Exam (elaborations)
Surgical-Specialities-Paediatric
- Module
- Institution
Surgical-Specialities-Paediatric
[Show more]
Seller
Follow
Lansky
Content preview
MyPasTest: MRCS A Online - Jan Exam 201521. Surgical Specialities; Paediatric Surgery (22Qs)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
01. Theme: Paediatric surgical disorders
A Acute appendicitis
B Duodenal atresia
C Duplication
D Hirschsprung’s disease
E Imperforate anus
F Inguinal hernia Page
G Intestinal volvulus 1288
H Intussusception
I Malrotation
J Meconeum ileus
K Necrotising enterocolitis
L Pyloric stenosis
M Septicaemia
N Testicular torsion.
The following are descriptions of paediatric surgical disorders. Please select the most appropriate
diagnosis from the above list. The items may be used once, more than once or not at all.
Scenario 1
A 1-day-old full-term infant presents with a 1-day history of abdominal distension and clear green vomiting.
Examination demonstrates upper abdominal distension. Plain abdominal radiograph shows a ‘soap bubble’
appearance in the right lower quadrant of the abdomen. A subsequent sweat test at 7 days of age reveals sodium
and chloride levels >60 mmol/litre.
A - Acute appendicitis « YOUR ANSWER
J - Meconeum ileus« CORRECT ANSWER.
J – Meconeum ileus:
The sweat test provides a definitive diagnosis of cystic fibrosis, although this can be confirmed by gene
probe which demonstrates the mutation on the long arm of chromosome 7. Around 10–15% of affected
infants present at birth with meconium ileus. Obstruction is caused by thick, sticky meconium within the
distal ileum lumen. Diagnosis is suspected on plain abdominal radiograph, which shows dilated loops of
bowel, absence of air-fluid levels and a ‘soap bubble’ appearance in the right lower quadrant. If
uncomplicated, the obstruction may be relieved by a therapeutic gastrografin enema (hyperosmolar and
emulsifying action); the success rate is approximately 55%. If unsuccessful, infants require an
enterotomy and mechanical washout.
Scenario 2
A 1-week-old pre-term infant presents with abdominal distension, green-stained vomit and bleeding per rectum.
Examination demonstrates upper abdominal distension. Plain abdominal radiograph shows intramural intestinal
gas.
B - Duodenal atresia « YOUR ANSWER
K - Necrotising enterocolitis« CORRECT ANSWER.
K – Necrotising enterocolitis:
This predominantly affects pre-term infants, and is one of the commonest surgical emergencies in the
neonatal period. Pathogenesis involves intestinal ischaemia, bacterial colonisation and translocation, and
presence of milk formula in the intestinal lumen. The radiological finding of intramural gas, (pneumatosis
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail: drsikhan@gmail.com
, MyPasTest: MRCS A Online - Jan Exam 2015
21. Surgical Specialities; Paediatric Surgery (22Qs)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
intestinalis), is pathognomonic. Management involves nasogastric decompression, broad-spectrum
antibiotics, fluid resuscitation and parenteral nutrition; it is successful in 70–80% of cases.
Scenario 3
A 9-month-old full-term infant presents with intermittent episodes of apparent abdominal pain, associated with
vomiting and the passage of blood per rectum. Abdominal examination reveals a palpable sausage-shaped mass.
C - Duplication « YOUR ANSWER
H - Intussusception« CORRECT ANSWER. Page
1289
H – Intussusception:
This is the most common cause of abdominal emergency in infants between 3 and 24 months, with
incidence peaking at 6–9 months. Most cases are idiopathic, the intussusceptum being an enlarged
Peyer’s patch secondary to a viral infection. The intussusceptum invaginates into neighbouring bowel,
(the intussuscipiens), causing subacute intestinal obstruction and venous compression of the
intussusceptum. The diagnosis may be made on the classical clinical findings of intermittent, recurrent
attacks of screaming and the infant drawing up its knees, passage of blood per rectum and a palpable
sausage-shaped mass. Diagnosis may be confirmed by contrast enema or ultrasound scan. Reduction, by
air or contrast enema under fluoroscopic or ultrasound control, can be successful in up to 90% of infants.
Scenario 4
A 5-week-old full-term infant presents with a 1-day history of abdominal distension and clear projectile vomiting.
Examination demonstrates a palpable ‘olive-shaped’ mass in the right upper quadrant.
D - Hirschsprung’s disease « YOUR ANSWER
L - Pyloric stenosis« CORRECT ANSWER.
L – Pyloric stenosis:
This occurs most commonly at 4–6 weeks of age and typically presents with projectile non-bilious
vomiting. Diagnosis is usually made by palpation of an ‘olive-shaped’ mass in the right hypochondrium. If
in doubt, ultrasound is the investigation of choice. Management involves fluid resuscitation and a
pyloromyotomy, which can be performed as open surgery or laparoscopically.
02. A 3-month-old girl presents with bile-stained vomit, abdominal tenderness and rectal bleeding. A
barium enema shows malrotation and a mid-gut volvulus. The small bowel is found to be ischaemic. What
is the best treatment option? Select one answer only.
Less than 50cm viable, excise all the ischaemic bowel« YOUR ANSWER
Less than 50cm viable, untwist the bowel and return it to the abdomen and close
Less than 50cm viable, untwist the bowel and return it to the abdomen and perform a second look
laparotomy« CORRECT ANSWER
More than 50cm viable, untwist the bowel and return it to the abdomen and close
More than 50cm viable, untwist the bowel and return it to the abdomen and perform a second look
laparotomy.
The patient has malrotation and volvulus neonatorum. The abdominal tenderness and rectal bleeding are
signs that there is bowel ischaemia. Urgent laparotomy is required. Once the volvulus has been
derotated, and the bowel returned to the abdomen the ischaemic bowel needs to be dealt with. If there is
more than 50cm of viable bowel remaining the ischaemic section can be excised, however, if there is less
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail: drsikhan@gmail.com
, MyPasTest: MRCS A Online - Jan Exam 2015
21. Surgical Specialities; Paediatric Surgery (22Qs)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
than 50cm the bowel should be returned to the abdomen and closed and a second look laparotomy
performed.
03. Theme: Kidney swellings in children
A Hypernephroma
B Wilms' tumour
C Hepatoma Page
D Hydronephrosis 1290
E Duplication cyst
F Polycystic kidney disease.
For each of the patients described below, select the single most likely diagnosis from the options listed
above. Each option may be used once, more than once or not at all.
Scenario 1
A 4-year-old with solid right-sided mass.
A - Hypernephroma« YOUR ANSWER
B - Wilms' tumour« CORRECT ANSWER.
Commonest renal tumour is a nephroblastoma (Wilms’ tumour). It presents most commonly from birth to
5 years of age. Ten per cent are bilateral. Presentation is in 90% of cases with a hard lateral abdominal
mass. Ten per cent present with fever, poor appetite, loss of weight and/or haematuria.
Scenario 2
An 8-month-old boy, with right renal angle mass. Ultrasound shows multiple cysts in both kidneys and liver.
B - Wilms' tumour« YOUR ANSWER
F - Polycystic kidney disease« CORRECT ANSWER.
Infantile Polycystic kidney disease is an autosomal recessive disease affecting the kidneys and the liver.
The kidney enlargement (bilateral) is conspicuous at birth or early infancy.
04. Theme: Paediatrics
A Pyloric stenosis
B Replicated bowel
C Meckel's diverticulum
D Intussusception.
For each of the clinical scenarios choose the most likely diagnosis. Each option may be used once, more
than once, or not at all.
Scenario 1
A 2-year-old child with bilious vomiting, per rectum (PR) bleeding and sausage-shaped mass.
A - Pyloric stenosis« YOUR ANSWER
D - Intussusception« CORRECT ANSWER.
Scenario 2
A 2-month-old girl with non-bilious projectile vomiting after feeds, weight loss and dehydration.
B - Replicated bowel« YOUR ANSWER
A - Pyloric stenosis« CORRECT ANSWER.
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail: drsikhan@gmail.com
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Lansky. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £12.16. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
79976 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy revision notes and other study material for 14 years now
Recently viewed by you
