paeds surgery

Question 1

midline of neck cyst children

Answer 1

thyroglossal
dermoid
lipoma

foramen cicum out

Question 2

thrid pharyngeal arch

Answer 2

thyroglossal duct cant get infeted so need to be removed
thyroid galnd
hyoid bone

Question 3

phimosis

Answer 3

foreskin is too tight to pull back

lichen sclerous
come in with urinary retention
narrowing of meatus
after 4/5 months of circumcision this occurs

Mx
topical steroids

Question 4

smegma cyst

Answer 4

cheesy chalky material stuck under the fore skin

Question 5

indicartions for circumcision

Answer 5

paraphimosis 
recurrent UTI
preotease on foreskin 
spina bifida 
urine reflux

Question 6

contraindication for circumcision

Answer 6

hypospadias

small/ webbing penis not enough ventral skin

Question 7

varicocele

Answer 7

11-14

hydrocele can go above the swelling

hernia can go below the swelling - marble can push back gurgling sound

encysted hydrocelel

Question 8

Mx of undescended testes

Answer 8

milking manoeuvre

Question 9

non palpable testes

Ix

Answer 9

intra abdominal
hypoplastic inguinal
vanishing testes - might have undergone torsion antenatal period testicle in the gor

checked agin 6 weeks
then 6 months
then its known as

left comes down before right

NO INVESTIGATION UNLESS IT BILATERAL OR HAVE SERIOUS HYDROSAPEDIUS
INTRASEX

fsh lh testosterone if testicles are not felt bilaterally

Question 10

rationale for orchidopexy

Answer 10

fertility
torsion
trauma
hernia
malignancy
cosmetic

Question 11

both not felt

Answer 11

retractile testis - if u pull it down adn it styas
ascended testis - born w descended testis but has moved up

trapped testis -

gliding testis - when u pull it down it goes back

Question 12

testicular torsion

Answer 12

clamp the cord deliver testis

Question 13

testicular torsion

Answer 13

clamp the cord deliver testis

Question 14

idiopathic scrotal oedema

Answer 14

peak age 4-5 years
presentation
swollen, red hemiscrotum or bilateral
pain minimum

Mx - conservative, self liming within 1-2 days

Question 15

varicocele

Answer 15

commonest on left side 11-14
pamipform plexus -

insertion is vertical on the left side

throbbing pain testicle not growing left is laggin behind 10/20%

Question 16

umbilical hernia

Answer 16

closes at the age of 3/4

hypothyroidism

Question 17

non billious vomiting projectile

Answer 17

gastric outlet obstruction

hx of pyloric stenosis

Question 18

oesophageal atresia

Answer 18

1A is the commonest

absent gastric buble antenatal means no fistula

no atresia no fistule
end fistula and oesopahgus and trachea communication
- Associated with tracheo-oesophageal fistula and polyhydramnios
May present with choking and cyanotic spells following aspiration
VACTERL associations

Question 19

what is hirschsrpung disease

diagnosis

Mx

Answer 19

The absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel results in a narrow, contracted segment. The abnormal bowel extends from the rectum for a variable distance proximally, ending in a normally innervated, dilated colon.

diagnosis
suction rectal biopsy

Mx
initally - rectal washouts/bowel irrigation
surgical and usually involves an initial colostomy followed by anastomozing normally innervated bowel to the anus.

Question 20

Hirschsprung ass w

Answer 20

• 3x common in males
• Downs syndrome
• Neurofibromatosis
• Waardenburg syndrome (a genetic condition causing pale blue eyes, hearing loss and patches of white skin and hair)
• Multiple endocrine neoplasia type II

Question 21

features of hirschsprung

Answer 21

failure to pass meconium within the first 48 hours of life.
Abdominal distension
- billious vomiting
- lethargy
- dehydration

In later childhood – profound chronic constipation, abdominal distension, and growth failure.

Question 22

what is hirschsprung associated enterocolitis

Answer 22

inflammation and obstruction of the intestine

within 2-4 weeks of birth with fever, abdominal distention, diarrhoea (often with blood) and features of sepsis. It is life threatening and can lead to toxic megacolon and perforation of the bowel. It requires urgent antibiotics, fluid resuscitation and decompression of the obstructed bowel.

Question 23

features of lymph nodes that requires further Ix in children

features children present

Answer 23

> 2 LN palpable for >2 weeks
2cm in size
2 or more regions affected

supraclavicular LNs

nodes that are firm, variable in size (TB), non-tender, matted together

fever
weight loss
night sweats

Question 24

Ix we do for lymphadenopathy and why

Answer 24

CRP - if increased raises level of concern

FBC
• Cytopaenia in more than one cell line – Leukaemia, lymphoma, SLE.
• Isolated leucopoenia or neutropenia – viral infection or leukaemia.
• Leucocytosis with left shift – bacterial infection.
• Atypical lymphocytosis – Ebstein-Barr virus infection.
• Anaemia – TB, SLE.
• Thrombocytosis – Kawasaki disease.

Question 25

what is gastrochisis and Mx

Answer 25

bowel outside w no covering

Mx
vaginal delivery may be attempted
newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours

Question 26

what is omphalocele Mx

Answer 26

abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.

ass
Beckwith-Wiedemann syndrome
Down’s syndrome
cardiac and kidney malformations

Mx
caesarean section is indicated to reduce the risk of sac rupture
a staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressure

Question 27

complications of undescended testis

Mx
unilateral
Bilateral

Answer 27

infertility
torsion
testicular cancer
psychological

unilateral

• At birth — re-examine the infant at 6–8 weeks of age.
• At 6–8 weeks of age — re-examine the infant at 4–5 months of age.
• At 4–5 months (corrected for gestational age), if the testis remains undescended, arrange referral to paediatric surgery or urology for specialist management depending on local referral pathways, to be seen by 6 months of age.

Bilateral

• identified at birth
• Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
• if disorder of sexual probs is excluded tests still not present in scrotum by4-5 months of age child referred by 6 ms

if at birth present but 6-8 weeks not there - urgent referral within 2 weeks

Surgical Mx
- palapble -> orchidopexy using inguinal approach

• non-palpable -> under anaesthesia with inguinal exploration and diagnostic laparoscopy may be needed to locate an intra-abdominal testis and perform subsequent orchidopexy or orchidectomy (removal of the testis).

Question 28

congenital diaphragmatic hernia (CDH)

Answer 28

outcome of prognosis

1. liver position
2. lung to head ratio

risk of recurrence of CDH is possible

more common on the left hand side

pulmonary HTN and hypoplasia -> RD

Question 29

what is hypospadias

characteristics

Answer 29

• a ventral urethral meatus
• a hooded prepuce
• chordee (ventral curvature of the penis) in more severe forms
• the urethral meatus may open more proximally in the more severe variants

Mx

• specialist services
• corrective surgery around 12 m

Question 30

what is phimosis

Answer 30

foreskin is too tight ot be pulled back over the head of the penis

<2 yrs non-retractile foreskin/ballooining during micturtionp it is normal -> resolves with time