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Paediatric 'mini' examination

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1. Regarding inguinal hernias in children

(a) Boys are affected more often than girls
(b) Are less common in preterm infants
(c) In infants (less than one years old) approximately 50% present with incarceration
(d) 50% of hernias are bilateral
(e) Approximately 20% of patients will develop a contralateral hernia

        
 
2. Regarding undescended testes
(a) 75% of undescended testes descend in the first year of life
(b) Is associated with a reduced risk of testicular malignancy
(c) Is associated with an increased risk of infertility
(d) Surgery should be considered in the neonatal period
(e) Laparoscopy is indicated for impalpable testes

        
 
3. Regarding testicular torsion
(a) The highest incidence is in the neonatal and peripubertal periods
(b) May present with abdominal pain and vomiting and few testicular symptoms
(c) Radiological investigation with doppler ultrasound or isotope scanning is invariably indicated
(d) Testicular viability is reduced if surgery is delayed more than 6 hours
(e) Contralateral orchidopexy should also be performed if a torsion is confirmed

        
 
4. Regarding exomphalos and gastroschisis
(a) A gastroschisis has a sac
(b) Gastroschisis is associated with major congenital abnormalities
(c) The postoperative mortality of surgery for gastroschisis approaches 50%
(d) Both conditions may be diagnosed prenatally with ultrasound
(e) Both conditions require delivery by caesarian section

        
 
5. Congenital diaphragmatic hernia
(a) Usually occur through the foramen of Bochdalek
(b) Are more common on the right than the left
(c) Are rarely associated with other congenital anomalies
(d) Present with respiratory distress in the neonatal period
(e) Neonates usually require sedation, ventilation and intestinal decompression prior to surgery

        
 
6. Regarding oesophageal atresia and tracheo-oesophageal fistula (TOF)
(a) Most cases of oesophageal atresia are associated with a proximal TOF to the lower oesophagus
(b) Often present prenatally with oligohydramnios
(c) Postnatally present with difficulty swallowing and aspiration
(d) The diagnosis my be confirmed by the inability to pass a nasogastric catheter
(e) Radiological evidence of gas in the stomach confirms the presence of distal TOF

       
 
7. Regarding meconium ileus
(a) Is a rare cause of neonatal intestinal obstruction
(b) Less than 5% of cases are associated with cystic fibrosis
(c) Obstruction usually occurs in the distal ileum
(d) Presents with neonatal bile-stained vomiting and abdominal distension
(e) A plain x-ray may show an intra-luminal 'ground glass' appearance

        
 
8. Regarding infantile hypertrophic pyloric stenosis
(a) Usually presents between 6 and 12 months of age
(b) The female : male ratio is 4:1
(c) Has a strong familial predisposition
(d) Pathologically shows hypertrophy of the longitudinal muscle layer of the pylorus
(e) Presents with bile-stained projectile vomiting

        
9. Regarding intussusception
(a) It is the commonest cause of intestinal obstruction between 6 and 18 months
(b) Usually occurs in the jejunum
(c) The lead point may be a Peyer's patch or Meckel's diverticulum
(d) Usually presents with few clinical signs
(e) Has a characteristic 'doughnut' appearance on ultrasound

        
10. Regarding Hirschsprung's disease
(a) Often presents with neonatal large bowel obstruction
(b) Results from absence of ganglion cells in both the Meissner's and Auberbach's plexus
(c) A contrast-study will show dilatation of the aganglionic segment
(d) The diagnosis can be confirmed by histological evdience of reduced acetylcholinesterase in the aganglionic segment
(e) Early treatment may involve rectal irrigation or an emergency colostomy

       
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