Paeds

Question 1

What is the operation of choice for Malrotation of the Gut?

Answer 1

Ladd’s procedure.

• Division of Ladds bands
• Place colon on left side, remove appendix

Question 2

What is the most common type of Diaphragmatic hernia?

Answer 2

Bochdalek hernia (usually left sided)

Question 3

How does Hirshprungs disease typically present?

Answer 3

With failure to pass meconium in 48 hours

Diagnose with suction rectal biopsy
Treat with serial washouts and pull through at 6 months

High incidence of NEC

Question 4

How does Pyloric stenosis tend to present?

Answer 4

Non bile stained vomiting at 4-6 weeks

Ramstedt pyloromyotomy
5-10% FH

Question 5

Where is the most frequent location of a thyroglossal cyst?

Answer 5

Just inferior to hyoid (65%)

Treat with Sistrunk procedure - excision of hyoid bone
Thin walled and anechoic

Question 6

Where are branchial cysts most frequently located?

Answer 6

Usually located anterior to SCM near angle of mandible

75% from second branchial cleft
Usually anechoic and water like unless infected

Question 7

Where is a cystic hygroma most commonly found?

Answer 7

Posterior to SCM
Usually present <2
Typically hypo echoic on USS

Question 8

How do infantile haemangiomas present?

Answer 8

Rapidly growing neck mass that often spontaneously regresses

Contains calcified phleboliths on XR

Question 9

What is the most common cause of PR bleeding in young children?

Answer 9

Probably Meckel’s or a polyp

IBD in older children

Question 10

What is the best imaging test for a Meckel’s diverticulum?

Answer 10

Technetium 99

Question 11

How do Meckel’s most frequently present if symptomatic?

Answer 11

Obstruction

Only 5% symptomatic
2% of population, 2 inches long , 2feet from IC valve

Question 12

What is the incidence of Cryptorchidism?

Answer 12

Defined by failure to reach bottom of scrotum by 3 months, then 1-2%.

5% at birth

Question 13

What congenital defects are associated with cryptorchidism?

Answer 13

PPV
Abnormal epididymis
Cerebral palsy
Learning difficulties
Wilms Tumour
Abdominal wall defects

Question 14

What is the increased risk of testicular cancer with undescended testis?

Answer 14

40 times normal risk (seminoma)

50% of intra-abdominal will become malignant

Question 15

When should an orchidopexy be performed for cryptorchidism?

Answer 15

6-18months of age.

If impalpable in the groin then laparoscopic exploration and 1/2 stage procedure

Above 2 the Sertoli cells degrade, and if presenting in teenage years, probably should just have orchidectomy

Question 16

When does intestinal rotation occur in embryological development?

Answer 16

About the 4th week 270deg anticlockwise twist

Question 17

What is the characteristic X-ray finding of duodenal atresia?

Answer 17

Double bubble sign on plain X-ray

40% have Down’s
8% of Downs have duodenal atresia

Treated with duodenoduodenostomy through transverse incision. Has good outcomes

Question 18

How frequent is umbilical hernia in infants?

Answer 18

Up to 20%. Majority close spontaneously

Question 19

What is the most common infective organism causing Omphalitis?

Answer 19

Staph Aureus

Question 20

How does a persistent urachus present?

Answer 20

Urinary discharge from umbilicus

Question 21

How does a persistent Vitello-intestinal duct present?

Answer 21

Umbilical discharge of small bowel content - often a Meckel’s diverticulum

Question 22

How are paediatric inguinal hernias repaired?

Answer 22

High risk of strangulation <1 and should be repaired urgently. If >1, ?electively

Herniotomy is the treatment of choice

Females should have bilateral exploration ?lap

Question 23

What are indications for circumcision?

Answer 23

Lichen sclerosus> BXO
Paraphimosis
Recurrent balanitis
Persistent phimosis - but only if pathological. 10% of 11 year olds non-retractile (does not matter)

Question 24

When should a paediatric hydrocele be considered for treatment in children?

Answer 24

> 12 months and not decreasing in size –> referral

Ligation of PPV

Question 25

How should microscopic haematuria be investigated in children?

Answer 25

If asymptomatic, may be benign and resolve. Consider repeating in 6 months

Red flag features include abnormal renal function, proteinuria, signs of fluid overload, hypertension or frank haematuria

Consider diagnosis of Alport syndrome or structural abnormalities
NB wilms (mass)

Question 26

What is the peak incidence of Intussusception?

Answer 26

5-7 months, 70%<1 year