Acute abdominal pain in children: Viva

Branch 1: The single clinical question

The candidate must immediately state that the central task in acute abdominal pain in children is to decide whether the child needs a surgeon, because the surgical abdomen threatens bowel or organ viability and demands theatre or interventional reduction within hours. This infant's episodic drawing up of the legs with pallor, the vomiting that has turned bilious, and the drowsiness between episodes together signal a surgical emergency, and the priority is resuscitation in parallel with an urgent surgical opinion rather than prolonged diagnostic debate. ^[3]

The candidate should give the first actions in parallel: assess airway, breathing and circulation, keep the infant nil by mouth, place a nasogastric tube on free drainage to decompress the stomach, secure intravenous access, start fluid resuscitation, check a glucose, give analgesia, and call the surgical team immediately. The recognition that this is intussusception until proven otherwise, and the move to act rather than to investigate exhaustively first, is what the examiner is testing. ^[3]