Pediatrics Chapter on Fluid Management

Questions and Answers

In a case of annular pancreas, which structure is constricted?

Second part of duodenum

First part of duodenum (correct)

Third part of duodenum

Proximal jejunum

What physiological consequence may occur in a patient ventilated with intermittent positive pressure?

Increased cardiac stroke volume

Decreased extracellular fluid volume

Decrease in cardiac preload

Increase in intrathoracic blood volume (correct)

What is the source of arterial blood supply for the upper rectum?

Coeliac artery

Inferior mesenteric artery (correct)

Superior mesenteric artery

Iliocolic artery

A stenosis in a lateral aortic branch at the level of the second lumbar vertebra is most likely associated with which vessel?

Inferior mesenteric artery Signup and view all the answers

Which combination of clinical signs is likely due to pressure on the SI roots in a prolapsed intervertebral disc?

Weak ankle plantarfiexion; altered sensation on the sole of the foot; loss of ankle jerk reflex Signup and view all the answers

What is the most likely cause of dark irregular gallstones found in the gallbladder after a cholecystectomy?

Increased blood level of conjugated bilirubin Signup and view all the answers

What is the most likely cause of severe hypotension after a surgical procedure in a patient with skin pigmentation abnormalities?

Adrenal insufficiency Signup and view all the answers

What is a likely consequence of a deep venous thrombosis?

Localized inflammation and pain Signup and view all the answers

In a 19-year-old woman who fell from a horse, which vessel is most likely damaged given the clavicular fracture?

Left subclavian artery Signup and view all the answers

The cremasteric muscle is derived from which muscle structure?

Internal oblique muscle Signup and view all the answers

What type of fluid might be used to treat a patient with severe vomiting?

A combination of 0.9% saline and dextrose Signup and view all the answers

What is a potential consequence of severe hypotension in a surgical patient post-operation?

Reduced cardiac output Signup and view all the answers

In the context of medical treatment, what is the primary use for 5% dextrose?

To prevent hypoglycemia Signup and view all the answers

What mechanism of injury could likely lead to a clavicular fracture in young patients?

Direct impact from a fall Signup and view all the answers

Which of the following might be a reason for choosing a 0.9% saline solution in IV therapy?

To rehydrate the patient Signup and view all the answers

A cough impulse observed in a patient with an inguinal hernia originates from which anatomical feature?

Inguinal canal Signup and view all the answers

Which gland's under-activity best explains the clinical picture of low voltage ECG complexes and prolonged QT interval?

Thyroid Signup and view all the answers

Which tendon forms a boundary of the anatomical snuff box following a fall on an outstretched hand?

Extensor pollicis longus Signup and view all the answers

What abnormality is most likely contributing to the confusion and nausea of a woman with metastatic breast cancer?

Hypercalcaemia Signup and view all the answers

In a child presenting with fever and inability to weight bear on the right leg, which diagnosis is most likely?

Septic arthritis Signup and view all the answers

What substance is likely to be elevated in a woman with recurrent peptic ulcers on proton pump inhibitors?

Gastrin Signup and view all the answers

A man presenting with backache may have underlying pathologies; which condition is least likely related to his symptom?

Ankle sprain Signup and view all the answers

Which hormone would be expected to be elevated in a patient with a peptic ulcer due to overproduction?

Gastrin Signup and view all the answers

In the case of a 4-year-old with fever and for whom septic arthritis is suspected, which laboratory finding would be most indicative?

Elevated C-reactive protein Signup and view all the answers

What is the most significant risk factor for the patient described?

Familial predisposition Signup and view all the answers

What is the most likely underlying pathology for the symptoms of weight loss, anxiety, and neck swelling?

Graves disease Signup and view all the answers

Based on the arterial blood gas results, what is the most likely diagnosis for the patient post anterior resection?

Respiratory acidosis Signup and view all the answers

After a diagnosis of melanoma in situ with a complete excision, what is the next most appropriate management?

Education about skin self-examination and discharge from follow up Signup and view all the answers

What does a pH of 7.28 indicate about the patient’s condition?

Acidosis Signup and view all the answers

Which of the following characteristics is commonly associated with Graves disease?

Severe anxiety Signup and view all the answers

In a patient with a confirmed diagnosis of melanoma in situ, which follow-up procedure might be necessary?

Regular skin checks Signup and view all the answers

What would be the likely cause of the drowsiness and pallor seen in the patient who received intrathecal morphine?

Medication overdose Signup and view all the answers

Which investigation is the most accurate for measuring the GFR?

Inulin clearance Signup and view all the answers

Which test is likely to be positive in a pregnant woman with a history of swelling in her legs?

Antiphospholipid antibodies Signup and view all the answers

What agent is most likely responsible for the problems of an alcoholic man with COPD and bladder carcinoma?

Alcohol Signup and view all the answers

Which structure is constricted in a 3-year-old boy suffering from annular pancreas?

First part of duodenum Signup and view all the answers

The external inguinal ring is a defect in which abdominal structure?

External oblique aponeurosis Signup and view all the answers

What is the pathological process responsible for the underdevelopment of legs in a woman with spina bifida?

Hypoplasia Signup and view all the answers

What type of imaging would best diagnose the extent of an inguinal hernia?

Ultrasound Signup and view all the answers

Which symptom is NOT commonly associated with bladder carcinoma in an elderly patient?

Sudden chest pain Signup and view all the answers

Study Notes

Fluid Solutions and Dextrose

Solutions like 4% dextrose with 0.18% saline and 0.9% saline are essential in clinical hydration and electrolyte management.
IV fluid combinations, such as 1 L of 0.9% saline plus 1.5 L of Hartmann's solution, are used for specific electrolyte replacement.

Annular Pancreas

Annular pancreas constricts the first part of the duodenum, causing gastrointestinal obstruction in children.

Ventilation and Hemodynamics

Positive pressure ventilation can decrease cardiac preload, affecting venous return and intrathoracic pressure.

Intervertebral Disc Prolapse

Prolapsed intervertebral discs impacting S1 roots may present with weak ankle plantarflexion and altered sensations in the foot.

Gallstones

Multiple dark irregular gallstones are associated with increased levels of conjugated bilirubin, leading to pigment gallstone formation.

Deep Venous Thrombosis and ECG Changes

A deep venous thrombosis can relate to low-voltage ECG complexes and prolonged QT due to potential thyroid gland underactivity.

Anatomical Snuff Box Injury

Tenderness in the anatomical snuff box may indicate a scaphoid fracture; it is bordered by the extensor pollicis longus tendon.

Confusion in Metastatic Cancer

Hypercalcemia is a common abnormality contributing to confusion and nausea in patients with metastatic breast cancer.

Pediatric Sepsis Indicators

In a child with fever and hip pain, septic arthritis may be diagnosed, especially with elevated CRP and WBC count.

Gastric Pathology and Hormonal Levels

Recurrent peptic ulcers may cause elevated gastrin levels due to gastric acid dysregulation despite proton pump inhibitor therapy.

Risk Factors for Back Pain

Significant risk factors, including age and family history, should be assessed in patients presenting with back pain.

Thyroid Pathology

Signs of thyroid disease, such as swelling and anxiety, may suggest conditions like Graves' disease in young women.

Postoperative Hypotension

Hypotension following surgery could indicate adrenal insufficiency resulting from chronic conditions like skin pigmentation changes.

Clavicular Fractures and Vascular Injury

Fractures of the clavicle can damage nearby vessels, specifically the left subclavian artery.

Inguinal Hernias

An indirect inguinal hernia is associated with a defect in the external oblique aponeurosis and can be indicated by a cough impulse.

Measuring GFR

Creatinine clearance is often the traditional method of estimating glomerular filtration rate (GFR), though inulin clearance is more accurate.

Pregnancy and Positive Antibody Tests

A pregnant woman with leg swelling may test positive for antiphospholipid antibodies, indicating a risk of thrombosis.

Substance Induced Pathology

Chronic issues like COPD and urinary tract carcinomas may be linked significantly to cigarette smoking habits.

Developmental Disorders: Spina Bifida

Spina bifida can lead to the developmental issue known as hypoplasia, concerning underdeveloped legs.

General Emergency Presentations

Cases with non-specific symptoms, such as chest pain in young adults, require thorough investigation to rule out serious conditions.

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Description

This quiz focuses on fluid management strategies and anatomical considerations in pediatric patients, particularly in cases like severe vomiting in children. It also addresses the complications related to annular pancreas and its impact on gastrointestinal structures.