Surgery

Question 1

What is congenital diaphragmatic hernia

Answer 1

Bowels with bowel gas above the diaphragm, pushing heart to side

Question 2

What is oesophagael atreasia

Answer 2

Stricture of oesophagus or joining of oesophagus to trachea

Question 3

XR sign of duodenal atresia

Answer 3

Double bubble

Question 4

What is duodenal atresia associated with

Answer 4

Downs

Question 5

What causes SB atresia

Answer 5

Hypoxia in utero

Question 6

what is meconium ileus

Answer 6

xs mucous causing sticky meconium

Question 7

assoication with meconium ileus

Answer 7

CF

Question 8

2 types of anorectal anomalies

Answer 8

High - ectopic faecal-urinary pathway
Low

Question 9

What is gastroschisis

Answer 9

Defect under umbilicus where bowel is extruded out of body
Picked up on 20 week scan

Question 10

What is exomphalos

Answer 10

Similar to gastroschisis but assoicated with trisomys/other syndromes

Question 11

what is bladder extrophy

Answer 11

bladder is open on abdominal wall
Small, splayed open penis
anterior ectopic anus

Question 12

What is NEC

Answer 12

Intramural gas
Patchy necrosis of bowel

Question 13

2 types of interesting vomitting to surgeons

Answer 13

Projectile (2 to 6 weeks)
Green - bile

Question 14

Is projectile vomitting common?

Answer 14

YES - all children will have it, but they dont mean proper projectile, which would not go down the childs front, but hit the wall

Question 15

Dx of pyloric stenosis

Answer 15

USS

Question 16

PC of pyloric stenosis

Answer 16

Projectile vomitting
Hungry
Dehydrated

Question 17

Electrolyte imbalance in pyloric stenosis

Answer 17

Hypocholoraemic alkalosis

Question 18

What age group gets pyloric stenosis

Answer 18

2-6 weeks

Question 19

What is malrotation

Answer 19

duodenum is fixed to abdominal wall, causing short mesentery which causes DJ flexure to be very high. Causes small bowel to twist on itself

Question 20

what does a dark green vomit indicate

Answer 20

malrotation

Question 21

when does malrotation surgery need to be done

Answer 21

within 4-6 hours

Question 22

3 months to 2 year old baby with sudden colicky pain. Dx?

Answer 22

Intususception

Question 23

pathognomonic late sign of intussusception

Answer 23

red currant jelly stool

Question 24

XR sign of intussusception

Answer 24

dilated small bowel loops

Question 25

Dx of intussusception

Answer 25

USS

Question 26

Mx of intussusception

Answer 26

IV ABx 80% Air enema - CO2 per rectum under measured pressures to push bowel back 20% need

Question 27

what is intussusception

Answer 27

invaginated ileum (telescopes into itself)

Question 28

what chronic abdo pain would you worry about

Answer 28

Persistent / recurrent pain that interferes with school Non central abdo pain - H/Pylori etc

Question 29

What inguinal lumps need urgent surgery

Answer 29

under 2 years old and painful ones

Question 30

what inguinal lumps are non urgent

Answer 30

reducible hernia (the majority) old than 2 years old empty scrotum

Question 31

when do you operate on undescended testes

Answer 31

by 2 years of age

Question 32

what is the risk of undescended testes

Answer 32

poor fertility increased risk of malignancy (3-11x increase risk, up to 25% if intrabdominal) cosmetic appearance

Question 33

Ix of undescended testes

Answer 33

Laparoscopy better than USS (can't see) or MRI (needs GA)

Question 34

how long do you have to operate on testicular torsion

Answer 34

4-6 hours

Question 35

age peaks of torsion

Answer 35

neonates pubertal

Question 36

PC of testicular torsion

Answer 36

RIF pain hemiscrotum red whole scrotum hard and tender

Question 37

Dx of epididimorchitis

Answer 37

surgery - can't clinically tell from torsion

Question 38

non urgent scrotal conditions

Answer 38

infantile hydrocele painless lumps - epidymal cysts varicocele

Question 39

describe natural history of foreskin

Answer 39

starts as narrow opening of prepuce, inner layer of prepuce adhered to the glans of penis then either of 2 problems can occur... adhesion separates but smegma accumulates causing balanitis OR early retractile of foreskin, where prepuce stays adhered

Question 40

Tx of balanitis

Answer 40

Regular washing

Question 41

what is hypospadias

Answer 41

incomplete foreskin ventrally but excess dorsally ureter not at the tip of the glans as it should be

Question 42

what are the most urgent things to deal with if swallowed?

Answer 42

button batteries causing dysphagia sharp

Question 43

if something passes into the stomach, what is the Mx?

Answer 43

LEAVE IT - it will pass if its got that far

Question 44

why are button batteries so dangerous?

Answer 44

In oesophagus they can cause burns and erosions

Question 45

what lumps need urgent surgery?

Answer 45

Large Painful Erythema / oedema - not always fluctuant Anxiogenic (worried)

Question 46

non acute lumps

Answer 46

acute midline cervical branchial lymph nodes under 2cm haemangiomas in infants

Question 47

when do you operate on umbilical hernias & why

Answer 47

4 years old - many are gone by then

Question 48

if you see a midline neck lump, what do you ask child to do? which lump are you trying to identify here?

Answer 48

stick tongue out - branchial cyst will move

Question 49

why do you leave haemangiomas alone in infants?

Answer 49

they often stabalise and self resolve

Question 50

what group is associated with rectal prolapse

Answer 50

toddlers with CF