia - vomit colour and distension: comment

Answer 17

no distension

bilious if distal to ampulla - most common

Question 18

exam thoughts: duodenal atresia = what syndrome

Answer 18

T21

Question 19

duodenal atresia have to screen for what and why

Answer 19

a/w congenital abnormalities 
echo - CHD 
renal USS 
cxr - TOF
annular pnacreas

Question 20

jejunoileal atresia - what kind of thing has gone wrong i.e. pathology

Answer 20

vascular shit

Question 21

non-operative Mx for mec ileus

Answer 21

NAC - water soluble enema

Question 22

NEC - clinical triad

Answer 22

bilious asps/vomiting
abdo distension
blood in stool

Question 23

pathogenesis of NEC

Answer 23

invasion of bad bacteria into wall
bad bacteria form gas + inflammation
ischaemic necrosis of wall

Question 24

risk factors for NEC

Answer 24

VLBW
aggressive enteral feeding
formula feeding
prolonged abx

Question 25

NEC - some possible axr findings

Answer 25

i. Dilated loops of bowel consistent with ileus ii. Pneumatosis intestinalis (hallmark of NEC) = bubbles of gas in the small bowel wall iii. Pneumoperitoneum = occurs with perforation; gas outlining both sides of the bowel wall v. Portal venous gas

Question 26

classic exam finding of intestinal perf

Answer 26

blue-black discolouration of abdominal wall

Question 27

most common cause of neonatal obstruction

Answer 27

Hirschprung's

Question 28

where in the colon is most Hirschprung disease

Answer 28

80% rectosigmoid

Question 29

Hirschprung's - most common associated gene

Answer 29

RET protooncogene

Question 30

Hirschprungs - how can they present

Answer 30

``` no mec in 48h bilious vomits abdo distension enterocolitis / obstruction / perf FTT constipation squirt sign ```

Question 31

age of umbi hernia surgery vs inguinal

Answer 31

umbi: 2-3yo - 9/10 resolve spontaneously before then inguinal: 6:2 rule <6 weeks within 2 days, if <6 months within 2 weeks, if >6 months within 2 months

Question 32

meckel's - rule of 2s

Answer 32

i. Most common in children under 2 ii. 2 times more common in males iii. Contains 2 types of tissue (pancreatic + gastric) iv. 2 inches long v. Found within 2 feet of the ileocaecal valve vi. Occurs in 2% of the population

Question 33

age of intussusception

Answer 33

3mo-2yo

Question 34

classic triad intussusception

Answer 34

abdo pain red currant jelly stool sausage shaped mass

Question 35

examples of pathological lead points in intussusception

Answer 35

i. Meckel’s diverticulum ii. Polyps iii. Henoch-Schonlein purpura iv. Duplication cyst v. Other 1. Intestinal lymphoma (>6 months) 3. Adenovirus or rotavirus infection 4. Celiac disease 5. CF

Question 36

US finding of intussusception

Answer 36

target sign

Question 37

paraphimosis vs phimosis

Answer 37

phimosis cant retract - foreskin will balloon. physiological or there's been scarring e.g. circumcision, recurrent balanitis paraphimosis - can't put back a retracted foreskin

Question 38

hypospadias - what

Answer 38

urethral meatus opens on underside of penis, and usually a/w chordee (bands pulling penis into curve) or hooded dorsal foreskin

Question 39

exam thoughts - priapism = what disease

Answer 39

1/3 sickle cell develop priapism

Question 40

when is foreskin fully retractable

Answer 40

3yo

Question 41

inguinal hernia age

Answer 41

greatest in 1st year of life

Question 42

when do most congenital UDT descend and why? so when do you need to refer for orchidopexy?

Answer 42

3mo - testosterone surge by 2mo so it wont descend after 4mo and need to refer orchidopexy by 6-12mo

Question 43

male newborn with bilaterally UDT - exam thoughts - think of what??

Answer 43

is it even a boy tho? could be virilised female with CAH

Question 44

whats the risks of a UDT

Answer 44

testicular cancer torsion infertility hernia - 90% have an associated patent tunica vaginalis

Question 45

age groups of appendage torsion testicular torsion E-O hydrocele varicocele idiopathic scrotal oedema

Answer 45

appendage torsion - pre-pubertal testicular - neonatal and adolescents E-O - rare pre-puberty until has UTI with genitourinary issue!! usually adolescent with STI hydrocele - infants varicocele - peri-pubertal idiopathic scrotal oedema - 3-7yo

Question 46

mumps orchitis occurs how long after parotitis

Answer 46

Mumps orchitis occurs 4-6days after parotitis**

Question 47

main complications of varicocele

Answer 47

impaired fertility in 10-15%

Question 48

pathophys of a non reactive hydrocoele | when to surgery and why

Answer 48

a. The patent processus vaginalis is narrow and enables peritoneal fluid, but not abdominal contents, into the cord structures b. Patent processus vaginalis often closes on its own, in the first 18 months of life surgery only if >2yo

Question 49

exam thoughts: mec ileus = what?

Answer 49

90% = cystic fibrosis!!