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ACE > ACE Review - Peds > Flashcards

ACE Review - Peds Flashcards

1
Q

Questions

A

Answers

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2
Q

What drug is used in Peds Resuscitation in American Heart Assoc

A

Epi

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3
Q

What is the most common congenital heart problem of downs patients

A

Atrial/ventricular septal wall defects.

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4
Q

What endo problem are downs patients more prone to have

A

Hypothyroidism

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5
Q

What are downs patients most prone to have as a complication of anesthesia

A

Upper airway obstruction.

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6
Q

What is the highest risk factors for infant postoperative apnea

A

Preterm infants born before 44weeks

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7
Q

Does Small birth weight increase the risk of postoperative apnea

A

No. It actually is beneficial to have a smaller birthweight.

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8
Q

What risk factor shows to have similar risk of postoperative apnea like small gestational age?

A

Anemia. Both risks are so high that it is hard to tell which has a higher relative risk.

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9
Q

what is the normal blood sugar of neonates

A

50-90

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10
Q

when should you consider blood glucose treatment in neonates for hypoglycemia

A

40

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11
Q

why are neonates prone to hypoglycemia

A

their livers are low on glycogen stores

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12
Q

what is the main type of hemoglobin in neonates

A

hemoglobin f in neonates

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13
Q

what is the hg range for neonates

A

15-20

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14
Q

is neonate urine creatinine low or high

A

urine creatinine is low because they are unable to concentrate urine

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15
Q

how are the plateletes in neonates

A

actually they are normal count

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16
Q

does a neonate have more or less tidal volume per weight

A

it has more tv per weight than adults

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17
Q

does a neonate have more frc than adult per weight

A

it has the same 30cc/kg

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18
Q

does a neonate have more oxygen consumption per weight than adult

A

it has more 6-8cc/kg/min versus 3-4cc/kg/min for adult

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19
Q

does a neonate have more total lung capacity per weight than adult?

A

no, adult has a greater total lung capacity per weight than neonates

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20
Q

does a neonte have more or less compliant lungs than adults

A

more compliant because it has less boney structures

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21
Q

xxxxxxxxxxxxxxxxxxxxxxxxxx

A

xxxxxxxxxxxxxxxxxxxxxxxxxx

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22
Q

what does a right to left shunt do to anesthesia gas induction

A

it slows it down by bypassing the lungs

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23
Q

what does a left to right shunt do to anesthesia gas induction

A

it has no rate change of induction by gas

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24
Q

what are pediatric examples of right to left shunt

A

tricuspid atresia, transposition of great arteries with asd/vsd, truncus arteriousus

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25
Q

what are examples of left to right shunt in peds

A

asd, vsd, and pda

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26
Q

does aortic coarctation cause a shunt

A

no

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27
Q

where does aortic coarctatin usually occur

A

it occurs near the pda

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28
Q

what is the most common cause of childhood genetic lifethreatening airway disease

A

praderwilli syndrome

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29
Q

what is prader willi syndrome

A

genetic mutation in chromosome 15 that causes fat and carbs metabolism malfunx

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30
Q

what are symptoms of prader willi

A

short, obese, weak muscle tone, difficulty swallowing, endocrine abnormalities

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31
Q

what is the cause of obesity in prader willi

A

hyperphagia…increase amount of eating

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32
Q

what is the pulmonary condition that prader willi develops

A

pickwickian syndrome

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33
Q

what is pickwickian

A

chronic hypoxemia, pulmonary hypertension, right sided heart failure, severe obesity

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34
Q

what perioperative concern is there for prader willi syndrome

A

post operative airway obstruction…obstructive sleep apena

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35
Q

what intraoperative airway concern is there for praderwilli

A

micrognathia, viscous saliva, high arched palate, poor dentition

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36
Q

why does prader willi have poor dentition

A

bc poor swallowing ability»regurge»acidic regurge»erode teeth

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37
Q

is MAC considered for prader willi

A

No…viscous saliva may cause airway obstruction

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38
Q

what post operative airway concern has been assoc w/ prader willi

A

pna

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39
Q

how do prader willi handle pain control

A

they have an increase threshold for handling pain

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40
Q

what endo abnormality is seen in prader willi syndrom

A

they may be very labile with post operative glucose levels

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41
Q

why is glucose levels labile in prader willi

A

they use serum glucose to make fat rather than supply metabolic needs…they may run hypoglycemic

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42
Q

what neurological endocrine problem is associated with prader willi

A

they are hypothyroid…2ndry to hypothalamus problem…they will have decreased tsh trh

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43
Q

what endocrine problem of prader willi may cause a small underdeveloped airway

A

prader willi assoc w/ decreased growth hormone

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44
Q

what is done in peds prader willi to prevent small airway (underdevelopment)

A

FDA has approved use of growth hormone for this

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45
Q

would a prader willi pt need cortisol stress dose in operative setting

A

no…they are not cortisol deficient

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46
Q

how is the temp regulation in prader willi pt

A

they run hyperthermic

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47
Q

how should muscle relaxant be dosed for prader willi pt

A

they are hyptonic…even after past 4 yrs of age, when hypotonia improves…less mm relaxant is needed

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48
Q

why is the eating habbits of prader willi difficult for anesthesia

A

these pts are hard to keep npo

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49
Q

what habbitual behavior dose prader willi have that may complicate anesthesia

A

they have skin picking behavior and pick out IV’

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50
Q

since prader willi has such dangerous post op outcomes…what is recommeded for pws

A

post op admit to picu or peds stepdown, 24hr pulse ox monitor, direct supervision to watch for iv picking and food foraging, decrease admin of opiods, judicious admin of post op feeding 2ndry to ileus

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51
Q

What is the estimated weight formula based on age

A

Age x 2 + 10

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52
Q

What is the neonate Hg

A

About 16

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53
Q

When does pediatric anemia occur

A

8-12 weeks after delivery

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54
Q

What is the Hg for pediatric anemia

A

8/9/2014

55
Q

Why is Hg high in neonates.

A

The hypoxemia state promotes epo

56
Q

Why does polycythemia decline in neonates

A

As the patient breaths, hypoxemia decreases and thus less drive for epo, along with short duration of HgF lifespan

57
Q

Do premature babies have higher or lower nadir in Hg

A

Premis have lower Hg at the nadir of the pediatric anemia

58
Q

If a premature is transfused blood initially, what happens to the Hg level at the nadir?

A

It actually becomes even lower because the HgA is right shifted versus the HgF. This gives more oxygen to cells and thus suppresses epo even more

59
Q

What common problems with Downs patient

A

Hypothyroid atlantoaxial Instability Cardiac issues

60
Q

What cardiac issues are involved with downs patient

A

endocardial cushin disease 40%, vsd 27, pda12, tof 8

61
Q

What drugs are down Patients not really sensitive to

A

Atropine

62
Q

Non-bilious projectile vomiting at 3 to 6 weeks of life

A

Pyloric stenosis

63
Q

What is the metabolic derangement in pyloric Stenosis

A

Hypokalemic hypochloremic metabolic alkalosis

64
Q

What is the preferred method of diagnosis For pyloric stenosis

A

Ultrasound …over barium swallow

65
Q

What should be placed in a patient Before giving atropine for pyloric stenosis patient

A

Orogastric tube for decompression

66
Q

Why are opiates avoid in pyloric stenosis patients postoperatively

A

The compensation mechanism for metabolic alkalosis as respiratory acidosis Giving opioids would further increase the chance for respiratory acidosis respiratory depression

67
Q

congenital diaphram hernia….what are the main treatments

A

Intubation and gi decompress

68
Q

Congenital diaphragm hernia… What side is it more likely in

A

Hernia usually on the left side

69
Q

Congenital diaphragm, hernia…what is risk of hyperinflation of the lungs.

A

Risk for pneumothorax on the contraleteral side

70
Q

Pyloric stenosis. What age shows this

A

3-6 weeks

71
Q

Pyloric stenosis. What electrolytes do u get depleted

A

HypoNaKClH

72
Q

Pyloric stenosis. What is the metabolic derangement

A

Metabolic alkalosis

73
Q

Pyloric stenosis. What is the diagnosis

A

Physical exam confirmed by ultrasound or barium study

74
Q

Pyloric stenosis. What is the treatment

A

Pyloromyotomy

75
Q

Pyloric stenosis. What is seen on barium study

A

String sign

76
Q

Pyloric stenosis. What is avoided in surgery

A

Opioids. Because of respiratory depression. Resp depression is a compensation technique for metabolic alkalosis

77
Q

Pyloric stenosis. Can u use succinylcholine

A

Yes. This is an acceptable disease for use of this muscle relaxant

78
Q

Pyloric stenosis. How can u treat postoperative pain.

A

Incision local anesthetic and rectal acetaminophen

79
Q

Tetralogy fallot. What kind of congenital heart disease is it

A

Cyanotic. Heart disease.

80
Q

Tetralogy of fallot. What are the causes of hypoxemia.

A

Increase right to left shunt.

81
Q

Tetralogy of fallot. What is the cause of increase right to left shunt.

A

Decrease svr or severity of right ventricular outflow track occlusion

82
Q

Tetralogy of fallot. What is a good induction agent.

A

Ketamine…because it does not decease svr.

83
Q

caudal block. what is the first sign in spinal block in peds pt

A

apnea

84
Q

caudal block. when do u see bradycardia if intrathecal injection is done

A

this is a late symptom and is usually due to the hyoxemia 2ndry to apnea

85
Q

caudal block. what is the treatment

A

supportive ventilatin till it resumes

86
Q

persistent fetal circulation. what is the mechanisms that causes reversion back to a fetal circulation

A

when there is an increase in PVR

87
Q

persistent fetal circulation. what physiologic conditions will cause an increase in PVR

A

hypoxemia. hyerkalemia, acidosis, hypOthermia

88
Q

persistent fetal circulation. why disease systems causes hypoxemia, hyperkalemia, acidosis, hypothermia, that increase pvr

A

sepsis, acidosis, meconium aspiration, pulm disease, prematurity, meconium aspiration

89
Q

hyperoxia. what is associated with this in neonates

A

retinopathy of prematurity

90
Q

iv caffiene. when given to a peds patient…what is the most common symptomt

A

severe irritability…

91
Q

iv caffiene. what is its purpose for peds patients

A

it is to preve post operative apnea

92
Q

preop URI. how many times a year do peds pts get a cold

A

6-8 times a year

93
Q

preop uri. how long do peds cods last

A

2-4 weeks

94
Q

preop uri. what to do to determin if the case should proceed in peds pts

A

determine if there is a lower resp infection

95
Q

preop uri. what are signs that it is an uncomplicated uri

A

rhinorrhea clear, ctabl, no fever, no hypoxemia, no fever, good activity level, good appearance

96
Q

caudal block. adding clonidine to the block…what side effect is most commonly seen

A

increase sedation

97
Q

caudal block. clonidine. does it cause respiratory changes

A

no

98
Q

caudal block. clonidine. does it cause hemodynamic changes

A

no

99
Q

hemoglobin. wht is the p50 of fetal hemoglobin

A

nineteen

100
Q

hemoglobin. what is the hct of neonates

A

45 to 65%

101
Q

hemoglobin. list the hemoglobins from least to greatest p50

A

carboxyhemoglbin, methhemoglobin, fetal hemoglobin, adult hemoglobin

102
Q

croup. what age does it occur at

A

1-3 yo kids…most likely at age 2

103
Q

croup. what symptoms do u see

A

stridor and cough

104
Q

croup. what kind of stridor

A

inspiratory

105
Q

croup. what kind of cough

A

barking

106
Q

croup. what is seen in neck xray

A

steeple sign

107
Q

croup. what symptoms do u see instead in epiglottis

A

drooling and sniffing position (hunched forward)

108
Q

croup. where is the obstruction

A

subglottic

109
Q

croup. what is the initial treatment

A

neb racemic EPI (not albuterol)

110
Q

croup. what to watch out if tx with racemic epi

A

must monitor pt bc up to 4 hours later, pt can get rebound-edema of subglottic airway

111
Q

PDA. what is the PVR if there is a diaphragmatic hernia

A

PVR is increased…can lead to hypoxemia

112
Q

umbilical artery catheters. how are they classified

A

high or low

113
Q

umbilical artery catheters. what classfiies a high

A

in the decending aorta between the diaphram and left subclavian aa

114
Q

umbilial artery catheter. what classifies it as low

A

in the descending aorta between the renal arteries and aortic bifurcation

115
Q

umbilical artery catheter. is it preductal or post ductal blood sampling

A

it is post ductal blood sampling

116
Q

tof. what is tetralogy of fallot

A

ventricular septal defect, overriding aorta, rvot obstruction. right ventricular hypertrophy

117
Q

tof. what is a tet spell

A

when crying leads to hypoxemia

118
Q

tof. what is the mechanism of action of a tet spell

A

crying leads to a decrease in svr and tachycardia. the decrease in svr promotes r>L shunt through the vsd and the tachycardia increases rvot obstruction

119
Q

tof. what vasopressor is good for tof tet spell

A

phenylephrine

120
Q

tof. what is an alternative to phenylephrine

A

beta blocker to slow hr down and volume!

121
Q

downs. what percentage of pts have cardiac problems

A

about 44%

122
Q

downs. what is the most common type of cardiac lesion

A

atrioventricular septal defects aka endocardial cushion defects

123
Q

downs. in adults. what is the most common type of valve problem

A

mitral regurge…occurs in 55 percent of pts

124
Q

downs. what is more common, hyper or hypothyroid

A

hypOthyroid…found in 30% of pts

125
Q

downs. what is increased in these pt with ett

A

post extubation stridor is high prevalence

126
Q

downs. what is more common asd or vsd

A

vsd…up to 35%….endocardial cusion defect is still the top cardiac lesion though…vsd is 2nd lesion

127
Q

lung volumes. neonates. frc increase or decrease

A

decrease

128
Q

lung volumes. neonates. closing capacity. increase or decrease

A

increase

129
Q

lung volumes. neonates. tidal volume increase or decrease

A

same as adult cc/kg

130
Q

lung volumes. neonates. dead space. increase or decrease

A

same as adult cc/kg

131
Q

lung volumes. neonates. what causes them to desaturate faster

A

higher metabolic rate. less alveoli. increase closing capacity

132
Q

lung volumes. neonates. what is closing capacity

A

the lung volume at which you start to find small airway closure

133
Q

lung volumes. neonates. how does increase in closing capacity cause desaturation in neonates

A

when closing capacity is higher than functional residual capacity. atelectasis forms…this leads to desatuation. since neonates have decrease frc and increase cc…it makes the cc/frc ratio even worse for atelectasis compared to adult values

134
Q

lung volumes. neonates. when do you expect adult values in the number of alveoli per kg wt

A

when pt reach 8 years old.

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