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Exam 3 Review Flashcards

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1
Q

Which of the following is not a cyanotic lesion?

Tricuspid atresia
TGA
ToF
Coarctation of the Aorta

A

Coarctation of the Aorta

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2
Q

Prostaglandins are used to:

Treat TET Spell
Close VSD
Keep PDA
Reverse Shunting

A

Keep PDA

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3
Q

Describe chest X-ray findings for the following:

D-TGA
L-TGA
ToF
Coarctation of the Aorta
RVH
TAPVR

A

D-TGA: Egg on a string
L-TGA:
ToF: Boot Shaped Heart
Coarctation of the Aorta: Figure 3 sign
RVH:
TAPVR: Snowman (wide superior mediastinum)

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4
Q

Which of the following is not a condition of ToF?

VSD
LVH
RVOT Obstruction
Overriding Aorta

A

LVH

(ToF includes RVH)

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5
Q

What is the BEST way to treat a TET spell?

Knee to chest position
Fentanyl
Fluid Bolus
Propanolol

A

Knee to chest position- increases intrathoracic pressure/reverses shunt

(Know all for exam)

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6
Q

Choanal Atresia
Gastroschisis
Omphalocele
Umbilical Hernia

A

Omphalocele: The WORST one

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7
Q

Recognize the following on an X-RAY:

Esophageal atresia
Volvulus
Esophageal Fistula

A

Esophageal Fistula: NG tube loops in pocket of esophagus

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8
Q

KUB (Abdominal X-RAY)

Midgut Volvulus
Intrussusception

A

Midgut Volvulus: Extensive gas trapping

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9
Q

POCUS Intussusception

A

Midline abdominal view: folded-over appearance

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10
Q

What patient should always be transported in the prone position?

Esophageal atresia
Choanal atresia
Pierre-Robin Syndrome
Guillain-Barre Syndrome

A

Pierre-Robin Syndrome

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11
Q

You have a newborn baby appearing with central cyanosis, grimace, and flexed extremities. Pulse is 86bpm and the baby is not breathing. What is the APGAR score?

A

Appearance, Pulse, Grimace, Activity, Respirations

A- 0
P- 1
G- 1
A- 1
R- 0

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12
Q

Which of the following is TRUE regarding neonates?

PAC’s show CHD
34 weeks gestations means MAP > 34mmHg
Normal neonatal HR is 100-150bpm
Urine output should be 2mL/hg/hr in the first 24 hours

A

A neonate that is 34 weeks gestation should have a MAP of at least 34mmHg.

(MAP = )

PAC’s are normal
HR is 120-160
UO: anuria is normal in the first 24 hours

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13
Q

Which of the following neonatal head bleeds does not cross the suture lines?

Cephalohematoma
Caput succedaneum
Subgaleal hemorrhage
Galea aponeurotica

A
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14
Q

Which of the following, regarding primitive reflexes in neonates, is false?

Palmar grasp disappears at 4 months of age
Moro reflex: Arms abduct at shoulder & extend elbow
Sucking reflex is the earliest reflex; formed at 16 weeks gestation
Extension and fanning of toes is positive Babinski

A

Extension and fanning of toes is positive Babinski
(Opposite of adult response. Flexion and closing of toes is positive; transitions @ 12-18 months when they begin to stand/walk)

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15
Q

What value is considered hypoglycemia in the neonate in the first 4 hours of life?

<40mg/dL
<45mg/dL
<50mg/dL
<60mg/dL

A

<40 mg/dL

(>4 hours: <45mg/dL)

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16
Q

You have a 3 hour old, 1600g neonate with a BGL of 30mg/dL. What is your first line of treatment?

6mL/kg D15
6mg D10
3mL D10
3mL/kg/min D12.5

A

3mL D10

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17
Q

Which of the following pathogens is the most likely cause of congenital pneumonia?

GBS
S. Aureus
H. Influenzae
H. Pylori

A

GBS (Group B Strep)

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18
Q

Which of the following is not part of the classic triad of congenital pneumonia?

Increased WOB
Tachypnea
Hypothermia
Tachycardia

A

Tachycardia

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19
Q

What broad-band antibiotic is first line empiric therapy for congenital pneumonia?

Ampicillin
Vancomycin
Tetracycline
Levaquin

A

Ampicillin

(Tetracycline and Levaquin are not given to neonates)

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20
Q

Which of the following is a sign of respiratory failure in the neonate?

PaCO2 > 60mmHg
Tachypnea
Rales
PaO2 <90mmHg in >90% FiO2

A

PaCO2 >60mHg

(Rales is VERY rare in neonates)

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21
Q

Cervical Palsy
Klompke Palsy
Erb-Duchenne Palsy
Cerebral Palsy

A
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22
Q

Erb-Duchenne Palsy presentation:

A

A form of brachial plexus injury

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23
Q

You’re resuscitating a neonate that Aeneid for 5 minutes. As a general rule, how long should you expect to provide PPV?

10-20 minutes
5-10 minutes
2-4 minutes

A

10-20 minutes

(2-4 minutes of PPV per minute of Apnea)

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24
Q

What FiO2 should be used when resuscitating a neonate?

21-30%
40-50%
>50%
100%

A

21-30%

(100% FiO2 can cause Brocho-Pulmonary Dysplasia, blindness; also closes PDA)

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25
Surfactant is required for all neonates less than ____ weeks gestation? 26 23 30 28
26 weeks
26
Why do we give surfactant?
Reduce surface tension to facilitate gas diffusion. (Surfactant is a detergent!)
27
What is the most common cause of respiratory failure in the neonate? Hyaline membrane disease Narcotic OD PPHN Tracheoesophageal fistula
Hyaline membrane disease
28
X-Ray: Hyaline Membrane Disease Tracheoesophageal fistula PPHN
29
What weight range should be transported using a thermoregulated isolette? <4.5kg <6.5kg <10kg <8kg
<4.5kg
30
What is the final electron acceptor in cellular respiration? Oxygen Carbon Dioxide Pyruvate NADH
Oxygen
31
What respiratory condition requires increased work during expiration? Obstructive disease Restrictive disease ARDS Cystic Fibrosis
Obstructive Disease
32
Which of the following causes a very high V/Q ratio? Pulmonary embolism Pulmonary shunt Pulmonary edema Pulmonary contusion
Pulmonary Emobolism
33
Which of the following is the most common cause of clinical hypoxemia? Hypoventilation Diffusion limitation Shunt V/Q mismatch
V/Q mismatch
34
Which of the following causes the oxyhemoglobin dissociation curve to shift up? Blood Transfusion Hemorrhage Acidosis Anemia
Blood Transfusion Hemorrhage: Down Acidosis: Right Anemia: Down
35
Which of the following shifts the oxyhemoglobin dissociation curve to the left? decreased [H+] Decreased pH Increased 2,3-DPG Acidosis
Decreased concentration of protons ([H+]) (alkalosis)
36
Increase in the concentration of CO2 displaces O2 from Hb and binding of O2 to Hb will displace CO2 from the blood due to: Haldane effect Bohr effect HAPE HACE
Haldane effect (Haldane describes CO2; Bohr describes O2)
37
What is the toxic dose of Acetaminophen? 140mg/kg 240mg/kg 90mg/kg 25mg/kg
140mg/kg
38
Which of the following is not absorbed by activated charcoal? Alcohol Phenobarbital Carbamazepine Aminophylline
Alcohol
39
What is the treatment for APAP OD? N-Acetylcysteine Sodium Bicarbonate Narcan MeOH
N-Acetylcysteine (Mucamyst)
40
Which of the following is not a treatment for HACE? Hyperventilation Lasix Dexamethasone Oxygen
Hyperventilation (High-altitude Cerebral Edema)
41
Which of the following is a Cation? K Cl O I
K (Potassium, K+) (Chloride, Oxygen, Iodide; all negative; Anions)
42
Carbonic anhydride facilitates the conversion of: CO2 and H2O to carbonic acid Carbonic acid to CO2 and H2O Carbonic acid to HCO3 and H+ HCO3 and H+ to Carbonic acid
CO2 and H2O to Carbonic Acid Carbonic acid then dissipates to HCO3 and an acid. Carbonic acid freely dissociates to CO2 and H2O
43
Which of the following conditions will present with a normal anion gap? Hyperkalemia Lactic Acidosis Uremia DKA
Hyperkalemia all the others are elevated gap metabolic acidosis MUDPILES Lactic Acidosis, DKA, and Uremia are the BIG 3 elevated anion gap acidosis’
44
Name that ABG: pH 7.33, PaO2 88, CO2 55, HCO3 23 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis
Respiratory Acidosis Uncompensated
45
Name that ABG: pH 7.33, PaO2 88, CO2 36, HCO3 20 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis
Metabolic Acidosis Partially Compensated (CO2 trending toward alkalosis)
46
Name that ABG: pH 7.53, PaO2 88, CO2 36, HCO3 30 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis
Metabolic Alkalosis pH and Bicarbonate are alkolotic Uncompensated
47
Using Slovis rule, what do you the PaCO2 will be compensation for with a HCO3 of 30? 45 30 15 50
45 Slovis Rule: Bicarb + 15= estimated PaCO2
48
You run a VBG and the patient has a pH of 7.33. Estimate the arterial pH. 7.36 7.33 7.30 Impossible to know
7.36 (Approximately 0.03 above the venous pH)
49
Which of the following is anaerobic? Glycolysis Citric acid cycle Electron transport chain None of these
Glycolysis (Citric acid cycle and electron transport chain are VERY aerobic) Glycolysis produces lactic acid (NADH + Pyruvate)
50
What plays an essential role in turning Pyruvate into Lactate? NAD+ CO2 FAD Acetyl Co-A
NAD+
51
Which is not an important determinant of oxygen delivery? PaO2 CO Hb SaO2
PaO2 Review this equation
52
Which is typical of hypovolemic shock? High SRV High CO High DO2 Normal PCWP
High SVR (Catecholamines cause vasoconstriction)
53
Which is typical of cardiogenic shock? Low DO2 Low SVR High CO Low PCWP
Low DO2 Catocholamines cause vasoconstriction, increasing afterload, decreasing CO. PCWP=LVEDP, CVP and PCWP increase.
54
Which is not typical of Sepsis? Low DO2 Low SVR Low PCWP High CO
Low DO2 High CO, Low SVR, and High DO2 are hallmarks of Sepsis hemodynamics
55
Which of the following is found in obstructive shock? Low SVR High Afterload High Contractility Low Preload
High Afterload High CVP=High Preload, Obstructed contractility, High SVR (Catecholamines)
56
Which of the following values is low in cardiogenic shock? SVR CI CVP PCWP
CI (Cardiac Index= Cardiac Output/BSA)
57
Which of the following values is high in hypovolemic shock? SVR CVP PCWP
SVR (Catecholamines)
58
Which of the following is correct regarding the EGT (end-goal-therapy) of septic shock? Lactate <4 CI >3.2 SvO2 >75% Hb >10
SvO2 >75%
59
Which drug is a negative inotrope with vasodilatory properties? milrinone Labetalol Hydralazine Norepinephrine
Labetalol Negative inotrope, alpha-blocking (vasodilation) Beta-blockers are the predominant category of negative inotropes
60
Which drug has the strongest alpha properties? Phenylephrine Dopamine Epinephrine Norepinephrine
Phenylephrine
61
Which of the following is excreted from the posterior pituitary gland? Prolactin LH FSH Oxytocin
Oxytocin
62
Which hormones are excreted by the posterior pituitary gland?
Oxytocin and Vasopressin
63
Which hormones are excreted by the anterior pituitary gland?
LH and FSH
64
As osmolarity increases, secretion of ADH: Decreases Remains the same Increases Impossible to know
Increases Linear and parallel correlation
65
This severe expression of hypothyroidism is accompanied by hypothermia: Grave’s disease NTIS Myxedema coma Thyroid storm
Myxedema coma (Thyroid storm is severe expression of hyperthyroidism; presents with hyperthermia)
66
What condition presents with increased action of T3 and T4, exceeding demands of the patient? NTIS Myxedema Coma Grave’s Disease Thyroid Storm
Thyroid Storm
67
What pre-existing condition is seen with DKA? DM-I DM-II Diabetes Incipidus Nephritis
DM-I (DM-II typically precedes HHS)
68
Which vent mode is a pressure controlled-volume targeted mode, delivering each breath at the lowest possible peak pressure? SIMV AC PRVC APRV
PRVC
69
Which of the following is false regarding APRV? Vt can fluctuate Pt can breathe spontaneously Utilizes a high and low pressure Pt should be paralyzed
PT should be paralyzed PT is preferably awake and able to augment their minute ventilation
70
Which of the following affects CO2? RR Vt PEEP FiO2
Respiratory Rate and Tidal Volume (Minute Ventilation= RR x Vt) (Ventilation = CO2) (Two types of respiratory failure: Hypoxic and Hypercarbic) (PEEP improves oxygenation and reduces V/Q mismatch)
71
Which of the following affects oxygenation? FiO2 RR PEEP Vt
FiO2 and PEEP
72
“The amount of the acceleration of a body is proportional to the acting force, and inversely proportional to the mass of the body.” Newton’s 1st law of motion Newton’s 2nd law of motion Newton’s 3rd law of motion Newton’s 4th law of motion
Newton’s 2nd law of motion
73
How much blood should be drained in a hemothorax injury? 500ml 1000ml 15000ml 2000ml
1500ml OR 400/hr x 4 hours
74
Tx of an open pneumothorax includes: Occlusive dressing, taped 3 sides place chest tube through opening High PEEP and Vt Occlusive dressing, taped 4 sides
Occlusive dressing, taped 4 sides
75
Beck’s triad includes all of the following EXCEPT: Tachycardia JVD Narrow pulse pressure Muffled heart sounds
Tachycardia
76
Which of the following is true regarding Beck’s triad? Early finding Hypotension is rare Only 40% show finding Muffled heat sounds are easy to hear
Only 40% show finding
77
In time-cycled pressure limited ventilation, the patient develops and pneumothorax. You should expect the PIP to: Slowly increase with each breath Decrease No Change Increase
No change (Pressure-limited mode! It’s going to always provide the same pressure. In this scenario, Vt will decrease)
78
In Volume-cycled ventilation, a patient develops a pneumothorax. You would expect the PIP to: Vary from breath to breath Increase Decrease No Change
Increase
79
What size ETT do you use for a 6yo? 6.0 5.5 5.0 6.5
5.5 (16+age)/4
80
A disease seen in pediatrics between the age of 3-5 years, caused by H. Influenzae? RSV Croup Laryngotracheobronchitis Epiglottitis
Epiglottitis (Croup = Laryngotrachealbronchitis) (H. Influenzae is a bacteria! RSV is a VIRUS)
81
What is the best treatment for a TET spell? Morphine Knee to chest position Versed Fentanyl
Knee to chest position
82
This condition starts with abdominal pain + diarrhea, then the child gets ill w/ renal failure: Meningitis DH HUS Bronchopulmonary Dysplasia
HUS
83
A patient with a Hb of 7.0 receives 4 unit of PRBC. What is the post-transfusion Hct? 33 11 25 40
33 (Hb increases by 1.0 per unit transfused) (Hct is ~3x the Hb)
84
Which of the following is used in the treatment of DIC? Albumin Platelets FFP Whole Blood
FFP (Heparin and FFP are the standard first line treatment for DIC)
85
What does mixing blood with D5W cause? Hemolysis Clotting Increased Osmolarity No Reaction
Hemolysis
86
Rule of 9’s: 2nd° burn, full face and anterior left arm. 10.5% 8.5% 12.5% 9.5%
8.5% Anterior left arm = 4.5% Full face= ~4%

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