Exam 1: Pediatric Anesthesia pt 3

Question 1

Neural tube defects is a group of birth defects that describe a common failure of the neural tube to develop properly during the ____ stage

Answer 1

embryonic

pg 41

Question 2

What are some non-genetic environmental factors that can cause neural tube defects?

Answer 2

• Folate deficiency
• Anti-epileptic drugs
• Retinoids
• Maternal diabetes

Question 3

____ _____ is characterized by abnormal or incomplete formation of midline structures over the back.

Answer 3

Spina Bifida

Question 4

What are characteristics of spina bifida occulta?

Answer 4

• Overlying tissue appears normal
• Possible hairy patch
• Sacral dimple
• Lipoma

Question 5

What are characteristics of spina bifida aperta?

Answer 5

• Obvious lesion on back

Either meningocele or myelomeningocele.

Question 6

Differentiate a meningocele and a myelomeningocele.

Answer 6

Question 7

Flip for picture of Spina Bifida sub-types.

Answer 7

Question 8

Hydrocephalus is more common with which category of spina bifida?

Answer 8

Spina Bifida Aperta

Question 9

Do nerve roots below the level of the lesion function for myelomeningocele?

Answer 9

No

Question 10

What additional surgery is necessary for spina bifida w/ concomitant hydrocephalus.

Answer 10

VP shunt

Question 11

What disorder is characterized by cerebellar herniation through foramen magnum into the cervical space?

Answer 11

Chiari Malformations

Question 12

Chronic increasing of _____ is characteristic of chiari malformations.

Answer 12

ICP

• Headache
• Irritability
• N/V

Question 13

What are the four types of chiari malformations?

Answer 13

Question 14

The following s/s are characteristic of what?

Answer 14

Arnold Chiari Malformation

Question 15

What are the varying types of craniosynostosis?

Answer 15

Question 16

“Cloverleaf” craniosynostosis, hypertelorism, proptosis, syndactaly, and hypoplasia of the midface are all symptoms characteristic of what?

Answer 16

Apert Syndrome

Question 17

What is hypertelorism?

Answer 17

Larger than normal distance between the eyes

Question 18

Crouzon syndrome is a syndrome similar to Apert except for what key differences?

Answer 18

Differing ophthalmic defects

especially optic atrophy and exopthalmos.

Question 19

What is another name for hemifacial microsomia?

Answer 19

Otomandibular dysplasia

Question 20

Hemifacial Microsomia is characterized by the acronym OMENS, what does this stand for?

Answer 20

• Orbital distortion
• Mandibular hypoplasia
• Ear anomaly
• Nerve involvement
• Soft tissue deficiency

Question 21

What factors may contribute to difficulty intubating a child with hemifacial microsomia?

Answer 21

• Mid-facial hypoplasia
• Asymmetry of mouth opening
• Retrognathic mandible

Question 22

What is the most common syndrome associated with hemifacial microsomia?

Answer 22

Goldenhar Syndrome

Question 23

What is a key feature of Treacher Collins Syndrome that differentiates it from other hemifacial microsomia syndromes?

Answer 23

Bilateral lower lid colobomas

Question 24

What syndrome is characterized by a triad of micrognathia, glossoptosis, and respiratory distress during the 1st 48 hours of life?

Answer 24

Pierre Robin Syndrome

Question 25

Which syndrome routinely involves a tongue suture placed for retraction?

Answer 25

Pierre Robin

Question 26

The difficult airway associated with Pierre Robin _______ with age.

Answer 26

improves

Question 27

The airway associated with Treacher Collins syndrome _______ with age.

Answer 27

worsens

Question 28

How is Pierre Robin treated?

Answer 28

Surgical advancement of the jaw over time.

Question 29

When is cleft lip typically repaired?

Answer 29

2-3 months of age

Question 30

When is cleft palate repaired?

Answer 30

6-10 months of age

Question 31

Palatal revision and alveolar bone grafts for cleft palate patients typically occur around ___ years of age.

Answer 31

10

Question 32

Is a bilateral or unilateral cleft a more difficult airway?

Answer 32

bilateral

Question 33

What intubation approach should be used in a cleft palate patient to avoid the cleft?

Answer 33

right paraglossal technique

Question 34

Awake extubations are standard of care for cleft lip/palate repairs. T/F?

Answer 34

True

Question 35

What four organ abnormalities are common for down syndrome patients?

Answer 35

- Duodenal atresia - Congenital heart defects - Hypotonia - Hypothyroidism

Question 36

What are hallmark signs of down syndrome?

Answer 36

Question 37

What characteristics of down syndrome are of particular importance to anesthesia?

Answer 37

- Subglottic stenosis - Obstructing upper airway - Atlantoaxial instability - Abnormal radial arteries - ↓HR from anesthesia

Question 38

What drugs should be ready on induction with down syndrome patients? Why?

Answer 38

Glycopyrrolate 0.01 mg/kg Atropine 0.01 mg/kg Down syndrome = Bradycardic induction

Question 39

Scoliosis repair is considered in all children with progressive curves greater than ______ degrees.

Answer 39

40 - 50 °

Question 40

What method is most commonly used to measure the magnitude of a scoliosis curve?

Answer 40

Cobb Angle

Question 41

What hemifacial microsomia disorder is commonly associated with scoliosis?

Answer 41

Goldenhar Syndrome

Question 42

What is Cook's Children's scoliosis repair anesthetic "recipe"?

Answer 42

Question 43

What volatile agent is not used in scoliosis repairs for children?

Answer 43

N₂O