Paediatric Surgery

Question 1

What are the 3 main symptoms that could warrant a surgical emergency in children?

Answer 1

Vomiting
Abdominal pain
Acute scrotum

Question 2

What is the differential diagnosis of a 6-week-old child with milky projectile vomit and bulges on their abdomen? How is it diagnosed and managed?

Answer 2

Pyloric stenosis
US
Pyloromyotomy

Question 3

What colour is bile-vomit?

Answer 3

Green (like Fairy-Liquid-green)

Question 4

Bile-coloured vomit is a red flag. True/False?

Answer 4

True

Question 5

A baby with bile-coloured vomit is what condition until proven otherwise? How is it diagnosed and managed?

Answer 5

Intestinal malrotation
Abdominal XR
Surgery

Question 6

What is the differential diagnosis of a 6-month-old child with hard abdominal masses and “redcurrant jelly” faeces? How is it diagnosed?

Answer 6

Intussusception (bowel telescopes in on itself (small bowel into large bowel)
US

Question 7

How is intussusception treated?

Answer 7

Blow air through bowel via anus

Question 8

A 6-year-old boy complains of abdominal pain and “not liking the bumps en route to hospital”. He is reluctant to stand up. What is top of your differential list? How is it diagnosed and managed?

Answer 8

Peritonitis (can jump)

Appendicitis (can’t jump, fever)
US
Laparoscopic removal

Question 9

List general symptoms of an acute scrotum

Answer 9

Redness
Swelling
Bruising
Pain
Abnormal position

Question 10

List differentials of acute scrotum

Answer 10

Testicular torsion
Epididymitis
Idiopathic scrotal oedema
BXO
Hernia
Undescended testis

Question 11

What is a hydatid of Morgagni?

Answer 11

Vestigial Mullerian duct structure from development present on the top of the testis
1/3 have palpable blue dot discoloration on testis

Question 12

What is balanitis xerotica obliterans? How is it managed?

Answer 12

Scarred foreskin with white hardened tissue which may prevent retraction
Circumcision

Question 13

Hypospadias is the most common congenital defect of the penis. What is it?

Answer 13

Abnormally placed external urethral orifice on the urethral groove underside the shaft of the penis, causing pee to eject backwards

Question 14

What is a hydrocele and what causes it?

Answer 14

Fluid accumulation around the testicle

Patent processus vaginalis

Question 15

What test is done to detect undescended testis?

Answer 15

Soap test
Place soap between ASIS and pubic tubercle and slide thumb along line to palpate the testicle: if palpable surgery is performed, if not palpable laparoscopic procedure is performed to locate the testicle

Question 16

What are the most common causes of GI obstruction in a child?

Answer 16

Congenital pyloric stenosis
Volvulus
Intusception
Malrotation

Question 17

What is a red flag to be aware of in constipation?

Answer 17

Hirshsprugs - delay in passage of meconium for more than 24 hours post-birth

Question 18

List features of tetralogy of fallot

Answer 18

Don't DROP baby
vsD
Rvh
Overriding aorta
Pulmonary stenosis

Question 19

List signs of testicular torsion. How is it managed?

Answer 19

Red, sore, hard to walk, solitary bruise

4-6hr to treat

Question 20

List signs of epididymitis. How is it managed?

Answer 20

Inflamed testicle
Red, sore
Antibiotics

Question 21

What is idiopathic scrotal oedema? How is it managed?

Answer 21

Acute itchy testicle
Swollen, red
Waterlogged tissue
Antihistamines, analgesia but self-limiting