Surgical Problems in children Flashcards Preview

MC > Surgical Problems in children > Flashcards

Flashcards in Surgical Problems in children Deck (103):
1

The head shape can recover to a normal
shape within about_____ weeks following birth

8

2

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

3

Plagiocephaly Mx

a _______________can be tried—best from 4 to 8 months

cranial remodelling helmet

4

This is premature fusion of one or more sutures of the
cranial vault and base, which act as lines of growth

Craniostenosis

5

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

6

Macrocephaly and microcephaly are defined as a head
circumference greater than the _______ percentile and less than the ______ percentile respectively

97th

3rd

7

The ears are almost adult size and firmness by _____

5
to 6 years of age

8

the ear cartilage is not strong
enough to cope with surgery under _____

3 years.

9

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

External angular dermoid

10

Congenital clefts of the lip and palate occur in
approximately _______

1:600 of all births.

11

Type of CLAP

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

submucus cleft,

12

The ideal age for repair of the cleft lip is
under ________ months of age

3

13

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

the child begins to speak

14

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

late adolescence.

15

-_______ 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

16

What condition?

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

Tongue tie (ankyloglossia)

17

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

4 months

18

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

19

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

Branchial sinus/cyst/fistula

20

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

21

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

22

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

23

A useful way to differentiate a true squint from a
pseudosquint is to observe the __________

(corneal reflections)

24

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

25

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

constant and
alternating ones,

26

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

27

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

Sternomastoid tumour/fibrosis

28

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

12 months.

29

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.

30

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

31

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

32

Lymphatic malformation/ lymphangioma/cystic hygroma location

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

33

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)

34

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

Venous malformations

35

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

Lymphatic malformation

36

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

6 weeks

37

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)

38

When to do surgery for macromastia

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

39

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

1 or 2 years.

40

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

41

Poland syndrome

Surgical correction can be undertaken from
________

10 to 20 years.

42

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

VSD

43

What type of VSD

_________harsh murmur,
usually asymptomatic and closes spontaneously.


_______symptoms appear in infancy

Small VSD (‘maladie de Roger’):



Larger VSD:

44

VSD Tx,

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

patch

45

As a general rule
about________ of all VSDs will close spontaneously

50%

46

VSD

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

membraneous

47

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

48

Signs of ASD

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

49

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

heart failure
with pulmonary hypertension

50

Prophylactic antibiotics
are needed for patients with ______

ostium primum

51

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’

52

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

Patent ductus arteriosus

53

Patent ductus arteriosus sx

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

54

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

Coarctation of the aorta

55

Inguinal hernias

These usually present in the first _______ months

3 to 4

56

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

57

______ are painless cystic swellings
around the testis

Scrotal hydroceles

58

Problem in scrotal hydrocele

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

59

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,

60

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.

61

Testes can still descend up to ____months after birth

3

62

Undescended testes

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

2 years

63

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

64

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

Phimosis

65

Phimosis

Probably the only indication for circumcision is
_________

persistent difficulty in passing urine

66

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

4 years of age

67

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

68

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

Para-umbilical hernia

69

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

epigastric hernia

70

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

herniated fat.

71

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

Anal fissures

72

________is caused by adhesions considered to be
acquired from perineal inflammation

Labial fusion

73

Dev dysplasia of hip

Detected by
1
2

clinical examination (Ortolani and
Barlow tests) and ultrasound examination

74

DDH

Infants are usually treated successfully by
_________

abduction splinting (e.g. Pavlik harness).

75

Bow legs (genu varum)

• Consider _______ in children at risk.
• Toddlers are usually bow-legged until 3 years of
age.

rickets

76

What to monitor in pts with genu varum?

Monitor _____________: distance
between medial femoral condyles

intercondylar separation (ICS)

77

What to monitor in pts with genu valgus:

Monitor ___________
distance between medial malleoli

Refer if: _______

intermalleolar separation (IMS):


IMS >8 cm

78

Causes of in-toeing are
1
2
3
4

metatarsus varus, internal tibial torsion and medial femoral
torsion.

79

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

femoral torsion

80

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

Out-toeing

81

Characteristic posture of Out-toeing pts

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

82

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’

83

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

stiff and severe

84

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)

85

Fortunately, most children outgrow inset hips before the age of_____

12.

86

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

11 years

87

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

tiptoe test

88

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

89

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

Oesophageal atresia:

90

Oesophageal atresia MX

Action: nil orally, oropharyngeal suction,
IV fluids

91

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

Diaphragmatic hernia

92

Mx Diaphragmatic hernia

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

93

Bilious (green vomiting) = ____ or ______

bowel obstruction or
malrotation (abdominal X-ray)

94

bowel obstruction or malrotation MX

Action: nasogastric drainage and refer (do not feed)

95

Imperforate anus and rectum

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

anoplasty


complex surgery

96

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

Bile duct atresia:

97

______________ respiratory
distress + cyanosis + signs of emphysema

Congenital lobar emphysema:

98

Congenital lobar emphysema MX

refer early for urgent assessment and
surgery to remove diseased lung

99

______________: respiratory
distress soon after birth

Congenital cystic disease of the lungs

100

______ (intestinal contents in a sac)

Exomphalos

101

_______(exposed bowel contents through
anterior wall defect

Gastroschisis

102

Action: as for exomphalos;_______

cover with plastic wrap

103

__________: micrognathia + cleft
palate + respiratory obstruction from tongue

Pierre–Robin syndrome