paed surg Di Flood Marking Pass mark 8 from 12 65 candidates 4 did not answer Overall 38 passed from 65 candidates 58 pass rate 62 of those that attempted Main pointers read the question ID: 934374
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Slide1
MOCK OSCE Feedback Q 22 paed surg
Di Flood
Slide2Marking Pass mark 8 from 12
65 candidates
4 did not answer
Overall 38 passed from 65 candidates = 58% pass rate
62% of those that attempted
Main pointers :
read the question
e.g.if
states diagnostic then rare sign is not going to get marks
Slide3You are the ED consultant in a metropolitan Emergency department when a 4 week old baby boy presents with significant vomiting over the past 8 hours.
The observations are as follows:
Temp 37.2
Heart Rate 130
RR 22
O2 Saturations 96%
You are concerned about intestinal obstruction.
12 marks
1.The history is suggestive of pyloric stenosis. Outline 2 specific investigations and their findings that would support this diagnosis( 4 marks)
1. Ultrasound – target sign on USS and thickened pylorus- sensitivity 95%
2. Laboratory tests – not diagnostic but
hypochloremic
alkalosis suggestive with increased creatinine,
3.
Fluroscopic
upper GI series – useful if more distal obstruction suspected – bilious vomiting.
4. Endoscopy – thickened pylorus
Slide42
. Please outline the 4 most likely causes of intestinal obstruction in this neonate and what clinical features would fit with this diagnosis.
8 marks
1. Pyloric stenosis
Forceful vomiting, typically nonbilious but can become bilious, usually 3-5 weeks of age
2.Malrotation with volvulus
Acute onset of bilious vomiting with acute abdomen
3.Incarcerated Hernia
Irritability with vomiting and inguinal mass
4.Intussception
Usually older age group 6 month to 36 months, can occur in neonates, periods of pallor, and intermittent pain with
haemochezia
. May have dance sign ( retraction RIF)
5. Intestinal Duplication, stenosis or atresia
Bilious vomiting if lesion at ampulla of
vater
, and gastric or
abdo
distension usually with hours or days of birth
6.Antral or duodenal web
Presentation depends on severity – vomiting and
abdo
distension
7.
Hirsprung
disease
Abdo distension and failure to pass meconium in first 48 hrs. May present with enterocolitis
8.Foreign Body
more likely 6 months plus, range of symptoms from asymptomatic through to food refusal, vomiting, perforation