paediatric surgery

Question 1

average weight (kg) =

Answer 1

2 x (age + 4)

Question 2

average blood volume (mls) =

Answer 2

80mls/kg

Question 3

average urine output =

Answer 3

1ml/kg/hr

Question 4

insensible fluid loss =

Answer 4

20ml/kg/day

Question 5

avg systolic BP (mmHg) =

Answer 5

80 + (2 x age)

Question 6

the pain barrier

Answer 6

if child has pain they must rely on someone to give them it - teacher waits for mum, mum waits for dr etc.

Question 7

pain management in children

Answer 7

WHO pain ladder

paracetamol
ibuprofen
weak opioid (not codeine in <12yrs)
strong opioid

Question 8

fluid management in children: resuscitation

Answer 8

20ml/kg bolus 0.9% sodium chloride

Question 9

fluid management in children: maintenance

Answer 9

0.9% NaCl or 5% dextrose +/- KCl

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

Question 10

sentinel signs

Answer 10

feed refusal
bile vomits - green
colour - grey is bad
tone - floppy/hyperrigidity
temperature - warm or cold

Question 11

appendicitis presenting features

Answer 11

pain - mid abdo then localises RLQ
vomiting
diarrhoea
anorexia
fever
raised neutrophils

Question 12

appendicitis investigations

Answer 12

FBC
CRP
USS
CT

Question 13

apendicitis complications

Answer 13

abscess
mass
peritonitis

Question 14

abdo pain investigations

Answer 14

urine - all
FBC - if diagnostic doubt
electrolytes - only if sick/very dry
x-rays - rarely

Question 15

management of apendicitis

Answer 15

analgesia - oral paracetamol

surgery

Question 16

features of non-specific abdominal pain

Answer 16

short duration 
central - periumbilical
constant
not made worse by movement
no Gi disturbance
no temp 
site and severity vary

Question 17

investigation if presents with bilious green vomiting

Answer 17

upper GI contrast study asap

Question 18

intussusception

Answer 18

prolapse of part of intestine into lumen of adjoining distal part
most often ilio-caecal region
causes intenstinal obsrtuction

Question 19

intussusception features

Answer 19

bilious vomiiting
colicky abdo pain
bloody mucous PR - redcurrant jelly stool
pallor
palpable abdo mass
lethargy/irritability between waves of pain

Question 20

USS intussusception

Answer 20

target sign

Question 21

intussusception Rx

Answer 21

pneumostatic reduction - air enema

laparotomy

Question 22

malrotation and volvulus

Answer 22

Malrotation predisposes patients to a risk of midgut volvulus
volvulus have twisting and loss of blood supply

Question 23

malrotation and volvulus features

Answer 23

bilious vomitng
abdo pain, distention
normal abdo exam
tachycardia

Question 24

malrotation and volvulus Ix

Answer 24

upper GI contrast study

Question 25

malrotation and volvulus Rx

Answer 25

laparotomy asap

Question 26

umbilical hernia

Answer 26

defect of anterior abdominal wall

umbilical rings fails to close

Question 27

umbilical hernia features

Answer 27

umbilical swelling
worse when crying
easily reducible
most close by 4yrs

Question 28

umbilical hernia complications

Answer 28

strangulation
incarceration
rupture

Question 29

when to repair umbilical hernia

Answer 29

complications
persists >4yrs
large, aesthetic reasons

Question 30

gastroschisis

Answer 30

abdo wall defect, gut eviscerated and exposed with no protective sac
10% assoc atresia

Question 31

exomphalos

Answer 31

umbilical defect with covered viscera

assoc anomalies: cardiac, neurological, renal, trisomy 21