Paediatric Surgery

Question 1

What are the Kocher criteria?

Answer 1

1. Non weight bearing on affected side
2. ESR > 40 mm/hr
3. Fever
4. WBC count of >12,000 mm3
   - when 4/4 criteria are met, there is a 99% chance that the child has septic arthritis

Question 2

Commonest micro-organism for septic arthritis?

Answer 2

S.Aureus

Question 3

Factors favouring septic arthritis diagnosis?

Answer 3

Factors favoring septic arthritis
WCC > 12
ESR >40
Inability to weight bear
Fever >38.5

Question 4

Causes of absence of vas deferens?

Answer 4

Absence of the vas may be unilateral or bilateral
Cystic fibrosis CFTR gene mutations are the cause in 40% of cases
Some non CF cases are due to unilateral renal agenesis
Sperm harvesting may allow for assisted conception

Question 5

Features of dermoid neck masses?

Answer 5

-Derived from pleuripotent stem cells and are located in the midline
-Most commonly in a suprahyoid location
-They have heterogeneous appearances on imaging and contain variable amounts of calcium and fat

Question 6

Features of infantile haemangioma?

Answer 6

May present in either triangle of the neck
Grow rapidly initially and then will often spontaneously regress
Plain x-rays will show a mass lesion, usually containing calcified phleboliths
As involution occurs the fat content of the lesions increases

Question 7

Features of pyloric stenosis?

Answer 7

• M>F
• 5-10% Family history in parents
• Projectile non bile stained vomiting at 4-6 weeks of life
• Diagnosis is made by test feed or USS
• Treatment: Ramstedt pyloromyotomy (open or laparoscopic)

Question 8

Features of oesophageal atresia?

Answer 8

Associated with tracheo-oesophageal fistula and polyhydramnios
May present with choking and cyanotic spells following aspiration
VACTERL associations

Question 9

Features of Hirchsprung’s disease?

Answer 9

Absence of ganglion cells from myenteric and submucosal plexuses
Occurs in 1/5000 births
Full thickness rectal biopsy for diagnosis
Delayed passage of meconium and abdominal distension
Treatment is with rectal washouts initially, thereafter an anorectal pull through procedure

Question 10

Features of biliary atresia?

Answer 10

Jaundice > 14 days
Increased conjugated bilirubin
Urgent Kasai procedure

Question 11

Main risk factor for NEC?

Answer 11

Prematurity

Question 12

Features of NEC?

Answer 12

-Early features include abdominal distension and passage of bloody stools
-X-Rays may show pneumatosis intestinalis and evidence of free air
-Increased risk when empirical antibiotics are given to infants beyond 5 days
-Treatment is with total gut rest and TPN, babies with perforations will require laparotomy

Question 13

Sites of ectopic testes

Answer 13

base of penis, femoral triangle and perineum, superficial inguinal pouch

Question 14

1st line treatment of CF meconium ileus?

Answer 14

enemas of either dilute gastrograffin or N-acetyl cysteine.

It’s important to ensure the child is adequately hydrated first. They are contra indicated if there is a suspected underlying perforation.

Question 15

Process behind unilateral cleft lip?

Answer 15

a failure of nasolabial ring fusion

Question 16

Features of hypospadias?

Answer 16

Absent frenular artery
Ventrally opened glans
Skin tethering to hypoplastic urethra
Splayed columns of spongiosum tissue distal to the meatus
Deficiency of the foreskin ventrally

Question 17

Management of hypospadias?

Answer 17

No routine cultural circumcisions
Urethroplasty
Penile reconstruction

Question 18

Most common location of urethral opening in hypospadias?

Answer 18

On the distal ventral surface of the penis

Question 19

what is bilious vomitinga sign of ?

Answer 19

intestinal malrotation

Question 20

What is intestinal malrotation volvulus treated with?

Answer 20

Ladd’s procedure

Question 21

what is a persistent vitello-intestinal duct?

Answer 21

persistent and ongoing discharge of small bowel content from the umbilicus

irritant to the surrounding skin

Question 22

Treatment of duodenal atresia?

Answer 22

Duodenoduodenostomy

Question 23

When should surgery for children with umbilical hernias occur?

Answer 23

Defer surgery until the child is 3 years or older.

Question 24

Features of congenital talipes equinovarus?

Answer 24

Equinus of the hindfoot
Adduction and varus of the midfoot
High arch

Question 25

Key anatomical deformities of talipes equinovarus?

Answer 25

Adducted and inverted calcaneus
Wedge shaped distal calcaneal articular surface
Severe Tibio-talar plantar flexion
Medial Talar neck inclination
Displacement of the navicular bone (medially)
Wedge shaped head of talus
Displacement of the cuboid (medially)

Question 26

Best conservative method for talipes?

Answer 26

ponseti method

Question 27

What is chonoanal atresia?

Answer 27

Congenital disorder with an incidence of 1 in 7000 births.
Posterior nasal airway occluded by soft tissue or bone.

cyanosis are usually worst during feeding. Improvement may be seen when the baby cries

Question 28

Subtype I osteogenesis imperfecta?

Answer 28

The collagen is normal quality but insufficient quantity.

Question 29

Subtype II osteogenesis imperfecta?

Answer 29

Poor collagen quantity and quality.

Question 30

Subtype III osteogenesis imperfecta?

Answer 30

Collagen poorly formed. Normal quantity.

Question 31

subtype IV osteogenesis imperfecta?

Answer 31

Sufficient collagen quantity but poor quality.

Question 32

Features of osteopetrosis?

Answer 32

Bones become harder and more dense.
Autosomal recessive condition.
It is commonest in young adults.
Radiology reveals a lack of differentiation between the cortex and the medulla described as marble bone.

Question 33

Features of nephroblastoma?

Answer 33

Nephroblastoma (Wilms tumours)
Usually present in first 4 years of life
May often present as a mass associated with haematuria (pyrexia may occur in 50%)
Often metastasise early (usually to lung)
Treated by nephrectomy
Younger children have better prognosis (<1 year of age =80% overall 5 year survival)

Question 34

Salter Harris Classification?

Answer 34

I ‘S’ = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
II ‘A’ = Above. The fracture lies above the physis, or Away from the joint.
III ‘L’ = Lower. The fracture is below the physis in the epiphysis.
IV ‘TE’ = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
V ‘R’ = Rammed (crushed). The physis has been crushed