Paediatric Surgery MCQs

The scenario is consistent with a food allergy, e.g. nuts, leading to an anaphylactic reaction. The patient should be treated with hydrocortisone (IV or IM) as well as antihistaminic drugs. Hereditary angioedema is an autosomal dominant condition caused by C1 esterase deficiency which leads to recurrent attacks of angioedema Bronchitis presents with a productive cough, fever and dyspnoea. It is usually caused by a viral infection. Reference: Harrison's Principles of Internal medicine, 21st Edition, Page Number-2728.

Sepsis is defined by SEPSIS-3 criteria as suspected or documented infection and an acute increase in >2 sepsis-related organ failure assessment (SOFA) points. Documented or suspected infection + Need for vasopressors to maintain MAP more than or equal to 65mmHg and elevated lactate (>2 mmol/L ) defines the septic shock according to SEPSIS -3 criteria.SIRS criteria were included in earlier criteria (SEPSIS I & II). Reference: Harrison's principles of internal medicine 20th Ed chap 297, pg.2045

Option A : Due to increased catabolism in response to surgical stress there will be Negative nitrogen balance occuring. Option B : There is frequently shifting of potassium into cells as well as losses occur in postoperative period that leads to hypokalemia. Option C : Following surgical stress there will be increased glucose production but decreased glucose utilization at tissue level due to insulin resistance, that leads to glucose intolerance. Option D : Following surgery there will be shifting of fluid into extracellular space seen that leads to Hypernatremia. Reference: Bailey & Love's short practice of surgery, chapter: 1, Edition: 28 th

Urine output is ideal indicator to measure organ perfusion and to monitor adequacy of fluid therapy. CVP is ideal to measure response to fluid therapy but it is not ideal to Measure organ perfusion Base deficit and lactate level are also good indicators but they are more Invasive and not rapidly available in all places. Reference: Bailey & Love's short practice of surgery, chapter: 2, Edition: 28th, Pg: 19

Complications of shunt include - Overdrainage can result in low-pressure headaches, which are typically worse on standing. Collapse of the ventricles can cause accumulation of fluid or blood in the subdural space, resulting in subdural hygroma or subdural haematoma. The slit ventricle syndrome occurs in children treated with shunts, whose ventricles and subarachnoid spaces are underdeveloped, resulting in poor brain compliance. In these patients normal fluctuations in ICP are exaggerated so that coughing and straining may cause symptoms of raised ICP. Shunts are vulnerable to disconnection, infection and blockage . Any shunt blockage may not be evident on scan, as the ventricles fail to enlarge. Reference : Bailey & Love's short practice of surgery 28th Edition, Chapter 48, Cranial neurosurgery, Pg: 705-706

Cryoprecipitate is a supernatant precipitate of FFP and is rich in factor VIII and fibrinogen. Reference: Bailey & Love's short practice of surgery, chapter: 2, Edition: 28 th , Pg: 21

Antibiotic should be given in such a way that maximum blood and tissue level of antibiotic is present before putting an incision. So, the ideal time to give antibiotics is 1 hour before surgery . Reference: Sabiston textbook of Surgery, Edition: 21 st

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged over the past decade as a promising method of obtaining temporary hemorrhage control in the decompensating trauma patient. Depending on the zone of trauma, REBOA is introduced through the common femoral artery, advanced proximal to level of injury , and inflated, effectively shunting blood to the heart and brain while also decreasing hemorrhage Reference : Sabiston textbook of Surgery, chapter: 17, Edition: 21st, Pg: 395