Gen Surg

Question 1

Presentation of Pyloric Stenosis

• age
• risk factors

Answer 1

NONbilious projectile vomiting
2 weeks - 2 years

RF: +ve FHx, first born, maternal feeding patterns

Question 2

Investigations for Pyloric stenosis

- cutoffs

Answer 2

Abdo u/s:
pylorus
>/= 14mm length
>/= 4mm thickness

(UGI: string sign)

Question 3

Pyloric stenosis

- labs

Answer 3

hypochloremic metabolic alkalosis

```
paradoxical aciduria
With ensuing volume contraction, kidney reabsorbs Na+ and volume at expense of H+ and K+
~~~

Question 4

Pyloric Stenosis

- mgmt

Answer 4

1) Fluid resuscitation w NS until UO resumes
2) maintenance fluids w dextrose and K
3) Need to normalize metabolic acidosis
4) Surgery - pyloromyotomy

Question 5

What is the MOST COMMON pathologic lead point seen with intussusception

Answer 5

Meckel’s diverticulum

Question 6

Intussusception

• peak age
• M or F?

Answer 6

3 weeks to 3 years

M>F

Question 7

Intussusception

- most common type

Answer 7

ileocolic

Question 8

Intussusception

- Pathological lead points

Answer 8

• Meckel’s diverticulum (most common)
• Polyps, Intestinal duplication
• Henoch-Schonlein purpura
• Appendix, hemangioma, foreign body, ectopic mucosa, hamartoma (Peutz-Jaeger’s)
• Malignancy (lymphoma, SB tumors, melanoma)

Question 9

Intussusception

- Gold standard test

Answer 9

Ultrasound

- Air enema to confirm

Question 10

Intussusception

- Mgmt

Answer 10

• NPO
• CBC, lytes
• IVF: resuscitations w bolus then maintenance
• Non operative: pneumatic reduction

Question 11

Intussusception

- contraindications to reduction

Answer 11

• Peritonitis
• Persistent hypotension
• Free air/pneumoperitoneum

Question 12

Meckels: Rule of 2s

Answer 12

ž 2% of population
ž 2:1 M:F
ž 2-6% symptomatic, complicated
ž 50-75% symptomatic by age 2 years
ž within 2 feet of ileocecal valve
ž 2 inches long
ž 2 types of heterotopic mucosa: gastric, pancreatic

Question 13

Congenital diaphragmatic hernia

- first step in mgmt

Answer 13

Immediate placement of a nasal or oral gastric tube

Intubate immediately

Question 14

Which major anomaly occurs MOST frequently with EA-TEF

Answer 14

cardiovascular

Question 15

Presentation of TEF

Answer 15

• Choking/cyanotic episodes with feeding

- profuse oral secretions

Question 16

Most common TEF

Answer 16

EA w distal TEF

2nd isolated EA

Question 17

TEF - oligo or poly hydramnios

Answer 17

polyhydramnios

Question 18

Ddx bilious vomiting in neonate

Answer 18

(a) Hirschsprung’s disease
(b) Malrotation +/- Midgut volvulus
(c) Intestinal atresia (small bowel)
(d) Ileus

Question 19

Malrotation/volvulus

Answer 19

Bilious vomiting
+/- Scaphoid abdomen

DX: UGI (gold standard)

Question 20

Cardinal Signs of Hirschprung

Answer 20

• Failure to pass meconium
within 24 hours of birth
• Abdominal distension
• Vomiting (bilious)

Question 21

How to treat umbilical granuloma

Answer 21

Silver nitrate

Question 22

How long can eat/drunk before surgery

Answer 22

2 Clear, sweet liquids
4 Breast milk
6 Infant formula, fruit juices, gelatin
8 Solid food

Question 23

When should a umbilical hernia be repaired

Answer 23

if it persists to age 4-5 yr
causes symptoms
becomes strangulated
becomes progressively larger after age 1-2 y

Question 24

When should a hydrocele be repaired

Answer 24

If still present at 12-18 mo (probably communicating)

Question 25

Cryptorchidism

• when to refer
• when is surgery

Answer 25

Refer at 9 months

Surgery by 9-15months

Question 26

Gastroschisis

Answer 26

• Defect to RIGHT of umbilicus
• NO covering membrane
• usually isolated defect
• associated with NEC

Question 27

Omphalocele

Answer 27

• Defect THROUGH umbilicus
• Covering membrane present
• can have defects in bowel, liver, and less often stomach