Surgery - Other

Question 1

What are the clinical features of pyloric stenosis?

Answer 1

vomiting - becoming increasingly frequent and forcefulness over time ultimately becoming projectile
hunger after vomiting until dehydration
weight loss if presentation is delayed

Question 2

What is pyloric stenosis?When does it present?

Answer 2

hypertrophy of the pyloric muscle causing gastric outlet obstruction presents at 2-8 weeks of age, irrespective of gestational age more common in boys

Question 3

How is a diagnosis made of pyloric stenosis?

Answer 3

• diagnosis can be made through ultrasound
• test feed is performed
• calms the hungry infant and allows examination to be performed
• gastric peristalsis can be seen across the abdomen and pyloric mass which feels like an olive is usually palpable in the right upper quadrant
• ultra sound examination can be helpful

Question 4

How is pyloric stenosis managed?

Answer 4

1) correct fluid and electrolyte disturbance with IV fluids

2) pyloromyotomy operation (division of hypertrophied muscle) can be performed

Question 5

What fluid and electrolytes imbalance occurs in pyloric stenosis?

Answer 5

vomiting contents from the stomach causes:

• a hypochloraemic metabolic alkalosis
• hyponatraemia
• hypokalaemia

Question 6

What are the differential diagnosis of cervical lymphadenopathy in children?

Answer 6

TB 
Toxoplasmosis 
SLE 
Syphilis 
Infection - chickenpox, HIV, rubella
Lymphoma 
Leukaemia

Question 7

How is lymphadenopathy investigated?

Answer 7

examination

biopsy for large nodes

Question 8

What is suppurative adenitis/lymphadenitis?

Answer 8

common form of soft tissue caused by staph aureus or strep pyogenes

Question 9

How does cleft lip present?

Answer 9

may be unilateral or bilateral

failure of fusion of the frontonasal and maxillary processs

Question 10

What are the common associations with cleft lip/palette?

Answer 10

may be part of a syndrome of abnormalities (chromosomal disorders) may be detected on antenatal ultrasound

Question 11

What are the problems associated with cleft lip/palette?

Answer 11

feeding is more difficult and in bottle fed babies though some breast fed babies can be successfully fed surgical repair of the lip occurs at 3 months and palette at 6-12 months

Question 12

How does congenital diaphragmatic hernia present?

Answer 12

• failure to respond to resuscitation
• respiratory distress
• heart and bowel sounds are displaced
• usually picked up on antenatal scan
• x ray shows left sided herniation of abdominal contents through posterolateral foramen of the diaphragm

Question 13

How is diaphragmatic hernia treated?

Answer 13

avoid mask ventilation 
intubate immediately 
use NG to deflate bowel 
surgical repair 
mortality is high if lungs are hypoplastic

Question 14

How does a trachea-oesophageal fistula present?

Answer 14

if not suspected before birth then presents with

• persistent salivation
• drooling from the mouth
• infant will cough and choke when fed
• may be aspiration into the lungs

Question 15

How is the diagnosis of oesophageal fistula made?

Answer 15

pass NG tube and x ray is checked to see if it reaches the stomach
see polyhyramnios antenatally as baby can’t swallow amniotic fluid

Question 16

What conditions is oesophageal atresia associated with?

Answer 16

VACTERL conditions

vertebral ano-rectal cardiactracheo-oesophageal atresia/fistula renal limb

Question 17

How is oesophageal atresia managed?

Answer 17

1-2 days after birth, tie off fistula post repair risk of strictures is high and RF for GORD later

• NG drainage, tracheostomy, gastrostomy, IV hydration + abx
• If no pulmonary complications, repair within first few days of life
• Complications – parenteral nutrition, gastrostomy + upper pouch suction until lower risk
• Palliative – treatment is relief of obstruction + diversion of contamination away from respiratory tract

Question 18

What is an ano-rectal malformation?

Answer 18

imperforate anus and fistula to vagina or scrotum classified as high or low (low easier to treat)

Question 19

How are anorectal malformations surgically managed?

Answer 19

colostomy initially and pull through later

long term issue of continence

Question 20

What are the differential diagnoses of a congenital neck cyst based on anatomical location?

Answer 20

thyroglossal duct cysts
brachial cleft cysts
dermoid cyst 
vascular malformations 
hemangiomas

Question 21

How should a child with a head injury be assessed and investigated?

(long)

Answer 21

ABCDE
Is the child responsive/unresponsive?
Is the child breathing?

Then:
Suspicion of non-accidental injury 
Post-traumatic injury 
Glasgow coma scale 
Suspected open or depressed skull fractures
Sign of basal skull fracture 
Focal neuro signs 
Bruise or swelling in <1 year olds 
if YES --> CT 

Then:
loss of consciousness >5 min
drowsiness
3 or more discrete episodes of vomiting
Dangerous mechanism of injury
Amnesia lasting >5 mins
if YES - admit and observe, CT if further concerns

Question 22

What are the indications for admission and imaging in a head injury?

Answer 22

no symptoms/signs and benign mechanism of injury = discharge home with written advice

minor symptoms or dangerous mechanism of injury = monitor for evolution of symptoms

significant or progressive symptoms or signs - resuscitate (if necessary), CT scan, and neurosurgical referral if appropriate

Question 23

What are the differentials for a solid tumour?

Answer 23

Sarcomas 
Carcinomas 
Neuroblastoma 
Wilms tumour 
Rhabdomyosarcoma 
Retinoblastoma 
Osteosarcoma and Ewing sarcoma

Question 24

What is Wilms tumour?

Answer 24

originates form embryological renal tissue
uncommon after 10 years
presents with large abdominal mass and haematuria

Question 25

What is neuroblastoma?

Answer 25

tumours arise from neural crest tissue in the adrenal medulla and sympathetic nervous system can be benign or highly malignant more common before the age of 5 can present with metastatic disease

Question 26

What is a sacrococcygeal teratoma?

Answer 26

presents in the newbron, tumour is located at the base of tail bone
they are not ususally malignant