Paediatric surgery

Question 1

What is the general calculation for the weight of children in kg?

Answer 1

2 x (age + 4)

Question 2

What is the general rule for the blood volume of children?

Answer 2

80ml/kg

Question 3

What is the general rule for urine output in children?

Answer 3

0.5-1ml/kg/hr

Question 4

What is the general rule for insensible fluid loss in children?

Answer 4

20ml/kg/hr

Question 5

What is the general calculation for systolic BP in children?

Answer 5

80 + (2 x age)

Question 6

What are the general vital signs in children?

Answer 6

HR and RR start very high and decrease

BP starts low and incerases

Question 7

What are the steps o pain management in children?

Answer 7

Paracetemol
Ibuprofen
(weak opioid)
strong opioid

Question 8

What is the dosage of paracetamol in children?

Answer 8

20mg/kg every 4-6 hours

Question 9

What is the dosage of ibuprofen in children?

Answer 9

10mg/kg every 8 hours

Question 10

Why are weak opioids rarely used in children?

Answer 10

Codeine not indicated under 12

Codeine has to be metabolised to become active

Question 11

What is resus fluid for children?

Answer 11

20ml/kg bolus 0.9% NaCl

Question 12

What maintenance fluid is used for children?

Answer 12

0.9% NaCl and 5% dextrose +/- 0.15% KCl

Question 13

How much maintenance fluid is used in children?

Answer 13

4ml/kg for first 10kg
2ml/kg for 10-20kg
1ml/kg thereafter

Question 14

What are the sentinel signs of a very ill child?

Answer 14

Feed refusals
Bile vomits
Colour
Tone 
Temperature

Question 15

What must you ask about re pain in abdominal pain in a child?

Answer 15

Colic vs constant
Onset
Previous episodes
Movement- ask about drive in
Vomiting- esp bile
Diarrhoea
Anorexia
Menstrual periods

Question 16

What would increased abdominal pain on movement suggest?

Answer 16

peritonitis

Question 17

What investigations are done in children with abdominal pain?

Answer 17

Urine dipstick always
FBC if diagnosis uncertain
U&E if very sick or dehydrated child
Rarely XR

Question 18

Who is appendicitis seen in?

Answer 18

Usually school age

Question 19

What are the clinical features of appendicitis?

Answer 19

Murphy’s triad- pain, vomiting, fever

Looks unwell

Question 20

What is the management of appendicitis?

Answer 20

Analgesia

Surgery- laprascopic ideally

Question 21

What are the possible complications of appendicitis?

Answer 21

Abscess
Mass
Peitonitis

Question 22

Who is non specific abdominal pain seen in?

Answer 22

Girls > boys

Question 23

What are the features of non specific abdominal pain?

Answer 23

Short duration
Central, constant
Not made worse by movement
No GI disturbance or temperature
Site and severity varies

Question 24

What is mesenteric adenitis?

Answer 24

Inflammation of mesenteric lymph nodes causing pain

usually following/with viral infection

Question 25

What are the features of mesenteric adenitis?

Answer 25

Abdo pain High temperature Not unwell when fever not there Usually gets better self

Question 26

How does pneumonia present with abdominal pain?

Answer 26

Referred pain, esp from right lower lobe, due to pleuritic infection, causing central abdominal pain Very unwell and associated cough

Question 27

Who is pyloric stenosis seen in?

Answer 27

Males > females

Question 28

What are the features of pyloric stenosis?

Answer 28

Non bilious vomiting- projectile | Weight loss

Question 29

What investigation if done for pyloric stenosis?

Answer 29

US

Question 30

What is the treatment f pyloric stenosis?

Answer 30

Test feed IV fluid Periumbilical pyloromyotomy

Question 31

Who is malrotation seen in?

Answer 31

Generally babies

Question 32

What are the features of malrotation?

Answer 32

Fairy liquid green vomiting

Question 33

What is the investigation and management of malrotation?

Answer 33

Very urgent upper GI contract study | Urgent laparotomy

Question 34

Who is intussusception sen in?

Answer 34

Mainly 6-18 months

Question 35

What is intussusception?

Answer 35

Section of intestine invaginate into joining intestinal lumen

Question 36

What're the features of intussusception?

Answer 36

``` History of viral illness Intermittent colic and dying spells Bloody mucus PR- red currant jelly stool Bilious vomiting Prolonged cap refill, floppy ```

Question 37

What are "dying spells"?

Answer 37

Waves of colic cause a vagal response, causing a low BP, slow pulse, no breathing

Question 38

What investigation if done for intussusception?

Answer 38

US- taget sign

Question 39

What is the management of intussusception?

Answer 39

Pneumostatic reduction- air enema | Laparotomy

Question 40

What are some risk factors for an umbilical hernia?

Answer 40

Low birthweight Trisomy 21 Hypothyroid

Question 41

What is done for umbilical hernias?

Answer 41

Nothing- spontaneous closure in 90% | Repair if there are complications or they are still there when starting school

Question 42

What is an epigastric hernia?

Answer 42

Defect in linea alba above umbilicus causing protrusion of pre peritoneal fat

Question 43

When to epigastric hernias normally present?

Answer 43

Age 2-3, only baby fat gone

Question 44

What is done for epigastric hernias?

Answer 44

Generally leave then, only cosmetic

Question 45

What is gastroschisis?

Answer 45

Abdo wall defect causing gut to be eviscerated and exposed

Question 46

What is the management of gastrochisis?

Answer 46

Primary/delayed closure | Total parenteral nutrition

Question 47

What is exomphalos?

Answer 47

Umbilical defect causing abode contents to protrude in covered viscera

Question 48

What is exomphalos associated with?

Answer 48

Cardiac anomalies Chromosomal Renal and neuro anomalies

Question 49

What is the management of exomphalos?

Answer 49

Primary/delayed closure

Question 50

What is the prognosis of exomphalous?

Answer 50

Very poor- if diagnosed antenatally, only 15% chance of taking baby home