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.
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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)
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c) Outline 6 features in the history that you gather from the patients family that might cause a cancellation (6 marks)
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d) Outline 4 features in your examination that might cause a cancellation ( 4 marks)
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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
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e) Outline how would you manage this (give doses of drugs if indicated)? (5 marks)
Question 2
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You are asked to assess a 15kg 4-year-old child who is scheduled for a strabismus (squint) correction as a day case procedure
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List the anaesthetic considerations of this case, with regards to:
a) Age of the patient (4 marks)
b) Day case surgery (3 marks)
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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)
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e) What strategies would you employ to reduce postoperative nausea and vomiting (4 marks)
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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.
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a) What is the normal weight for this child, please show your working? (1 mark)
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b) What is a normal CRT and how would you perform this? (2 marks)
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c) List 2 approriate resuscitation goals for this child (2 marks)
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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
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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)
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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
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a) Describe cerebral palsy (3 marks)
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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:
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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)
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f) Outline 2 expected problems in providng adequate postoperative analgesia in this patient (2 marks)
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g) Name 5 ways you could optimise an analgesia management plan for this patient (5 marks)
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