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apex review > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Compared to epiglottitis, which findings are MORE likely to occur with laryngotracheobronchitis? (select 3)
a. age affected <2 years
b. high fever
c. tripod position
d. steeple sign
e. onset between 24-72 hours
f. more likely to require anesthesia for urgent airway control

A

a. age affected <2 years
d. steeple sign
e. onset between 24-72 hours

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2
Q

Epiglottitis is _______ in nature.

A

bacterial

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3
Q

Epiglottitis affects ages ________

A

2-6 yrs

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4
Q

Epiglottitis is a _______ onset

A

rapid

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5
Q

Clinical presentation of epiglottitis includes

A

the 4 D’s: drooling, dyspnea, dysphonia, dysphagia, & high fever
tripod position

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6
Q

Treatment of epiglottitis includes

A

O2
urgent airway management antibiotics

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7
Q

With epiglottitis, _______ must be present for induction

A

ENT

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8
Q

Laryngeotracheobronchitis is otherwise known as

A

croup

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9
Q

Croup is _________ in nature

A

viral

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10
Q

Croup affects ages __________

A

<2 yrs

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11
Q

The onset of croup is

A

gradual

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12
Q

Clinical presentation of croup includes

A

mild fever
inspiratory stridor
barking cough
retractions- suprasternal, substernal, or intercostal

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13
Q

Croup should be treated with

A

O2
racemic epi
steroids
humidification
and fluids

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14
Q

________ is rarely required with croup

A

Intubation

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15
Q

The region affected with epiglottitis includes

A

supraglottic structures: epiglottis, vallecula, arytenoids, aryepiglottic folds

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16
Q

The region affected with croup includes

A

laryngeal structures below the vocal cords

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17
Q

Describe the neck XR of epiglottis

A

Thumb sign (lateral XR)

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18
Q

Describe the neck XR of croup

A

Steeple sign (frontal XR)

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19
Q

When diluted into 2.5 mL of 0.9% sodium chloride, what is the most appropriate dose of racemic epinephrine to administer to a 30-kg child with postintubation croup?
a. 0.5 mL of 0.25% solution
b. 0.5 mL of 2.25% solution
c. 5 mL of a 0.25% solution
d. 5 mL of a 2.25% solution

A

b. 0.5 mL of a 2.25% solution

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20
Q

Post-intubation laryngeal edema can occur with

A

cuffed or uncuffed endotracheal tubes

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21
Q

_________ should be maintained to prevent post-intubation laryngeal edema

A

air leak <25 cmH2O

22
Q

If you are using a cuffed ETT, then you should use a ______ to measure cuff pressure intermittently.

A

manometer

23
Q

Risk factors for postintubation laryngeal edema

A

using an ETT that is too large (most common)
age <4 (more common in small children)
cuff pressure too high
prolonged intubation
trauma due to multiple intubating attempts
coughing (cuff rubs against trachea mucosa)
head or neck surgery
head repositioning during surgery
trisomy 21
history of infectious or post-intubation croup

24
Q

Treatment for postintubation laryngeal edema includes

A

cool and humidified O2
dexamethasone
racemic epinephrine
heliox

25
Q

The patient with post-intubation laryngeal edema presents with

A

hoarseness
a barky cough
stridor

26
Q

__________ is the preferred treatment for post-intubation laryngeal edema to reduce welling and improve airflow

A

Racemic epinephrine

27
Q

What is the volume of 2.25% racemic epinephrine for children 0-20 kg?

A

0.25 mLs
(diluted with 2.5 mLs)

28
Q

What is the volume of 2.25% racemic epinephirne for children 20-40 kg?

A

0.5 mLs (diluted with 2.5 mls)

29
Q

What is the volume of 2.25% racemic epinephrine for children >40 kg?

A

0.75 mLs (diluted with 2.5 mLs)

30
Q

The patient should be observed for a minimum of ___________ after the racemic epinephrine treatment is complete

A

four hours

31
Q

A five year old child presents with surgery with clear rhinorrhea, but she is afebrile and appears active. Rank the following airway techniques from MOST to LEAST favorable to minimize the risk of airway reactivity.
LMA
Endotracheal tube
facemask

A

Facemask
LMA
Endotracheal tube

32
Q

A child with an active or recent history of upper respiratory tract infection is

A

at an increased risk of pulmonary complications

33
Q

Most clinicians _____________ after the onset of URI symtpoms

A

postpone the procedure for 2-4 weeks

34
Q

Reasons to cancel surgery for upper respiratory infection include

A

purulent nasal discharge
temperature >38.0 C
lethargy
persistent cough
poor appetite
wheezing and rales that don’t clear with a cough

35
Q

Methods to reduce the risk of pulmonary complications in a child with a recent upper respiratory infection include:

A

avoid mechanical irritation of the airway (facemask>LMA»»ETT)
If an ETT is used, use a smaller size than normal
Decadron 0.25-0.5 mg/kg will reduce the risk of post-intubation croup
propofol attenuates airway reactivity and may reduce the risk of bronchospasm

36
Q

__________ is the best volatile agent with an URI

A

sevoflurane

37
Q

Pretreatment with an inhaled bronchodilator or glycopyrrolate for URI

A

does not provide a clear benefit

38
Q

A child with an active history or recent history of URI is more likely to

A

bronchospasm
mucous plug
laryngospasm
have atelectasis
desaturation events
postoperative hypoxemia

39
Q

For a patient with URI___________ should be ensured before instrumenting the airway

A

a deep plane of anesthesia

40
Q

A 3-year-old child aspirated a peanut and presents for rigid bronchoscopy. What is the MOST important anesthetic consideration for this patient?
a. inhalation induction
b. observing NPO guidelines
c. positive pressure ventilation
d. rocuronium

A

a. inhalation induction

41
Q

Over 60% of children with foreign body aspiration present with

A

the classic triad of cough, wheezing, and decreased breath sounds on the affected side (usually the right)

42
Q

A supraglottic obstruction presents with

A

stridor

43
Q

A subglottic obstruction presents with

A

wheezing

44
Q

__________ is the “gold standard” procedure to retrieve the foreign body from the airway

A

Rigid bronchoscopy

45
Q

What is the best anesthetic for a foreign body aspiration?

A

sevoflurane induction with spontaneous ventilation
TIVA is probably the best maintenance

46
Q

If the patient with a foreign body aspirate coughs or bucks, the

A

foreign body can move distally

47
Q

__________ can push the foreign body deeper into the bronchial tree

A

positive pressure ventilation

48
Q

A foreign body most commonly lodges in the

A

right bronchus

49
Q

Complications of rigid bronchoscopy include

A

laryngospasm
bradycardia during scope insertion
pneumothorax
post-intubation croup
patients may not improve immediately after the foreign body is removed due to residual lung inflammation

50
Q

Alternatives to rigid bronchoscopy for foreign body aspiration include

A

flexible bronchoscopy or thoracotomy

51
Q

________ is a concern when using a rigid bronchosope.

A

Some degree of air leak which can dilute concentration of volatile anesthetic (turn up FGF and vaporizer output)

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