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Surgery Flashcards

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1
Q

How would you roughly calculate a childs weight based on their age?

A

(Age + 4) x 2

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2
Q

What is the average urine output for a child?

A

1ml/kg/hour

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3
Q

What is the average insensible fluid loss?

A

20ml/kg/day

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4
Q

How could you calculate the systolic BP based on age?

A

80 + (2 x Age )

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5
Q

What is the average blood volume for a child?

A

80ml/kg

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6
Q

What is the average RR in a infant < 1 year old?

A

30-40

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7
Q

What is the average HR in a infant < 1 year old?

A

110-160

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8
Q

What is the average systolic BP in a infant < 1 year old?

A

70-90

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9
Q

What is the average RR in a 2-5 year old?

A

25-30

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10
Q

What is the average HR in a infant 2-5 year old?

A

95-140

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11
Q

What is the average systolic BP in a 2-5 year old?

A

80-100

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12
Q

What is the average RR in a infant 5-10 year old?

A

20-25

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13
Q

What is the average HR in a 5-10 year old?

A

80-120

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14
Q

What is the average systolic BP in a infant 5-10 year old?

A

90-110

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15
Q

What is the average RR in a >12 years old?

A

15-20

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16
Q

What is the average HR in a infant >12 year old?

A

60-100

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17
Q

What is the average systolic BP in a infant 5-10 year old?

A

100-120

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18
Q

What dose of paracetamol would you give for pain management?

A

20mg/kg

4-6 hly

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19
Q

What dose of ibuprofen would you give to manage pain in a child?

A

10mg/kg

8 hly

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20
Q

What are the red flag signs of abdominal pain?

A
  • FEED REFUSAL
  • BILE VOMITS - means obstruction!!!!
  • COLOUR - grey baby
  • TONE - floppy
  • TEMPERATURE- more anxious about cold than warm babies
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21
Q

What investigations would you perform in the context of abdominal pain?

Study These Flashcards
A
  • Urine
  • FBC - Only if diagnostic doubt
  • Electrolytes - Only if sick / very dry
  • X-rays
22
Q

What is acute appendicitis?

Study These Flashcards
A

Inflammation of the appendix

23
Q

What can cause acute appendicitis?

Study These Flashcards
A

Primary obstruction of the appendix, caused by:

  • Bezoars
  • Foreign bodies
  • Trauma
  • Intestinal worms
  • Lymphadenitis
  • Appendicoliths or fecoliths
24
Q

What are the clinical features of appendicitis?

Study These Flashcards
A
  • Murphy’s Triad
    • Pain - initially central and colicky, then localising to the right iliac fossa; McBurney’s point
    • Vomiting - slight vomiting
    • Fever - low grade
  • Anorexia
  • Flushed face
  • Oral fetor
25
What age range is appendicitis unusual to present in?
Rare if less than 5 yrs
26
What on examination would make appendicitis an unlikely diagnosis?
* **Appears well** * **Can sit foreward unsupported** * **Can hop**
27
What investigations could be done if you suspected appendicitis?
No investigations are consistently helpful in making diagnosis - CLINICAL DIAGNOSIS from repeated reviews
28
How would you treat appendicitis?
* **Conservative** - antibiotics * If mass but no signs of peritonitis * **Pain relief** * **Appendicectomy** * If signs of perforation -\> fluid resus with IV Abx prior to procedure
29
What is the definition non-specific abdominal pain?
Abdominal pain which resolves within 24-48 hrs Most often associated with resp. tract infection + cervical lymphadenopathy
30
What can non-specific abdominal pain mimic?
Acute appendicitis
31
What can cause non-specific abdominal pain in children?
* **Mesenteric Adenitis** * **Pneumonia**
32
What is mesenteric adenitis?
Inflammation of the mesenteric lymph nodes in the right lower quadrant, and is clinically often mistaken for acute appendicitis
33
What is mesenteric adenitis caused by?
* **Viruses** * **Yersinia enterocolitica** * **Helicobacter jejuni** * **Campylobacter jejuni** * **Salmonella spp** * **Shigella spp**
34
What is malrotation?
During rotation of the small bowel in foetal life, a lack of fixed mesentery at the duodenojejunal flexure or the ileoceacal region, it's base is shorter than normal and is predisposed to volvulus
35
How does malrotation present?
**Bilious vomiting** Tends to present within a few days of birth
36
What is volvulus?
Loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction
37
How would you investigate suspected malrotation?
Upper GI contrast scan
38
What are the surgical causes of acute abdominal pain?
* **Acute appendicitis** * **Intestinal obstruction** * **Inguinal hernia** * **Peritonitis** * **Inflamed Meckel's Diverticulum** * **Pancreatitis** * **Trauma**
39
What are medical causes of acute abdominal pain?
* **Non-specific abdominal pain** * **Gastroenteritis** * **Urinary Tract** - UTI, acute pyelonephritis, hydronephrosis, renal calculi * **HSP** * **Diabetic ketoacidosis** * **Sickle cell disease** * **Hepatitis** * **IBD** * **Constipation** * **Chronic abdominal pain** * **Gynaecological pain** * **Psychological**
40
What are extra-abdominal causes of abdominal pain?
* **URTI** * **Lower lobe Pneumonia** * **Testicular Torsion** * **Hip and spine pathology**
41
What proportion of children can develop an umbilical hernia?
1/6
42
What are risk factors for the development of Umbilical hernia?
* **LBW** * **Trisomy 21** * **Hypothyroidism** * **Mucopolysaccharidosis**
43
What indications are there for surgical repair of umbilical hernia?
* **Complications** * **Persistence \> 4 years** * **Large defect** * **Aesthetics**
44
What is gastroschisis?
Bowel protrudes through a defect in the abdominal wall, adjacent to the umbilicus, and there is no covering of the sac.
45
What is exomphalos?
Abdominal contents protrude through the abdominal ring, covered by a sac formed by the amniotic memebrane and peritoneum
46
What is the volume of resuscitation fluid used in children?
20 ml/kg bolus of 0.9% saline
47
How would you calculate the volume of maintenance fluid to give a child?
**calculate weight based on age** = (age+4)x2 **4, 2, 1 rule** - to get fluid rate per hour * **1st 10kg** - 4ml/kg * **2nd 10 kg** - 2ml/kg * **1ml/kg every kg thereafter** **Example** * 10 yrs = 2 x (10+4) = 28kg = 40+20+8 = 68mls/hr
48
What intestinal deformity can those with down's syndrome have?
Duodenal atresia
49
What can cause small bowel obstruction in a child?
* **Atresia/stenosis** - duodenum/jejunum/ileum * **Malrotation with volvulus** * **Meconium Ileus** * **Meconium Plug**
50
What can cause large bowel obstruction in a Child?
* **Hirschprungs disease** * **Rectal atresia**

Paediatrics (27 decks)

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