Fellowship - Paeds

Question 1

Outline the advantages and disadvantages of using the paediatric circle system and the Jackson-Rees modification of Ayre’s T-piece (Mapleson F) for anaesthesia in a 15 kg child.

Answer 1

A

Question 2

A 9-year-old girl with cerebral palsy is scheduled to undergo bilateral femoral varus derotation osteotomy and adductor lengthening. Outline the challenges of providing effective postoperative analgesia for her surgery and discuss the analgesia options available.

Answer 2

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Question 3

“The following venous blood gas result of a five-week-old infant with pyloric stenosis
pH 7.50
pCO2 50
HCO3 38
Base excess +5
Sodium 129
Potassium 3.6
Chloride 92
Interpret this VBG. Discuss your preoperative resuscitation and justify your criteria for proceeding to surgery”

Question 4

Justify your perioperative management plan of a six-year-old child with a penetrating eye injury

Answer 4

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Question 5

A 14-year-old with severe autism is rescheduled for dental surgery. The operation was previously abandoned due to their poor cooperation with the team. Justify your perioperative management plan.

Answer 5

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Question 6

Discuss the issues relevant to the perioperative care of a seven-year-old child with Down Syndrome who has sustained a supracondylar fracture of the humerus.

Answer 6

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Question 7

An infant born at 30 weeks gestation is booked for repair of bilateral inguinal herniae at 46 weeks post-conceptual age. Discuss the important issues when providing perioperative care for this infant

Answer 7

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Question 8

A two-year-old boy scheduled for hypospadias repair is found to have a praecordial murmur. Justify your decision to proceed.

Answer 8

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Question 9

A three year old child requires an adenotonsillectomy for obstructive sleep apnoea. Outline and justify your peri-operative management plan.

Answer 9

A

Question 10

An 8 week old baby is scheduled for an inguinal hernia repair on your list at a local general hospital tomorrow. a) Outline the important issues when providing anaesthesia care for this baby. (70%) b) Justify your decision to proceed with surgery at the local general hospital (30%)

Answer 10

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Question 11

“A 7-year-old nonverbal girl with severe spastic cerebral palsy is scheduled for cystoscopy.a. Describe the important features of cerebral palsy relevant to planning anaesthesia for this procedure. (70%)b. What are the advantages and disadvantages of inhalational
induction in this child? (30%)”

Answer 11

A

Question 12

A child with active upper respiratory tract infection presents for general anaesthesia.a. Outline the factors that increase the rate of adverse respiratory events during anaesthesia. (50%)b. How can you reduce the risk of an adverse event occurring? (50%)

Answer 12

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Question 13

“You hear a cardiac murmur in a two-year-old child presenting for elective minor surgery.(a) What are the features of the murmur that would differentiate an innocent from a pathological murmur? (50%)(b) How would you evaluate this child’s fitness for anaesthesia
from the cardiac perspective? (50%)”

Answer 13

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Question 14

Compare the algorithms for advanced life support of adults and term newborns and explain the rationale for the differences

Answer 14

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Question 15

Describe your assessment of a four-year-old child who has been rescued from a house fire

Answer 15

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Question 16

A six-week-old term baby weighing 4.0 kg requires pyloromyotomy for pyloric stenosis. How would you assess the baby’s hydration status? (50%) Detail and justify your resuscitation regimen. (50%)

Answer 16

A

Question 17

A 3-year-old presents to the emergency department with a recent onset of stridor.a. List the differential diagnoses (30%)b. How do you differentiate between the potential causes of this stridor? (70%)

Answer 17

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Question 18

“A 6-month-old boy presents with an acute abdomen. He is diagnosed with intussusception and booked for laparotomy after a failed attempt at reduction. His heart rate is 160bpm and BP is 75/45 mmHg.
His electrolyte profile is as shown:

Na⁺ 132 mmol/l (135 – 145)
K⁺ 2.7 mmol/l (3.5 – 5.5)
Cl⁻ 106 mmol/l (95 – 110)
Urea 3.3 mmol/l (3.5 – 8.5)
Creatinine 86 μmol/l (60 – 110)
Lactate 4.5 mmol/l (1.0 – 1.8)

(a) How would you determine his degree of dehydration and how severe is it likely to be? (40%)
(b) Describe your perioperative fluid management. (40%)
(c) When would you proceed to surgery and why? (20%)”

Answer 18

A

Question 19

a. Describe the factors that influence emergence delirium in children. (50%) b. How would you manage emergence delirium in a 3 year old child having had myringotomy tubes inserted under general anaesthesia? (50%)

Answer 19

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Question 20

List methods to prevent hypothermia in paediatric patients during anaesthesia and surgery, commenting on the effectiveness of each.

Answer 20

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Question 21

“You are asked to anaesthetise a two-year-old child for an eight-hour craniotomy. The child is susceptible to developing malignant hyperthermia.
Outine your strategies for obtaining intravenous access in this child. (50%)
Discuss the issues of using a total intravenous technique in this situation. (50%)”

Answer 21

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Question 22

Describe your technique to provide caudal epidural analgesia for an infant weighing 10kg undergoing hypospadias surgery

Answer 22

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Question 23

Describe the anatomy relevant to performing a caudal block in a two-year-old male.

Answer 23

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Question 24

You are asked to give a practical tutorial on paediatric airway management to Emergency Department registrars at a large hospital. What are the important aspects of paediatric airway management that you would present to them?

Answer 24

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Question 25

Outline the steps you would take to ensure the safe introduction of elective paediatric surgery at your local private hospital.

Answer 25

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Question 26

A 6yo girl with severe spastic cerebral palsy presents for orthopaedic surgery to correct lower limb deformities. Outline the implications of cerebral palsy for anaesthesia management for this operation.

Answer 26

A

Question 27

You are asked to provide assistance to resuscitate a baby. One minute after birth the baby is apnoeic, grey/blue all over, floppy and unresponsive to stimulation, with a pulse felt at the umbilical stump of 60/min. What is this baby’s APGAR score? Describe your resuscitation of the baby.

Answer 27

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Question 28

You are the anaesthetist at a childrens’ hospital. A 3yo schedules for dental restoration and extractions is found to have a systolic murmur during your preoperative assessment on the day of surgery. They have been on a waiting list for 6 months and have had a dental abscess that settled with antibiotics. Describe how you would evaluate the significance of this murmur and how this decision would affect your decision to proceed or not with surgery.

Answer 28

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Question 29

“A 3 week old male infant who was born by uncomplicated vaginal delivery at term presents with projectile vomiting for 2 weeks. His weight is now 2.8 kg from a birth weight of 3.1kg. His presumed diagnosis is pyloric stenosis. His blood chemistry results are: Measured Normal Range
Na 129 mmol/L 135-145 mmol/L
K 3.0 mmol/L 3.5-5.5 mmol/L
Cl 84 mmol/L 95-110 mmol/L
HCO3 36 mmol/L 18-25 mmol/L
Creatinine 69 μmol/L 20-75 mmol/L
Glucose 3.0 mmol/L 2.5-5.5 mmol/L
Explain how these abnormal results come about.
Describe an appropriate fluid resuscitation regime for this infant.
List the laboratory criteria by which you would consider him sufficiently resuscitated for surgery.”

Answer 29

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Question 30

A 2 year old child has burns to lower body from immersion into a hot bath. Describe your assessment and management of pain and fluid requirements in the first 2 hours following injury.

Answer 30

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Question 31

Discuss in detail the technique of rapid sequence induction with cricoid pressure in a child. Include the reasons for your choice of relaxant.

Answer 31

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Question 32

What are the indications for tracheal intubation in a 3 year old who presents with “croup”? Describe your technique for intubation.

Answer 32

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Question 33

“Working in a small obstetric unit you are asked to attend at the birth of a child where there is meconium stained liquor. How will you manage the infant’s resuscitation?

Describe the characteristics of a ventilator suitable for neonates.”

Answer 33

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Question 34

A 4 yo boy weighing 15kg presents for day surgery repair of a left inguinal hernia for which you plan general anaesthesia and caudal block. He has no significant past history, and is well. Justify your choice of agent(s) for caudal injection for this child.

Answer 34

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Question 35

“A four week old infant presents for bilateral inguinal herniotomy at a free-standing day surgery unit with a siginificant paediatric caseload. This infant is to have a gerneral anaesthestic. The parents wish to return to the country that evening.
1. Is the use of a laryngeal mask an acceptable option for airway management? Justify your answer.
2. How would you provide post-operative analgesia for this infant? Include information on dosage and routes of administration.
3. On what basis would you decided if it is appropriate for this infant to return to the country that evening?”

Answer 35

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Question 36

“You discover a heart murmur, which has not been noted before, in a 3 yo child presenting for elective inguinal hernia repair.
1. How would you assess this child at the bedside with respect to this murmur, and what findings would prompt you to refer this child to a cardiologist prior to surgery?
2. A cardiological opinion is sought, and echocardiography is advised. The child becomes extremely upset, and the paediatrician and parents ask you to sedate him for the procedure. How will you manage this?
3. The echocardiogram is reported as normal and the cardiological opinion is that the murmur is physiological and of no concern. Outline and justify your plan for postoperative analgesia following the hernia repair, including after discharge.”

Answer 36

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Question 37

“An 8 month old, 10 kg infant presents for laparotomy following failed barium enema reduction of an intussusception.
7. Describe and justify your perioperative fluid management.
8. At the completion of surgery the haemoglobin is measured at 70g/L. Would you transfuse this patient? Justify your answer.
9. In what circumstances would it be reasonable to provide continuous epidural analgesia for postoperative pain relief in this child?”

Answer 37

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Question 38

List the anatomical differences between the neonatal and adult airway. Include the significance of each difference.

Answer 38

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Question 39

“A three year old child is being assessed for insertion of middle ear drainage tubes. On examination you discover that the child has a precordial murmur.
10. What information would you be seeking in your assessment of this child to decide if the murmur is innocent?
11. If the child is found to have a ventricular septal defect, but is otherwise well, how will this influence your anaesthetic management?
12. Describe the pharmacokinetics and dosing schedule of paracetamol for post op analagesia.”

Answer 39

A

Question 40

“A nine year old child with spina bifida presenting for a tendon transfer procedure is said to have multiple allergies including latex and antibiotics.
10. How would you decide whether or not the child has latex allergy?
11. If the child does have latex allergy, describe the precautions that should be taken peri-operatively to prevent this child developing a latex reaction?
12. What would you advise the parents regarding the risks that latex allergy adds to the perioperative period?”

Answer 40

A

Question 41

“A 4 yo boy weighing 15kg presents for day surgery repair of a left inguinal hernia for which you plan GA and a caudal block. He has no significant past history and is well.
4. Describe how you would perform a caudal injection for this child.
5. Justify your choice of agent(s) for caudal injection for this child.
6. If his parents express concern about caudal analgesia, what alternative analgesia options would you offer? Include a brief comment on their particular advantages and disadvantages.”

Answer 41

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Question 42

Compare propofol with sevoflurane as the sole anaesthetic general anaesthetic agent for a 3 yo child requiring insertion of drainage tubes for chronic otitis media.

Answer 42

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Question 43

“A 14yo girl, 130cm tall, with idiopathic scoliosis is scheduled for corrective fixation via a thoracotomy. Controlled hypotension will be used.
7. What are the options available for providing collapse of the right lung?
8. Two hours into the operation the urine output is measured as 5 ml (in two hours). How would you manage this?
9. At the time of skin closure her core temperature is 34.1 degrees celcius. How would you manage this?”

Answer 43

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Question 44

“A 3 year old child presents with respiratory distress associated with a respiratory tract infection
13. How would you assess the need for tracheal intubation?
14. Describe the facilities you require when you decide to intubate the trachea.
15. What are the possible causes of cardiac arrest in this child one hour after intubation?”

Answer 44

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Question 45

What are your views on the statement: “Children having a tonsillectomy should not be prescribed narcotic analgesics post-operatively”?

Answer 45

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