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MRCS A - Dr Bishoy > 25- Pediatric Explains > Flashcards

25- Pediatric Explains Flashcards

1
Q

What is the most common cause of bronchogenic cysts?

A

Bronchogenic cysts most commonly arise from anomalous development of the ventral foregut.

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2
Q

Where do bronchogenic cysts typically occur?

A

Bronchogenic cysts often lie near the midline and are commonly found in the region of the carina.

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3
Q

Are bronchogenic cysts usually single or multiple?

A

While most bronchogenic cysts are single, multiple cysts can also occur.

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4
Q

What are the common symptoms of bronchogenic cysts in the neonatal period?

A

Bronchogenic cysts may be asymptomatic or present with respiratory symptoms early in the neonatal period.

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5
Q

Where do bronchogenic cysts rank among the different types of foregut cysts in the middle mediastinum?

A

Bronchogenic cysts are the second most common type of foregut cysts (after enterogenous cysts) in the middle mediastinum.

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6
Q

How often are bronchogenic cysts diagnosed before the age of 15?

A

Up to 50% of bronchogenic cyst cases are diagnosed prior to 15 years of age.

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7
Q

What imaging technique is recommended for diagnosing bronchogenic cysts?

A

Once bronchogenic cysts are suspected, a CT scan should be performed for confirmation.

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8
Q

What is the ideal treatment for bronchogenic cysts?

A

Thoracoscopic resection is considered the ideal treatment for bronchogenic cysts.

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9
Q

At what age can very young babies undergo surgical treatment for bronchogenic cysts?

A

Very young babies can be operated on once they reach six weeks of age.

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10
Q

What are the components of the umbilicus during embryonic development?

A

During development, the umbilicus has two umbilical arteries and one umbilical vein.

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11
Q

What arteries are the umbilical arteries continuous with?

A

The umbilical arteries are continuous with the internal iliac arteries.

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12
Q

What does the umbilical vein connect to after birth?

A

After birth, the umbilical vein is continuous with the falciform ligament (ductus venosus).

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13
Q

What happens to the umbilical cord after birth?

A

The umbilical cord dessicates and separates, and the umbilical ring closes.

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14
Q

What percentage of neonates may have an umbilical hernia?

A

Up to 20% of neonates may have an umbilical hernia.

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15
Q

Are umbilical hernias more common in premature infants?

A

Yes, umbilical hernias are more common in premature infants.

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16
Q

Is strangulation of an umbilical hernia common?

A

No, strangulation of an umbilical hernia is rare.

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17
Q

Do umbilical hernias typically close spontaneously?

A

Yes, the majority of umbilical hernias will close spontaneously, although it may take between 12 months and three years.

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18
Q

What causes omphalitis, an infection of the umbilicus?

A

Omphalitis is commonly caused by infection with Staphylococcus aureus.

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19
Q

Why is omphalitis considered a potentially serious condition?

A

Omphalitis can spread rapidly through the umbilical vessels, putting neonates at risk of portal pyaemia and portal vein thrombosis.

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20
Q

How is umbilical granuloma typically treated?

A

Umbilical granulomas, characterized by cherry red lesions, can often be treated with chemical cautery using topically applied silver nitrate.

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21
Q

What is the most common presentation of persistent vitello-intestinal duct?

A

Persistent vitello-intestinal duct typically presents as an umbilical discharge containing small bowel content.

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22
Q

What is persistent urachus?

A

Persistent urachus is characterized by urinary discharge from the umbilicus due to the persistence of the urachus, which attaches to the bladder.

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23
Q

How are persistent vitello-intestinal ducts managed?

A

Persistent vitello-intestinal ducts are best imaged using a contrast study to evaluate the anatomy and are managed through laparotomy and surgical closure.

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24
Q

What is the estimated prevalence of biliary atresia?

A

Biliary atresia affects approximately 1 in 17,000 individuals.

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25
Q

What causes progressive liver damage in biliary atresia?

A

The lumen of the biliary tree is obliterated by an inflammatory cholangiopathy, leading to progressive liver damage.

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26
Q

What are the clinical features of biliary atresia?

A

In the first few weeks of life, infants with biliary atresia appear well. They typically have no family history of liver disease. Jaundice persists for more than 14 days in term infants (or more than 21 days in preterm infants). Other features include pale stool and yellow urine (which may appear colorless in babies). Biliary atresia is also associated with cardiac malformations, polysplenia, and situs inversus.

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27
Q

What investigations are commonly performed for biliary atresia?

A

Investigations for biliary atresia include measuring conjugated bilirubin levels (as opposed to unconjugated bilirubin seen in physiological or breast milk jaundice), ultrasound of the liver (to exclude extrahepatic causes and identify potential gallbladder changes), and a hepato-iminodiacetic acid radionuclide scan (which typically shows good uptake but no excretion).

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28
Q

What is the initial management approach for biliary atresia?

A

Nutritional support is an essential component of management for individuals with biliary atresia.

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28
Q

Why is early recognition of biliary atresia important?

A

Early recognition of biliary atresia is crucial to prevent the need for liver transplantation.

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29
Q

What surgical procedure is commonly performed for biliary atresia?

A

The Roux-en-Y portojejunostomy, also known as the Kasai procedure, is often performed as the initial surgical intervention for biliary atresia.

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30
Q

When is a liver transplant considered for biliary atresia patients?

A

If the Kasai procedure fails or if biliary atresia is recognized late, a liver transplant becomes the only viable option.

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31
Q

What are the common causes of intestinal obstruction with bilious vomiting in neonates?

A

Common causes include duodenal atresia, malrotation with volvulus, jejunal/ileal atresia, meconium ileus, and necrotizing enterocolitis.

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32
Q

What is the incidence of duodenal atresia?

A

Duodenal atresia occurs in approximately 1 in 5000 neonates, with a higher incidence in individuals with Down syndrome.

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33
Q

When does duodenal atresia typically present?

A

Duodenal atresia usually presents a few hours after birth.

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34
Q

What radiographic sign is associated with duodenal atresia?

A

The “double bubble sign” is seen on abdominal X-ray (AXR), and a contrast study may be performed to confirm the diagnosis.

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35
Q

What is the recommended treatment for duodenal atresia?

A

Duodenoduodenostomy is the surgical procedure commonly performed for duodenal atresia.

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36
Q

What is the main cause of malrotation with volvulus in neonates?

A

Malrotation with volvulus is usually caused by incomplete rotation during embryogenesis.

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37
Q

When does malrotation with volvulus typically present?

A

Malrotation with volvulus usually presents between 3 and 7 days after birth, and in severe cases, it can result in peritoneal signs and hemodynamic instability.

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38
Q

What imaging studies can help diagnose malrotation with volvulus?

A

An upper gastrointestinal contrast study may show abnormal positioning of the duodenojejunal (DJ) flexure, and an ultrasound may reveal abnormal orientation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV).

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39
Q

What is the incidence of jejunal/ileal atresia in neonates?

A

Jejunal/ileal atresia occurs in approximately 1 in 3000 neonates.

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40
Q

What is the surgical procedure of choice for malrotation with volvulus?

A

The Ladd’s procedure is the recommended surgical treatment for malrotation with volvulus.

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41
Q

When does jejunal/ileal atresia typically present?

A

Jejunal/ileal atresia usually presents within 24 hours of birth.

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42
Q

What radiographic finding is associated with jejunal/ileal atresia?

A

Abdominal X-ray (AXR) typically shows air-fluid levels.

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43
Q

What is the recommended treatment for jejunal/ileal atresia?

A

Laparotomy with primary resection and anastomosis is the standard treatment for jejunal/ileal atresia.

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44
Q

What is the incidence of meconium ileus in neonates?

A

Meconium ileus occurs in approximately 1 in 5000 neonates, but the incidence is higher in babies with cystic fibrosis (15-20%).

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45
Q

When does meconium ileus typically present?

A

Meconium ileus typically presents within the first 24-48 hours of life, characterized by abdominal distension and bilious vomiting.

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46
Q

What radiographic finding is associated with meconium ileus?

A

Abdominal X-ray (AXR) shows air-fluid levels, and a sweat test is performed to confirm cystic fibrosis.

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47
Q

What is the recommended treatment for meconium ileus?

A

Surgical decompression is performed, and in cases with serosal damage, segmental resection may be necessary.

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48
Q

What is the incidence of necrotizing enterocolitis (NEC) in neonates?

A

Necrotizing enterocolitis occurs in up to 2.4 per 1000 births, with increased risks in premature infants and those with intercurrent illness.

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49
Q

When does necrotizing enterocolitis typically present?

A

Necrotizing enterocolitis usually presents during the second week of life.

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49
Q

What radiographic findings are associated with necrotizing enterocolitis?

A

Abdominal X-ray (AXR) shows dilated bowel loops, pneumatosis, and portal venous air.

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50
Q

What is the recommended management approach for necrotizing enterocolitis?

A

Conservative and supportive measures are used for non-perforated cases, while laparotomy and resection are performed in cases with perforation or ongoing clinical deterioration.

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51
Q

What is the gender predilection for pyloric stenosis?

A

Pyloric stenosis is more common in males than females.

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52
Q

What percentage of cases of pyloric stenosis have a family history in parents?

A

Approximately 5-10% of cases of pyloric stenosis have a family history in parents.

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53
Q

What are the typical symptoms of pyloric stenosis?

A

Projectile, non-bile stained vomiting usually occurs at 4-6 weeks of life.

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54
Q

How is the diagnosis of pyloric stenosis made?

A

The diagnosis of pyloric stenosis can be made through a test feed or an ultrasound (USS).

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55
Q

What is the recommended treatment for pyloric stenosis?

A

The recommended treatment for pyloric stenosis is Ramstedt pyloromyotomy, which can be performed using an open or laparoscopic approach.

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56
Q

How may acute appendicitis present in young children?

A

In young children, acute appendicitis may present atypically.

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56
Q

At what age is acute appendicitis uncommon in children?

A

Acute appendicitis is uncommon in children under 3 years of age.

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57
Q

What are the typical symptoms of mesenteric adenitis?

A

Mesenteric adenitis is characterized by central abdominal pain and symptoms of upper respiratory tract infection (URTI).

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58
Q

What is the recommended management approach for mesenteric adenitis?

A

Conservative management is typically used for mesenteric adenitis.

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59
Q

What is intussusception?

A

Intussusception refers to the telescoping of one segment of the bowel into another.

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60
Q

At what age does intussusception commonly occur?

A

Intussusception commonly occurs between 6 and 9 months of age.

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61
Q

What are the typical symptoms of intussusception?

A

Colicky pain, diarrhea and vomiting, a sausage-shaped mass in the abdomen, and red jelly-like stools are typical symptoms of intussusception.

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62
Q

What is malrotation?

A

Malrotation refers to the abnormal positioning of the intestines, particularly the high placement of the cecum at the midline.

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63
Q

How is intussusception treated?

A

Intussusception is treated through a reduction procedure using air insufflation.

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64
Q

What conditions are associated with malrotation?

A

Malrotation may be associated with exomphalos, congenital diaphragmatic hernia, and intrinsic duodenal atresia.

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65
Q

What complications can occur with malrotation?

A

Malrotation may lead to the development of volvulus, which can cause bile-stained vomiting in infants.

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66
Q

How is malrotation diagnosed?

A

The diagnosis of malrotation is made through an upper gastrointestinal (GI) contrast study and an ultrasound (USS).

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67
Q

What is the recommended treatment for malrotation?

A

The treatment for malrotation is usually a laparotomy, and if volvulus is present or at high risk of occurring, a Ladd’s procedure is performed.

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68
Q

What is Hirschsprung’s disease?

A

Hirschsprung’s disease is a condition characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the intestines.

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68
Q

What is the incidence of Hirschsprung’s disease in births?

A

Hirschsprung’s disease occurs in approximately 1 in 5000 births.

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69
Q

How is Hirschsprung’s disease diagnosed?

A

The diagnosis of Hirschsprung’s disease is made through a full-thickness rectal biopsy.

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70
Q

What are the typical symptoms of Hirschsprung’s disease?

A

Delayed passage of meconium and abdominal distension are typical symptoms of Hirschsprung’s disease.

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71
Q

What is the initial treatment for Hirschsprung’s disease?

A

Initial treatment for Hirschsprung’s disease involves rectal washouts. Ultimately, an anorectal pull-through procedure is performed.

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72
Q

What is oesophageal atresia associated with?

A

Oesophageal atresia is associated with tracheo-oesophageal fistula and polyhydramnios.

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73
Q

What are the potential symptoms of oesophageal atresia?

A

Oesophageal atresia may present with choking and cyanotic spells following aspiration.

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74
Q

What is the majority cause of meconium ileus?

A

The majority of cases of meconium ileus are associated with cystic fibrosis.

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74
Q

What is VACTERL associations?

A

VACTERL associations are commonly associated with oesophageal atresia.

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75
Q

What are the typical symptoms of meconium ileus?

A

Delayed passage of meconium and abdominal distension are typical symptoms of meconium ileus.

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76
Q

What imaging findings may be seen in meconium ileus?

A

X-rays may not show a fluid level as the meconium is viscid. PR contrast studies may help dislodge meconium plugs and be therapeutic.

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77
Q

What lab finding is increased in biliary atresia?

A

Biliary atresia is associated with increased conjugated bilirubin levels.

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77
Q

What is the recommended treatment for meconium ileus?

A

Infants who do not respond to PR contrast and NG N-acetyl cysteine will require surgery to remove the plugs.

78
Q

What is the duration of jaundice for biliary atresia?

A

Jaundice lasting more than 14 days is concerning for biliary atresia.

79
Q

What is the recommended procedure for biliary atresia?

A

Urgent Kasai procedure is the recommended treatment for biliary atresia.

80
Q

What is the main risk factor for necrotising enterocolitis?

A

Prematurity is the main risk factor for necrotising enterocolitis.

81
Q

What are the early features of necrotising enterocolitis?

A

Early features of necrotising enterocolitis include abdominal distension and passage of bloody stools.

82
Q

What imaging findings may be seen in necrotising enterocolitis?

A

X-rays may show pneumatosis intestinalis and evidence of free air.

82
Q

What is the recommended treatment for necrotising enterocolitis?

A

Treatment for necrotising enterocolitis involves total gut rest and total parenteral nutrition (TPN). Babies with perforations will require laparotomy.

83
Q

When is there an increased risk of necrotising enterocolitis?

A

There is an increased risk of necrotising enterocolitis when empirical antibiotics are given to infants beyond 5 days.

84
Q

What are the most common causes of acyanotic congenital heart disease?

A

The most common causes of acyanotic congenital heart disease include ventricular septal defects (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), coarctation of the aorta, and aortic valve stenosis.

84
Q

Which type of congenital heart defect is the most common among acyanotic conditions?

A

Ventricular septal defects (VSD) are the most common type of congenital heart defect among acyanotic conditions, accounting for 30% of cases.

85
Q

Which congenital heart defect is more common in adults than in children?

A

Atrial septal defects (ASD) are more commonly diagnosed in adult patients as they generally present later in life.

86
Q

What are the most common causes of cyanotic congenital heart disease?

A

The most common causes of cyanotic congenital heart disease include Tetralogy of Fallot, Transposition of the great arteries (TGA), Tricuspid atresia, and Pulmonary valve stenosis.

87
Q

What are common symptoms that children may present with in paediatric proctology?

A

Children may present with altered bowel habit and/or rectal bleeding.

88
Q

Is classical haemorrhoidal disease common in children?

A

No, classical haemorrhoidal disease is relatively rare in children.

89
Q

What is a more common cause of painful rectal bleeding in children?

A

Painful bright red rectal bleeding is much more common in children due to constipation, which is a relatively common childhood disorder.

90
Q

How may inflammatory bowel disease present in paediatric practice?

A

Inflammatory bowel disease may present with altered bowel habit (usually diarrhoea) and bleeding in paediatric practice. Systemic features may also be present, and endoscopy may be required for investigation.

91
Q

What symptoms are commonly seen in children with intussusception?

A

Children with intussusception usually present with colicky abdominal pain and may have a palpable mass on clinical examination.

92
Q

What is a rare but classical feature of intussusception?

A

The often cited “red current jelly” type stool is a rare but classical feature of intussusception.

92
Q

How do juvenile polyps typically appear externally?

A

Juvenile polyps, which are hamartomas, often appear cherry red if they protrude externally.

93
Q

What is the association between juvenile polyps and familial polyposis coli syndromes?

A

Juvenile polyps may occur as part of the familial polyposis coli syndromes.

94
Q

Why is it generally safer to remove objects under general anaesthesia in theatre?

A

In general, children do not tolerate procedures well, so it is usually safer to remove objects in theatre under general anaesthesia with a secure airway.

95
Q

What is the recommended approach for removal of airgun pellets or glass lodged in soft tissues?

A

Airgun pellets and glass lodged in soft tissues are usually difficult to localize and extract, so removal in theatre is usually the best option.

96
Q

What is the normal embryological process for the intestines?

A

During the fourth week of embryogenesis, the intestine moves into the abdomen via the base of the umbilicus. It undergoes a 270 counterclockwise twist, placing the ligament of Treitz to the left of the spine and the caecum in the right lower quadrant.

97
Q

What is malrotation?

A

Malrotation occurs when the rotational process of the intestines is incomplete. The duodenal loop typically lies to the left of the caecum, lacking 90 degrees of its 270-degree rotation, and becomes fixed in this position with peritoneal attachments known as Ladd’s bands.

98
Q

What is the cardinal symptom of intestinal malrotation in neonates?

A

Bilious vomiting is the cardinal symptom and sign of intestinal malrotation in neonates.

99
Q

What may happen if intestinal malrotation is left untreated?

A

If untreated, intestinal malrotation can lead to impaired gut perfusion and the development of further symptoms.

100
Q

What are the main diagnostic tests for intestinal malrotation?

A

The main diagnostic tests for intestinal malrotation include an abdominal ultrasound scan to assess the relationship between the superior mesenteric artery (SMA) and vein (SMV) and an upper GI contrast series to confirm the correct positioning of the DJ flexure to the left of the vertebral bodies.

101
Q

What is the treatment for intestinal malrotation?

A

The treatment for intestinal malrotation involves a laparotomy and division of adhesional bands (Ladd’s procedure). This allows widening of the small bowel mesentery, untwisting of the bowel, assessment of bowel viability, and return of the bowel to the abdominal cavity in the non-rotated fashion. The caecum is positioned in the left upper quadrant. Appendicectomy may also be performed due to the diagnostic difficulty of appendicitis in this patient group.

102
Q

What is the incidence of UTIs in young girls and males?

A

UTIs may occur in 5% of young girls and 1-2% of males. The incidence is higher in premature infants.

103
Q

Which organism accounts for 80% of UTI cases?

A

E-Coli is responsible for 80% of UTI cases in children.

104
Q

What is important to establish in children with UTIs?

A

It is important to establish whether there is underlying urinary stasis or vesico-ureteric reflux (or both) in children with UTIs.

105
Q

What is the risk of renal scarring in children with pyelonephritis?

A

Pyelonephritis in children carries a risk of renal scarring, which is around 10%. This translates to a 10% risk of developing end-stage renal disease.

106
Q

What duration of pyrexia mandates urine testing in children with suspected UTI?

A

Pyrexia lasting for more than 3 days mandates urine testing in children with suspected UTI.

107
Q

Which types of urine samples are preferred for testing?

A

Mid-stream urine samples or supra-pubic aspiration are preferred for urine testing. Urine collected from nappies usually have fecal contaminants.

108
Q

What is the significance of >10 colony-forming units of a single organism in urine samples?

A

In both children and adults, >10 colony-forming units of a single organism in urine samples are usually indicative of a UTI.

109
Q

What is the management approach for a single isolated UTI in girls?

A

A single isolated UTI in girls may be managed expectantly.

110
Q

When should further testing be prompted in children with UTIs?

A

More than 2 UTIs in a 6-month period (or 1 UTI in males) should prompt further testing.

111
Q

What are the recommended first-line tests for UTIs in males and females?

A

Voiding cystourethrograms show the greatest anatomical detail and are the ideal first-line test in males. Isotope cystography, which has a lower radiation dose, is the first-line test in girls.

112
Q

What additional imaging should be performed when renal scarring is suspected?

A

In suspected cases of renal scarring, renal cortical scintigraphy should be performed, along with a ultrasound scan (USS).

113
Q

What are the indications for IV fluids in children?

A

Indications for IV fluids in children include resuscitation and circulatory support, replacing ongoing fluid losses, maintenance fluids for children who cannot take oral fluids, and correction of electrolyte disturbances.

114
Q

Which fluids should be avoided in children outside the neonatal period?

A

In children outside the neonatal period, saline/glucose solutions, especially saline 0.18%/glucose 4% solutions, should be avoided. The report suggests that 0.45% saline/5% glucose may be used, but preference should be given to isotonic solutions with few indications for the former.

115
Q

Which fluids are recommended to be used in paediatric fluid management?

A

The recommended fluids for paediatric fluid management include 0.9% saline, 5% glucose (only with saline for maintenance and not to replace losses), and Hartmann’s solution.

116
Q

What should be considered when adding potassium to maintenance fluids?

A

Potassium should be added to maintenance fluids based on the patient’s plasma potassium levels, which should be monitored.

117
Q

What type of fluid should neonates receive during surgery?

A

Neonates should receive glucose 10% during surgery.

118
Q

What type of fluid should other children receive during surgery?

A

Other children should receive isotonic crystalloid fluids during surgery.

119
Q

What is the recommended rate of glucose administration in neonates for fluid maintenance?

A

For fluid maintenance, neonates usually require glucose 10% at a rate of 60ml/kg/day.

120
Q

What are the daily water, sodium (Na), and potassium (K) requirements for maintenance fluids based on weight?

A

For the first 10kg of body weight, the water requirement is 100ml/kg/day, sodium requirement is 2-4mmol/kg/day, and potassium requirement is 1.5-2.5mmol/kg/day. For the second 10kg of body weight, the water requirement is 50ml/kg/day, sodium requirement is 1-2mmol/kg/day, and potassium requirement is 0.5-1.5mmol/kg/day. For subsequent kilograms of body weight, the water requirement is 20ml/kg/day, sodium requirement is 0.5-1.0mmol/kg/day, and potassium requirement is 0.2-0.7mmol/kg/day.

121
Q

What is cryptorchidism?

A

Cryptorchidism refers to a congenital condition where a testis fails to descend into the scrotum by 3 months of age.

122
Q

What is the incidence of undescended testis at birth, and how does it change by 3 months of age?

A

At birth, up to 5% of boys may have an undescended testis. However, postnatal descent occurs in most cases, and by 3 months of age, the incidence of cryptorchidism falls to 1-2%.

123
Q

What are some possible causes of cryptorchidism?

A

In the majority of cases, the cause of cryptorchidism is unknown. However, a proportion of cases may be associated with other congenital defects, including patent processus vaginalis, abnormal epididymis, cerebral palsy, mental retardation, Wilms tumor, and abdominal wall defects such as gastroschisis and prune belly syndrome.

124
Q

What are the differential diagnoses for cryptorchidism?

A

Differential diagnoses for cryptorchidism include retractile testes and the possibility of intersex conditions in the case of absent bilateral testes. A retractile testis can be manually brought into the scrotum by a clinician and remains in the scrotum when released. If the testis rapidly returns to the inguinal canal upon release, surgery is likely indicated.

125
Q

What are the reasons for correcting cryptorchidism?

A

The reasons for correcting cryptorchidism include reducing the risk of infertility, allowing examination for testicular cancer, avoiding testicular torsion, improving cosmetic appearance, and reducing the increased risk of testicular cancer (seminoma) in males with undescended testes.

126
Q

What is the recommended treatment for cryptorchidism, and at what age is it typically performed?

A

The recommended treatment for cryptorchidism is orchidopexy, which involves inguinal exploration, mobilization of the testis, and implantation into a dartos pouch. Orchidopexy is usually performed between 6-18 months of age. In cases of intra-abdominal testes, evaluation laparoscopically and mobilization should be done. The type of procedure, whether single-stage or two-stage, depends on the exact location.

127
Q

What happens if cryptorchidism is left untreated after the age of 2 years?

A

In untreated individuals after the age of 2 years, the Sertoli cells will degrade. Late presentation in teenage years may be better served by orchidectomy (removal of the testis) rather than attempting to salvage a non-functioning testis with an increased risk of malignancy.

128
Q

What is vesicoureteric reflux (VUR)?

A

Vesicoureteric reflux is the abnormal backflow of urine from the bladder into the ureter and kidney.

129
Q

How common is VUR in children, and what does it predispose them to?

A

VUR is a relatively common abnormality of the urinary tract in children and predisposes them to urinary tract infections (UTIs). It is found in approximately 30% of children who present with a UTI.

130
Q

Why is it important to investigate for VUR in children following a UTI?

A

Investigating for VUR is important because approximately 35% of children with VUR develop renal scarring.

131
Q

What is the pathophysiology of VUR?

A

In VUR, the ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle. This results in a shortened intramural course of the ureter, causing the vesicoureteric junction to not function adequately.

132
Q

What is the grading system for VUR?

A

The grading system for VUR is as follows:<br></br>Grade I: Reflux into the ureter only, no dilatation.<br></br>Grade II: Reflux into the renal pelvis on micturition, no dilatation.<br></br>Grade III: Mild/moderate dilatation of the ureter, renal pelvis, and calyces.<br></br>Grade IV: Dilation of the renal pelvis and calyces with moderate ureteral tortuosity.<br></br>Grade V: Gross dilatation of the ureter, pelvis, and calyces with ureteral tortuosity.

133
Q

What are the common investigations for VUR?

A

VUR is typically diagnosed through a micturating cystourethrogram. A DMSA scan may also be performed to assess for renal scarring.

134
Q

What is Meckel’s diverticulum?

A

Meckel’s diverticulum is a congenital abnormality that occurs due to incomplete obliteration of the vitello-intestinal duct.

135
Q

What happens normally during fetal development?

A

During fetal development, there is an attachment between the vitello-intestinal duct and the yolk sac, which disappears at 6 weeks gestation.

136
Q

Where is the tip of Meckel’s diverticulum located?

A

In the majority of cases, the tip of Meckel’s diverticulum is free.

137
Q

What are some associated conditions with Meckel’s diverticulum?

A

Meckel’s diverticulum can be associated with enterocystomas, umbilical sinuses, and omphaloileal fistulas.

138
Q

What is the arterial supply to Meckel’s diverticulum?

A

The arterial supply to Meckel’s diverticulum is through the omphalomesenteric artery.

139
Q

What are the characteristics of Meckel’s diverticulum in terms of population, length, and distance from the ileocaecal valve?

A

Meckel’s diverticulum affects approximately 2% of the population. It is around 2 inches long and located 2 feet from the ileocaecal valve.

140
Q

What are the possible types of mucosa lining Meckel’s diverticulum?

A

Meckel’s diverticulum is typically lined by ileal mucosa, but ectopic gastric mucosa, pancreatic mucosa, and jejunal mucosa can also occur.

141
Q

Is Meckel’s diverticulum usually symptomatic or asymptomatic?

A

Meckel’s diverticulum is usually asymptomatic and is often an incidental finding.

142
Q

What complications can occur with Meckel’s diverticulum?

A

Complications of Meckel’s diverticulum can arise from obstruction, ectopic tissue, or inflammation.

143
Q

What are the treatment options for Meckel’s diverticulum?

A

If Meckel’s diverticulum has a narrow neck or causes symptoms, it may need to be removed. Treatment options include wedge excision or formal small bowel resection and anastomosis.

144
Q

What is the normal condition of the foreskin at birth and during the neonatal period?

A

The normal foreskin is non-retractile due to adhesions between the foreskin and glans. These adhesions typically separate spontaneously, and by the end of puberty, 95% of foreskins can be retracted.

145
Q

What is balanitis?

A

Balanitis is inflammation of the glans penis and can occur in both circumcised and non-circumcised individuals.

146
Q

What is posthitis?

A

Posthitis is inflammation of the foreskin and can result from infections such as gonorrhea and other STDs. It can also complicate diabetes. Posthitis may progress to phimosis and balanoposthitis if not managed properly.

147
Q

What is paraphimosis?

A

Paraphimosis occurs when the foreskin is retracted for a prolonged period, causing edema. This can make foreskin manipulation difficult. It can usually be managed by compression to reduce edema and replacement of the foreskin. If conservative measures fail, a dorsal slit may be necessary, followed by delayed circumcision.

148
Q

What is phimosis?

A

Phimosis is the inability to retract the foreskin and can be partial or complete. It may occur secondary to balanoposthitis or balanitis xerotica obliterans. Treatment with circumcision may be required depending on the severity and symptoms.

149
Q

What is balanitis xerotica obliterans?

A

Balanitis xerotica obliterans is a dermatological condition characterized by scarring of the foreskin, leading to phimosis. It is rare in children below the age of 5 years. Treatment usually involves circumcision.

149
Q

What is the common occurrence of inguinal hernias in children?

A

Inguinal hernias are a common disorder in children, with a higher incidence in males. This is due to the migration of the testis from its location on the posterior abdominal wall down through the inguinal canal.

150
Q

What is the significance of a patent processus vaginalis in inguinal hernias?

A

A patent processus vaginalis may persist in some children and can be the site of subsequent hernia development.

151
Q

Which age group of children is at the highest risk of strangulation in inguinal hernias?

A

Children presenting in the first few months of life are at the highest risk of hernia strangulation, requiring urgent repair.

152
Q

What is the recommended approach for surgical repair in children over 1 year of age with inguinal hernias?

A

In children over 1 year of age, who are at lower risk, surgery may be performed electively. A herniotomy without implantation of mesh is usually sufficient for pediatric hernias.

153
Q

What is the typical management for most cases of pediatric inguinal hernias?

A

Most cases of pediatric inguinal hernias can be performed as day cases, where the child undergoes surgery and is discharged on the same day. However, neonates and premature infants are kept in the hospital overnight due to the recognized increased risk of post-operative apnea.

154
Q

What are the typical symptoms of intussusception in pediatric patients?

A

Intussusception is characterized by colicky abdominal pain and vomiting. The telescoping of the bowel can lead to mucosal ischemia, and there may be bleeding resulting in the passage of red “current jelly” stools.

155
Q

What are some recognized causes of intussusception in pediatric patients?

A

Intussusception can be caused by lumenal pathologies such as polyps, lymphadenopathy, and diseases like cystic fibrosis. However, the most common variant is idiopathic intussusception of the ileocecal valve and terminal ileum, which typically affects young children and toddlers.

156
Q

How is the diagnosis of intussusception usually made in pediatric patients?

A

The diagnosis of intussusception is typically made through abdominal ultrasound investigation.

157
Q

What factors influence the choice of treatment for intussusception in pediatric patients?

A

The patient’s physiological status and abdominal signs dictate the optimal treatment approach for intussusception.

158
Q

What is the recommended treatment for unstable pediatric patients with intussusception?

A

Unstable pediatric patients with localizing peritoneal signs should undergo laparotomy (surgical intervention), especially if attempted radiological reduction has failed.

159
Q

What is the usual treatment for relatively well pediatric patients without localizing signs?

A

Relatively well pediatric patients without localizing signs typically undergo attempted pneumatic reduction (non-surgical procedure) under fluoroscopic guidance. However, this is not done in cases where there are concerns about impending perforation or if there is a small bowel intussusception.

160
Q

What is the most common cause of infravesical outflow obstruction in males?

A

Posterior urethral valves are the most common cause of infravesical outflow obstruction in males.

161
Q

How can posterior urethral valves be diagnosed?

A

Posterior urethral valves can be diagnosed on antenatal ultrasonography, which allows for early detection.

162
Q

Why is renal impairment commonly seen in boys with posterior urethral valves?

A

Due to the bladder having to develop high emptying pressures in utero, boys with posterior urethral valves may develop renal parenchymal damage. As a result, renal impairment is noted in about 70% of boys at the time of presentation.

163
Q

What is the recommended treatment for posterior urethral valves?

A

The initial treatment for posterior urethral valves is bladder catheterization, which helps relieve the obstruction and improve urinary flow.

164
Q

What is the definitive treatment of choice for posterior urethral valves?

A

Endoscopic valvotomy is the definitive treatment of choice for posterior urethral valves. This procedure is performed using a cystoscope and is followed by regular cystoscopic and renal follow-up to monitor the condition.

165
Q

What is the most common cause of cyanotic congenital heart disease?

A

Tetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart disease.

166
Q

When does TOF typically present in infants?

A

TOF typically presents at around 1-2 months of age, although it may not be detected until the baby is 6 months old.

167
Q

How does the severity of right ventricular outflow tract obstruction affect TOF?

A

The severity of right ventricular outflow tract obstruction determines the degree of cyanosis and clinical severity in TOF.

168
Q

What are the four characteristic features of TOF?

A

The four characteristic features of TOF are ventricular septal defect (VSD), right ventricular hypertrophy, right ventricular outflow tract obstruction (pulmonary stenosis), and overriding aorta.

169
Q

What are some additional features of TOF?

A

Additional features of TOF include cyanosis, a right-to-left shunt causing cyanotic episodes, an ejection systolic murmur due to pulmonary stenosis (the VSD usually does not cause a murmur), and a right-sided aortic arch seen in 25% of patients.

170
Q

What are the typical findings on chest X-ray and ECG in TOF?

A

Chest X-ray shows a ‘boot-shaped’ heart, while ECG shows right ventricular hypertrophy.

171
Q

What is the management approach for TOF?

A

Surgical repair of TOF is often done in two parts. Cyanotic episodes may be managed with the use of beta-blockers to reduce infundibular spasm.

172
Q

What is the incidence of pyloric stenosis in live births?

A

The incidence of pyloric stenosis is approximately 4 per 1,000 live births.

172
Q

When does pyloric stenosis typically present in infants?

A

Pyloric stenosis typically presents in the second to fourth weeks of life with vomiting. However, it can rarely present later, up to four months of age.

173
Q

What causes pyloric stenosis?

A

Pyloric stenosis is caused by hypertrophy of the circular muscles of the pylorus.

174
Q

Is pyloric stenosis more common in males or females?

A

Pyloric stenosis is about 4 times more common in males.

175
Q

What percentage of infants with pyloric stenosis have a positive family history?

A

Approximately 10-15% of infants with pyloric stenosis have a positive family history.

176
Q

What are the common features of pyloric stenosis?

A

Common features of pyloric stenosis include “projectile” vomiting, typically occurring 30 minutes after a feed. Constipation, dehydration, and a palpable mass in the upper abdomen may also be present.

177
Q

What electrolyte imbalance is commonly seen in pyloric stenosis?

A

Pyloric stenosis can lead to hypochloremic, hypokalemic alkalosis due to persistent vomiting.

178
Q

How is the diagnosis of pyloric stenosis usually made?

A

The diagnosis of pyloric stenosis is most commonly made by ultrasound or a test feed to evaluate for the characteristic signs.

179
Q

What is the management approach for pyloric stenosis?

A

The management of pyloric stenosis involves a surgical procedure called Ramstedt pyloromyotomy.

180
Q

What is the most common cause of neck swellings?

A

Reactive lymphadenopathy is the most common cause of neck swellings. It is often associated with a history of local infection or a generalized viral illness.

181
Q

What are the characteristic features of lymphoma-related lymphadenopathy?

A

Lymphoma-related lymphadenopathy presents as rubbery and painless swelling. It is uncommon to experience pain while drinking alcohol. Other associated symptoms may include night sweats and splenomegaly.

182
Q

Where is a thyroglossal cyst typically located in the neck?

A

A thyroglossal cyst is usually midline, between the isthmus of the thyroid and the hyoid bone.

182
Q

Who is more commonly affected by thyroglossal cyst?

A

Thyroglossal cyst is more common in patients younger than 20 years old.

183
Q

What are the typical symptoms of a pharyngeal pouch?

A

Pharyngeal pouch is more common in older men and presents with symptoms of dysphagia, regurgitation, aspiration, and chronic cough. It represents a posteromedial herniation between the thyropharyngeus and cricopharyngeus muscles.

184
Q

What is a cystic hygroma?

A

Cystic hygroma is a congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side. Most are evident at birth, with around 90% presenting before 2 years of age.

185
Q

What is a branchial cyst and how does it develop?

A

A branchial cyst is an oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx. It develops due to the failure of obliteration of the second branchial cleft in embryonic development. Branchial cysts usually present in early adulthood.

186
Q

Who is more commonly affected by a cervical rib, and what condition can it lead to?

A

Cervical ribs are more common in adult females, and around 10% of individuals with cervical ribs develop thoracic outlet syndrome.

187
Q

What are the characteristic features of a carotid aneurysm as a neck lump?

A

A carotid aneurysm presents as a pulsatile lateral neck mass that does not move on swallowing.

188
Q

When are inguinal hernias most common in children?

A

Inguinal hernias are most common in the first few weeks of life in children.

189
Q

Is there an association between inguinal hernia and undescended testis?

A

Yes, there is a recognized association between inguinal hernia and undescended testis.

190
Q

What is the hernia sac often a remnant of in children with inguinal hernia?

A

The hernia sac in children with inguinal hernia is often a remnant of the processus vaginalis.

191
Q

What type of hernias are nearly all inguinal hernias in children?

A

Nearly all inguinal hernias in children are indirect hernias.

192
Q

What is the treatment for inguinal hernias in children?

A

The treatment for inguinal hernias in children is inguinal herniotomy. Formal repair using meshes is not usually required as the posterior wall of the canal is usually intact.

193
Q

Are neonatal inguinal hernias repaired promptly due to the risk of strangulation?

A

Yes, most neonatal inguinal hernias are repaired on the next available list due to the higher risks of strangulation in younger children.

MRCS A - Dr Bishoy (58 decks)

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