Embryology & paeds surgery Flashcards
1
Q
What arises from the Mesoderm
A
Muscle
Skeleton
Kidney
Reproductive system
3 bones = spleen
3 sides = trigone of bladder, mesonephric duct
3 sides organ = adrenal cortex
3 sides nucleus pulpous –> notochord
1
Q
what arises from surface ectoderm
A
Anterior pituitary
2
Q
What arises from endoderm
A
Endocrine glands
Lungs
Digestive tract
Liver
3
Q
What arises from neuroectoderm
A
Posterior pituitary
Brain
Spinal cord
4
Q
Pharyngeal apparatus
A
CAP = OUT to IN
Cleft - ectoderm
Arch - mesoderm
Pouch - endoderm
5
Q
Cystic hygroma vs branchial cyst
A
B = before = anterior to SCM = branchial
C is after B = posterior to SCM = cystic hygroma
6
Q
1st cleft (outside)
A
External auditory canal
Tympanic membrane
7
Q
2nd-4th cleft (outside)
A
Temporary cervical sinus –> obliterates
8
Q
Pouches
A
Pain when have cold
Ear = 1
Tonsil = 2 (t for tonsil)
Parathyroid = 3 (inferior)
9
Q
1st pouch
A
Inner/middle ear (e. tube & tympanic membrane)
10
Q
2nd pouch
A
Palatine tonsils
11
Q
3rd pouch
A
Inferior parathyroids
Thymus
12
Q
4th pouch
A
Superior parathyroids
Para4licular “C” cells
13
Q
Pharyngeal arches
A
1 = max –> maxillary
2 = second –> stapedial
3 = 3 words –> common carotid artery
4 = 4 limps –> L aortic arch & R subclavian
6 = pulmonary arteries & ductus arteriosus
14
Q
Nerves from pharyngeal arches
A
5, 7, 9 and 10
15
Q
Nerve associated with 1st pharyngeal arch
A
Trigeminal
5
16
Q
Nerve associated with 2nd pharyngeal arch
A
Facial
7
17
Q
Nerve associated with 3rd pharyngeal arch
A
Glossopharyngeal
9
Gag reflex
18
Q
Nerve associated with 4th and 6th pharyngeal arch
A
Vagus
10
19
Q
Lateral neck mass in child
A
Branchial before SCM
Cystic hygroma posterior to SCM
20
Q
Midline neck mass in child
A
Dermoid cyst
Thyroglossal duct cyst
21
Q
Why are children with cleft palate prone to ear infections?
A
Due to lack of tension in tensor veli palatini
22
Q
Cleft lip
A
Failure of intermaxillary and maxillary prominences to fuse
23
Q
Cleft palate
A
Failure of lateral palatine shelves to fuse
24
Umbilical cord
Contains 2 arteries and 1 vein
25
Most common septal defect in child
VSD
Due to failure of endocardial cushions
26
Use of PGE2 in PDA
PGE2 kEEps the PDA open
27
Use of indomethacin in PDA
Indomethacin closes PDA - coarctation of aorta
28
Murmur heard in PDA
Machinery
Pansystolic
Best at back
29
Coarctation of aorta
Upper limb hypertension
Lower limb delay
Keep PDA open
Collateral supply via intercostal arteries
30
Preductal via post ductal coarctation
Pre-terms are bad
Preductal coarctation is worse
31
Notching of ribs
Seen in PDA due to collateral supply from intercostal arteries
32
Tetralogy of Fallot
PROVe squatting and cyanosis
Squatting increases SVR (after load) - reduced R to L shunt
Pulmonary stenosis
RVI
Overriding aorta
VSD
33
Tracheoesophageal fistula
Polyhydramnios
Drooling
Vomit with 1st feet
Choking
Cyanosis
Increased air in stomach
34
T10
Oesophagus
Vagus
35
T12
Red, white & blue
Aorta
Thoracic duct
Azygous vein
36
T8
IVC
R phrenic nerve
37
Bochdalek
Bad, back and Bochdalek
Posterior
Respiratory distress
38
Morgagni
Anterior
39
Foregut
Coeliac artery
40
Midgut
SMA - supplies 2/3rd transverse colon
41
Hindgut
IMA
42
Gut rotation around SMA at 6 weeks
90 degrees
43
Gut rotation around SMA at 12 weeks
180 degrees
44
Total gut rotation around SMA
270 degrees
45
Gastroschisis
G for Gash - no covering membrane
G for Gastric symptoms
46
Omphalocoele
O - OMG
O - OK for long term
O - omphalocoele
O - overcoat cover
O - opening
47
Effect of nicotine and progesterone on LOS
RELAX
48
Pyloric stenosis
2-6 weeks
Hypertrophy and hyperplasia of pyloric
Male
Non bilious vomit
OLIVE MASS
49
ABG pyloric stenosis
Hypochloraemic, hypokalaemia, metabolic alkalosis
50
Surgical management of pyloric stenosis
Ramstedt's pyloromyotomy
51
Conditions with palmar crease
Duodenal atresia - scaphoid abdomen, bilious vomiting
Hirschsprung's
52
Duodenal atresias
DUO = 2 Ds
Failure to recanalise
2nd part of duodenum
Day 2 vomiting
Double bubble on XR
Down's syndrome
Single palmar crease
53
Annular pancreas
Ventral bud fails to rotate
54
Mid-gut malrotation
Ladd band
Incomplete 270 degree malrotation
Caecum in RUQ
Volvulus
3rd part duodenal obstruction
Ladd band fibrous tissue
Bilious vomit
Scaphoid abdomen
55
Zenker's diverticulum
False - muscularis not involved
56
Meckel's diverticulum
True - muscularis involved
57
Formation of Meckel's diverticulum
Persistent vitelline duct
58
Contents of Meckel's
Gastric tissue
Pancreatic tissue
59
Meckel scan
99mTc-Pertechnetate sctintigraphy
Parietal scan
60
Meckel rule of 2s
2% population
2x in men
2 years of life
2 feet from ileocecal valve
2 inches long
2 epithelia
61
Signs of Meckels in paeds
PR bleed
Intussuception - vein collapses first --> ischaemia -> pain
Obstruction
62
Signs of Meckel's in adults
Asymptomatic
63
Myenteric plexus
Inner - circular muscle
Outer - longitudinal muscle
64
Submucosal plexus
Meissner's plexus - submucosal
65
Hirschsprung's
Bilious vomiting, abdominal distension, failure to pass meconium 48hrsa, tight anal sphincter
Down's
Squirt sign - tight empty rectum
66
Pathophysiology of Hirschsprung's
Failure of ganglia migration from cranial to caudal, thus rectum always involved
67
Gene mutation Hirschsprung's
RET gene mutation - REcTum mutation (RET)
Also associated with Hirschsprung's
68
Test for Hirschsprung's
Rectal suction biopsy submucosa
69
Meconium ileus
Cystic fibrosis
Soap bubble sign on AXR
70
Necrotising enterocolitis
<4 days of life
Abdo distension and vomiting
Erythema of skin
Bloody stool - portal vein, pneumotosis intestinalis
71
Risks of necrotising enterocolitis
Prematurity
LBW
Formula fed
Maternal cocaine
72
Gold standard management for intussusception
Air enema
73
Intussusception signs
Red currant jelly stool
Sausage mass
74
Cause of intussusception in children
Meckel's
Polyps
Peyer patch
75
Cause of intussusception in adult
Cancer
76
Imaging result in intussusception
USS --> target sign
77
Blunt abdominal trauma --> organ injured
Pancreas
Neck at L1
78
Mesonephric duct (Wolffian duct)
Turns into male reproductive organs and ureteric bud in both genders
79
Paramesonephric duct (Mullerian duct)
Turns into female reproductive organs
80
Remnants of mesonephric duct (Wolffian) in females
Gartner duct
81
Remnants of paramesonephric duct (Mullerian) in males
Hydtatid of Morgagni - appendix testes
82
Cryptorchidism
Hooded foreskin
Associated with undescended testes
83
Hypospadias
Urethral fold anomaly
84
Epispadias
Top = tubercle
85
Undescended testes
Not yet reached line of descent
86
Most common place for ectopic testis
Superficial inguinal pouch
87
Stephen-Fowler procedure
Testicular artery is clipped
Testicle receives supply from internal and external iliac
6 months later mobilised on vas with collateral vascularisation
88
Patent processus vaginalis
Hydrocoele
89
PUJO
Pain after drinking alcohol
MAG III to see if urine in bladder
90
Relevance of IMA in horseshoe kidney
First anterior structure when kidneys moving up into abdomen - stop at level of IMA - L3
91
Posterior urethral valves
Causes secondary reflux
Boys
No voiding
Catheter to relieve obstruction
ESRF
92
Primary vesicoureteric reflux
Girls
UTI
Micturating cystogram
93
Spina bifida occulta
Tuft of hair
94
Meningocoele
Subarachnoid space extends into skin
Skin thinning
95
Myelomeningocoele
Spinal cord extends into skin
Skin thinning
96
Likely diagnosis hip pain in < 4 yo
Transient synovitis
Osteomyelitis
JIA
NAI
97
Likely diagnosis hip pain in 4-10 years
Transient synovitis
Perthes
Osteomyelitis
98
Likely diagnosis hip pain in 10-16 years
SUFE
Avulsion fractures
Osteomyelitis
99
Transient synovitis
Recent URTI, pain, limp, fever
100
Kocker criteria
Septic arthritis
1. Unable to WB
2. Temp >38.5
3. WCC >12
4. ESR >40
101
Developmental dysplasia of the hip
Risk - obstetric
Female > male
Fox
Left hip > right hip
102
Barlow manouvre
Bring hip in
103
Ortolani manœuvre
Bring hip out
104
Galeazzi skin fold
USS scan < 4 months
XR > 4 months
Management - Pavlik harness
105
SUFE
Obese, male, early teen
106
XR needed SUFE
AP frog leg & lateral
107
Orientation of femoral head in SUFE
Head is posterior and inferior to femoral neck
108
Greenstick fracture
Bone bent with fracture line that does not extend through width of the bone
109
Buckle fracture
Bulging cortex due to trabecular compression
110
Salter Harris I
Separated growth plate
111
Slater Harris II
Above growth plate - most common
112
Salter Harris III
Below growth plate
113
Salter Harris IV
Through growth plate
114
Salter Harris V
Erasure of growth plate
115
Elbow ossification centers
CRITOE
116
When does capitellum ossify?
1 year
117
When does radial head ossify?
3 years
118
When does int epicondyle ossify?
5 years
119
When does trochea ossify?
7 years
120
When does olecranon ossify?
9 years
121
When does external epicondyle ossify?
11 years
122
Primary vertebral ossification center
3
123
Secondary vertebral ossification center
5
