Paediatric Surgery

Question 1

How is systolic BP determined in children?

Answer 1

80 + (2 x age)

Question 2

What are the normally heart rates for children?

Answer 2

<1 (110-160)
2-5 (95-140)
5-10 (80-120)
>10 (60-100)

Question 3

What is used as pain management in children?

Answer 3

Paracetamol
Ibuprofen
Weak opioid (codeine not recommended <12)
Strong opioid

Question 4

What are the important red flag signs in children?

Answer 4

Feed refusal 
Bile vomits
Colour 
Tone
Temperature

Question 5

What key symptoms should be covered when taking a history from a child?

Answer 5

Pain 
Vomiting 
Diarrhoea 
Anorexia 
Previous episodes 
Menstrual history

Question 6

What are key investigations to do in a child who is a possible surgical candidate?

Answer 6

Urine
FBC
Electrolytes
Xrays

Question 7

What is Murphy’s triad?

Answer 7

Pain
Vomiting
Fever

Question 8

What are the symptoms of appendicitis?

Answer 8

Murphy’s triad

Tenderness over McBurney’s point

Question 9

What are the complications of appendicitis?

Answer 9

Abscess
Mass
Peritonitis

Question 10

What is the management for appendicitis?

Answer 10

Analgesia (paracetamol)

Surgery (ideally laparoscopic)

Question 11

What are the features of non specific abdominal pain?

Answer 11

Short duration 
Central 
Constant 
Not made worse by movement 
No GIT disturbance 
No temperature 
Site and severity of tenderness vary

Question 12

What are the features of a mesenteric adenitis?

Answer 12

High temperature
URTI often
Not “unwell”

Question 13

What is malrotation?

Answer 13

Abnormality of the bowel which happens when the baby is developing in the womb

Question 14

What is volvulus?

Answer 14

Complication of malrotation and occurs when the bowel twists so the blood supply to that part of the bowel is cut off

Question 15

What are the symptoms of malrotation and volvulus?

Answer 15

Sudden bouts of crying and pulling legs into the body
Passing little or no faeces
Vomiting “fairy liquid” green

Question 16

What are the investigations used for malrotation or volvulus?

Answer 16

Upper GI contrast study

Question 17

What is the treatment for malrotation?

Answer 17

Laparotomy

Question 18

What is intussusception?

Answer 18

Condition where the bowel “telescopes” in on itself, causing the bowel walls to press on one another, blocking the bowel and leading to loss of blood supply to that part of the bowel

Question 19

What are the symptoms of intussusception?

Answer 19

Severe abdominal pain that comes and goes 
Child looks pale, tired and floppy
Pain becomes more constant 
Loss of appetite
Vomiting 
Dehydration 
High temperature 
Swollen stomach 
Faeces can contain blood or mucus

Question 20

What are the investigations for intussusception?

Answer 20

USS abdomen

Question 21

What is the treatment for intussusception?

Answer 21

Pneumostatic reduction

Laparotomy

Question 22

What increases the risk of umbilical hernia?

Answer 22

LBW
Trisomy 21
Hypothyroidism
Mucopolysaccharidosis

Question 23

When should an umbilical hernia be repaired?

Answer 23

Complications
Persistence after 4yrs
Large defect
Aesthetic purposes

Question 24

What is an epigastric hernia?

Answer 24

Defect in linea alba above the umbilicus that causes a protrusion of preperitonal fat

Question 25

When is operative repair considered for an epigastric hernia?

Answer 25

Cosmetic reasons only