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neonates > surgical > Flashcards

surgical Flashcards

1
Q

ddx neonatal bilious vomiting

A

Surgical

a. Malrotation with midgut volvulus
b. Intestinal atresia
c. Meconium ileus
d. Necrotising enterocolitis
e. Hirschsprung’s disease

Non-surgical

a. Sepsis
b. Meningitis
c. Omphalitis
d. Reflux

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2
Q

exomphalos vs gastroschisis

A

exomphalos:

  • herniation through defect at base of umbi
  • therefore protected by sac (membrane) continuous with umbi
  • poor outcome 10% survival
  • more associated with genetics - BW, T13, T18
  • if liver in sac, less likely aneuploidy risk

gastroschisis:
- herniation through abdo wall defect, usually to right of umbi
- no protective sac
- better outcome 90% survival
- AFP high
- cord paraumbi

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3
Q

consequences of CDH and long-term

A

pulmonary hypoplasia and pul HTN
malrotation
dextrocardia

long-term:
reflux, CLD, obstruction, recurrence of hernia

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4
Q

treatment of CDH

A

supportive: NGT
ventilate: HFOV vs CV, ECMO
treat pul HTN: NO, open PDA
surgical

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5
Q

what is diaphragmatic eventration

A

part of the diaphgram didnt muscularise good -> moves paradoxically
most is whatever, doesnt need repair

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6
Q

which TOF kind most common

A

type C = oesophageal atresia with distal TOF

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7
Q

types of TOF

A 
A = atresia only
B = atresia + prox TOF
C = atresia + distal TOF
D = atresia + both TOF
E = h type = TOF no atresia
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8
Q

presence of air in stomach/bowel with a TOF must mean what type?

A

distal fistula present

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9
Q

how may TOFs present

A

US scan - polyhydramnios cant swallow fluid

birth - cant feed, vomiting/coughing, resp distress, infections, frothy mucous

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10
Q

which TOF type can present later?

A

H - no atresia, so stuff could go down to GI (or resp)

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11
Q

which type of TOF has worst prognosis?

A

A - pure atresia

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12
Q

pyloric stenosis

  • age
  • biochemical finding
A
  • 2-6 weeks

- hypokalaemic hypochloraemic met alkalosis (vomit up Cl and H2O, kidneys conserve Na/H2O and kick out H/K)

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13
Q

exam thoughts: pyloric atresia = what condition?

A

= EB

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14
Q

when does malrotation present?

A

most within first year

most in D1-D3 of life

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15
Q

most common type of intestinal atresia

A

duodenal

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16
Q

duodenal atresia radiological finding

A

double bubble

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17
Q

duodenal atresia - vomit colour and distension: comment

A

no distension

bilious if distal to ampulla - most common

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18
Q

exam thoughts: duodenal atresia = what syndrome

A

T21

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19
Q

duodenal atresia have to screen for what and why

A 
a/w congenital abnormalities 
echo - CHD 
renal USS 
cxr - TOF
annular pnacreas
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20
Q

jejunoileal atresia - what kind of thing has gone wrong i.e. pathology

A

vascular shit

21
Q

non-operative Mx for mec ileus

A

NAC - water soluble enema

22
Q

NEC - clinical triad

A

bilious asps/vomiting
abdo distension
blood in stool

23
Q

pathogenesis of NEC

A

invasion of bad bacteria into wall
bad bacteria form gas + inflammation
ischaemic necrosis of wall

24
Q

risk factors for NEC

A

VLBW
aggressive enteral feeding
formula feeding
prolonged abx

25
Q

NEC - some possible axr findings

A

i. Dilated loops of bowel consistent with ileus
ii. Pneumatosis intestinalis (hallmark of NEC) = bubbles of gas in the small bowel wall
iii. Pneumoperitoneum = occurs with perforation; gas outlining both sides of the bowel wall
v. Portal venous gas

26
Q

classic exam finding of intestinal perf

A

blue-black discolouration of abdominal wall

27
Q

most common cause of neonatal obstruction

A

Hirschprung’s

28
Q

where in the colon is most Hirschprung disease

A

80% rectosigmoid

29
Q

Hirschprung’s - most common associated gene

A

RET protooncogene

30
Q

Hirschprungs - how can they present

A 
no mec in 48h
bilious vomits
abdo distension 
enterocolitis / obstruction / perf 
FTT
constipation 
squirt sign
31
Q

age of umbi hernia surgery vs inguinal

A

umbi: 2-3yo - 9/10 resolve spontaneously before then
inguinal: 6:2 rule <6 weeks within 2 days, if <6 months within 2 weeks, if >6 months within 2 months

32
Q

meckel’s - rule of 2s

A

i. Most common in children under 2
ii. 2 times more common in males
iii. Contains 2 types of tissue (pancreatic + gastric)
iv. 2 inches long
v. Found within 2 feet of the ileocaecal valve
vi. Occurs in 2% of the population

33
Q

age of intussusception

A

3mo-2yo

34
Q

classic triad intussusception

A

abdo pain
red currant jelly stool
sausage shaped mass

35
Q

examples of pathological lead points in intussusception

A

i. Meckel’s diverticulum
ii. Polyps
iii. Henoch-Schonlein purpura
iv. Duplication cyst
v. Other
1. Intestinal lymphoma (>6 months)
3. Adenovirus or rotavirus infection
4. Celiac disease
5. CF

36
Q

US finding of intussusception

A

target sign

37
Q

paraphimosis vs phimosis

A

phimosis cant retract - foreskin will balloon. physiological or there’s been scarring e.g. circumcision, recurrent balanitis

paraphimosis - can’t put back a retracted foreskin

38
Q

hypospadias - what

A

urethral meatus opens on underside of penis, and usually a/w chordee (bands pulling penis into curve) or hooded dorsal foreskin

39
Q

exam thoughts - priapism = what disease

A

1/3 sickle cell develop priapism

40
Q

when is foreskin fully retractable

A

3yo

41
Q

inguinal hernia age

A

greatest in 1st year of life

42
Q

when do most congenital UDT descend and why? so when do you need to refer for orchidopexy?

A

3mo - testosterone surge by 2mo
so it wont descend after 4mo and need to refer
orchidopexy by 6-12mo

43
Q

male newborn with bilaterally UDT - exam thoughts - think of what??

A

is it even a boy tho? could be virilised female with CAH

44
Q

whats the risks of a UDT

A

testicular cancer
torsion
infertility
hernia - 90% have an associated patent tunica vaginalis

45
Q

age groups of
appendage torsion
testicular torsion
E-O

hydrocele
varicocele
idiopathic scrotal oedema

A

appendage torsion - pre-pubertal
testicular - neonatal and adolescents
E-O - rare pre-puberty until has UTI with genitourinary issue!! usually adolescent with STI

hydrocele - infants
varicocele - peri-pubertal
idiopathic scrotal oedema - 3-7yo

46
Q

mumps orchitis occurs how long after parotitis

A

Mumps orchitis occurs 4-6days after parotitis**

47
Q

main complications of varicocele

A

impaired fertility in 10-15%

48
Q

pathophys of a non reactive hydrocoele

when to surgery and why

A

a. The patent processus vaginalis is narrow and enables peritoneal fluid, but not abdominal contents, into the cord structures
b. Patent processus vaginalis often closes on its own, in the first 18 months of life

surgery only if >2yo

49
Q

exam thoughts: mec ileus = what?

A

90% = cystic fibrosis!!

neonates (4 decks)

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