Memory Master overview select.

Question 1

When do liver enzyme become completely functional in the neonate?

Answer 1

One month of age

Question 2

What are the angles of the left and right bronchi in a child less than three years of age?

Answer 2

Left 55

Right 25 to 70

Question 3

What factors contribute to the decreased functional residual capacity in the neonate and infant during general anesthesia?

Answer 3

• Comopliant chest wall

- poorly compliant lungs.

Question 4

What is the distance from the teeth to midtrachea in the newborn, In six month to 1 year, Two year old, three year old, and 4 year year old?

Answer 4

Newborn = 10
6 month to 1 year =11
2 yr =12
3 yr =13 -14
4 yr = 15
5yr = 15 -16

Question 5

Describe the physiologiical anemia of the neonate and pediatric patient?

Answer 5

Full term =
-Normal hemoglobin levels 14 -20 until 9th to 12 week and then bottom out to 10 - 11 and then in the 3 month the levels stop dropping and at 2 years of age the level begin to climb to normal adult.

Question 6

Compare the physiological anemia in the preterm neonate?

Answer 6

Decrease of hemoglobin is greater and earlier with the low being 8 for hemoglobin by week 4-8 and at 1 year the preterm and full term are comparable.

Question 7

Below what hemoglobin concentration is anemia sufficient to jeopardize oxygen carrying capacity in the neonate? Infant older than three months.

Answer 7

New born = 13

3 month old =10

Question 8

During the preoperative evaluation of a 6 month old surgical candidate you note physiologic anemia. What is a likely cause for the physiologic anemia?

Answer 8

Premature infant

Question 9

What is the normal heart rate of the term infant?

Answer 9

120 - 180

Question 10

List two way the physiology of the cardiovascular system of the neonate differs form that of the adult?

Answer 10

• Cardiac output is heart rate dependent

- Left ventricular compliance is decreased

Question 11

At what age is basal metabolic rate normally the highest?

Answer 11

6 -12 months old

Question 12

Where is brown fat located?

Answer 12

• Interscapular space
• around large blood vessels
• around the neck
• behind the sternum
• around the kidneys and adrenals

Question 13

What contral non shivering thermogenesis in infants?

Answer 13

Autonomic nervous system

Question 14

Non shivering thermogenesis a crucial heat generating mechanism in the neonate and infant as you know. At approximately what age does non shivering thermogenesis cease to be clinically significant?

Answer 14

2 years of age

Question 15

At what rate do infants consume oxygen?

Answer 15

7 ml/kg/min

Question 16

How much faster does infants consume oxygen than adults?

Answer 16

twice as fast

Question 17

Blood shunts through what two structures in the neonate with persistent fetal circulation?

Answer 17

• Ductus arteriosus

- Foramen ovale

Question 18

What is a patent ductus arteriosus? When does the ductus arteriosus normally close

Answer 18

Few hours to a few days

Question 19

What is the probable problem if the pediatric patient has a systolic and diastolic murmur?

Answer 19

Patent ductus arteriosus

Question 20

Identify the best site to obtain arterial blood gases from in the neonate?

Answer 20

Radial artery

Question 21

Identify 4 factors that may cause a neonate infant to return to fetal circulation?

Answer 21

• Hypoxia
• acidosis
• pneumonia
• hypothermia

Question 22

List three condition that increase right to left shunt?

Answer 22

• Acidosis
• hypercarbia
• hypotension

Question 23

List three congenital anomalies associated with prune belly syndrome?

Answer 23

• cryptorchidis
• club feet
• genitourinary tract abnormalities

Question 24

Name four condition in which the patient presents with a large tongue. What is the concern if the patient has a large tonguue?

Answer 24

• Down’s syndrom
• Pierre Robin syndrome
• Acromegaly
• Hypothyroidism

Question 25

Treacher Collins syndrome is associated with cleft palate as you know indicating a difficult airway. What congenital heart diseases is associated with Treacher Collins syndrome?

Answer 25

Ventricular Septal Defect

Question 26

At what age is cleft Palate usually repaired?

Answer 26

12 - 18 month

Question 27

List 7 anomalies often co existent with myelomeningocele.

Answer 27

``` -club foot hydrocephalus dislocation of hips exsstrophy of bladder exstrophy of bladder prolapsed uterus Klippel feil syndrome congenital cardiac defects ```

Question 28

What is Arnold Chiari Malformation?

Answer 28

Elongated cerebellar vermis that herniates through the foramen magnam

Question 29

What are four symptoms of Arnold Chiari malformation?

Answer 29

-Difficulty swallowing recurrent aspiration stridor apneic episode

Question 30

In addition to cleft palate and ventriculoseptal defects, what other condition are associated with Treacher collins syndrome?

Answer 30

``` Malar hypoplasia colobomas (Notching of the lower eyelids macrostomia (Large moutn malocclusion small oral cavity ```

Question 31

Chidren with long standing obstructive sleep apnea show what anatomic changes in the heart?

Answer 31

Pulmonary artery hypertension | Right ventricualr hypertrophy develop

Question 32

Children of what ages get croup (Laryngotracheobronchitis)?

Answer 32

Croup wuually occurs in children aged 2 or less

Question 33

List three treatments for postintubation laryngeal edema?

Answer 33

Coo humidified mist with O2 Aerosolized racemic epinephrine 0.05mL/kg of 2.25 Intravenous dexamethasone

Question 34

What is the pathogenesis of post intubation croups?

Answer 34

Glottic tracheal edema

Question 35

Identify 6 risk factors for post intubation croup?

Answer 35

``` Early childhood repeated intubation attempts large endotracheal tube prolonged surgery head and neck procedures excessive movement of the endotracheal tube ```

Question 36

What is the appropriate treatment for post intubation croup?

Answer 36

- Nebulized racemic epinephrine | - Intravenous dexamethasone

Question 37

Children of what ages get epiglottitis?

Answer 37

1 to 7 years (greater frequency with children less than 3 years)

Question 38

List four anesthesia consideration for the patient with congenital diaphragmatic hernia?

Answer 38

-Ketamine 0.5 mg/kg or fentanyl 1-3 mcg/kg -avoid nitrous oxide -Gently attempt to reexpand the lungs under direct vision using pressure no greater the 30 cm H2O after repair Anticipate the need for postoperatice support of ventilation

Question 39

The newborn has undergone a pyloromyotomy. What might you be concerned about in the postoperative period?

Answer 39

Respiratory depression and hypo ventilation in the recovery room because of persistent metabolic or cerebrospinal fluid alkolosis.

Question 40

What is the average amount of blood lost (in mL/kg) during tonsillectomy?

Answer 40

4 mL/kg

Question 41

Should extubation be performed while the patient is awake or asleep after a tonsillectomy? Why?

Answer 41

An awake extubation is preferred by most anesthetists because risk of aspiration is reduced.

Question 42

Identify ten factors associated with postintubation laryngeal edam.

Answer 42

- age younger than 4 year - tight fit in endotracheal tuve - traumatic or repeated intubation - prolonged intubation - high pressure low volume cuff - patient bucking or coughing during intubation - head repositioning while intubated - history of infections or postintubation croup - upper respiratory infection - Trisomy

Question 43

What is the most common cause for liver transplantation in children?

Answer 43

Cholestatic liver disease secondary biliary atresia

Question 44

What are three major concerns related to anesthetizing the Down's patient?

Answer 44

- intubation may difficult to large tongue, short neck, small mouth, and subglottic stenosis - neck flexion during laryngoscopy and intubation may result in atlanto occipital dislocation because of congenitally weak ligaments - Congenital hear disease is present in 40% of patient

Question 45

What are four pathophysiological feature associated with Down's syndrome, in addition to difficult airway, atlanto occipital instabiliity and congenital heart defects?

Answer 45

- Irregular dentition - Mental retardation - hypotonia - tracheoesophageal fistual - chronic pulmonary infection - seizures

Question 46

Where should PCO2 be maintained during intracranial surgery in children?

Answer 46

20 - 25 mm Hg

Question 47

State two reasons why neonates require more succinylcholine on a mg/kg basis than adults?

Answer 47

- Larger volume of ditribution for succinylcholine that adults 40 - 50 % - Neuromuscular junction is immature

Question 48

Maximum dose of bupivacaine for a pediatric patient?

Answer 48

- 1 mL/kg | - up to 25 cc can be used

Question 49

Is elimination of amide local anesthetics shortened or prolonged in the neonate compared with the adult.

Answer 49

- Prolonged in the neonate by 2 - 3 times | - (approaches adult levels at 6 month)

Question 50

Which local anesthetic is not metabolized in neonates?

Answer 50

Mepivicaine

Question 51

State 3 reason why the uptake of anesthetic drugs is typically faster in children than in adults?

Answer 51

- Child's higher alveolar ventilation per weight account largely for this effect - Increased cardiac output wiht greater distribution to the vessel risk groups - Anesthetic agents appear to be less blood solube in children thatn in adults.

Question 52

Give the two most important reasons why children are induced faster than adults with inhalational agents?

Answer 52

- Smaller functional residual capacity per unit of body | - Greater blood flow to the brain

Question 53

Which fluid is most appropriate for a normal six month old?

Answer 53

D5 lactated ringer's

Question 54

What is the best criteria for determining premedication dosages in kids?

Answer 54

body weight of child