Surgery Flashcards
If a child has a septic hip, what position do they normally hold their hip in?
a. abducted and internally rotated
b. abducted and externally rotated
c. adducted and internally rotated
d. adducted and externally rotated
b. abducted and externally rotated
A mother comes to you with her 2.5 year old son who she says is intoeing. On exam, you find evidence of metatarsus adductus. What do you suggest?
a. Reassure
b. Avoid W sitting
c. Refer to orthopedics
reassure
torsional deformities, such as meta-tarsus abductus, intoeing secondary to tibial torsion, and femoral torsion resolve spontaneously by adulthood.
Which is the most sensitive test for early detection of Legg-Calve-Perthes?
a. Bone scan
b. Bone densitometry
c. Ultrasound
d. AP and frog leg Xrays
bone scan
AP and frog leg Xrays -this would be the first test, but is often negative in early disease therefore not most sensitive
Child has insidious onset testicular pain. On exam there is a Blue dot, management?
a) reassure
b) Ultrasound testes
reassure
Septic joint next step?
a) Aspirate
b) Urgent consult to Ortho - I would consult ortho because this is a surgical emergency
c) Admit and start IV antibiotics
urgent ortho consult
- A 12 year old was in an MVC that resulted in severe splenic laceration requiring splenectomy. What does she need now?
a. Penicillin prophylaxis
b. Penicillin prophylaxis and meningococcal and pneumococcal vaccines
c. Meningococcal and pneumococcal vaccines
d. Nothing required
penicillin prophylaxis
All children with these conditions, regardless of age, should receive vaccines to protect against S pneumoniae, N meningitidis, Hib and seasonal influenza.
49. When should repair for a persistent hydrocele occur? 6 months 12 months 18 months 24 months
12 months
A 10 year old boy presents with 12 hours of scrotal pain. He has focal tenderness at the upper pole of the testis with a focal blue discolouration, and there is some edema. What is the best next step?
a. Ultrasound
b. Analgesia and scrotal support
C. Urology consult
b. Analgesia and scrotal support
Torsion of the appendix testis - management is reassure, bedrest and analgesia
Adolescent girl with scoliosis has undergone spinal surgery. She present with bilious vomiting for the last few days. What is the etiology?
a. bowel adhesions
b. superior mesenteric artery syndrome
c. malrotation with volvulus
d. Pancreatitis
SMA syndrome
5 mo Kid flexion of arms and legs, and with associated vomiting and abdo distention, sleepy after episodes. What will give diagnosis?
a) EEG
b) US abdomen
US abdo
Kid with abdo pain; describes kid with malrotation and intermittent volvulus; what investigation?
a. AXR 2 views
b. U/S
c. UGI
d. Barium enema
UGI
A 3 month old male infant presents to the emergency department with a 1 month history of “spit ups” and 2 day history of projectile vomiting. His last two vomits were bilious. On exam, he looks dehydrated and unwell. His abdomen is distended, non tender, with no palpable masses. What diagnostic test would MOST likely reveal the underlying abnormality?
a. Abdominal ultrasound
b. Barium enema
c. Upper GI series
d. Abdominal X ray (anterioposterior and lateral)
c. Upper GI series
New born baby born with refractory hypoglycemia and attached photo. What is he most at risk for?
Hirschprung’s disease
Wilm’s tumour
Hypothyroid
wilms tumor
This is an omphalocele; baby likely has beckwith wiedeman syndrome and is thus at risk of Wilm’s tumor :(
The majority (≈75%) of infants with omphalocele have associated congenital anomalies/syndromes, including Beckwith-Wiedemann syndrome (omphalocele, macrosomia, hypoglycemia), and other chromosomal (29%, including trisomies 13 and 18) and nonchromosomal (45%) multiple and isolated congenital anomalies (musculoskeletal, 24%; urogenital, 20%; cardiovascular, 15%; and central nervous system, 9%).
17 year old female present with a small firm lump in her breast. What is the MOST likely cause
Fibrocystic changes
Fibroadenoma
fibroadenoma
5 month old with vomiting for 6 hours intermittently, has had 3 or 4 episodes of flexion and extension of arms and legs, drowsy after, abdomen is distended, which test would reveal diagnosis? A. EEG B. CT abdomen C. Ultrasound abdomen D. Abdominal x-ray
abdo u/s
Adolescent girl with scoliosis has undergone spinal surgery. She present with bilious vomiting for the last few days. What is the etiology?
a. bowel adhesions
b. superior mesenteric artery syndrome
c. malrotation with volvulus
d. pancreatitis
SMA
5 mo Kid flexion of arms and legs, and with associated vomiting and abdo distention, sleepy after episodes. What will give diagnosis?
a) EEG
b) US abdomen
b) US abdomen
The success rate of radiologic hydrostatic reduction under fluoroscopic or ultrasonic guidance is approximately 80-95% in patients with ileocolic intussusception
The recurrence rate after reduction of intussusceptions is approximately 10%, and after surgical reduction it is 2-5%; usually within 72 hr
In patients with multiple ileal–colonic recurrences, a lead point should be suspected and laparoscopic surgery considered
Photo of G tube site as below. What would you do?
(this exact photo shown, brought to you by googling granulation tissues)
a. Oral antibiotics
b. Consult surgery
c. Silver nitrite cautery
d. Reassure
reassure
Teen with large firm symmetrically enlarged thyroid. Negative for thyroid antibodies. What next?
a. f/u in 6 mo
b. do ultrasound
c. Biopsy
fu in 6 months
Peritonitis, what to do next?
a. Bolus & analgesics
a. Bolus & analgesics
Would like an answer that includes antibiotics. If secondary peritonitis then this answer makes sense + Abx
2 year old umbilical hernia
a. Reassure
b. refer to surg
reassure
Most umbilical hernias that appear before the age of 6 months disappear spontaneously before 1 year of age. Even large hernias (5-6 cm) have been known to close spontaneously by 5-6 years of age. Strangulation is extremely rare. Surgery is not advised unless the hernia persists until 4-5 years old, causes symptoms, becomes strangulated or becomes progressively larger after 1-2 years.
A 1 month old boy is diagnosed with pyloric stenosis. He has a severe metabolic alkalosis, bicarbonate 34. What do you do:
a. Operate immediately
b. Give HCl
c. Give K bolus
d. Give large amounts of chlorinated fluid IV
d. Give large amounts of chlorinated fluid IV
correct before surgrey d/t post op APNEA
get paradoxical aciduria
NEED TO REPLENISH CHLORIDE TO ALLOW EXCHANGE BY KIDNEYS - REABSORB CL AND EXCRETE HCO3
hypochloremic, hypokalemic, metabolic alkalosis due to the loss of large amounts of gastric hydrochloric acid
olume deficit triggers an expansion of the extracellular volume rather than maintenance of pH → RAAS activated and aldosterone effects begin. Na is resorbed, but K is lost via an aldosterone mediated mechanism and this leads to excretion of H ion
Picture of gastroschisis (still same poor picture). Most common associated anomaly?
a. Intestinal atresia
Gastroschisis (R of umbilicus)
Picture of gastroschisis. What is this associated with:
a. intestinal atresia
b. cardiac defect
c. renal defects
IA
cardiac- omphalocele
Description of baby pulling legs up, well between. What investigation should you do?
a. EEG
b. Abdominal ultrasound
u/s
1 year old with rectal abscess. Mgt?
a. Systemic abx
b. Excision by surgery
c. I and D
I and D
If 3 months of age or older:
Low grade/no fever and no systemic sx = observe after drainage; Abx only if no improvement or culture grows something other than staph
Significant cellulitis or low grade fever with no systemic sx = PO TMP/SMX + Cephalexin pending cultures
Systemic symptoms = IV abx
