Paediatrics

Question 7 (Sept 2019)

You are assessing a five year old for an elective ENT case. The parents describe how she has had a recent cough.

a) Name 2 social factors that may preclude paediatric daycase surgery (2 marks)

 

b) List 3 reasons why might you proceed with surgery ( 3 marks)

c) Outline 6 features in the history that you gather from the patients family that might cause a cancellation (6 marks)

d) Outline 4 features in your examination that might cause a cancellation ( 4 marks)

You discuss with a consultant and decide to go ahead with the theatre case. After securing IV access and on insertion of the airway the patient goes into laryngospasm

e) Outline how would you manage this (give doses of drugs if indicated)? (5 marks)

Question 2

 

You are asked to assess a 15kg 4-year-old child who is scheduled for a strabismus (squint) correction as a day case procedure

List the anaesthetic considerations of this case, with regards to:

a)  Age of the patient (4 marks)

 

b) Day case surgery (3 marks)

c) Type of surgery (4 marks)

 

d) During the operation, the patient suddenly develops a profound bradycardia. What is your immediate management of this situation? (2 marks)

e) What strategies would you employ to reduce postoperative nausea and vomiting (4 marks)

f) What strategies would you employ to reduce postoperative pain (3 marks)

Question 12 (Sept 2018)

 You are caled to the Emergency department to se a 2 year-old child who presents with a 4 hour history of high temperature and drowsiness. On examination there is prolonged capillary refill time and a non-blanching rash. A presumptive diagnosis of meningococcal septicaemia is made.

a) What is the normal weight for this child, please show your working? (1 mark)

b) What is a normal CRT and how would you perform this? (2 marks)

c) List 2 approriate resuscitation goals for this child (2 marks)

d) In each of the categories below name 2 managment strategies/goals to do in the first 15 minutes: (8 marks)

- Airway/Breathing

- Circulation

- Blood test

- Drugs

e) After 15 minutes, the child remains shocked and is unresponsive to fluid. What are the most likely pathophysiological derangements in this child's circulation? (2 marks)

f) Name 5 important treatment options (5 marks)

Question 8 (March 2018)

 An 8 year old child is scheduled for an elecctive right femoral osteotomy due to impending dislocation of the hip. She has severe cerebral palsy

a) Describe cerebral palsy (3 marks)

There are many clinical features of severe cerebral palsy which have associated anaesthetic implications. List these clinical features and their anaesthetic implications for each system below:

b) 3 features of the central nervous system (3 marks)

c) 2 features for the respiratory system (2 marks)

d) 3 features for the muscoskeletal system (3 marks)

e) 2 features for the gastrointestinal system (2 marks)

f) Outline 2 expected problems in providng adequate postoperative analgesia in this patient (2 marks)

g) Name 5 ways you could optimise an analgesia management plan for this patient (5 marks)