Surgery

Question 1

How do you calculate a child’s weight?

Answer 1

Weight (Kg) = 2x(age+4)

Question 2

How do you estimate blood volume?

Answer 2

80ml/kg

Question 3

What is expected urine output in children?

Answer 3

1ml/kg/hour

Question 4

What is expected insensible fluid losses in children?

Answer 4

20ml/kg/day

Question 5

What is expected blood pressure?

Answer 5

80 + (2 x age)

Question 6

What should be given for pain relief/fever at home?

Answer 6

Calpol

Question 7

What pain relief is used for children?

Answer 7

Paracetamol
Ibuprofen
Weak opioid - not codeine in under 12s, tramadol?
Strong opioid - morphine

Question 8

What is given for fluid resus?

Answer 8

20ml/kg bolus 0.9% saline - 1/4 of circulatory volume

Question 9

What is given for fluid maintenance and how much is given?

Answer 9

0.9% saline/5% dextrose/Potassium chloride
4ml/kg for 1st 10kg
2ml/kg for 2nd 10kg
1ml/kg every kg after

Question 10

Are crystalloids or colloids given?

Answer 10

Crystalloids

Question 11

What are major red flag clinical features in children?

Answer 11

Feed refusals
Bile vomits - green
Colour of child - grey 
Tone
Temperature - hypothermia - poor perfusion

Question 12

What should be asked about a child’s pain in the history?

Answer 12

Site - close to umbilicus = less chance of pathology
Colic vs constant
Movement (what was car trip like - speedbumps)
Vomiting - increases significane - ask about bilious
Diarrhoea
Anorexia - significant appendicitis
Previous episodes

Question 13

What is tenesmus?

Answer 13

Incomplete evacuation

Question 14

What is important on examination of abdo pain?

Answer 14

Distraction is essential
General appearance
Temperature
Guarding

Question 15

What investigations can be done for abdominal pain?

Answer 15

Urine for all
CRP/WCC for negative prediction
FBC
Electrolytes if sick or very dry
Rarely X-rays

Question 16

What are diagnoses for abdominal pain?

Answer 16

Appendicitis - will kill you - unusual in under 4s

Question 17

What is Murphy’s triad?

Answer 17

Appendicitis:
Pain
Vomiting
Fever

Question 18

What are features of appendicitis?

Answer 18

Murphy’s triad

Tenderness over McBurney’s point

Question 19

What are complications of appendicitis?

Answer 19

Abscess
Mass
Peritonitis

Question 20

What surgery should be done for appendicitis?

Answer 20

Laparscopy

Question 21

What are features of non-specific abdominal pain?

Answer 21

Short duration
Central
Constant
Not made worse by movement
No GI disturbance
No temp
Site and severity of tenderness variable

Question 22

What is the best course of action for non-specific abdominal pain?

Answer 22

Watch and wait

Question 23

What are features of mesenteric adenitis?

Answer 23

High temo
Often URTI
Not ‘unwell’

Question 24

What are features of abdominal pain causes by pneumonia?

Answer 24

Sicker than abdominal signs

Pain referred to right iliac fossa

Question 25

If a baby presents with bile vomiting what is diagnosis until proven otherwise?

Answer 25

Malrotation and volvulus

Question 26

What is malrotation?

Answer 26

Gut doesn't rotate properly in development so gut is unstable

Question 27

What is volvulus?

Answer 27

Twisted midgut - not survivable if not treated

Question 28

What is the classical age of intussusception?

Answer 28

9 months

Question 29

What is history of intsussusception?

Answer 29

3 day history of viral illness then intermittent colic and dying spells Bilious vomiting 4 sec cap refill on admission Blood mucous post rectal (redcurrant jelly stool)

Question 30

What sign is seen on ultrasound of intussusception?

Answer 30

Target sign

Question 31

How is intussusception managed?

Answer 31

Pneumostatic reduction (air pressure)

Question 32

What increases risk of umbilical hernia?

Answer 32

Increase risk in low birth weight, trisomy 21, hypothyroid Spontaneous closure by 4 years is rule Complications rare Repair if complications Important to distinguish for paraumbilical hernia - just above umbilicus

Question 33

Where does epigastric hernia appear?

Answer 33

Defect in linea alba above the umbilicus

Question 34

What is gastroschisis?

Answer 34

Abdominal wall defect - gut exposed

Question 35

How is gastroschisis treated?

Answer 35

Primary/delayed closure | Total parenteral nutrition so they can grow

Question 36

What is survival rate of gastroschisis?

Answer 36

>90%

Question 37

What is exomphalos?

Answer 37

Umbilical defect with COVERED viscera

Question 38

What are associated anomalies with exomphalos?

Answer 38

``` Cardiac abnormalities Trisomies Renal problems Neurological Beckwith-Weideman syndrome ```

Question 39

What is the main feature of beckwith Weideman syndrome?

Answer 39

Overgrowth