Surgery

Question 1

What is the rough weight of a child formula?

Answer 1

2 x (Age+4)

Question 2

What is the rough blood volume in mls of a child?

Answer 2

80 mls / kg

Question 3

What is the urine output of a child?

Answer 3

0.5-1 ml / kg / hr

Question 4

What is normal systolic BP of a child

Answer 4

80 + 2 x Age

Question 5

What is the trend of vital signs as a child ages?

Answer 5

RR = decreases

HR = decreases

BP = increases

Question 6

What are the big differences between children and adults?

Answer 6

Communication
Signs
Disease processes
Physiological parameters
Expectations
Stress

Question 7

What is the WHO pain ladder in children?

Answer 7

Paracetamol
Ibuprofen
Weak opiod
Strong opiod

Question 8

What weak opiod is not recommended for children under 12?

Answer 8

Codeine

Question 9

What is the dose of paracetamol?

Answer 9

20 mg/kl

4 - 6 hrly

Question 10

What is the dose of ibuprofen?

Answer 10

10 mg/kl

8 hrly

Question 11

How much is resuscitation fluid bolus in children?

Answer 11

20 ml/kg bolus of 0.9% NaCl

Question 12

How much is maintenance fluid for children?

Answer 12

0.9 Nacl / 5% dextrose +/- 0.15% KCl

4 ml/kg (1st 10kg)
2 ml/kg (2nd 10kg)
1 ml/kg (every kg after)

Four Two One rule!

Question 13

How much maintenance fluid would an average 10 year old need?

Answer 13

10 years = 28kg (2 x (10+4))

40 + 20 + 8 = 68mls / hr

Question 14

What are red flag symptoms in children?

Answer 14

Feed refusal
Bile Vomits
Colour
Tone
Temperature

Question 15

History or abdominal pain in children

Answer 15

Pain
-colic vs constant

Vomiting

• Increases significance
• Bile is important

Diarrhoea
Anorexia
Previous episodes?

Question 16

Abdominal examination in children

Answer 16

General appearance important
Temperature
“Guarding and rebound”

Question 17

What are the abdominal investigations in children?

Answer 17

Urine
FBC (only if diagnostic doubt)
Electrolytes (if very sick)
X-rays (rarely)

Question 18

What is classical appendicitis presentation?

Answer 18

Murphy's triad
-Pain
-Vomiting
-Fever
Tenderness over McBurney's point

Complications = abscess, mass or peritonitis

Question 19

What is non-specific abdominal pain?

Answer 19

Short duration
Central
Constant
Not made worse by movement
No GIT disturbance or temperature
Site and severity varies

Question 20

How to diagnose Mesenteric adenitis?

Answer 20

High temp
URTI often
Not “unwell”

Question 21

How to diagnose Pneumonia with abdominal pain?

Answer 21

Usually R-LL = referred pain

Sicker than abdominal signs show

Question 22

How to diagnose malrotation?

Answer 22

3-day old presents with bile vomiting
-Green
D = malrotation and volvulus until proven otherwise

Question 23

What are the investigations for malrotation?

Answer 23

Upper GI contrast ASAP

Question 24

What is the treatment for malrotation?

Answer 24

Laparotomy ASAP

Question 25

What is the presentation of intussusception?

Answer 25

6-12 months
3 day history of illness then intermittent colic and dying spells
+/- bilious vomiting

4 second cap refill
Bloody mucous PR

Question 26

What is the investigation and management for intussusception?

Answer 26

I = USS

M = pneumostatic reduction
Laparotomy

Question 27

What is gastorschisis?

Answer 27

Abdominal wall defect = gut exposed

Management = closure and TPN

Question 28

What is exomphalos?

Answer 28

Umbilical defect covered with viscera

T = closure