Paediatric surgery

Question 1

what is the equation to work out a childs weight?

Answer 1

2 x (age + 4)

Question 2

how do you determine the normal value of a childs systolic BP?

Answer 2

80 + (2 x age)

Question 3

what is the volume of insensible fluid loses in children?

Answer 3

20ml/kg/day

Question 4

how do you determine a childs blood volume?

Answer 4

80ml/kg

Question 5

what is the normal urine output in a child?

Answer 5

0.5-1ml/kg/day

Question 6

what is the trend in heart rate from neonates to older children?

Answer 6

neonates have a HR about 110-160
decreases as you age
reaches 60-100bpm about 10 yrs old

Question 7

what is the trend in systolic BP from neonates to older children?

Answer 7

neonates have a systolic BP from 70-90

increases as you age until it reaches about 100-120 at 10yrs old

Question 8

what is the trend in respiratory rate from neonates to older children?

Answer 8

neonates have a high respiratory rate about 30-40

starts to decrease until it reaches 15-20 at about 10yrs old

Question 9

what does of paracetamol do you give a child?

Answer 9

20mg/kg 4-6 hourly

Question 10

what dose of ibuprofen do you give a child?

Answer 10

10mg/kg 8 hourly

Question 11

at what age are weak opioids allowed in children?

Answer 11

> 12 years

Question 12

what fluid type and volume is given for resuscitation in children?

Answer 12

20ml/kg bolus 0.9% NaCl

Question 13

what volume of fluid do you give children for maintenance?

Answer 13

4ml/kg 1st 10kg
2ml/kg 2nd 10kg
1ml/kg every other kg thereafter

Question 14

a 4 year old boy requires maintenance fluids.
what is his average weight?
what volume of maintenance fluids would you give?

Answer 14

approx 16kg

40+6= 48ml/hour

Question 15

how do you assess a childs response to fluids you have just given?

Answer 15

assess heart rate and blood pressure

Question 16

what are the red flag signs in paediatrics?

Answer 16

feed refusal 
bile vomiting 
grey colour 
decreased tone / floppy 
temperature (particularly hypothermia)

Question 17

a child presents to the ED with abdominal pain.

what questions would you ask in the history to determine if the child required surgery?

Answer 17

site - closer to the umbilicus = less chance of pathology

colic vs constant

movement - sore when going over speed bumps? indicates ve+ rebound = appendicitis

vomiting green? (bile)

diarrhoea

menstrual history (menstrual pain?)

anorexia

previous episodes (less chance of surgical diagnosis)

Question 18

a child presents to the ED with abdominal pain.

what investigations will you carry out?

Answer 18

urinalysis and dipstick 
FBC if not sure of diagnosis 
electrolytes if unwell/dehydrated
CRP 
X-ray (rarely)

Question 19

what is the presentation of appendicitis?

Answer 19

pain
vomiting
fever

Question 20

what would you observe on clinical examination which would indicate appendicitis’s?

Answer 20

tenderness over mcburneys point

Question 21

name 3 complications of appendicitis.

Answer 21

abscess
mass
peritonitis

Question 22

what is the treatment for appendicitis?

Answer 22

analgesia

surgical opinion - laparoscopic removal

Question 23

what are features of non-specific abdominal pain?

Answer 23

central 
constant 
not made worse by movement 
no GIT upset 
no temperature 
site and severity of tenderness varies

Question 24

what are differential diagnoses of abdominal pain in children?

Answer 24

appendicitis
mesenteri adenitis
pneumonia

Question 25

what is a clue to suspect pneumonia with a child who presents with abdominal pain?

Answer 25

they will be sicker than the abdominal signs show

Question 26

what is mesentery adenitisand how does it present?

Answer 26

inflammation and swelling of the lymph nodes in the abdomen presents with high temperature, abdominal pain and often a URTI

Question 27

what features on a blood gas would you expect with pyloric stenosis?

Answer 27

hypochloraemia hypokalaemia alkalosis

Question 28

a 3 day old baby presets with bile vomiting. | what is the most likely diagnosis?

Answer 28

malrotation and volvulus age of the patient - only few days old makes malrotation most likely

Question 29

a 9 month old baby presents with a 3 day history of viral illness then on and off abdominal pain and 'fainting'. he has also been vomiting which is green in colour. what is the most likely diagnosis?

Answer 29

intussusception | most common in 6-9 month olds with bilious vomiting

Question 30

what is the pathological location most commonly found in intussusception?

Answer 30

illiocaecal valve

Question 31

in what age group is intersusception most common?

Answer 31

peak at 9 months | 6-9 months

Question 32

what is the presentation of intususception?

Answer 32

billious vomiting bloody mucous stool intermittent abdominal colic dying spells

Question 33

how is intussusception diagnosed?

Answer 33

USS to confirm diagnosis | 'target sign'

Question 34

what is the management of intussusception?

Answer 34

``` pneumostatic reduction (air enema) laparotomy ```

Question 35

what are risk factors for an umbilical hernia?

Answer 35

downs syndrome low birth weight mucopolyssacharidosis hypothyroidism

Question 36

what is the management for umbilical hernias?

Answer 36

conservative - usually close by year 4 | if persistent > 4 years or complications then surgery

Question 37

what is the defect that results in an epigastric hernia?

Answer 37

defect in linea alba above the umbilicus | protrusion of retroperitoneal fat

Question 38

what's the difference in the pathology with exomphalos and gastroschisis?

Answer 38

``` exomphalos = umbilical defect gastroschisis = abdominal wall defect ```

Question 39

what anomalies are associated with exomphalos?

Answer 39

``` cardiac chromosomal i.e. trisomy 21, 13, 18 renal neurological beckwith-weideman syndrome ```