Surgery

Question 1

Hypospadeuis

Answer 1

Ventrallly def foreskin
Chordee >15 degrees erect
Prox urinary meatus

Question 2

Hydrocele and inguinal hernia

Answer 2

Part of the same process
Incomplete closure of the process vaginalis
Testicles descends 32-36 weeks embryo

Question 3

Inguinal hernias

Answer 3

Increased risk in prem infants
More likely to strangulate in prem infants
Males:females 10:1
If not reducible surgical emergency

Question 4

Hydrocele

Answer 4

Common in the neonatal period

90% reduce in the first year

Question 5

Undescended testis

Answer 5

USS NOT helpful gives high rate of false neg ( retractible)
If T down at birth likely retractible
If not down at birth likely undescended and will need laparaoscopy

Question 6

Acute scrotum 7

Answer 6

Torsion of testicular appendage
Torsion of the testicle
Hernia 
Trauma 
Infection 
Scrotal edema
Tumor  
HSP

Question 7

Torsion of the testicular appendage

Answer 7

Just before puberty 8-11 years Males
95% Hydatid of Morgagni
Blue dot sign
Pain upper pole of the T quickly becomes everywhere and that is indistinguishable from T of T

Question 8

Torsion of Testis

Answer 8

Peaks Neonate and 13-15 year but can happen any time
Rapid onset acute severe pain Abdo pain Vomiting
Unable to walk
Neonatal t of T likely happened inutero and the T is not salvageable
Testis is red and swollen possible with a reactive Hydrocele
Elevated lost the cremastic reflex
Contralateral testicle can like horizontally and it has an increased risk of T of T

Question 9

Management of T of T

Answer 9

Early exploration of T
 <6 hours  of pain 85-97% survive 
>24 hours of pain <10% survive 
USS NOT Recommended delays Surgery
High risk of false neg
Esp not accurate in a small child

Question 10

Midline neck lumps 4

Answer 10

Thyroglossal cyst ( poke out tongue/drink h2O)
Dermioid cyst
Pre- tracheal cyst
Ran UCLA

Question 11

Lateral neck lumps

Answer 11

Lymph nodes 4
Sternomastoid tumor lump in the SM muscle
Dermoid cyst ( lateral angular dermoid lat eyebrow common site)
Lymphoid proliferation (present birth/later avoid surgery)
Brachial remnant brachial sinus or fistula anterior to the SM muscle

Question 12

Lymph nodes in the neck 4 causes

Answer 12

1 reactive ln
2 inflammatory
3 MAIS
4 Cancer rare but important esp teenagers

Question 13

MAIS

Answer 13

Mycobacterium lymphadenitis
Submandibular position
Hard and red 6-8/52
Asymptomatic no fever no pain 
Ix Mantoux test positive 
Dd reactive ln <2cm soft and spongy

Question 14

Pre auricular sinus

Answer 14

In front of the ear
Can be bilateral
Run in the family
Treatment is elective surgical excision when ‘cold’

Question 15

Pyloric stenosis dd

Answer 15

Sepsis and GOR
In GOR the child thrives as it continues to vomit
In PS the child gets sicker as it continues to vomit

Question 16

Examination in PS

Answer 16

Do a test feed
Feel for the gastric peristaltic waves
Palpable tumor sometimes

Question 17

Investigations PS

Answer 17

USS is 90% Sn and 100% SP

Question 18

Resuscitation in PS

Answer 18

Hypochoraemic alkaliss lose Acid and Cl as they vomit
Needs rehydration and maintainece 100/50/20 or 4,2,1
Check electrolytes 2x per day
Surgery when the child has the dehydration electrolyte mixup fixed