Paeds

Question 1

M:F pyloric stenosis

Answer 1

4:1

Question 2

Features of pyloroic stenosis on examination

Answer 2

Olive mass RUQ

Question 3

What age does Pyloric Stenosis present?

Answer 3

around 6 weeks

Question 4

Ix pyloric stenosis

Answer 4

USS
Test feed

Question 5

Treatment pyloric stenosis

Answer 5

Ramstedt pyloromyotomy

Question 6

What age and below would you not expect a child to have acute appendicitis?

Answer 6

<3

Question 7

Features of mesenteric adenitis

Answer 7

Central abdominal pain
URTI
Mimics appendicitis

Question 8

Mx of mesenteric adenitis

Answer 8

Conservative

Question 9

What is intussusception

Answer 9

one segment of bowel is pulled into itself or a neighbouring loop of the bowel by peristalsis (telescoping)

Question 10

Where in the GIT does intussusception usually occur?

Answer 10

proximal to ileocaecal valve
(Ileocolic)

Question 11

Age at which intussusception presents

Answer 11

9 months

Question 12

Sx intussusception

Answer 12

Colicky pain
Diarrhoea (red current)
Vomiting

Question 13

On examination what would you feel in intussusception

Answer 13

Sausage shaped mass RUQ

Question 14

What is red current jelly stools an indication of

Answer 14

Intussusception
That ischaemia has occured

Question 15

Ix intussusception

Answer 15

XR - RUQ mass
Target sign USS
Fluoroscopy + contrast enema (gold standard)

Question 16

Mx intussusception

Answer 16

Air insufflation

Question 17

When not to use air insufflation in intussusception

Answer 17

Ileo-ileo intussuception

Question 18

What is the most common cause of neonatal bowel obstruction ?

Answer 18

Hirschsprungs

Question 19

M:F Hirschsprung

Answer 19

3:1

Question 20

What is Hirschsprung’s

Answer 20

ganglionosis (absence of ganglion cells) in the distal colon and rectum in myenteric + submucosal plexuses

Question 21

PS Hirschsprung’s

Answer 21

Failure to pass meconium in 1st 1-2 days post birth

Question 22

Ix Hirschsprung

Answer 22

Rectal biopsy
Contrast enema

Question 23

Mx Hirschsprung

Answer 23

Rectal washouts
Definitively anorectal pull through

Question 24

What 3 things is oesophageal atresia associated with?

Answer 24

Tracheo-oesophageal fistula
Polyhydramnios
VACTERL

Question 25

What is VACTERL

Answer 25

Vertebral defects Anal atresia Cardiac defects Tracheo-oesophageal fistula Renal anomalies Limb abnormalities

Question 26

Sx oesophageal atresia

Answer 26

Choking + cyanotic spells following aspiration

Question 27

Which condition is meconium ileus associated with?

Answer 27

Cystic fibrosis

Question 28

Ix/Tx meconium ileus

Answer 28

Initially PR contrast studies - can actually dislodge meconium NG N-acetylcysteine If this fails --> surgery

Question 29

Features of biliary atresia

Answer 29

Jaundice >14 days increase in conjugated bilirubin

Question 30

Mx biliary atresia

Answer 30

Urgent Kasia procedure

Question 31

Biggest RF necrotising enterocolitis

Answer 31

Prematurity

Question 32

Sx necrotising enterocolitis

Answer 32

Abdo distention Passage bloody stools

Question 33

XR features necrotising enterocolitis

Answer 33

Pneumatosis intestinalis free air

Question 34

Mx necrotising enterocolitis

Answer 34

Gut rest TPN If fails --> laparotomy

Question 35

What is a Littres hernia

Answer 35

Hernia containing meckels diverticulum

Question 36

Mx Littre's hernia

Answer 36

Mesh repair

Question 37

By what age do 95% of umbilical hernia's resolve by?

Answer 37

Age 2

Question 38

After what age would you surgically repair an umbilical hernia?

Answer 38

After 3rd birthday

Question 39

Through where does a Morgagni hernia form?

Answer 39

foramen magni in diaphragm

Question 40

What part of the bowel will more advanced Morgagni hernia contain?

Answer 40

Transverse colon

Question 41

Management Morgagni hernia

Answer 41

Direct anatomical repair

Question 42

Bochdalek vs Morgagni hernia - which is associated with polmonary hypoplasia and respiratory compromise?

Answer 42

Bolchadek

Question 43

Where are the majority of Bochdalek hernias?

Answer 43

Left hemidiaphragm (85%)

Question 44

Which gender > Bochdalek hernias?

Answer 44

Male

Question 45

Mx Bochdalek hernias

Answer 45

Direct anatomical repair or mesh repair

Question 46

Asymptomatic Meckels - what type of cells?

Answer 46

Ileal mucosa

Question 47

Symptomatic Meckel's - what type of cells?

Answer 47

Gastric mucosa