Surgery

Question 1

Alvorado Appendicitis Score

Answer 1

Migratory RLQ pain = 1
N/V = 1
Anorexia = 1
RLQ tenderness = 2
RLQ rebound tenderness = 1
Fever = 1
Leukocytosis = 2
Left shift of neutrophils = 1

5-6 = possible
7-8 = probable
> 9 = very probably

Question 2

Pediatric Appendicitis Score

Answer 2

Fever > 38 = 1
Anorexia = 1
N/V = 1
cough/hop/percussion tenderness = 2
RLQ tenderness = 2
migration of pain = 1
Leukocytosis > 10 = 1
PMN > 7.5 = 1

< 4 low risk (discharge)
4-7 intermediate (observe vs. image)
> 7 high risk (consult surgery)

Question 3

Contraindications to IR reduction of intussception

Answer 3

• peritonitis
• persistent hypotension/hemodynamically unstable
• free air/pneumoperitoneum

Question 4

Meckel’s Rule of 2’s

Answer 4

• 2% of population
• 2-6% symptomatic/complicated
• present around 2 years of age
• 2 inches long
• within 2 feet of ileocecal valve
• 2 types of tissue (gastric and pancreatic)
• 2:1 M:F

Question 5

Metabolic derangements in hypertrophic pyloric stenosis

Answer 5

• hypochloremia
• hypokalemia
• metabolic alkalosis
• paradoxical aciduria (H secreted by kidneys to retain Na due to volume losses, due to aldosterone)
• unconjugated hyperbilirubinemia

Question 6

Conditions that have malrotation always present?

Answer 6

• congenital diaphragmatic hernia
• gastroschisis
• omphalocele

Question 7

Risk factors for post-op apnea

Answer 7

• prematurity
• multiple congenital anomalies
• history of apnea/bradycardia
• chronic lung disease
• post-conceptual age < 60 weeks at time of surgery
• anemia

Question 8

Who should be observed post-operatively for apnea?

Answer 8

• age < 3 months
• preterm < 60 weeks CGA

Question 9

Fasting guidelines in procedural sedation

Answer 9

• 6 hours for formula/non human milk and food
• 4 hours for breast milk
• 1 hour for clear fluids