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Royal Super 4th Year Brain > General Surgery > Flashcards

General Surgery Flashcards

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1
Q

Findings for malrotation with volvulus on AXR, US, and UGI?

A 
AXR = double bubble sign
US = whirlpool sign
UGI = dilated duodenum, corkscrew sign
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2
Q

Intussception - age range, etiology, presentation, imaging findings, and management

A 
Age = 3 months to 3 years
Etiology = idiopathic (peyer's patches) or leadpoints (polyps, Meckel's, CF, IBD, lymphoma)
Presentation = acute colicky abdo pain, currant jelly stools, bilious emesis, sausage mass
Imaging = AXR (obstructive), US (target lesion)
Management = enema reduction (if stable), surgical
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3
Q

Definition, management, + most common associated abnormality for hypospadias

A

= congenital defect where urethral opening is located on the ventral side of the penis

  • Mgmt: Surgical correction 6-12 months of age, avoid circumcision until then (as may use the tissue)
  • Chordee: fibrous band of tissue on ventral side causing curvature
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4
Q

Clinical presentation of intussception

A
  • Classic triad (only 20%) = colicky pain, emesis, red currant bloody stool
  • Other = toxic, shock, dehydration, RLQ mass, distention
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5
Q

Umbilical hernias: (a) approximate size when unlikely to spontaneously close and (b) what age to intervene if not closed?

A

(a) >1.5-2.0cm

(b) 5 years of age

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6
Q

Phimosis - definition + possible treatment

A

=narrowing of distal foreskin that prevents retraction over the glans penis

  • Normal adhesions in the newborn
  • May require circumcision
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7
Q

Paraphimosis - definition, complication, management steps

A

=incarceration of retracted foreskin behind the glans

  • Progressive edema –> ischemia
  • Ice, anesthesia, manual reduction –> surgical
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8
Q

Most common associated abnormality to gastroschisis?

A

intestinal atresia

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9
Q

Important initial steps in management of a neonate born with gastroschisis

A
  • Wrap bowel in sterile/saline dressings + plastic wrap
  • Maintain normothermic
  • Fluids
  • IV Abx
  • OG for decompression
  • Surgical intervention
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10
Q

What is the most common congenital anomaly of the GI tract?

A

Meckel’s Diverticulum

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11
Q

Rule of 2’s for Meckel’s Diverticulum

A
  • 2% of the population
  • 2:1 of M:F
  • 2-6% symptomatic, complicated
  • 50-75% symptomatic by age 2
  • Within 2 feet of ileocecal valve
  • 2 inches long
  • 2 types of heterotropic mucosa - gastric, pancreatic
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12
Q

x3 main complications/presentations of Meckel’s Diverticulum

A
  • Bleeding = most common, painless
  • Diverticulitis
  • Obstruction
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13
Q

What is the investigation (+what does it detect) for Meckel’s Diverticulum?

A

99Tc Meckel’s scan = gastric mucosa

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14
Q

US findings for pyloric stenosis

A
  • Length >14mm + thickness >4mm

- Shouldering

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15
Q

Metabolic derangement in pyloric stenosis

A
  • HypoCl metabolic alkalosis

- Paradoxical aciduria

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16
Q

x3 cardinal features of Hirschsprung’s disease

A
  • Failure to pass meconium within 24 hours of birth
  • Abdo distention
  • Bilious emesis
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17
Q

Infectious complication of Hirschsprung disease, including symptoms

A

Hirschsprung-associated enterocolitis

-acute diarrhea, explosive stools, abdo distention

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18
Q

Important management steps for Malrotation

A
  • Surgical center
  • NG to LIS
  • IVF resus
  • IV Abx
  • Surgical Ladd’s procedure
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19
Q

Top x5 diagnoses for bilious emesis

A
  • Malrotation with midgut volvulus
  • Duodenal or other atresia
  • Annular pancreas
  • Hirschsprung’s disease
  • Ileus
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20
Q

Where is the level of obstruction if (a) no abdo distention vs (b) abdo distention?

A

(a) proximal

(b) distal

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21
Q

Reasons to repair an umbilical hernia early (x2)

A
  • Bowel incarceration

- Hernia size = controversial

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22
Q

x3 risk factors for an inguinal hernia in children

A
  • Prematurity
  • VP shunt
  • Peritoneal dialysis
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23
Q

Incarcerated inguinal hernia - rate of incidence (+ inc if prem)

A

~8%

-x2 greater if prem

24
Q

If no clear reason for a hydrocele, what must you think about?

A

Secondary hydrocele - think of testicular pathology

25
Q

When do most hydroceles resolve?

A

> 2/3 will resolve by 18-24 months

26
Q

Timeline for hydrocele repair

A

-Typically a 2 year cut off

27
Q

Best modality to differentiate hernia from hydrocele?

A

Transillumination

28
Q

DDx for acute scrotum

A
  • Testicular torsion
  • Appendiceal torsion
  • Epididymitis/orchitis
  • Inguinal hernia - first presentation and/or complicated
  • Acute hydrocele - primary or secondary
  • Trauma
  • HSP
  • Tumors
29
Q

x2 peaks in incidence during pediatrics for testicular torsion

A
  • Infantile

- Post-pubertal

30
Q

How to make dx of testicular torsion in adolescents?

A

Clinical

31
Q

Clinical sign of appendiceal torsion

A

Blue dot sign

32
Q

Tx for appendiceal torsion

A

NSAIDs + excision

33
Q

Tx for testicular torsion

A
  • Infantile: controversial, testicular salvage is rare because of ++delay in presentation
  • Post-pubertal: manual detorsion < surgical consultation for testicular salvage
34
Q

When should you refer a hydrocele to surgery?

A

One year of age

35
Q

What bug in addition to STIs cause epididymitis?

A

E coli

36
Q

At what age can you consider doxy over amox for lyme disease?

A

8 years old

37
Q

When do you start Abx right away and when to test first for lyme disease that is symptomatic?

A

Tx right away if early and test before for late

38
Q

Next step in evaluation to differentiate CDH vs eventration

A

Diaphragm fluoroscopy after CXR

39
Q

What investigations should be done if epididymitis/orchitis?

A
  • UA
  • UCx
  • Urethral swab for sexually active adolescents
  • US
40
Q

If bacterial epididymitis/orchitis then what Ix and referral are your next steps?

A
  • Urology consultation

- VCUG

41
Q

If there is bilateral cryptorchidism what must you think about?

A

Syndromic or DSD = requires immediate work-up

42
Q

Main reasons for treating cryptorchidism?

A
  • Malignancy
  • Fertility
  • Trauma
  • Torsion
  • Hernia
43
Q

When to treat cryptorchidism?

A

Orchidopexy between 6-12 months of age

44
Q

Role of US in cryptorchidism?

A
  • Determine presence or size of testicle

- NOT helpful for position or to differentiate between undescended vs retractile

45
Q

What x3 investigations should occur prior to OR repair of TEF?

A
  • Rectal exam
  • Echo - given association with VACTERL
  • Abdo US (if no urination)
46
Q

Location of defect for (a) gastroschisis vs (b) omphalocele

A

(a) right of umbilicus

(b) through umbilicus

47
Q

What abdo wall defect is larger: (a) gastroschisis vs (b) omphalocele?

A

b

48
Q

Best test to differentiate between CDH and eventruation?

A

Diaphragm fluoroscopy

49
Q

Most common associated anomaly with gastrochisis?

A

Intestinal atresia

50
Q

What is the primary mode of treatment for a perianal abscess in an infant or young child?

A

I+D

51
Q

x2 most common complications from a ruptured appendicitis management (in order of prevalence)?

A

Wound infection > intra-abdo abscess

52
Q

What are your first investigations if child with bilious emesis? - As per Tito

A
  • XR = determine if gas in abdo
  • If yes = LGI
  • If no = UGI
53
Q

Alvarado score

A 
=Out of 10
			§ Anorexia
			§ N/V
			§ Migration of pain to RLQ
			§ Fever
			§ RLQ tenderness = 2 points
			§ Rebound pain
			§ WBC > 10 =  2 points (CRP no advantage)
PMNs > 75%
54
Q

When is an intussception most likely to recur?

A

Within 6 hours

55
Q

What does a thoracotomy as an infant put you at risk of later on from an MSK perspective?

A

Scoliosis

Royal Super 4th Year Brain (25 decks)

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