Pediatric

Question 1

A 4 year-old child is admitted to the Emergency Department with suspectedmeningococcal septicaemia. You are asked to help resuscitate the patientprior to transfer to a tertiary centre.a) List the clinical features of meningococcal septicaemia. (35%)b) Outline the initial management of this patient. (45%)c) Which investigations will guide care? (20%

Question 2

A 9 year-old child with Down’s syndrome is scheduled for anadenotonsillectomy.a) List the airway/respiratory (30%), cardiovascular (10%) and neurological(10%) features of the syndrome relevant to the anaesthetist.b) What are the general principles involved in the preoperative (15%),intraoperative (25%) and postoperative (10%) management of this patient withDown’s syndrome

Question 3

You are asked to assess a 4 year-old child who is scheduled for a strabismus(squint) correction as a day case procedure.a) List the anaesthetic related issues this case presents. (60%)b) During surgical traction, the patient suddenly develops profound sinusbradycardia. How would you manage this situation? (10%)c) Describe the key postoperative problems and relevant managementstrategies. (30%

Question 4

A two year-old child presents to the Emergency Department (ED) with suddenonset of fever (38.5
o
C aural), sore throat, drooling and stridor.a) What conditions should be considered in the differential diagnosis? (20%)b) What would be your initial management of this child in the ED? (25%)c) How would you subsequently manage a deteriorating child? (45%)

Question 5

You are asked to review a 5 year-old child who has undergone a tonsillectomyearlier that day. The child needs to return to theatre for control of bleeding.a) What are the important considerations in the assessment of this child?(40%)b) Compare the advantages and disadvantages of intravenous andinhalational induction of anaesthesia in this patient. (40%)c) How may the incidence of post-operative nausea and vomiting be reducedin this child? (10%)You are asked to review a 2 year-old child admitted to the EmergencyDepartment with status epilepticus.a) Define status epilepticus. (10%)b) Outline your initial management plan to deal with this patient. (50%)c) List the common causes of status epilepticus in children. (30%)

Question 6

A 4 year-old (20kg) girl is admitted with acute appendicitis and is scheduledfor urgent surgery. She has been vomiting for two days and is pyrexial 38.7
o
C. Her pulse rate is 170 beats per minute with a capillary refill time of 4seconds.a) Describe the perioperative intravenous fluid management of this case.(60%)b) Outline the metabolic and clinical complications that can occur withinappropriate intravenous crystalloid therapy. (30%)

Question 7

All health care professionals have a responsibility to act if they suspect that achild has been subjected to physical abuse.a) In what situations may the anaesthetist encounter possible child abuse?(20%)b) List the clinical features that would arouse suspicion that physical childabuse has occurred. (40%)c) What should the anaesthetist do if they suspect child abuse has takenplace? (

Question 8

A 4 year old (20kg) is admitted with acute appendicitis and is scheduled forurgent surgery. She has been vomiting for 2 days, is pyrexial, has atachycardia of 170 bpm and prolonged capillary refill.a) Describe the perioperative fluid management of this case using intravenouscrystalloids. (60%)b) Outline the complications that can occur with inappropriate intravenouscrystalloid therapy. (30

Question 9

What strategies are available and appropriate to decrease preoperativeanxiety in children for day case surgery? (45

Question 10

A 12 year old girl is admitted for prominent ear correction as a day case. Sheis very anxious and uncooperative when you see her preoperatively. She willnot engage with any attempts to calm her down and subsequently refuses tocooperate with anaesthetic induction. However, her mother is insistent thatyou go ahead with the anaesthetic.b) How would you proceed with this scenario? Explain your reasoning.

Question 11

List the normal anatomical features of young children (< 3 years old) whichmay adversely affect airway management. (25%)b) What airway problems may occur due to these anatomical features? (30%)c) Describe how these problems are overcome in clinical practice

Question 12

Regarding caudal anaesthesia in children:a) What anatomical features are important to consider when performing theblock (caudal) safely? (30%)b) What are the contraindications? (20%)c) What are the problems and complications? (20%)d) What constraints limit the effectiveness of the block and how can they beovercome? (20%

Question 13

You are scheduled to anaesthetise a 15 year-old girl for correction of heridiopathic scoliosis.What are the key (a) preoperative (25%), (b) intraoperative (40%), and (c)postoperative (25%) issues in your anaesthetic management of this patient

Question 14

one day old term neonate has arrived at your regional paediatric intensivecare unit. A congenital diaphragmatic hernia has been diagnosed. The baby isalready intubated and receiving artificial ventilation.Outline, with reasons, the principles of preoperative management

Question 15

Outline, with reasons, your peri-operative management of an otherwisehealthy 4 year old admitted for tonsillectomy

Question 16

You are called to the A and E department to review a 4 year old child whorequired intubation. She has a clinical diagnosis of meningococcal sepsis.She has a reduced consciousness and a petechial rash. Describe yourimmediate managemen

Question 17

4 year-old child who has been knocked unconscious by a blow from acricket bat arrives at a paediatric neurosurgical centre. After initial appropriatemanagement a CT scan shows an extradural haematoma. There are no otherinjuries. Discuss the subsequent management

Question 18

Describe the anaesthetic management of a penetrating eye injury in ascreaming 5 year old child

Question 19

Describe the anaesthetic management of a penetrating eye injury in ascreaming 5 year old child

Question 20

A ten week old male infant weighing 3.5kg is scheduled for inguinal herniarepair. He was delivered prematurely at 34 weeks. List the risk factors andstate how these can be minimised

Question 21

Outline the early management of a one year old child with 25% burns causedby scalding

Question 22

A ten week old male infant weighing 3.5kg is scheduled for inguinal herniarepair. He was delivered prematurely at 34 weeks. List the risk factors andstate how these can be minimised

Question 23

Describe your procedure for cardiac life support of a child aged 5 years

Question 24

Outline the anaesthetic management of a 2 year old child who is scheduledfor therapeutic bronchoscopy following inhalation of a foreign body 2 daysago. The child does not exhibit any signs of upper airway obstruction

Question 25

What are the choices for post-operative analgesia for a child aged 4 yearspresenting for repair of an inguinal hernia as a day case? State briefly theadvantages and disadvantages of each method