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Pediatric Physiology - B. Stevens/Bernstein 2017 > Common Pediatric Surgeries - Quiz 2, Part 1 > Flashcards

Common Pediatric Surgeries - Quiz 2, Part 1 Flashcards

1
Q

Disease most associated with human dwarfism; its have slight to mod obesity, large heat, short extremities, height of ~4 ft, delayed motor milestones, blowing of lower legs, freq ear infections, and dyspnea r/t airway restriction; they commonly suffer from depression

A

Achondroplasia

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2
Q

What is characterized by an “olive-shaped mass” that may be palpated b/t midline and RUQ?

A

Hypertrophic pyloric stenosis

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3
Q

What is commonly seen on barium swallow in a pt with hypertrophic pyloric stenosis?

A

a high degree of obstruction of the gastric outflow tract with a “wisp” of barium escaping through the pylorus

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4
Q

What is the renal response to the protracted vomiting of hypertrophic pyloric stenosis?

A

alkaline urine with Na and K loss and eventually acidic urine after the electrolytes are depleted resulting in worse metabolic alkalosis

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5
Q

Fluid loss and pre renal azotemia (elevated BUN and Cr) may indicate which two adverse events seen in hypertrophic pyloric stenosis?

A

hypovolemic shock

metabolic acidosis

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6
Q

protracted vomiting in hypertrophic pyloric stenosis leads to what 3 electrolyte/acid-base imbalances?

A

HypoK
HypoCl
alkalosis

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7
Q

What is the priority in its with Hypertrophic Pyloric Stenosis

A

Intravascular volume and metabolic stabilization/correction

NOT SURGERY

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8
Q

In a pt with duodenal and/or ileal obstruction, what is often given to clear viscid meconium plugs, and how does this affect the baby?

A

Hyperosmolar enemas

may result in SERIOUS SHIFTS IN INTRAVASC VOL –> hypovolemia

Hypovolemia must be treated before anesthetic induction

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9
Q

What disorder is associated with bilious vomiting beginning within the first 24-48 hrs after birth and notoriously shows the “double bubble sign” on radiographs?

A

Duodenal atresia

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10
Q

You have just administered a spinal for an infantile hernia repair. You have laid the child flat post spinal. The infant suddenly stops crying and becomes apenic. What just happened?

A

high spinal

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11
Q

Until what age should elective cases on premature babies be postponed? Why?

A

55 weeks post-conceptual age

premies have a high risk for apnea

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12
Q

Occurs in association with an unborn baby’s gastroschisis and intestinal atresia

A

Polyhydramnios

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13
Q

What is the difference between the location of an omphalocele vs gastroschisis?

A

omphalocele is within the umbilical cord

gastroschisis is peri-umbilical (usually to the R or the umbilical cord)

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14
Q

Infants with giant ombpaloceles typically have which two respiratory characteristics?

A
  1. small, bell-shaped thoracic cavities

2. minimal pulm reserve

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15
Q

Why might a parent be concerned that their infant undergoing repair of an omphalocele will need a tracheostomy?

A

repair of omphalocele may –> resp fail which may become chronic–> trach, long-term vent, and ECMO

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16
Q

What measures should be taken pre-op to decrease evaporative volume losses and hypothermia in a gastroschisis pt?

A

plastic wrap around the exposed bowel

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17
Q

Formation of a silo containing intestine until inflammation has resolved occurs following the correction of which disorder?

A

Gastroschisis

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18
Q

True or False: Respiratory distress in a neonate with gastroschisis may be treated by gastric decompression.

A

True

although ETT may still be needed

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19
Q

what fluid regimen should be used to minimize/correct ongoing fluid losses in a gastroschesis pt?

A
  1. LR or NS IV bolus 20 mL/kg
    then
  2. D10 / 0.25NS at 2-3x MIV rate
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20
Q

Defects in the spine are known as _________

A

Spina bifida

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21
Q

What is the difference b/t a meningocele and a meningomyelocele?

A

Meningocele contains CSF but no spinal tissue

Meningomyelocele is a meningocele that contains neural tissue

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22
Q

A pt who has a VP shunt for hydrocephalus decompression has a high risk of developing hypersensitivity and/or anaphylaxis to _______

A

Latex

VP shunts usually require many revisions/repeat operations

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23
Q

2 major anesthetic considerations for pts with myelodysplasia

A
  1. Position for intubation (doughnut vs lateral decubitus)

2. Blood loss from skin graft to close defect

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24
Q

Major post op concern for a pt with myelodysplasia?

A

Pt may have diminished or absent ventilatory responses to hypoxia and hypercarbia if a Chiari malformation coexists

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25
Q

Consists of a bony abnormality in the posterior fossa and upper C-spine with caudal displacement of the cerebellar vermis, 4th ventricle, and lower brainstem below the plane of the foramen magnum

A

Arnold-Chiari Malformation

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26
Q

Most common fatal inherited disease among white people

A

cystic fibrosis

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27
Q

Diagnostic sign of cystic fibrosis

A

elevated sweat chloride concentrations

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28
Q

main cause of morbidity and mortality in cystic fibrosis pts

A

lung disease

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29
Q

Pathophys of cystic fibrosis that leads to respiratory problems

A
  1. lack of regulation of Na absorption and Cl secretion –> decreased liq on airway luminal surfaces –> viscous mucus –> slowed mucus clearance –> mucus plugging –>
  2. chronic infection –>
  3. inflammation –>
  4. epithelial injury
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30
Q

Efficacy of clearance secretions in normal lung function is dependent on _________

A

adequate hydration of the mucus

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31
Q

Why is a cystic fibrosis pt at increased risk for pneumothorax?

A

Bullae formed by progressive chronic lung damage

32
Q

2 pulm characteristics of Cystic Fibrosis that may be noted by an anesthetist

A
  1. bronchial hyperreactivity

2. increased airway resistance

33
Q

Pulm fx abnormalities in CF are commonly obstructive or non obstructive in nature?

A

obstructive

34
Q

How would one expect the following values to deviate from normal in a cystic fibrosis pt?

  1. FRC
  2. FEV1
  3. peak exp flow rate
  4. VC
A
  1. increased FRC
  2. decreased FEV1
  3. decreased PEFR
  4. decreased VC
35
Q

2 characteristics that are closely associated with and may even predict poor lung fx in a CF pt

A
  1. low weight

2. low BMI

36
Q

What 2 factors lead to coagulation issues in a CF pt?

A

1 Hepatic dysfunction (causes decreased plasma cholinesterase and clotting factors II, VII, IX, and X)

  1. malabsorption of vit K
37
Q

Why might inhalation induction be prolonged on a CF pt?

A

large FRC
small tidal volumes
V/Q mismatch

38
Q

What is the isothermal saturation point?

A

the point just below the carina at which inspired gases are warmed to body temp and saturated with water vapor

39
Q

True or False. Humidified warmers should be used during GA of a CF pt

A

true

40
Q

What can an anesthetist do to enhance clearance of secretions and minimize atelectasis in a CF surgical pt?

A
  1. physiotherapy
  2. airway humidification
  3. pay close attention to analgesia
  4. early mobilization
41
Q

True or False: A CF pt should always be kept in the hospital after surgery or at least one night to monitor for post-op complications

A

False.

Ambulatory surgery is optimal if feasible

42
Q

Which type of ETT is preferable in a child with epiglottitis: oral or nasal?

A

oral

may be changed to nasal later if desired

43
Q

Why should an anesthetist be sure the tube is well secured in a pt with epiglottitis?

A

“Accidental extubation” is almost always FATAL

44
Q

What is the medical management for Croup?

A

nebulizer racemic epi

45
Q

What is another name for croup?

A

laryngotracheobronchitis

46
Q

Why is tracheostomy a preferred tx in a pt with croup?

A

prolonged intub has a high incidence of subglottic stenosis

47
Q

Cleft palate repair is usually delayed until ________

A

~ 1 y/o

48
Q

Cleft lip repair is usually done when the child is how old? Why?

A

4-6 weeks

To facilitate feeding and growth

49
Q

2 major concerns for cleft lip/palate surgery

A
  1. Intubation (laryngoscope and tube tend to slip into the defect)
  2. post op airway mgmt
50
Q

What type of tube should be used for a cleft lip/palate repair? Why?

A

RAE tube taped midline on the lower lip

for stability and visual reference for the surgeon

51
Q

What terribly uncomfortable-sounding procedure may be valuable in maintaining the airway after cleft lip/palate repair?

A

Tongue suture

52
Q

Why is laryngospasm a major problem after cleft palate/lip repair?

A

it can destroy the repair and be difficult to break

53
Q

Common pediatric surgeries

A
  1. hernia and hydrocele
  2. tonsillectomy and adenoidectomy
  3. myringotomy (tubes in ears)
54
Q

What is intusseption?

A

condition in which part of the intestine telescopes onto itself

55
Q

Koplick spots are associated with which disease? (also skin rash)

A

Measles (rubeola)

56
Q

What is the difference b/t bronchitis and bronchiolitis?

A

Bronchitis occurs in the primary and secondary bronchi

bronchiolitis occurs in the bronchioles

57
Q

What anesthesia concerns are associated with arachnodactyly and Marfan Syndrome?

A
  1. Congenital heart defects
  2. aortic insufficiency/aortic dissection
  3. precuts excavatum/kyphosis

Fun fact: Marfan pts are commonly on B-blokers

58
Q

Disorder characterized by fixation or fusion of joints in extremities and vertebrae with crippling/distortion and reduced muscle strength?

Associated anesthesia concerns

A

Arthrogryposis

  1. IV access (fixed joint position)
  2. airway/intub (fixed jaw and neck
  3. some have cardiac defects
59
Q

Disorder characterized by impaired osteoblast activity that leads to poor calcification of bones

Associated anesthesia concerns

A

Osteogenesis imperfecta

  1. positioning can cause fractures
  2. hyperthermia is common (from hypermetab)
  3. Plt dysfx –> increased bleeding
60
Q

Disease characterized by an anterior horn cell lesion; results in “flaccid” infant

Associated anesthesia concerns

A

Werdnig-Hoffmann disease

  1. difficulty swallowing - aspiration risk
  2. tolerance of relaxants unpredictable
61
Q

Disorder characterized by nonprogressive myotonia that improves with activity

Associated anesthesia concerns

A

Myotonia Congenita

prolonged tonicity with NDNMBs; sometimes just with stimulation

62
Q

Disorders characterized by progressive atrophy of muscles

Associated anesthesia concerns

A

Muscular dystrophies

  1. aspiration risk
  2. resp insufficiency
  3. avoid/minimize relaxants
63
Q

Syndrome characterized by atrophy of the perineal muscle due to degeneration of perineal nerve

Associated anesthesia concerns

A

Charcot-Marie-Tooth Syndrome

None =) surgery is musc transfer to compensate

64
Q

Disease characterized by softening of the fem head from inadeq blood supply; often occurs at times of rapid growth

Associated anesthesia concerns

A

Legg-Perthes disease

None =) surgery is for hip nailing

65
Q

Disorder characterized by fibromatous nodules that arise from the nerve sheaths all over the body; while many are benign, others can invade the airway, spinal cord, brain, etc.

Associated anesthesia concerns

A

Neurofibromatosis

  1. location of other fibromas than those operated upon and their significance
  2. increased blood loss - ? etiology
66
Q

Is a Septic hip joint an emergency for a child?

A

Nope. It is urgent but not emergent.

67
Q

How does a child with a septic hip joint often present?

A

febrile and dehydrated

68
Q

What can you often call a surgeon who states that he is going to do a “15 minute” aspiration of a septic hip joint?

A

a liar.

It can become an open procedure with blood loss and take 90 min

69
Q

What are the anesthesia concerns for a pt with a slipped femoral capital epiphysis?

A
  1. IV access
  2. blood loss
  3. need good relaxation
  4. slow emergence
70
Q

anesthesia concerns assicated with club foot repair

A
  1. long operation
  2. post-op pain w castings
  3. child stressed by serial castings
71
Q

Anesthesia concerns r/t congenital hip dislocation

A
  1. spica cast application
  2. spica table supports shoulder and coccyx only
  3. need placement of “belly pad” to allow breathing room post op
72
Q

Severe Pectus Excavatum is concerning because it may cause:

A

cardiac and pulm development problems

73
Q

most common reason for children to come to the OR

A

Fractures

74
Q

All fractures are???

A

FULL STOMACHS

75
Q

Why is no waiting period safe when taking a pediatric fx to the OR? (for aspiration risk) Therefore there is no need to delay surgery.

A

pain of the fx will often completely stop gastric emptying and can do so for DAYS

76
Q

Safest way to induce a peds fx pt

A

RSI followed by OG decompression

Pediatric Physiology - B. Stevens/Bernstein 2017 (7 decks)

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