Surgery Flashcards

1
Q

At which month is it very unlikely for an undescended testicle to descend?

A

4 months

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2
Q

What are the complications or risks of an undescended testicle?

A
  • Poor testicular growth
  • Testicular malignancy (peak age 15-45 years, most common = seminoma)
    • 4x higher in the undescended testis, less common if orchiopexy <10yo but risk still exists
    • Adolescents should be instructed in testicular self-examinations
  • Associated hernia
  • Torsion of the cryptorchid testis
  • Infertility
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3
Q

What are indications for surgical repair of an umbilical hernia?

A
  • Hernia persists to 4 to 5 years of age
  • Causes symptoms
  • Becomes strangulated
  • Becomes progressively larger after 1-2 years
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4
Q

What is the best investigation for breast mass in teens?

What is the most common etiology?

What is the management for this issue?

A

Ultrasound → mammogram NOT indicated

Fibroadenoma

Management: observe 2 menstrual cycles or until adulthood, 10% will regress. Serial US to monitor.

FNA indication: >5cm (risk of giant fibroadenoma, cystosarcoma phylloides)

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5
Q

At what age is intussusception mostly seen?

A
  • Most common cause of intestinal obstruction between 5 months and 3 years
  • Approximately 80% of cases occur <2 years of age; rare in neonates
  • M>F (3:1)
  • Ileo-colic (90%) > ceco-colic > ileo-ileal
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6
Q

What are the classic clinical presenting symptoms?

A
  • Sudden onset of severe paroxysmal colicky pain accompanied by straining and flexed knees
  • Progressively weaker and lethargic, as well shock-like state with fever and peritonitis
  • Vomiting, may be bilious
  • Red currant jelly stool in 60% of infants; may more commonly be bloody
  • “Sausage-shaped” RUQ mass in 30% of patients
  • Classic triad of paroxysmal pain, palpable sausage-shaped RUQ abdominal mass and currant jelly stool present in <30% of affected patients
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7
Q

What are the contraindications to air enema for intussusception?

A
  • Prolonged intussusception
  • Signs of shock
  • Peritoneal irritation / peritonitis
  • Intestinal perforation
  • Pneumatosis intestinalis
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8
Q

What is the most common associated anomaly with gastroschisis?

A

Intestinal atresia

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9
Q

What are the differences between non-communicating and communicating hydroceles?

A
  • Non communicating - fixed amount of fluid and the tract has closed off; common in newborns and rare > 1 year → conservative, typically self-resolves (surgery if persistent at 18mo)
  • Communicating - persistence or delayed closure of the processus vaginalis but smaller so doesn’t cause hernia. Fluid amounts change with gravity and throughout the day → can be corrected in 1st if truly changing volumen
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10
Q

What are indications for emergent or urgent removal of foreign bodies in the esophagus?

A
  • Signs of airway compromise
  • Symptoms consistent with esophageal obstruction
  • Button battery in the esophagus
  • Sharp or long (>5cm) objects in the esophagus or stomach
  • High-powdered magnets
  • Intestinal obstruction
  • FB impacted in the esophagus for >24h or an unknown period
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11
Q

What is the peak age of appendicitis?

A
  • Most common non-traumatic surgical emergency in children
  • 1 in 1000 kids per year
  • 20-25% perforated on presentation
  • Peak incidence: 11-12yo (⅓ present < 18y)
  • Lifetime risk: 7% female, 9% male
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12
Q

What is the sensitivity and specificity for ultrasound vs. CT scan in appendicitis?

A
  • US - non compressible appendix, abscess
    • Sensitivity 85%, specificity > 90%
  • CT scan - ALARA principle
    • Sensitivity 95%, specificity 94%
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