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MC > Surgical Problems in children > Flashcards

Surgical Problems in children Flashcards

1
Q

The head shape can recover to a normal

shape within about_____ weeks following birth

A

8

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2
Q

This is asymmetry of the skull with a normal head

circumference. The shape can be likened to a tilted
parallelogram.

It is the most common
cause of an abnormal head shape

A

Plagiocephaly

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3
Q

Plagiocephaly Mx

a _______________can be tried—best from 4 to 8 months

A

cranial remodelling helmet

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4
Q

This is premature fusion of one or more sutures of the

cranial vault and base, which act as lines of growth

A

Craniostenosis

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5
Q

Craniostenosis Mx

Prompt referral to a paediatric craniofacial surgeon is
necessary as planning for possible complex surgery,
best at________months, is required

A

5 to 10

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6
Q

Macrocephaly and microcephaly are defined as a head

circumference greater than the _______ percentile and less than the ______ percentile respectively

A

97th

3rd

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7
Q

The ears are almost adult size and firmness by _____

A

5

to 6 years of age

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8
Q

the ear cartilage is not strong

enough to cope with surgery under _____

A

3 years.

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9
Q

This dermoid cyst, which has a readily identifiable
constant position, lies in the outer aspect of the
eyebrow

A

External angular dermoid

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10
Q

Congenital clefts of the lip and palate occur in

approximately _______

A

1:600 of all births.

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11
Q

Type of CLAP

frequently not recognised in infancy because the palate appears to be intact

A

submucus cleft,

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12
Q

The ideal age for repair of the cleft lip is

under ________ months of age

A

3

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13
Q

The repair of the palate, which requires preliminary diagnostic ultrasound, is best performed before _______

A

the child begins to speak

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14
Q

Rhinoplasty is best deferred to ________
If performed early there is a higher incidence of
secondary surgery.

A

late adolescence.

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15
Q

-_______ may be unilateral, leading to
delayed diagnosis, or bilateral, where there is no
instinctive reaction to breathe through the mouth,
leading to asphyxia

A

Choanal atresia

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16
Q

What condition?

• tongue may appear heart-shaped
• infants unable to protrude the tongue over the
lower lip
• breastfeeding problems

A

Tongue tie (ankyloglossia)

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17
Q

The ideal time to release the ‘tie’ is in infancy,

under ______

A

4 months

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18
Q

This common condition can get recurrently infected
with pus discharge from a small opening immediately
anterior to the ear at the level of the meatus in front
of the upper crus of the helix

A

Pre-auricular sinus

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19
Q

This is a rare condition and is located inferior to
the external auditory meatus or anterior to the
sternomastoid muscle

A

Branchial sinus/cyst/fistula

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20
Q

A squint is rarely obvious in the first weeks of life,
but tends to show up when the baby learns to use the
eyes, from about__________

A

2 weeks to 3 or 4 months of age

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21
Q

Types of squint

• ___________ is one that is permanent—
always present.
• __________ is one that only appears under
stressful conditions such as fatigue.
• _________ is one that is noticeable for short
periods and then the eye appears normal.

A

Constant or true squint

Latent squint

Transient squint

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22
Q

Types of squint

• ___________ is one that changes between
the eyes so the child can use either eye to fix
vision.
• __________ is not a true squint but only appears
to be one because of the shape of the eyelids, i.e.
broad epicanthic folds

A

Alternating squint

Pseudosquint

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23
Q

A useful way to differentiate a true squint from a

pseudosquint is to observe the __________

A

(corneal reflections)

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24
Q

If one eye is ‘lazy’ (that is, not being used), it

is standard practice to _________

A

wear a patch (maybe on

glasses) over the good eye for long periods

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25
Q

The two serious squints are the _____ and _______ which require early referral

A

constant and

alternating ones,

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26
Q

Children with strabismus (even if the ocular
examination is normal) need specialist
management because the deviating eye will
become _________

A

amblyopic (a lazy eye with reduced vision

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27
Q

• hard painless lump (2–3 cm long) within
sternomastoid muscle
• tight and shortened sternomastoid muscle
• usually not observed at birth

A

Sternomastoid tumour/fibrosis

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28
Q

If surgery for a persistent fibrotic shortened muscle is required it is best before
__________

A

12 months.

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29
Q

Associations of shortened sternomastoid muscle

A
  1. rotation of the head to the affected side,
  2. hemihypoplasia of the face and a
  3. wasted ipsilateral trapezius muscle.
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30
Q

This is the most common childhood midline neck
swelling. It moves with swallowing and tongue
protrusion. It is prone to infection, including abscess
formation.

A

Thyroglossal cyst

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31
Q

These usually present as soft cystic tumours of the
neck, face or oral cavity. They resemble clusters of
vesicles and are often poorly localised

A

Lymphatic malformation/

lymphangioma/cystic hygroma

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32
Q

Lymphatic malformation/ lymphangioma/cystic hygroma location

A

If located in the floor of the mouth or peripharyngeal

area they endanger the airway

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33
Q

These start soon after birth as a red
pinpoint lesion and grow rapidly for the first 6 months,
then involute and become pale

A

Infantile haemangioma

strawberry naevus

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34
Q

These are aggregations of abnormal subcutaneous

veins that may infiltrate deeper tissues.

A

Venous malformations

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35
Q

These appear sometimes as skin lesions because of

the red discolouration on the surface of the tumour

A

Lymphatic malformation

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36
Q

If giant naevi they can be dermabraded at ideally less

than _______

A

6 weeks

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37
Q

These pigmented lesions, which typically appear on
the face, are usually surgically excised because of their
rapid growth and family concerns

A

Benign juvenile melanoma

Spitz naevus

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38
Q

When to do surgery for macromastia

A

Reduction surgery should also be delayed until breast

growth is complete, at late adolescence

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39
Q

If it develops in the pubertal stage, gynaecomastia may resolve spontaneously within ________

A

1 or 2 years.

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40
Q

This syndrome is an absent sternal head of pectoralis
major with associated chest wall deformity plus a
hypoplastic or absent breast and nipple–areolar
complex

A

Poland syndrome

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41
Q

Poland syndrome

Surgical correction can be undertaken from
________

A

10 to 20 years.

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42
Q

_______ is the commonest congenital heart lesion (1:500

births).

A

VSD

43
Q

What type of VSD

_________harsh murmur,
usually asymptomatic and closes spontaneously.

_______symptoms appear in infancy

A

Small VSD (‘maladie de Roger’):

Larger VSD:

44
Q

VSD Tx,

A ______ can close the defect through open-heart surgery.

A

patch

45
Q

As a general rule

about________ of all VSDs will close spontaneously

A

50%

46
Q

VSD

The
________ type, unlike the muscular type, is less
likely to close spontaneously.

A

membraneous

47
Q

In ASD the defect connects the two atria with two
distinct types—________ with holes higher
in the septum (most common) and _________
with holes lower in the septum (more serious)

A

ostium secundum

ostium primum

48
Q

Signs of ASD

A

Signs are a mid-systolic murmur in the

pulmonary area, a split 2nd sound and a loud P2.

49
Q

Symptoms are uncommon in infancy and

childhood with ostium secundum but ______ and ________develops early with ostium primum.

A

heart failure

with pulmonary hypertension

50
Q

Prophylactic antibiotics

are needed for patients with ______

A

ostium primum

51
Q

Mx of ASD

Options are repair by________ or an insertion
of a patch or a device closure using a ___________manipulated into the defect
via cardiac catheterisation.

A

direct surgical suture

self-expanding
‘double umbrella device’

52
Q

The ductus fails to close after birth. A loud, continuous

machinery murmur is heard

A

Patent ductus arteriosus

53
Q

Patent ductus arteriosus sx

A

The child presents with a murmur with
possible respiratory infections, failure to thrive and
heart failure.

54
Q

This usually presents in infancy with heart failure.
Refer for early surgery to remove the narrowed
portion of the aorta

A

Coarctation of the aorta

55
Q

Inguinal hernias

These usually present in the first _______ months

A

3 to 4

56
Q

They and _______ hernias should be referred
urgently as early surgery is advisable to avoid the
high risk of bowel incarceration or strangulation and
ovarian entrapment and ischaemia in females

A

femoral

57
Q

______ are painless cystic swellings

around the testis

A

Scrotal hydroceles

58
Q

Problem in scrotal hydrocele

A

The opening of the processus

vaginalis is narrow and often closes spontaneously

59
Q

Hydrocele

Two types can be identified—
1. _______ which disappear within 12 months,

  1. _____ which often persist after the first year
A

slack, often bilateral,

tense, often
unilateral,

60
Q

Hydrocele

Ninety per cent resolve by 18 months of age; for
those that persist, referral is recommended with a
view to surgical intervention if present for longer
than _________

A

2 years.

61
Q

Testes can still descend up to ____months after birth

A

3

62
Q

Undescended testes

Refer by 6 months with a view to correction between
9 and 12 months but definitely before ______

A

2 years

63
Q

What condition

Non-urgent cases should be evaluated by 6 months
with a view to surgery at around 12 months; these
patients should not be circumcised.

A

Hypospadias

64
Q

uncommon and almost all cases of
tight foreskin with narrowing of the preputial orifice
resolve naturally

A

Phimosis

65
Q

Phimosis

Probably the only indication for circumcision is
_________

A

persistent difficulty in passing urine

66
Q

Surgery is not usually required for umbilical herniae

as most close naturally by _______

A

4 years of age

67
Q

A good guideline is that if the hernial orifice is greater than 1 cm at ______ then surgical intervention is a possibility.
It is usual to operate at 4–5 years

A

12 months

68
Q

This is due to a defect in the linea alba adjacent to the

umbilicus proper. Most lie just above the umbilicus.

A

Para-umbilical hernia

69
Q 
An \_\_\_\_\_\_\_\_ (not to be confused with
divarification of the rectus muscles) lies between the
umbilicus and the xiphisternum.
A

epigastric hernia

70
Q

epigastric hernia is likely to incarcerate and causes pain by strangulation of _______

A

herniated fat.

71
Q

________are often seen in infants and toddlers
with uncomfortable defecation and minimal bright
bleeding

A

Anal fissures

72
Q

________is caused by adhesions considered to be

acquired from perineal inflammation

A

Labial fusion

73
Q

Dev dysplasia of hip

Detected by
1
2

A 
clinical examination (Ortolani and
Barlow tests) and ultrasound examination
74
Q

DDH

Infants are usually treated successfully by
_________

A

abduction splinting (e.g. Pavlik harness).

75
Q

Bow legs (genu varum)

• Consider _______ in children at risk.
• Toddlers are usually bow-legged until 3 years of
age.

A

rickets

76
Q

What to monitor in pts with genu varum?

Monitor _____________: distance
between medial femoral condyles

A

intercondylar separation (ICS)

77
Q

What to monitor in pts with genu valgus:

Monitor ___________
distance between medial malleoli

Refer if: _______

A

intermalleolar separation (IMS):

IMS >8 cm

78
Q 
Causes of in-toeing are 
1
2
3
4
A

metatarsus varus, internal tibial torsion and medial femoral

torsion.

79
Q

Children with __________ tend to sit in

a characteristic ‘W’ sitting position

A

femoral torsion

80
Q

Have restricted internal rotation of hip due to an

external rotation contracture

A

Out-toeing

81
Q

Characteristic posture of Out-toeing pts

A

Exhibit a ‘Charlie Chaplin’ posture between 3 and

12 months—up to 2 years

82
Q

Most abnormal-looking feet in infants are not a
true club foot deformity; the majority have postural
problems referred to as _______ such as
talipes calcaneovalgus, metatarsus varus and postural
talipes equinovarus

A

‘postural talipes’

83
Q

True club foot deformity is usually_____, and requires orthopaedic correction.

A

stiff and severe

84
Q

What condition?

the femur tends to rotate
inwards especially when the child is about 5–6 years
old and is normal up to 12 years

A

Inset hips (medial femoral torsion)

85
Q

Fortunately, most children outgrow inset hips before the age of_____

A

12.

86
Q

All newborns have flat feet but 80%
develop a medial arch by their sixth birthday and
most by _______

A

11 years

87
Q

The presence of the medial arch can be

demonstrated to parents by the _______

A

tiptoe test

88
Q

MC type of curly toe

A

Usually the third toe curls inward under the second toe
so that the second toe lies above the level of the first
and third toes

89
Q

________rattling respiratory
distress + excessive drooling and
secretions + choking with feeding (passage of
10F catheter stops about 10 cm)

A

Oesophageal atresia:

90
Q

Oesophageal atresia MX

A

Action: nil orally, oropharyngeal suction,

IV fluids

91
Q

severe respiratory
distress + barrel-shaped chest + scaphoid
abdomen (X-rays of chest/abdomen show loops
of bowel in chest)

A

Diaphragmatic hernia

92
Q

Mx Diaphragmatic hernia

A

Give O 2 , nasogastric tube (avoid bag and

mask)

93
Q

Bilious (green vomiting) = ____ or ______

A

bowel obstruction or

malrotation (abdominal X-ray)

94
Q

bowel obstruction or malrotation MX

A

Action: nasogastric drainage and refer (do not feed)

95
Q

Imperforate anus and rectum

Action: refer for surgery on day of birth,
_______ for low lesions; ______ for
high lesions

A

anoplasty

complex surgery

96
Q 
\_\_\_\_\_\_\_\_\_\_neonatal jaundice (conjugated
bilirubin) (usually 4–6 weeks) → white stools
A

Bile duct atresia:

97
Q

______________ respiratory

distress + cyanosis + signs of emphysema

A

Congenital lobar emphysema:

98
Q

Congenital lobar emphysema MX

A

refer early for urgent assessment and

surgery to remove diseased lung

99
Q

______________: respiratory

distress soon after birth

A

Congenital cystic disease of the lungs

100
Q

______ (intestinal contents in a sac)

A

Exomphalos

101
Q

_______(exposed bowel contents through

anterior wall defect

A

Gastroschisis

102
Q

Action: as for exomphalos;_______

A

cover with plastic wrap

103
Q

__________: micrognathia + cleft

palate + respiratory obstruction from tongue

A

Pierre–Robin syndrome

MC (90 decks)

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