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Paediatrics > Urology and Surgery > Flashcards

Urology and Surgery Flashcards

1
Q

How do urological problems present systemically?

A 
Fever
Vomiting
Failure to thrive
Anaemia
Hypertension
Renal failure
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2
Q

How do urological problems present locally?

A 
Pain
Changes in urine
Abnormal voiding
Mass
Visible abnormalities
Incidental
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3
Q

How do urological problems present antenatally?

A

Asymptomatic

Permits immediate postnatal assessment

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4
Q

What is Hernia?

A

A groin swelling where tissue exits through a hole in the abdominal wall.
Most commonly through deep inguinal ring.
B>G 9:1 due to descent if testis.

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5
Q

When does the deep inguinal ring close?

A

3rd trimester

Hernias more risk in prematurity.

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6
Q

What is the management for hernia?

A

<1 year old then urgent referral to be repaired.
>1 year old can just watch and wait, elective referral for repair.
Incarcerated (stuck) - reduce and repair on same admission.

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7
Q

What is a hydrocele?

A

Scrotal swelling where fluid collects in the thin sheath surrounding the testicle.

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8
Q

What are some features of Hydrocele?

A

Very common in new borns and usually resolve by themselves.
Painless
Bluish colour
Increases with crying, straining, in evening.

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9
Q

What is the management of Hydrocele?

A

Watch and wait until 5yrs.

May repair when older if requested.

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10
Q

What is Cryptorchidism?

A

Any testis that can’t be manipulated into the bottom half of the scrotum.

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11
Q

What are the different types of Cryptorchidism?

A

True cryptorchidism - undescended testis
Retractile - sit high and can be pulled down but string back.
Ectopic - come down in wrong place e.g. thigh
Ascending testis

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12
Q

Why are testes in the scrotum?

A

Enzymes of spermatogenesis work better in lower temperatures.
Scrotum = 34 degrees.

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13
Q

When does the normal descent of testes take place?

A

3rd trimester event.

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14
Q

What are the indications for orchidopexy?

A 
Fertility - 1% loss of germs cells per month of undescent.
Malignancy
Trauma 
Torsion
Cosmetic
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15
Q

What is circumcision?

A

Removal of the foreskin.

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16
Q

What are the indications for circumcision?

A

Balanitis Xerotica Obliterans (BXO)
Balanoprosthitis
Religious reasons
UTI

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17
Q

What are some complications of circumcision?

A

Bleeding
Meatal stenosis
Fistula
Cosmetic

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18
Q

What is meant by acute scrotum?

A

Unremitting pain within testes.

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19
Q

What are some causes of acute scrotum?

A 
Torsion testis
Torsion appendix testis
Epididymitis
Trauma
Haematocele
Incarcerated inguinal hernia
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20
Q

How long do you have before a torsion testis becomes necrotic?

A

6-8hours

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21
Q

Why do we investigate UTI?

A

Prevent renal scarring (reflux nephropathy, CRF)

Prevent hypertension

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22
Q

How do we assess UTI in children?

A
  • History & examination
  • Ultrasound - number, size, position, shape, hydronephrosis.
  • Renography - MAG3 for draining function, reflux and DMSA for function and scarring.
  • Micturating cystourethrogram (MCUG).
23
Q

What is Vescicoureteral reflux?

A

Flow of urine goes back up the ureter and sometimes into kidney.
Grade 3-5 need surgery.

24
Q

What is the management of VUR?

A
  • Conservative - voiding advice, constipation, fluids.
  • Antibiotic prophylaxis - until age 4 Trimethoprim.
  • STING (submucosal teflon injection) for mild/moderate.
  • Ureteric Reimplantation.
25
Q

What is Hypospadias?

A

Urethral meatus on the ventral aspect on the penis.

Can be anterior, middle or inferior with severity worse the more posterior.

26
Q

What are associated anomalies with hypospadias?

A

Ambiguous genitalia

Upper tract anomalies

27
Q

What is the management for Hypospadias?

A

1 or 2 stage reconstruction procedure.

Do NOT circumcise as need foreskin for reconstruction.

28
Q

What is Chordee?

A

Congenital defect of the penis where it usually curves downwards.

29
Q

What is the formula for calculating Systolic BP in children?

A

80 + ( 2 x Age)

30
Q

What is the formula for calculating weight (kg) in children?

A

2 x (Age + 4)

31
Q

Why do 1 in 5 people not feel any pain relief from codeine?

A

Don’t have the enzyme in body needed to metabolise it into morphine.

32
Q

What are some analgesics safe to use in children?

A

Paracetamol 2omg/kg 4-6hrs
Ibuprofen 10mg/kg 8 hrs
Weak opioid e.g. codeine tho not suitable in < 12yrs.
Strong opioids

33
Q

What is used a maintenance fluid in children?

A

0.9% NaCl with 5% dextrose +/- 0.15% KCl.

34
Q

What is the 4 2 1 rule?

A

Rule for maintenance fluid.
4ml/kg for 1st 10kg
2ml/kg for 2nd 10kg
1ml/kg for every kg after that.

35
Q

What are some warning signs of an unwell baby?

A 
Feed refusal
Biliary vomiting
Abnormal colour
Loss of tone - floppy
Temperature - hypo/hyper
36
Q

What are some useful investigations for suspected appendicitis?

A

Hx - pain on speed bumps
CRP and WCC are useful negatives.
Urine

37
Q

How does Appendicitis present?

A

Murphy’s triad - pain, vomiting, fever.
Tenderness over McBurney’s Point
Moderate temp
Looks unwell

38
Q

What are some complications of appendicitis?

A

Abscess
Mass
Peritonitis

39
Q

What are some features of Non Specific Abdominal Pain?

A 
Short duration
Central
Constant
Not made worse by movement
No GIT disturbance
No temperature
Site and severity of tenderness vary.
40
Q

What is mesenteric adenitis?

A

Inflammation and swelling of lymph nodes in abdomen.

Presents with high temp, URTI often and not unwell.

41
Q

What is the treatment for Pyloric stenosis?

A

Test feed
IV fluids
Ultrasound
Periumbilical pyloromyotomy

42
Q

What is pyloric stenosis?

A

Narrowing of the stomach that opens into duodenum.

Commonly presents with projectile vomiting that has no bile in it.

43
Q

What is malrotation?

A

Anatomical failure during development where the small bowel does not rotate correctly.

44
Q

What are some features of Malrotation?

A

Newborn babies
Bilious vomiting
Need upper Gi contrast study ASAP and if confirms it then Laparotomy ASAP to correct.

45
Q

What is Volvulus?

A

Loop of bowel twists around itself and mesentery resulting in bowel obstruction. Gut necrosis.

46
Q

What is Intussusception?

A

One segment of intestine slides inside another, causing a blockage.

47
Q

How does Intussusception usually present?

A 
6-12month baby
Viral illness hx
Intermittent colic then dying spells (baby goes grey/floppy with vagal response)
Bilious vomiting
4 sec cap refill
Bloody mucous stool (red currant jelly)
48
Q

What is seen on ultrasound of intussusception?

A

Target sign in abdomen

49
Q

What is the management of intussusception?

A 
Pneumostatic reduction (air enema)
Laparotomy
50
Q

What is Gastroschisis?

A

Congenital defect where an opening forms in the baby’s abdomen. Bowel pushes through hole and develops in the amniotic fluid.

51
Q

What is the management for Gastroschisis?

A

Primary/delayed closure

TPN (total parenteral nutrition)

52
Q

What is Exomphalos?

A

Umbilical defect where abdominal contents push through weak muscle and develops within a visceral sac that surrounds umbilical cord.

53
Q

What anomalies are associated with Exomphalos?

A 
Cardiac
Chromosomal - trisomy 13,18,21. 
Renal
Neurological
Beckwith-Weideman syndrome
54
Q

What is the management for Exomphalos?

A

Primary/delayed closure

Paediatrics (12 decks)

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