Intro to Paeds Surgery

Question 1

Equation for working out weight from age

Answer 1

2 x (age + 4)

Question 2

Equation for working out blood volume of kid per kg

Answer 2

80mls/kg

Question 3

Urine output = …../kg/hour

Answer 3

0.5-1ml/kg/hour

Question 4

Insensible fluid loss = …/kg/hour

Answer 4

20ml/kg/day

Question 5

Systolic BP (mm Hg) =

Answer 5

80 + (2x Age)

Question 6

Paeds range of Respiratory rate

Answer 6

infants - 30-40

above ten - 15-20

Question 7

Paeds range of heart rate

Answer 7

infants - 110-160

above ten - 60-100

Question 8

Paeds range of BP

Answer 8

infants - 70-90

above ten - 100-120

Question 9

What is the pain barrier in paeds?

Answer 9

kids dont get analgesia as teacher wants to ask parent who wants to ask doctor who wants to ask hospital and all are scared calpol will mask signs

Question 10

Pain ladder is

Answer 10

paracetamol
ibuprofen
weak opiod
strong opiod (morphine)

Question 11

which weak opiod should not be given to kids?

Answer 11

codeine

Question 12

what rule is used to calculate maintenance fluids in paeds?

Answer 12

421 rule

4ml/kg 1st 10kg
2ml/kg 2nd 10 kg
1ml/kg every kg thereafter

10 yrs = 2 x (10+4) = 28kg = 40+20+8 = 68mls/hr

Question 13

what fluid would you use for maintenance fluid in paeds?

Answer 13

0.9% NaCl / 5% Dextrose +/- 0.15% KCl

Question 14

what fluid would you use for resus in paeds

Answer 14

0.9% NaCl

20ml/kg bolus

Question 15

5 sentinel signs in paeds?

Answer 15

feed refusal
bile vomits
colour
tone
temperature

Question 16

clues - signs of appendicitis

Answer 16

moderate temperature, vomiting

looks unwell

Question 17

Murphys triad (appendicitis) is

Answer 17

pain
vomiting
fever

Question 18

in appendicitis where do you get tenderness?

Answer 18

McBurney’s point

Question 19

complications of appendicitis

Answer 19

abscess
mass
peritonitis

Question 20

management of appendicitis

Answer 20

laparoscopic / open appendicectomy

Question 21

NSAP - non specific abdomen pain FEATURES

Answer 21

short duration
central
constant
not made worse by movement
no GIT disturbance
no temperature
site and severity of tenderness vary

Question 22

mesenteric adenitis is

Answer 22

great big swollen glands in abdomen

high temperature
URTI often
not “unwell”

Question 23

Malrotation presentation

Answer 23

3 day old baby
with bile vomiting
“fairy liquid” green

Question 24

3 day old baby
with bile vomiting
“fairy liquid free” whats the diagnosis?

Answer 24

MALROTATION and VOLVULUS

Question 25

what is malrotation?

Answer 25

failure of midgut to rotate during embryogenesis. Mobile midgut with short mesentery and propensity to twist?

Question 26

what is volvulus?

Answer 26

where the malrotation twists

Question 27

investigation of malrotation

Answer 27

URGENT upper GI contrast study

Question 28

management of malrotation

Answer 28

URGENT surgery (laparotomy)

Question 29

What is Intussusception?

Answer 29

Telescoping f one portion of bowel into an immediately adjacent segment. Subsequent restriction of blood supply and oedema of bowel wall rapidly leads to obstruction and potentially gangrene/ perforation (one bit of bowel sliding into another bit)

Question 30

incidence of intussusception

Answer 30

most common in those aged 3 - 12 months

Question 31

symptoms of intussusception

Answer 31

3 day history of viral illness then intermittent COLIC and DYING SPELLS bilious vomiting

Question 32

Whats a DYING SPELL?

Answer 32

baby goes floppy and white - parents think they have died- vagal response- crying 20 mins later

Question 33

Signs of intussusception

Answer 33

palpable sausage shaped mass, redcurrant jelly stools (PR)

Question 34

investigations of intussusception

Answer 34

USS - target sign

Question 35

Management of intussusception

Answer 35

reduction with air enema | if this fails - reduction at laparotomy

Question 36

incidence of umbilical hernia

Answer 36

1:6 kids | increased risk in LBW, trisomy 21, hypothyroidism

Question 37

Rx of umbilical hernia

Answer 37

spontaneous closure by 4 years

Question 38

What is an epigastric hernia?

Answer 38

defect in linea alba above the umbilicus | protrusion of peritoneal fat

Question 39

Rx of epigastric hernia

Answer 39

leave alone | operative role is cosmetic but leaves big scar instead

Question 40

What is Pyloric Stenosis?

Answer 40

Hypertrophy of the gastric pylorius causing upper GI obstruction

Question 41

incidence of pyloric stenosis

Answer 41

males 5:1 female, FH often | 2-8 weeks

Question 42

Symptoms of pyloric stenosis

Answer 42

non bilious - milky - vomiting - "projectile" after every feed, constantly hungry baby, acute weight loss

Question 43

Signs of pyloric stenosis

Answer 43

dehydration, palpable olive mass in right upper abdomen,

Question 44

investigations of pyloric stenosis -

Answer 44

cap gas hyperchloraemic, hypokalaemia metabolic alkalosis Abdo USS

Question 45

Rx of Pyloric stenosis

Answer 45

mild by mouth, correct electrolyte abnormalities with iv fluids, NG tube and replace NG losses surgical pyloromyotomy

Question 46

Gastroschisis is

Answer 46

herniation through abdominal wall defect to right of umbilicus. bowel not covered with membrane bowel comes out in utero and just doesn't go back in

Question 47

Management of gastroschisis

Answer 47

primary surgical closure or delayed if bigger

Question 48

Exomphalos

Answer 48

herniation through umbilicus. bowel and viscera covered with membranous sac associated with other congenital abnormalities

Question 49

Management of Exomphalus

Answer 49

primary/ delayed surgical closure