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eMRCS questions > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Inguinal hernia mx in infant

A

Surgery over next few days

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2
Q

Neonate with decreased air entry on the left side of his chest and a displaced apex beat. Abdominal examination demonstrates a scaphoid abdomen

A

Congenital diaphragmatic hernia

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3
Q

Neonate with episodes of choking, cyanosis, hx of polyhyradminos

A

Oesophageal atresia

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4
Q

Mx of oesophageal atresia

A

Replogle tube which can be used to remove the oesophageal secretions, pending surgery.

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5
Q

Movement limited in SUFE

A

Internal rotation

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6
Q

Cherry red lesion, rectal bleeding

A

Juvenile polyp

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7
Q

Hyhpospadius symtoms

A

Urethra opens on ventral side of penis
Def of foreskin there
Skin tethering to hypoplastic urethra
Splayed columns of spongiosum tissue distal to the meatus

10% crytporchidism

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8
Q

Mx of hypospadias

A

Urethroplasty
Penile reconstruction

May not be needed in very distal disease

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9
Q

Usual diagnosis with meconium ileus and mx

A

Majority have cystic fibrosis

Infants who do not respond to PR contrast and NG N-acetyl cysteine will require surgery to remove the plugs

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10
Q

Mx of biliary atresia

A

Kasai at 8w
Roux-en Y portojejunostomy

45% who have kasai will require a transplantation

Overall survival 80%

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11
Q

Which is an ectopic teste
Canalicular or superficial inguinal pouch

A

Superficial inguinal pouch

Canalicular- between internal and external ring

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12
Q

Associated conditions and features with oesophageal atresia

A

Polyhydraminos
Imperforate anus
Absent gastric fluid on US
Sporadic risk
Distal fistula most common

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13
Q

Mx of NEC

A

Treatment is with total gut rest and TPN, babies with perforations will require laparotomy

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14
Q

Factors favouring septic arthritis

A

WCC > 12
ESR >40
Inability to weight bear
Fever >38.5

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15
Q

Swollen, erythematous umbilicus with septic neonate

A

Omphalaitis

Risk of portal pyaemia, and portal vein thrombosis

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16
Q

Mass above hyoid, multiloculated, heterogeneous

A

Dermoid cyst

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17
Q

Recurrent infections, slow loss of vision, Multiple x-rays show brittle bones with no differentiation between the cortex and the medulla

A

Osteopetrosis

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18
Q

No vas deferens, with recurrent chest infections

A

Cystic fibrosis

Sperm harvesting

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19
Q

Baby with undescended testicles mx

A

Review at 6-8w
Then 3m
Then will need referral to surgeon before 6m

Orchidopexy at 6- 18 months of age.

he operation usually consists of inguinal exploration, mobilisation of the testis and implantation into a dartos pouch.

Intra-abdominal testis should be evaluated laparoscopically and mobilised. Whether this is a single stage or two stage procedure depends upon the exact location.

After the age of 2 years in untreated individuals the Sertoli cells will degrade and those presenting late in teenage years may be better served by orchidectomy than to try and salvage a non functioning testis with an increased risk of malignancy.

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20
Q

Maintenance fluids in children

A

First 10kg- 100ml
Next 10- 50ml
After- 20ml/kg

E.g 21kg
1000+500+20= 1520ml/day

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21
Q

Maintenance fluid in neonates

A

From birth to day 1: 50-60 ml/kg/day.
Day 2: 70-80 ml/kg/day.
Day 3: 80-100 ml/kg/day.
Day 4: 100-120 ml/kg/day.
Days 5-8: 120-150 ml/kg/day.

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22
Q

Buckle vs greenstick fracture

A

Greenstick- unilateral cortisol breach only

Buckle - incomplete cortical disruption- resulting in periosteal haematoma only

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23
Q

Choanal atresia

A

Congenital disorder in which the nasal choanae, (i.e., paired openings that connect the nasal cavity with the nasopharynx), are occluded by soft tissue

episodes of cyanosis are usually worst during feeding. Improvement may be seen when the baby cries as the oropharyngeal airway is used.

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24
Q

Ix after bilious vomitting

A

Upper GI contrast study

Contrast should be seen to exit the stomach and the location of the DJ flexure is noted (it lies to the left of the midline). If this is not the case, or the study is inconclusive, a laparotomy is performed.

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25
Q

Mx of uncomplicated umbilical hernia

A

After 3 years of age

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26
Q

Ix if perches disease does not show on X ray

A

MRI

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27
Q

Painful bright red defecation

A

Anal fissure

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28
Q

Breech presentation with Barlow and ortolani normal, what next

A

Hip USS

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29
Q

Cause of unilateral cleft lip

A

Incomplete fusion of nasolabial muscle ring

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30
Q

Ix for DDH

A

Initially no obvious change on plain films and USS gives best resolution until 3 months of age. On plain films Shentons line should form a smooth arc

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31
Q

Painful area at umbilicus, with clear yellow fluid draining

A

Patent urachus

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32
Q

Billious vomiting, DJ flexure is displaced to the right - what mx

A

Malrotation

Ladds procedure- Laparotomy and division of adhesional bands

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33
Q

Umbilicus providing diffuse foul smelling brown fluid with granulation tissue

A

Peristent vitello intestinal ducts

Small bowel content to umbilicus
meant to obliterate at 5w when yolk sac no longer required for nutrition

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34
Q

Features of Rickets

A

Failure to thrive
Bowing
Large head
Deformity of chest walll- thickening of costochondral junction (rickettary rosary)

Transverse sulcus in the chest caused by the pull of the diaphragm (Harrison’s sulcus).

X- Rays show widening and cupping of the epiphysis of the long bones, most readily apparent in the wrist.

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35
Q

A 3 day old baby develops dyspneoa. A chest x-ray is performed and shows a radio-opaque shadow with an air-fluid level in the chest

A

Bronchogenic cyst

Foregut-derived cystic malformations of the respiratory tract

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36
Q

Ix and tx of bronchogenic cyst

A

Many cases are diagnosed on antenatal ultrasound. Others may be detected on conventional chest radiography as a midline spherical mass or cystic structure. Once the diagnosis is suspected a CT scan should be performed.

Mx- thorascopic resection after 6w

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37
Q

Mx of FB in external auditory meatus not easily removed

A

Removal under GA in next operative list

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38
Q

Smooth mass anterior triangle, near mandible

A

Brachial cyst

Derived from second brachial cleft

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39
Q

Delayed meconium ix

A

Full thickness rectal biopsy

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40
Q

Mx of Hirschsprungs

A

Washout
Definitive surgery

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41
Q

Projective non billions vomiting

A

Pyloric stenosis

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42
Q

Ix and mx of pyloric stenosis

A

Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

Diagnosis is most commonly made by ultrasound or test feed

Management is with Ramstedt pyloromyotomy

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43
Q

Single palmar crease and prominent epicanthic folds of the eyes, with projectile vomiting

A

Duodenal atresia

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44
Q

Fluids for replacement of high output ileostomy

A

0.9% NaCL with K added

Do not give glucose/Na outside neonates

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45
Q

Testes that come out in bath but otherwise aren’t there and mx

A

Retractile testes

If the examining clinician notes the testis to return rapidly into the inguinal canal when released then surgery is probably indicated.

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46
Q

Impalpable testes in scrotum or inguinal region 13m

A

Laparoscopy

US not very useful

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47
Q

Jaundice ix

A

Present <24hrs- haemolytic anaemia, sepsis
Measure direct(conjugated) serum BR + blood film

2d-2w can be normal- physiological, breastfeeding, breastmilk jaundice
Transcutaneous BR + blood film

> 2w- can be normal or biliary atresia
Direct and indirect serum BR

prolonged physiological jaundice or breast milk jaundice will cause a rise in unconjugated bilirubin, whereas those with obstructive liver disease will have a rise in conjugated bilirubin)

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48
Q

VACTERL sx

A

Vertebral, Ano-rectal, Cardiac, Tracheo-oesophageal, Renal and Radial limb anomalies

Intolerant of feeds, pan systolic murmur, forearms not developed properly

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49
Q

Pellet lodged in liver, patient is well mx?

A

Do not operate and review several weeks later

Airgun pellets (and glass) lodged in the soft tissues are usually notoriously difficult to localise and extract

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50
Q

Gastroschisis vs omphalocele

A

Gastroschisis: Isolated abnormality, bowel lies outside abdominal wall through defect located to right of umbilicus.
Other anomalies rare- intestinal atresia in 10%

Exomphalos:
Central umbilical
Peritoneal sac
Other anomalies present- heart

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51
Q

most common abdominal emergency in children under 1 year of age?

A

Intussesception

52
Q

Mx of NEC

A

NG decompression

Laparotomy should be undertaken in patients do not who progress despite conservative management or in whom compelling indications for surgery exist (eg free air).

53
Q

Exophalmus and diaphragmatic hernia, now has biliary stained vomit

A

Intestinal malrotation

54
Q

Feature of talipes equinovarus

A

Adducted and inverted calcaneus

Wedge shaped head of talus and distal calcaneal articular surface

Severe Tibio-talar plantar flexion

Medial Talar neck inclination

Displacement of the cuboid and navicular (medially)

Bilateral in 50%

55
Q

Features of perthes disease

A

Hyperactivity
Short
Hip pain- may be reared to knee
5-12
Bilateral in 20%

56
Q

Cause of expanding head in NAI

A

Hydrocephalus

57
Q

Ix of SUFE

A

Hip X ray

58
Q

If suspicious of Perthes and nothing from 2 x ray what next

A

Hip MRI

59
Q

Scaphoid abdomen and hypoxic at birth dx

A

Bochdalek hernia- Associated with pulmonary hypoplasia
Poor prognosis

Morgani- have little effect on lungs

60
Q

Incision for laparotomy in children

A

Transverse supra umbilical abdominal

61
Q

Where does spinal cord end in neonates

A

L3

62
Q

Young girl, facial oedema, distended abdo, fever low Bp

A

Nephrotic syndrome now SBP

63
Q

Patient had open abdo surgery, now erythema of wound and distention what ix

A

USS

64
Q

Mx of ileo-ileal intussescpetion

A

Laparotomy

65
Q

Tetralolgy of Fallot

A

VSD
RVH
Right ventricular tract obstruction- Pul Stenosis
Overriding aorta

Right to left shunt

66
Q

Conditions causing intusseption

A

Peyers patches inflammed
CF
Meckels
Mucosal polyps

67
Q

Calculating fluid bolus

A

kg x 10
10 if arrest

68
Q

Presentation of biliary atresia

A

Jaundice in infants > 14 days in term infants (>21 days in pre term infants)
Pale stool, yellow urine (colourless in babies)
Associated with cardiac malformations, polysplenia, situs inversus

69
Q

Ix of biliary atresia

A

Conjugated bilirubin (prolonged physiological jaundice or breast milk jaundice will cause a rise in unconjugated bilirubin, whereas those with obstructive liver disease will have a rise in conjugated bilirubin)

Ultrasound of the liver (excludes extrahepatic causes, in biliary atresia infant may have tiny or invisible gallbladder)

Hepato-iminodiacetic acid radionuclide scan (good uptake but no excretion usually seen)

70
Q

Ix of duodenal atresia

A

AXR shows ‘double bubble sign, contrast study may confirm

71
Q

Features of NEC

A

Premature
Second week of life
Dilated bowel loops on AXR, pneumatosis and portal venous air

72
Q

Types of cleft palate

A

The primary palate consists of all anatomical structures anterior to the incisive foramen.

The secondary palate lies more posteriorly and is sub divided into the hard and soft palate.

Cleft palate occurs as a result of non fusion of the two palatine shelves.

73
Q

What are those with cryptorchidism more likely to develop

A

Seminoma

74
Q

Intrabominal teste mx

A

Laparoscopy and mobilised

75
Q

> 2 yrs non descended teste mx

A

After the age of 2 years in untreated individuals the Sertoli cells will degrade and those presenting late in teenage years may be better served by orchidectomy than to try and salvage a non functioning testis with an increased risk of malignancy.

76
Q

Tx of inguinal hernia in children

A

Inguinal herniotomy - cut open then tie off patent TV

In females offer bilateral As common

The younger the child the higher the risks of strangulation and most neonatal inguinal hernias are repaired on the next available list.

77
Q

Ix of malrotation

A

Bowel viability depends of mesentery containing MSA

Abdominal ultrasound scan to determine the relationship between the superior mesenteric artery and vein (normally SMA lies to the left of the SMV).

This test is complemented with an upper GI contrast series and this aims to establish that the DJ flexure is correctly sited to the left of the vertebral bodies

78
Q

What happens in malrotation

A

Malrotation occurs when the rotational process described is incomplete. Typically the duodenal loop lies to the left of the caecum and therefore lacks 90 o of its 270o rotation. It becomes fixed in this position with peritoneal attachments (Ladds bands).

79
Q

Formation of cystic hygroma

A

Cystic hygroma result from occlusion of lymphatic channels

80
Q

Infantile haemangioma features

A

Grow rapidly initially and then will often spontaneously regress
Plain x-rays will show a mass lesion, usually containing calcified phlebolith

81
Q

Dermoid features

A

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

82
Q

Where does Wilms tumour mets to

A

Lung

83
Q

Toddler fracture

A

Oblique tibial fracture in infants

84
Q

Plastic deformity

A

Stress on bone resulting in deformity without cortical disruption

Bends

85
Q

Central abdominal pain and URTI, dx and mx

A

Mesenteric adeninitis - conservative

86
Q

Post op care of inguinal hernia

A

Most cases are performed as day cases, neonates and premature infants are kept in hospital overnight as there is a recognised increased risk of post operative apnoea.

87
Q

Features of Congenital talipes equinovarus.

A

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

88
Q

Mx of Congenital talipes equinovarus.

A

Conservative first, the Ponseti method is best described and gives comparable results to surgery. It consists of serial casting to mold the foot into correct shape. Following casting around 90% will require a Achilles tenotomy. This is then followed by a phase of walking braces to maintain the correction.

Surgical correction is reserved for those cases that fail to respond to conservative measures. The procedures involve multiple tenotomies and lengthening procedures. In patients who fail to respond surgically an Ilizarov frame reconstruction may be attempted and gives good results.

89
Q

Grade of VUR

A

1- reflux into ureter no dilation

2- renal pelvis no dilation

3- mild dilation od ureter, renal pelvis and calyces

4- dilatation with moderate ureteral tortuosity

5- gross dilation dn with ureteral tortuosity

90
Q

Ladd procedure steps

A

Usually rotates 270 Anticlockwise

DJ normally to left

This doesn’t occur

Urgent laparotomy
Rotate volvulus anticlockwise

Return small bowel to right and caecum and colon to left and perform appendectomy

91
Q

Most common cause of obstruction in paeds

A

Intusseption

92
Q

What conditions are associated with intussusception

A

Haemangiomas, lymphomas, HSP, Haemophilia

93
Q

Urinary pH in pyloric stenosis

A

Low

94
Q

Locations of hypospadias

A

70% glandular
20% scrotal
10% penile

95
Q

Pneumatosis intestianlis and postral venous gas

A

Severe NEC

96
Q

Dose of IO vs IV

A

Same

97
Q

Mx of rectal prolapse

A

Conservative

98
Q

When should NAC be given

A

If above treatment line or delayed presentation >8 hrs

99
Q

Child with congenital hypothyroid and what hernia

A

Umbilical

100
Q

Positive Barlow test, when to US hip

A

4-6w

101
Q

Normal urine output under 2

A

> 2ml/kg/hr

102
Q

Pass meconium, bilious aspirates, not opened bowel since, distended small bowel

A

Small bowel atresia

103
Q

Most common cause of intussepetion

A

Hypertrophic peyeres

104
Q

Purpose of brown fat in children and location

A

Thermogenesis
Scpaulas, mediastinum, kidneys, adrenal

105
Q

Feeding neonates post major bowel surgery

A

Often can’t tolerate gastric feeds
Parenteral nutrition

106
Q

Condition associated with myelomenignocele

A

Hydrocephalus

107
Q

Hypothermia effects

A

Decreased platelet activity
Increased anaesthetic duration
Acidosis due to resp Depression

108
Q

Tumour of all 3 cell layers

A

Teratoma

109
Q

Dose of IV morphine

A

0.1mg/kg

110
Q

Most common ectopic teste location

A

Superficial inguinal pouch

111
Q

If failed IV 2x

A

IO in tibia

112
Q

Hormones levels post surgery

A

Catecholamines evaluated immediately
Cortisol- stays high for shorter period than adults <24hrs

113
Q

Term vs pre term IV fluid requirements

A

Pre term required more <26 80-150ml/kg

Term- 60-80 per day

114
Q

When should meconium be passed

A

By 48hrs

115
Q

Persistent bilious vomiting after birth

A

Duodenal atresia

116
Q

Most common cause of delayed passage of meconium and Ix

A

CF

Guthrie test- spot test
Sweat chloride - 2-5x more Cl

117
Q

Na in pyloric stenosis

A

Low

118
Q

What is CO most dependent on in paeds

A

HR

119
Q

Edwards

A

Trisomy 18

Heart defect
Omphalocele
Oesophageal atresia
Microcepahly
Cleft lip

120
Q

Paracetamol dose for <50kg

A

15mg/kg per dose

121
Q

Important mechanism in heat conservation in newborns

A

Noradrenergic symp stimulation

122
Q

Glucose and lactate in hypothermia

A

Glucose decrease lactate increase- anaerobic

123
Q

Main cause of heat loss in surgery

A

Radiation

124
Q

Rostral vs caudal

A

Rostral - nose
Caudal- posterior head

125
Q

Mx of malrotation with regards to amount of viable bowel

A

If <50cm- untwist, return- perform second look lap

> 50cm- excise ischaemic bowel

126
Q
A

eMRCS questions (45 decks)

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