General Surgery

Question 1

criteria for diagnosis of pyloric stenosis

Answer 1

US that shows length of pylorus >= 14 mm, thickness >= 4mm

Question 2

metabolic disturbance in pyloric stenosis

Answer 2

metabolic alkalosis, paradoxical aciduria

Question 3

most common type of intussuception

Answer 3

ileo-colic (85%)

ileo-ileal 10%

Question 4

recurrence rate of intussusception

Answer 4

3-11% (most often within 24 hrs after reduction)

Question 5

what finding do you see on u/s in intussusception

Answer 5

target sign

Question 6

treatment of intussusception

Answer 6

pneumatic reduction

Question 7

characteristics of meckel’s

Answer 7

2% of population, 2% symptomatic, 2 feet of IC valve, 2 inches long

Question 8

diagnosis of meckel’s

Answer 8

technicium 99 scan (meckel’s scan) - detects gastric mucosa, can give ranitidine before to suppress acid in stomach and pick up ectopic gastric mucosa better!

Question 9

diagnostic test for malrotation with volvulus

Answer 9

upper GI series

Question 10

what do you see on upper GI in context of midgut volvulus

Answer 10

should see ligament of treitz at the level of the pylorus, to the left of the spine (C-loop)

Question 11

components of ladd’s procedure

Answer 11

• detort volvulus
• lyse Ladd’s bands
• widen mesentery
• remove appendix

Question 12

ddx bilious vomiting

Answer 12

• midgut volvulus
• malrotation
• duodenal or other atresia
• hirschsprung’s
• ileus

Question 13

cardinal signs of hirschprung’s

Answer 13

failure to pass meconium within 24 hours, abdominal distension, bilious vomiting

Question 14

management of hirschprung’s

Answer 14

• insertion of rectal tube with saline irrigations
• antibiotics if signs of enterocolitis
• surgery: pull-through

Question 15

most common cardiac anomaly associated with omphalocele

Answer 15

tetrology of fallot

Question 16

where is the defect in the abdo wall with gastroschisis?

Answer 16

right of umbilicus

Question 17

abdominal wall defect with peritoneal sac

Answer 17

omphalocele

Question 18

abdominal wall defect associated with other congenital anomalies

Answer 18

omphalocele

Question 19

infants with inguinal hernia: indication for bilateral exploration

Answer 19

prematurity

Question 20

increased risk of hernia incarceration with a wait time after diagnosis of….

Answer 20

> 30 days

Question 21

complications of inguinal hernia repair

Answer 21

• scrotal swelling/hermatoma
• iatrogenic undescended testicle
• recurrence
• injury to vas deferens
• testicular atrophy

Question 22

main indication for orchidopexy

Answer 22

risk of infertility

Question 23

risk of undescended testicle

Answer 23

fertility, malignancy, torsion/hernia

Question 24

undescended testicle: when to refer to surgery

Answer 24

9 months of age, should have surgery around 1 year

Question 25

How do you diagnose Hirschprungs?

Answer 25

Rectal biopsy

Question 26

What is seen on a rectal biopsy in Hirschprungs?

Answer 26

absence of ganglion cells
hypertrophic nerves
Increased acetylcholine staining

Question 27

What is associated with omphalocele?

Answer 27

Cardiac defects (most common: tetrology of fallot)

Question 28

What is associated with gastroschesis?

Answer 28

intestinal atresia

Question 29

What might you see on contrast enema in Hirschprungs?

Answer 29

transition zone (usually recto-sigmoid)