Surgical

Question 1

Three differentials for acute abdominal pain in child

Answer 1

1. Non specific (e.g. anxiety)
2. Appendicitis
3. Viral/ gastroenteritis
4. Constipation

Question 2

What investigation must you always perform in child with abdo pain?

Answer 2

urinalysis

Question 3

Why must you examine ENT in child with abdominal pain?

Answer 3

ENT infection can be a source for mesenteric adenitis

Question 4

What is mesenteric adenitis?

Answer 4

Mesenteric adenitis is a syndrome characterized by right lower quadrant pain secondary to an inflammatory condition of mesenteric lymph nodes.

Question 5

Two organisms associated with mesenteric adenitis?

Answer 5

E.coli
Salmonella
Streptococci

Question 6

How to demonstrate whether child has peritonism when assessing/examining?

Answer 6

ask patient to blow up tummy like a balloon

Question 7

Which system must you always examine in male child with abdominal pain?

Answer 7

testicular

Question 8

Name two medical differentials for abdominal pain

Answer 8

UTI
Basal pneumonia
Gastro/viral

Question 9

How long to wait before taking bloods in patient with suspected appendicitis?

Answer 9

8 hours. If taken before then no abnormalities will be found ..?

Question 10

Why can appendicitis mimic UTI symptoms and findings on urinalysis?

Answer 10

due to proximity of right ureter and appendix, leading to painful urination and blood + WCC in urine

Question 11

How can you distinguish between mesenteric adenitis and appendicitis?

Answer 11

temperature +- vomiting comes first in mesenteric adenitis, then abdo pain

abdo pain is the first symptom in appendicitis

Question 12

First imaging investigation for appendicitis? Name two signs that indicate appendicitis

Answer 12

USS
Fluid, increased size
Compressibility?

Question 13

Name three more uncommon differentials for acute abdominal pain in a child

Answer 13

testicular torsion
meckel’s diverticulum
basal pneumonia
malrotation of bowel
mittleschmertz

Question 14

What is mittleschmertz?

Answer 14

ovulation pain

Question 15

Name two causes of vomiting in baby?

Answer 15

overfeeding
small bowel obstruction
viral illness

Question 16

Is weight loss normal in a baby?

Answer 16

normal the first week to lose weight, however this period it would be concerning

Question 17

For which condition is there a separate growth chart?

Answer 17

down’s syndrome

Question 18

What does green vomit indicate in a newborn?

Answer 18

bilious vomiting- bowel obstruction

Question 19

What is the management of newborn with bilious vomiting?

Answer 19

always needs surgical review

Question 20

Three differentials for vomiting in baby?

Answer 20

reflux, Hirschprung’s, food intolerance

Question 21

Which electrolyte disorder can pyloric stenosis cause?

Answer 21

metabolic alkalosis

Question 22

What is the cause of metabolic alkalosis in pyloric stenosis?

Answer 22

Decreased potassium and chloride due to vomiting

Question 23

Why is family history important in pyloric stenosis?

Answer 23

strong FH link, therefore ask if any parent had pyloric stenosis/surgery as a child

Question 24

Three differentials for bilious vomiting?

Answer 24

sepsis, malrotation, ischaemic bowel

Question 25

2 day old infant present to GP with one episode of dark green vomit. He was born at term and there were no antenatal issues. He handles well on examination.

What is the most appropriate next step?

Answer 25

Refer to paeds surgical team

Bilious vomiting in a baby is always serious. This early in life duodenal atresia is a significant diagnosis that must be excluded.

Question 26

A 1-week-old infant is referred following episodes of vomiting, feeding intolerance , and abdominal distension. Examination reveals watery stools with specks of blood present within the nappy. An abdominal X-ray is requested which reveals gas cysts in the bowel wall. What is the most likely diagnosis?

Answer 26

Necrotising enterocolitis

Question 27

Two signs of necrotising enterocolitis on AXR?

Answer 27

dilated bowel loops (often asymmetrical in distribution)
bowel wall oedema
pneumatosis intestinalis (intramural gas)
pneumoperitoneum resulting from perforation
air both inside and outside of the bowel wall (Rigler sign)

Question 28

A 6-week old baby has been brought in to the hospital. Her Dad is worried because she has had problems retaining feeds. He says that soon after being fed she vomits up uncurdled milk quite forcefully. He is worried because she does not appear to be gaining weight. Given the likely diagnosis, which metabolic abnormality would the patient most likely present with?

Answer 28

Hypochloraemic hypokalaemic metabolic alkalosis

The most likely diagnosis here is pyloric stenosis. Due to vomiting up stomach contents which is acidic (hydrogen chloride - HCl), the patient will be hypochloraemic. Potassium is also lost in the vomitus.

The loss of hydrogen ions due to the vomiting up of stomach acid is the cause of the metabolic alkalosis.

Question 29

Difference between atresia and stenosis?

Answer 29

atresia is worse- complete blockage
stenosis= narrowing