Surgery

Question 1

What is the daily fluid requirement for neonates?

Answer 1

150ml/kg/day

Question 2

What is the most common maintenance fluid given to children?

Answer 2

0.45% saline/5% dextrose

Question 3

What fluid and what volume is given in paediatric resuscitation?

Answer 3

10ml/kg of 0.9% saline

Question 4

After which volume of resuscitation fluids with no response from the child should a surgeon/ITU be contacted?

Answer 4

40ml/kg

Question 5

Give 4 important questions to ask when a baby presents with vomiting

Answer 5

• Is it bilious vomit? (fairy liquid green)
• Projectile?
• Feeding?
• Weight gain?

Question 6

Give 4 causes of non-bilious vomiting in a baby

Answer 6

Overfeeding

Possetting

GORD

Pyloric stenosis

Question 7

At which age and gender is pyloric stenosis likely to occur?

Answer 7

2-6 weeks

Male

Question 8

Give 3 features in a pyloric stenosis history

Answer 8

Acute weight loss

Vomit after feeds

Hungry baby

Question 9

Give 3 clinical features of pyloric stenosis

Answer 9

Dehydration

Hypokalaemia

Metabolic acidosis

Question 10

Which 2 methods can diagnose pyloric stenosis?

Answer 10

Test feed (visible peristalsis and ‘olive’ mass)

USS

Question 11

What is the Tx of pyloric stenosis?

Answer 11

Correct electrolytes with IV fluids

Surgery

Question 12

Give 4 causes of bilious vomiting in a baby

Answer 12

• Malrotation
• NEC
• Atresia
• Hirschsprung’s

Question 13

How does malrotation occur?

Answer 13

Failure of intestinal fixation at 4-12 weeks gestation =

narrow midgut mesentery liable to twist

Question 14

How is malrotation diagnosed?

Answer 14

Barium contrast studies

Question 15

How is malrotation treated?

Answer 15

Resuscitation then early laparotomy

Question 16

What is necrotising enterocolitis?

Answer 16

Acute inflammatory disease in intestines of premature babies

Question 17

Give 4 features of NEC

Answer 17

o Abdominal distension
o Blood in stool
o Feeding intolerance
o Vomiting

Question 18

How is NEC treated?

Answer 18

Stop feeds
IV Fluids/ABX

Severe: resection + stoma

Question 19

What is atresia of intestine?

Answer 19

Congenital, narrowed/absent segment of intestine commonly in jejunum/ileum

Question 20

What is Hirschsprung’s disease?

Answer 20

Congenital ganglionic megacolon starting at anus and progressing upwards

Question 21

Give 3 features of Hirschsprung’s disease

Answer 21

Delayed meconium

Distension

FTT

Question 22

Give 4 key questions in an acute abdomen history

Answer 22

• Pain using SOCRATES
• Urinary/bowel symptoms
• Last menstrual period in girls
• Last meal

Question 23

Give 5 differentials for an acute abdomen

Answer 23

• Acute appendicitis
• Mesenteric adenitis
• Constipation
• Gastroenteritis
• UTI

Question 24

What is intussusception?

Answer 24

Full thickness invagination of proximal bowel into distal intestine, commonly ileo-colic

Question 25

What is the triad of intussusception?

Answer 25

Severe intermittent abdominal pain Redcurrant jelly stools Vomiting

Question 26

Give 3 risk factors for inguinal hernias

Answer 26

Male Premature Low birth weight

Question 27

How are inguinal hernias managed?

Answer 27

Elective surgery soon after diagnosis

Question 28

What is a hydrocele?

Answer 28

Fluid in scrotum due to patent processus vaginalis

Question 29

Give 3 features of a hydrocele on examination

Answer 29

Swollen Translluminates Can't get above it

Question 30

When should undescended testes be operated on?

Answer 30

3-6 months and no later than 1st birthday

Question 31

Give 4 differentials for an acute scrotum

Answer 31

1. Testicular torsion 2. Torsion of appendage 3. Epidydimo-orchitis 4. Hydrocele (rarely painful)

Question 32

Give 5 key questions to ask in head trauma

Answer 32

- How did it happen? - Vomiting? - Loss of consciousness or post traumatic amnesia? - Any other injuries? - Does the story fit (NAI)?

Question 33

Give 3 indications for a child with a head injury to have.a CT

Answer 33

- Witnessed LOC >5 minutes - Abnormal drowsiness - 3 or more discrete episodes of vomiting