Intro to paediatric surgery

Question 1

How do you calculate expected systolic BP (mmHg) for children?

Answer 1

80 + (2x age)

Question 2

How much paracetamol would you give to manage pain in a child?

Answer 2

20mg/kg every 4-6 hours

Question 3

How much ibuprofen would you give to manage pain in a child?

Answer 3

10mg/kg every 8 hours

Question 4

Can you give codeine in children <12 y/o?

Answer 4

Not recommended

Question 5

What is used for fluid resuscitation?

Answer 5

20ml/kg bolus 0.9% Sodium Chloride

Question 6

What would you use for fluid maintenance?

Answer 6

0.9% NaCl/ 5% Dextrose +/- KCl
4ml/kg 1st 10kg
2ml/kg 2nd 10 kg
1mlkg every kg thereafter

Question 7

What are some important sentinel signs to look out for in children?

Answer 7

FEED REFUSAL
BILE VOMITS
COLOUR
TONE
TEMPERATURE

Question 8

10 year old boy
 2 day history of abdominal pain
 vomited x 2
 pain was initially periumbilical
 now in RIF
 temp 37.8, flushed
 tender RIF with guarding

Answer 8

Appendicitis

Need to decide if he needs surgery

Question 9

What are some useful tests in suspected appendicitis?

Answer 9

Urine
FBC
Electrolytes

Question 10

What is Murphy’s triad for appendicitis?

Answer 10

Pain
Vomiting
Fever

Question 11

Where does tenderness usually occur in appendicitis?

Answer 11

McBurney’s point

Question 12

What are some possible complications of appendicitis?

Answer 12

Abscess
Mass
Peritonitis

Question 13

What are some differentials in nsap?

Answer 13

Mesenteric adentitis

Pneumonia

Question 14

What is volvulus?

Answer 14

Complication of malrotation

Occurs when the bowel twists so the blood supply to that part of the bowel is cut off

Question 15

3 day old baby with “fairy liquid green” bile vomiting

Answer 15

Malrotation and volvulus
Urgent upper GI contrast to confirm
Laparotomy ASAP

Question 16

Nine month old
3 day viral illness
Colic and dying spells
Bilious vomiting
Bloody mucus stool
4 second cap refill

Answer 16

Intussusception
USS abdomen shows “target sign”
Pneumostatic reduction (air enema)
Laparotomy

Question 17

8 month baby
 umbilical swelling
 present from about 4 days old
 worse with crying
 easily reducible

Answer 17

Umbilical hernia

Question 18

What is gastroschisis?

Answer 18

Abdominal wall defect
Gut eviscerated and exposed
Associated atresia

Question 19

How is gastroschisis managed?

Answer 19

Delayed closure

TPN

Question 20

What is exomphalos?

Answer 20

Umbilical defect with covered viscera

Some associated with cardiac, chromosomal, renal or neuro abnormalities

Question 21

Which syndrome is associated with exomphalos?

Answer 21

Beckwith-Wiedermann