Surgery

Question 1

Presentation of appendicitis in children?

Answer 1

Central abdo pain which localizes to RIF
Low grade pyrexia
Minimal vomiting
Atypical presentation if retrocaecal appendix.
Uncommon in children <4 but this group will tend to present with perforation.

Question 2

Low risk features of fever in paeds?

Answer 2

Normal colour.
Responds to social cues, content/smiles, stays awake, strong/normal cry.
No respiratory distress.
Moist mucus membranes.

Question 3

Intermediate/amber risk features of fever in paeds?

Answer 3

Pallor reported by parent.
No smile, difficult to wake, decreased activity, not responding to cues.
Nasal flaring, RR > 50 if aged 6-12 months or > 40 if >12 months, crackles, O2 sats less than 95% air.
Tachycardia > 160bpm if <12 months, > 150 if aged 1-2y and > 140 if 2-5 years.
CRT 3+ secs, dry mucus membranes, reduced urine output.
Fever > 5 days, age 3-6months with temp 39+, rigors, not weight bearing

Question 4

Red/high risk features of fever in paeds

Answer 4

Pale/mottled/ashen/blue.
Appears ill to healthcare professional, does not wake, no response to social cues, weak continuous cry.
Grunting, tachypnoea >60 breaths/min or mod/severe chest indrawing.
Reduced skin turgor,
Age <3 months with temp of 38+.
Non blanching rash
Bulging fontanelle
Neck stiffness,
focal neurology
focal seizures

Question 5

Management of fever in paeds?

Answer 5

If green (low risk) - Supportive care at home with safety netting.
If amber - safety netting or referral to paeds.
Red - urgently refer to paeds

Question 6

Criteria for a head CT in paediatrics following trauma/injury

Answer 6

Loss of consciousness lasting > 5 mins,
Amnesia lasting > 5 mins,
Abnormal drowsiness,
Three or more episodes of vomiting,
Post traumatic seizure.
GCS < 14 or less than 15 if baby is under 1.
Suspicion of open/depressed skull injury.
Signs of basal skull fracture.
Injury >5cm on head if baby is < 1 year old.
Dangerous mechanism of injury.