Surgical Problems in children Flashcards by MA CARMELA CONCEPCION SALES

The head shape can recover to a normal

shape within about_____ weeks following birth

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This is asymmetry of the skull with a normal head

circumference. The shape can be likened to a tilted
parallelogram.

It is the most common
cause of an abnormal head shape

Plagiocephaly

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Plagiocephaly Mx

a _______________can be tried—best from 4 to 8 months

cranial remodelling helmet

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This is premature fusion of one or more sutures of the

cranial vault and base, which act as lines of growth

Craniostenosis

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Craniostenosis Mx

Prompt referral to a paediatric craniofacial surgeon is
necessary as planning for possible complex surgery,
best at________months, is required

5 to 10

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Macrocephaly and microcephaly are defined as a head

circumference greater than the _______ percentile and less than the ______ percentile respectively

97th

3rd

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The ears are almost adult size and firmness by _____

to 6 years of age

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the ear cartilage is not strong

enough to cope with surgery under _____

3 years.

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This dermoid cyst, which has a readily identifiable
constant position, lies in the outer aspect of the
eyebrow

External angular dermoid

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Congenital clefts of the lip and palate occur in

approximately _______

1:600 of all births.

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Type of CLAP

frequently not recognised in infancy because the palate appears to be intact

submucus cleft,

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The ideal age for repair of the cleft lip is

under ________ months of age

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The repair of the palate, which requires preliminary diagnostic ultrasound, is best performed before _______

the child begins to speak

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Rhinoplasty is best deferred to ________
If performed early there is a higher incidence of
secondary surgery.

late adolescence.

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-_______ may be unilateral, leading to
delayed diagnosis, or bilateral, where there is no
instinctive reaction to breathe through the mouth,
leading to asphyxia

Choanal atresia

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What condition?

• tongue may appear heart-shaped
• infants unable to protrude the tongue over the
lower lip
• breastfeeding problems

Tongue tie (ankyloglossia)

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The ideal time to release the ‘tie’ is in infancy,

under ______

4 months

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This common condition can get recurrently infected
with pus discharge from a small opening immediately
anterior to the ear at the level of the meatus in front
of the upper crus of the helix

Pre-auricular sinus

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This is a rare condition and is located inferior to
the external auditory meatus or anterior to the
sternomastoid muscle

Branchial sinus/cyst/fistula

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A squint is rarely obvious in the first weeks of life,
but tends to show up when the baby learns to use the
eyes, from about__________

2 weeks to 3 or 4 months of age

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Types of squint

• ___________ is one that is permanent—
always present.
• __________ is one that only appears under
stressful conditions such as fatigue.
• _________ is one that is noticeable for short
periods and then the eye appears normal.

Constant or true squint

Latent squint

Transient squint

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Types of squint

• ___________ is one that changes between
the eyes so the child can use either eye to fix
vision.
• __________ is not a true squint but only appears
to be one because of the shape of the eyelids, i.e.
broad epicanthic folds

Alternating squint

Pseudosquint

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A useful way to differentiate a true squint from a

pseudosquint is to observe the __________

(corneal reflections)

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If one eye is ‘lazy’ (that is, not being used), it

is standard practice to _________

wear a patch (maybe on

glasses) over the good eye for long periods

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The two serious squints are the _____ and _______ which require early referral

constant and | alternating ones,

Children with strabismus (even if the ocular examination is normal) need specialist management because the deviating eye will become _________

amblyopic (a lazy eye with reduced vision

• hard painless lump (2–3 cm long) within sternomastoid muscle • tight and shortened sternomastoid muscle • usually not observed at birth

Sternomastoid tumour/fibrosis

If surgery for a persistent fibrotic shortened muscle is required it is best before __________

12 months.

Associations of shortened sternomastoid muscle

1. rotation of the head to the affected side, 2. hemihypoplasia of the face and a 3. wasted ipsilateral trapezius muscle.

This is the most common childhood midline neck swelling. It moves with swallowing and tongue protrusion. It is prone to infection, including abscess formation.

Thyroglossal cyst

These usually present as soft cystic tumours of the neck, face or oral cavity. They resemble clusters of vesicles and are often poorly localised

Lymphatic malformation/ | lymphangioma/cystic hygroma

Lymphatic malformation/ lymphangioma/cystic hygroma location

If located in the floor of the mouth or peripharyngeal | area they endanger the airway

These start soon after birth as a red pinpoint lesion and grow rapidly for the first 6 months, then involute and become pale

Infantile haemangioma | strawberry naevus

These are aggregations of abnormal subcutaneous | veins that may infiltrate deeper tissues.

Venous malformations

These appear sometimes as skin lesions because of | the red discolouration on the surface of the tumour

Lymphatic malformation

If giant naevi they can be dermabraded at ideally less | than _______

6 weeks

These pigmented lesions, which typically appear on the face, are usually surgically excised because of their rapid growth and family concerns

Benign juvenile melanoma | Spitz naevus

When to do surgery for macromastia

Reduction surgery should also be delayed until breast | growth is complete, at late adolescence

If it develops in the pubertal stage, gynaecomastia may resolve spontaneously within ________

1 or 2 years.

This syndrome is an absent sternal head of pectoralis major with associated chest wall deformity plus a hypoplastic or absent breast and nipple–areolar complex

Poland syndrome

Poland syndrome Surgical correction can be undertaken from ________

10 to 20 years.

_______ is the commonest congenital heart lesion (1:500 | births).

VSD

What type of VSD _________harsh murmur, usually asymptomatic and closes spontaneously. _______symptoms appear in infancy

Small VSD (‘maladie de Roger’): Larger VSD:

VSD Tx, A ______ can close the defect through open-heart surgery.

patch

As a general rule | about________ of all VSDs will close spontaneously

50%

VSD The ________ type, unlike the muscular type, is less likely to close spontaneously.

membraneous

In ASD the defect connects the two atria with two distinct types—________ with holes higher in the septum (most common) and _________ with holes lower in the septum (more serious)

ostium secundum ostium primum

Signs of ASD

Signs are a mid-systolic murmur in the | pulmonary area, a split 2nd sound and a loud P2.

Symptoms are uncommon in infancy and | childhood with ostium secundum but ______ and ________develops early with ostium primum.

heart failure | with pulmonary hypertension

Prophylactic antibiotics | are needed for patients with ______

ostium primum

Mx of ASD Options are repair by________ or an insertion of a patch or a device closure using a ___________manipulated into the defect via cardiac catheterisation.

direct surgical suture self-expanding ‘double umbrella device’

The ductus fails to close after birth. A loud, continuous | machinery murmur is heard

Patent ductus arteriosus

Patent ductus arteriosus sx

The child presents with a murmur with possible respiratory infections, failure to thrive and heart failure.

This usually presents in infancy with heart failure. Refer for early surgery to remove the narrowed portion of the aorta

Coarctation of the aorta

Inguinal hernias These usually present in the first _______ months

3 to 4

They and _______ hernias should be referred urgently as early surgery is advisable to avoid the high risk of bowel incarceration or strangulation and ovarian entrapment and ischaemia in females

femoral

______ are painless cystic swellings | around the testis

Scrotal hydroceles

Problem in scrotal hydrocele

The opening of the processus | vaginalis is narrow and often closes spontaneously

Hydrocele Two types can be identified— 1. _______ which disappear within 12 months, 2. _____ which often persist after the first year

slack, often bilateral, tense, often unilateral,

Hydrocele Ninety per cent resolve by 18 months of age; for those that persist, referral is recommended with a view to surgical intervention if present for longer than _________

2 years.

Testes can still descend up to ____months after birth

Undescended testes Refer by 6 months with a view to correction between 9 and 12 months but definitely before ______

2 years

What condition Non-urgent cases should be evaluated by 6 months with a view to surgery at around 12 months; these patients should not be circumcised.

Hypospadias

uncommon and almost all cases of tight foreskin with narrowing of the preputial orifice resolve naturally

Phimosis

Phimosis Probably the only indication for circumcision is _________

persistent difficulty in passing urine

Surgery is not usually required for umbilical herniae | as most close naturally by _______

4 years of age

A good guideline is that if the hernial orifice is greater than 1 cm at ______ then surgical intervention is a possibility. It is usual to operate at 4–5 years

12 months

This is due to a defect in the linea alba adjacent to the | umbilicus proper. Most lie just above the umbilicus.

Para-umbilical hernia

``` An ________ (not to be confused with divarification of the rectus muscles) lies between the umbilicus and the xiphisternum. ```

epigastric hernia

epigastric hernia is likely to incarcerate and causes pain by strangulation of _______

herniated fat.

________are often seen in infants and toddlers with uncomfortable defecation and minimal bright bleeding

Anal fissures

________is caused by adhesions considered to be | acquired from perineal inflammation

Labial fusion

Dev dysplasia of hip Detected by 1 2

``` clinical examination (Ortolani and Barlow tests) and ultrasound examination ```

DDH Infants are usually treated successfully by _________

abduction splinting (e.g. Pavlik harness).

Bow legs (genu varum) • Consider _______ in children at risk. • Toddlers are usually bow-legged until 3 years of age.

rickets

What to monitor in pts with genu varum? Monitor _____________: distance between medial femoral condyles

intercondylar separation (ICS)

What to monitor in pts with genu valgus: Monitor ___________ distance between medial malleoli Refer if: _______

intermalleolar separation (IMS): IMS >8 cm

``` Causes of in-toeing are 1 2 3 4 ```

metatarsus varus, internal tibial torsion and medial femoral | torsion.

Children with __________ tend to sit in | a characteristic ‘W’ sitting position

femoral torsion

Have restricted internal rotation of hip due to an | external rotation contracture

Out-toeing

Characteristic posture of Out-toeing pts

Exhibit a ‘Charlie Chaplin’ posture between 3 and | 12 months—up to 2 years

Most abnormal-looking feet in infants are not a true club foot deformity; the majority have postural problems referred to as _______ such as talipes calcaneovalgus, metatarsus varus and postural talipes equinovarus

‘postural talipes’

True club foot deformity is usually_____, and requires orthopaedic correction.

stiff and severe

What condition? the femur tends to rotate inwards especially when the child is about 5–6 years old and is normal up to 12 years

Inset hips (medial femoral torsion)

Fortunately, most children outgrow inset hips before the age of_____

12.

All newborns have flat feet but 80% develop a medial arch by their sixth birthday and most by _______

11 years

The presence of the medial arch can be | demonstrated to parents by the _______

tiptoe test

MC type of curly toe

Usually the third toe curls inward under the second toe so that the second toe lies above the level of the first and third toes

________rattling respiratory distress + excessive drooling and secretions + choking with feeding (passage of 10F catheter stops about 10 cm)

Oesophageal atresia:

Oesophageal atresia MX

Action: nil orally, oropharyngeal suction, | IV fluids

severe respiratory distress + barrel-shaped chest + scaphoid abdomen (X-rays of chest/abdomen show loops of bowel in chest)

Diaphragmatic hernia

Mx Diaphragmatic hernia

Give O 2 , nasogastric tube (avoid bag and | mask)

Bilious (green vomiting) = ____ or ______

bowel obstruction or | malrotation (abdominal X-ray)

bowel obstruction or malrotation MX

Action: nasogastric drainage and refer (do not feed)

Imperforate anus and rectum Action: refer for surgery on day of birth, _______ for low lesions; ______ for high lesions

anoplasty complex surgery

``` __________neonatal jaundice (conjugated bilirubin) (usually 4–6 weeks) → white stools ```

Bile duct atresia:

______________ respiratory | distress + cyanosis + signs of emphysema

Congenital lobar emphysema:

Congenital lobar emphysema MX

refer early for urgent assessment and | surgery to remove diseased lung

______________: respiratory | distress soon after birth

Congenital cystic disease of the lungs

______ (intestinal contents in a sac)

Exomphalos

_______(exposed bowel contents through | anterior wall defect

Gastroschisis

Action: as for exomphalos;_______

cover with plastic wrap

__________: micrognathia + cleft | palate + respiratory obstruction from tongue

Pierre–Robin syndrome

Surgical Problems in children Flashcards

(103 cards)