Surgery

Question 1

How to quickly work out the weight?

Answer 1

Wt (kg ) = 2 x (Age +4)

Question 2

Blood Volume (mls)

Answer 2

80ml/kg

Question 3

Urine output

Answer 3

1ml/kg/hour

Question 4

Insensible fluid loss

Answer 4

20ml/kg/day

Question 5

Systolic BP (mm Hg)

Answer 5

80 + (2 x Age )

Question 6

babies have?

Answer 6

high RR
high HR
low BP

Question 7

max dose of paracetamol given followed by?

Answer 7

20mg/kg 4-6 hly

IBUPROFEN - 10mg/kg 8 hly

Weak opiod, strong opiod (morphine)

Question 8

codeine is not recommended?

Answer 8

in <12 - can cause respiratory stress

Question 9

Resuscitation fluid?

Answer 9

20ml/kg bolus 0.9% Sodium Chloride

1/4 of circulatory volume

Question 10

Maintenance of fluid?

how much ml per kg?

Answer 10

• 0.9% NaCl/ 5% Dextrose +/- KCl
• 1.2% can cause hyponatremia - cell oedema - fatal
• 4ml/kg 1st 10kg
• 2ml/kg 2nd 10 kg
• 1mlkg every kg thereafter

Question 11

what are some of the sentinel signs? (5)

Answer 11

FEED REFUSAL
BILE VOMITS
COLOUR - grey = poor skin perfusion
TONE - floppy, hyperrigid 
TEMPERATURE

Question 12

basis of management of abdo pain?

Answer 12

• do they need a surgical opinion?

- do they need an operation?

Question 13

constant pain indicates ?

pain on movement ?

Answer 13

peritonitis

Question 14

appendicitis and affect on diarrhoea?

weight?

Answer 14

• retro-ileal / retro-colic
• tenesmus in pelvic appendix
• anorexia
• menstrual history

Question 15

Examination of abdo (appendicitis) - what are you looking for? (4)

Answer 15

distraction techniques essential

general appearance important

temperature

“guarding and rebound”

Question 16

investigations for appendicitis?

Answer 16

• Urine
• FBC - if getting fluid bolus
• electrolytes if they are sick
• x-rays - rarely

Question 17

Is it appendicitis?

- how to tell?

Answer 17

unusual <4 years
can be difficult diagnosis
20% admissions

• 1 in 5 with abdo pain will have appendicitis
• moderate temperature, vomiting, looks unwell!!

Question 18

what triad is indicative of appendicitis? - what are the features

Answer 18

Murphy’s Triad - pain, vomiting ,fever

Question 19

appendicitis - where will a tender point be?

Answer 19

Mc Burney’s

• umbilicus and anterior iliac spine

Question 20

complications of appendicitis?

Answer 20

abscess
mass
peritonitis

Question 21

management of appendicitis?

Answer 21

analgesis - oral paracetamol

• surgery

Question 22

NSAP - Non Specific Abdominal Pain - features?

Answer 22

short duration
central 
constant 
not made worse by movement
no GI disturbance
no temperature
site & severity of tenderness vary

Question 23

NSAP - Non Specific Abdominal Pain is more common in?

Answer 23

girls
- most common cause

• can mimic early appendicitis (risk is low) , do bloods

Question 24

Differential Diagnoses of NSAP - (2) - give features

Answer 24

mesenteric adenitis - swollen glands

high temperature
URTI often
not “unwell”

pneumonia - clue “sicker than abdominal signs”
usually Right Lower Lobe - crackles
soft abdomen

Question 25

bile vomiting presentation? - investigations - most common diagnosis ? - management ?

Answer 25

– upper GI contrast study ASAP - malrotation and volvulus – Laparotomy ASAP

Question 26

presentation .. nine-month baby 3 day history of viral illness then intermittent COLIC and DYING SPELLS - bilious vomiting - bloody mucous PR (redcurrant jelly stool) - 4 second cap refill - delayed perfusion - DIAGNOSIS? - common in what age group?

Answer 26

Intussusception 6-18 months

Question 27

investigations for Intussusception?

Answer 27

USS abdomen - “target sign”

Question 28

management for Intussusception? - most common type

Answer 28

- pneumostatic reduction (air enema) - laparotomy -- ilecolic Intussusception

Question 29

presentation of 8 month old with umbilical hernia ?

Answer 29

- umbilical swelling - present from about 4 days old - worse with crying - easily reducible

Question 30

Umbilical hernia - often close by? when do you chose to repair?

Answer 30

4 years - complications relative persistance>4yrs, large defect, aesthetic)

Question 31

paraumbilical hernia tend to point down to?

Answer 31

the feet

Question 32

Abdominal Wall Defects - Gastroschisis - what is this?

Answer 32

gut eviscerated and exposed 10% associated atresia (gut outside the abdomen)

Question 33

management of Gastroschisis | - what can we give?

Answer 33

delayed closure | TPN

Question 34

short gut usually happens in?

Answer 34

utero - lose the entire mid gut - need surgery - lifetime tan , BOWEL AND liver

Question 35

what is Exomphalos? | - associated anomalies

Answer 35

umbilical defect with covered viscera - 25% cardiac 25% chromosomal - Trisomy13, 18, 21 15% renal, neurological Beckwith-Weideman syndrome

Question 36

Exomphalos management? | outcome?

Answer 36

primary / delayed closure | post natal mortality - 25%