Pediatric Anes. Pt. 3 (Exam 4 Final)

Question 1

What nerve is primarily involved in the hyper-responsive reflex seen in laryngospasm?
A. Recurrent laryngeal nerve
B. Phrenic nerve
C. Superior laryngeal nerve
D. Glossopharyngeal nerve

Answer 1

C. Superior laryngeal nerve

Anesthetic Emergency!

Slide 4

Question 2

Which of the following is TRUE about laryngospasm in pediatric patients?
A. It is less common than in adults
B. It only occurs during intubation
C. It is typically self-limiting and non-emergent
D. It may cause negative pressure pulmonary edema

Answer 2

D. It may cause negative pressure pulmonary edema

Which can lead to cardia arrest 💔

There is a greater percent of patients in the pediatric world that will have laryngospasm than adults

slide 4

Question 3

Which patient is MOST at risk for developing laryngospasm?
A. Adult patient undergoing orthopedic surgery
B. Pediatric patient with recent URI undergoing tonsillectomy
C. Pediatric patient with no URI undergoing foot surgery
D. Adult patient with GERD undergoing ENT procedure

Answer 3

B. Pediatric patient with recent URI undergoing tonsillectomy

slide 4

Question 4

Which of the following statements best explains why pediatric patients have increased incidence of laryngospasm?
A. They require higher concentrations of volatile anesthetics
B. They have a stronger sympathetic response
C. They more frequently undergo surgeries without paralysis
D. They have longer vocal cords

Answer 4

C. They more frequently undergo surgeries without paralysis

slide 4

Question 5

What is the estimated incidence of laryngospasm in the pediatric population?
A. 0.5%
B. 1.7%
C. 5.0%
D. 10%

Answer 5

B. 1.7%

…up to 25% in procedures like ENT procedures, tonsils, and adenoids where
we’re really interfering in the airway.

Slide 4

Question 6

Patients exposed to __________ in their home environment are at increased risk for laryngospasm.
A. pets
B. mold
C. gluten
D. secondhand smoke

Answer 6

D. secondhand smoke

slide 5

Question 7

Laryngospasm is more likely to occur during which phase of anesthesia?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV

Answer 7

B. Stage II (Excitement)

slide 5

Question 8

Which of the following are preoperative risk factors for laryngospasm? (Select 3)
A. GERD
B. 3rd phase of inhalation induction
C. Recent upper respiratory infection
D. Mechanical irritants
E. Use of NMBD

Answer 8

A. GERD
C. Recent upper respiratory infection
D. Mechanical irritants (oropharyngeal secretions)

slide 5

Question 9

Which of the following is the BEST way to prevent laryngospasm during extubation?
Select 2
A. Extubate while the patient is in Stage II
B. Administer midazolam prior to extubation
C. Extubate while the patient is fully awake
D. Perform oral suctioning after extubation
E. Extubate while deeply anesthetized

Answer 9

C. Extubate while the patient is fully awake
E. Extubate while deeply anesthetized

slide 6

Question 10

Which medication can be used topically or intravenously to reduce sensory input to the larynx before extubation?
A. Propofol
B. Succinylcholine
C. Lidocaine
D. Epinephrine

Answer 10

C. Lidocaine

Supresses laryngeal nerve activity

slide 6

Question 11

What is the purpose of administering 100% oxygen for 3–5 minutes prior to extubation?
A. Increase end-tidal CO₂
B. Promote muscle relaxation
C. Prolong anesthesia
D. Provide oxygen reserve

Answer 11

D. Provide oxygen reserve in case of airway obstruction

slide 6

Question 12

Which of the following is a correct method to reduce airway irritation before extubation?
A. Suction the oral pharynx prior to extubation
B. Increase tidal volume prior to extubation
C. Administer naloxone
D. Delay emergence with sevoflurane

Answer 12

A. Suction the oral pharynx prior to extubation

slide 6

Question 13

Incomplete Airway obstruction

What is the first step in managing an incomplete airway obstruction following extubation?
A. Administer succinylcholine
B. Perform laryngoscopy
C. Apply gentle positive pressure
D. Give atropine

Answer 13

C. Apply gentle positive pressure with 100% oxygen

a lil’ CPAP action

slide 7

Question 14

Which of the following should be eliminated early in laryngospasm treatment?
A. Inhaled anesthetic
B. Oxygenation
C. Noxious stimuli
D. Intravenous fluids

Answer 14

C. Noxious stimuli

SUCTION the airway, don’t touch the patient

slide 7

Question 15

If a patient with incomplete laryngospasm improves after suctioning and CPAP, what is the appropriate next step?
A. Administer succinylcholine
B. Deepen anesthesia
C. Resume anesthetic and stabilize
D. Reintubate immediately

Answer 15

C. Resume anesthetic and stabilize

slide 7

Question 16

If there is no improvement with laryngospasm after trying CPAP and 100% O2. Which IV anesthetic is commonly used to deepen anesthesia?
A. Etomidate
B. Midazolam
C. Ketamine
D. Propofol

Answer 16

D. Propofol

…turn up your gas or propofol.. I’ll still give a small dose of propofol, maybe like half a milligram or less per kilo.

slide 7

Question 17

Which drug combination is appropriate when a patient has no improvement after deepening anesthesia during laryngospasm?
A. Ketamine + glycopyrrolate
B. Midazolam + atropine
C. Succinylcholine + atropine
D. Rocuronium + naloxone

Answer 17

C. Succinylcholine + atropine

Ventilate with 100% O2 and intubate if needed

slide 7

Question 18

Complete Airway obstruction

Which of the following is a unique first-line maneuver for treating complete airway obstruction due to laryngospasm?
A. CPAP with nasal cannula
B. Laryngospasm notch pressure
C. Cricoid pressure
D. Needle decompression

Answer 18

B. Laryngospasm notch pressure

“a little more aggressive and a little faster with our treatment and management of a laryngospasm.”

slide 8

Question 19

Which steps are appropriate initial management for a complete airway obstruction? (Select 3)
A. Administer 100% O₂
B. Flutter the bag
C. Administer atropine alone
D. Spray the airway with lidocaine
E. Listen and watch for oxygen entry

Answer 19

A. Administer 100% O₂
B. Flutter the bag
E. Listen and watch for oxygen entry

Fluttering the bag - When you apply positive pressure using a mask and anesthesia bag (like the reservoir bag on your circuit), you squeeze the bag gently and then let go, repeatedly. You’re gently cycling small breaths of 100% oxygen into the patient.

Slide 8

Question 20

If you have suctioned and removed noxious stimulus and still no air movement is present and the patient has IV access, what is the appropriate next step?
A. Give IV propofol
B. Apply CPAP and wait
C. Administer IV succinylcholine with atropine
D. Administer IM succinylcholine with atropine

Answer 20

C. Administer IV succinylcholine with atropine

If NO IV then use IM succinylcholine with atropine

Ventilate with 100% O2 and attempt intubation

Slide 8

Question 21

What is the appropriate airway action if succinylcholine and atropine are given but intubation fails?
Select 2

A. Administer naloxone
B. Repeat laryngoscopy
C. Start steroids
D. Suction stomach contents
E. Administer lidocaine spray

Answer 21

B. Repeat laryngoscopy
E. Administer lidocaine spray

Attempt intubation again and call for help EARLY (circulator nurse usually first)!

Slide 8

Question 22

Which of the following indicates a failed airway and should prompt consideration of cricothyrotomy or tracheostomy?

A. Bronchospasm unresponsive to albuterol
B. Two failed intubation attempts
C. ETCO₂ increase to 50 mmHg
D. Moderate inspiratory stridor

Answer 22

B. Two failed intubation attempts and no ventilation

START CPR

Slide 8

Question 23

If you have suctioned and removed noxious stimulus and air movement is present, what is the appropriate next step?
(Select 2)

A. Increase concentration of volatile anesthetic
B. Apply gentle positive pressure
C. CPR or cricothyrotomy
D. Decrease concentration of volatile anesthetic
E. Attempt intubation

Answer 23

A. Increase concentration of volatile anesthetic
D. Decrease concentration of volatile anesthetic

Slide 8

Question 24

Once air movement is present and you have increased or decreased your volatile anesthetic you are ok to spray with lidocaine and intubate again

Answer 24

False

You should apply gentle positive pressure to the airway and continue 100% oxygen

Slide 8

Question 25

Where exactly is the laryngospasm notch where you apply pressure? A. At the thyroid cartilage B. Behind the angle of the mandible C. Over the mastoid process D. At the cricoid cartilage

Answer 25

B. Behind the angle of the mandible ## Footnote slide 9

Question 26

Which statement about succinylcholine dosing for IV treatment of laryngospasm is correct? A. 0.1–0.3 mg/kg IV B. 0.35–0.45 mg/kg IV C. 0.25–0.5 mg/kg IV D. 0.75–1.5 mg/kg IV

Answer 26

C. 0.25–0.5 mg/kg IV Up to 2mg/kg "A lot of times just a small dose of succs will relax the vocal cords enough to start moving air." ## Footnote slide 9

Question 27

Which anticholinergic medication should be co-administered with **IV** succinylcholine to prevent bradycardia? A. Glycopyrrolate B. Epinephrine C. Midazolam D. Albuterol

Answer 27

A. Glycopyrrolate ..or Atropine IV 0.02mg/kg ## Footnote slide 9

Question 28

When using **IM** succinylcholine during a laryngospasm, what is the appropriate dosing range? A. 1–2 mg/kg B. 2–3 mg/kg C. 3–4 mg/kg D. 5–6 mg/kg

Answer 28

C. 3–4 mg/kg Atropine IM - 0.04mg/kg ## Footnote slide 9-10

Question 29

# Bronchospasm Which of the following best describes the pathophysiology of bronchospasm? A. Disorder of skeletal muscle B. Disorder of smooth muscle C. Infection of alveolar tissue D. Paralysis of the diaphragm

Answer 29

B. Disorder of smooth muscle ## Footnote Slide 11

Question 30

Which conditions increase a patient's risk of intraoperative bronchospasm? (Select 3) A. Active asthma B. Recent upper respiratory infection C. Controlled hypothyroidism D. History of anaphylaxis E. Hypertension without airway disease

Answer 30

A. Active asthma B. Recent upper respiratory infection D. History of anaphylaxis "...the risk factors are kids with asthma, upper respiratory infections, but also patients with **allergies** or a history of anaphylaxis, patients that have **ingested a foreign body or have pulmonary edema.** ## Footnote slide 11

Question 31

Which clinical signs are associated with bronchospasm during anesthesia? (Select 3) A. Audible wheezing B. Shark-fin capnography C. Increased SPO2 D. Hypercapnia E. Increased tidal volume

Answer 31

A. Audible wheezing B. Shark-fin capnography - *Prominent slope on expiratory portion of ETCO2* D. Hypercapnia (increased CO₂) **Decreased SPO2** "It's characterized by an expiratory wheeze, a prolonged expiration, increase in our airway pressures. " ## Footnote Side 11

Question 32

Which of the following are appropriate first-line treatments for bronchospasm under anesthesia? (Select 3) A. Deepen anesthesia with volatile agent B. Administer succinylcholine C. Remove stimulus D. Switch to 100% FiO₂ E. Increase PEEP aggressively

Answer 32

A. Deepen anesthesia with volatile agent *or propofol* C. Remove stimulus D. Switch to 100% FiO₂ ## Footnote Slide 11

Question 33

Which interventions are appropriate if bronchospasm if **air trapping** may be might be happening? (Select 3) A. Decrease PEEP B. Increase PEEP C. Increase expiratory time D. Decrease expiratory time E. Beta agonists F. Beta blockers

Answer 33

A. Decrease PEEP C. Increase expiratory time E. Beta agonists (**albuterol**) "Other treatment options are to decrease your PEEP and increase your expiratory time to minimize any air trapping they might be having." "Other treatments will be **corticosteroids (fluticasone or budesonide)**, so some beta agonists like albuterol." ## Footnote Slide 11

Question 34

Which interventions are appropriate for treating **persistant** bronchospasm with no air movement after trying beta agonist and corticosteroids? (Select 2) A. IV Epinephrine B. Administer propofol C. IV Magnesium D. Administer succinylcholine E. Nebulized Epinephrine

Answer 34

A. IV Epinephrine C. IV Magnesium ## Footnote Slide 11

Question 35

What is an appropriate epinephrine dose for severe bronchospasm in an adult patient? A. 0.1–0.2 micrograms/kg B. 1–2 mg/kg C. 5–10 micrograms/kg D. 50–100 micrograms total

Answer 35

C. 5–10 micrograms/kg "Epi is a great second line option for severe bronchospasm. If you *know* it's a bronchospasm and feel like it's pretty severe, you could even say it's a first line treatment." ## Footnote Slide 11

Question 36

What is the primary cause of post-extubation croup? A. Infection of the alveoli B. Hyperventilation postoperatively C. Airway collapse during deep anesthesia D. Edema in a narrow pediatric airway

Answer 36

D. Edema in a narrow pediatric airway ## Footnote Slide 12

Question 37

Which symptoms are most characteristic of post-extubation croup? Select 2 A. Barking cough B. Productive cough with thick sputum C. Inspiratory stridor D. Expiratory stridor

Answer 37

A. Barking cough C. Inspiratory stridor "Typically the patient will have a barking cough or sort of a hoarseness. They may have some inspiratory stridor and increased work of breathing." ## Footnote Slide 12

Question 38

Which of the following are risk factors for post-intubation croup? (Select 3) A. Using too large of an ETT B. Multiple direct laryngoscopy attempts C. High FiO₂ for prolonged periods D. Changing position during the case E. Using too small of an ETT

Answer 38

A. Using too large of an ETT B. Multiple direct laryngoscopy attempts D. Changing position during the case * Surgical time * Age * Upper airway infection * Coughing on ETT ## Footnote Slide 12

Question 39

Which treatments are appropriate for managing post-extubation croup? (Select 3) A. Hypertonic saline instillation B. Nebulized racemic epinephrine C. Immediate bronchoscopy D. Supplemental O₂ E. IV Steroids

Answer 39

B. Nebulized racemic epinephrine D. Supplemental O₂ E. Steroids ""You can also do **nebulized steroids.** Typically with patients that **we know** are susceptible for post intubation or extubation croup, we'll go ahead and do a dose of 0.5mg/kg IV steroids. ## Footnote slide 12

Question 40

# True or False Supplemental oxygen is cooled and humidified.

Answer 40

True ## Footnote Slide12

Question 41

Racemic epinephrine for croup is typically dosed at __________ mL/kg of a 2.25% solution. A. 0.01 B. 0.05 C. 0.1 D. 0.5

Answer 41

B. 0.05 ## Footnote Slide 12

Question 42

What precaution must be taken after giving racemic epinephrine for croup? A. Repeat racemic epi immediately after 15 minutes B. Administer hypertonic saline C. Extubate the patient if breathing improves D. Observe for rebound swelling after 4 hours

Answer 42

D. Observe for rebound swelling after 4hrs ## Footnote Slide 12

Question 43

What is the best prevention strategy for post-extubation croup in pediatric patients? A. Use a smaller-than-predicted ETT B. Immediately inflate the ETT cuff to maximum volume C. Verify a leak at before inflating the cuff D. Routinely intubate without a cuffed tube

Answer 43

C. Verify a leak at before inflating the cuff "...what you do is you typically turn your pop off valve to 20 cm and just hold and somebody will listen at the **tracheal notch** and see if they hear an air leak. And you'll inflate the balloon to make the leak go away. And so there's **no certain milliliters** that you put in a pediatric airway cuff." ## Footnote Slide 12

Question 44

In pediatric patients, which factor would most likely suggest a difficult airway? A. A history of snoring or feeding difficulties B. A history of abdominal surgery C. A history of good bottle feeds D. A history of eye infection

Answer 44

A. A history of snoring or feeding difficulties ## Footnote slide 13

Question 45

Which components are essential in assessing a pediatric airway during physical exam? (Select 3) A. Mandible structure B. Visual acuity C. Palpation of liver size D. Tongue size E. Dental development

Answer 45

A. Mandible structure D. Tongue size E. Dental development Face, Mouth, tongue, teeth, etc. ## Footnote slide 13

Question 46

Which syndromes are associated with a large tongue that can complicate airway management? A. Pierre Robin and Goldenhar B. Trisomy 21 and Beckwith-Wiedemann C. Treacher Collins and Cri du Chat D. Klippel-Feil and Goldenhar

Answer 46

B. Trisomy 21 and Beckwith-Wiedemann "Remember: **B**ig **T**ongue" "Both these kids have large tongues that can cause upper airway occlusion, so an **oral airway** might be helpful for them." ## Footnote Slide 14

Question 47

Which syndromes are associated with a small or underdeveloped mandible? A. Trisomy 21 and Beckwith B. Klippel-Feil and Trisomy 21 C. Pierre Robin and Treacher Collins D. Beckwith and Cri du Chat

Answer 47

C. Pierre Robin and Treacher Collins "Remember: **P**lease **G**et **T**hat **C**hin" **P**ierre Robin Sequence **G**oldenhar Syndrome **T**reacher Collins Syndrome **C**ri du Chat Syndrome **"These are kids you definitely want to have a fiber optic or video scope nearby"** ## Footnote Slide 14

Question 48

Which syndromes are associated with **cervical spine** anomalies? (Select 3) A. Beckwith-Wiedemann B. Trisomy 21 C. Treacher Collins D. Klippel-Feil E. Goldenhar F. Cri du Chat

Answer 48

B. Trisomy 21 D. Klippel-Feil E. Goldenhar "Remember: **K**ids **Tr**y **Gold**" **K**lippel-Feil Syndrome **Tri**somy 21 (Down Syndrome) **Gold**enhar Syndrome "...you want to be careful manipulating their necks. So again, having a video scope might help you intubate these patients without having to manipulate their head and neck as much." ## Footnote Slide 14

Question 49

Why are neuromuscular blocking drugs (NMBDs) often avoided in patients with suspected difficult airways? A. They cause laryngospasm B. They can increase airway swelling C. So we can wake them up quickly D. They prolong recovery time

Answer 49

C. So we can wake them up quickly "A lot of times we'll avoid muscle relaxant. That way if we need to wake them up quickly, we don't have any muscle relaxant on board." ## Footnote Slide 15

Question 50

Which of the following are critical steps when preparing for a potentially difficult airway? (Select 3) A. Maintain VC ventilation B. Prepare multiple sizes of ETTs C. External manipulation of the trachea D. Administer succinylcholine immediately for induction E. Plan for different induction techniques

Answer 50

B. Prepare multiple sizes of ETTs C. External manipulation of the trachea E. Plan for different induction techniques * Maintain Spontaneous Ventilation (SV) * Establish IV access * Adjunct airway equipment like LMAs "We have multiple sizes of pediatric equipment and nearby...you want to make sure to have two different size ET tubes, the size you need, a size smaller, stylets, oral airways of multiple sizes." ## Footnote Side 15

Question 51

In pediatric cases, after achieving a deep plane of anesthesia, ensure delivery of 100% __________ before proceeding with airway instrumentation. A. nitrous oxide B. FiO₂ C. air D. helium

Answer 51

B. FiO₂ ## Footnote Slide 15

Question 52

Which of the following should you consider if you anticipate a difficult pediatric airway during surgery? A. Calling ENT for standby assistance B. Administering muscle relaxants immediately C. Using only one airway attempt before canceling the case D. Planning to extubate deeply anesthetized

Answer 52

A. Calling ENT for standby assistance "...having our pediatric ENT on standby, because if you need an emergent airway, you want the expert in the room" ## Footnote Slide 15

Question 53

What is the primary purpose of having a difficult airway algorithm readily available during airway management? A. For rapid decision-making if intubation or ventilation fails B. To help organize surgical case lists C. To provide pharmacology references for emergency drugs D. To document postoperative complications

Answer 53

A. For rapid decision-making if intubation or ventilation fails ## Footnote Slide 15-16

Question 54

During emergency airway management, what is the first maneuver to attempt after calling for help? A. Perform tracheostomy immediately B. Attempt Two-Person, Two-Hand mask ventilation C. Insert an oral RAE tube D. Start rigid bronchoscopy

Answer 54

B. Attempt Two-Person, Two-Hand mask ventilation ## Footnote Slide 17

Question 55

What is the peak age range for foreign body aspiration in children? A. 2 months –5 years B. 5 months - 4 years C. 6 months–3 years D. 1 month– 4 years

Answer 55

C. 6 months–3 years ## Footnote Slide 18

Question 56

Which symptoms may indicate a child has aspirated a foreign body? (Select 3) A. Cough B. Bucking C. Wheezing D. Increased tidal volume E. Stridor

Answer 56

A. Cough C. Wheezing E. Stridor ## Footnote Slide 18

Question 57

If a foreign body is located **supraglottically**, the patient is most likely to present with __________. A. Wheezing B. Stridor C. Decreased breath sounds D. Productive cough

Answer 57

B. Stridor ## Footnote slide 18

Question 58

If a foreign body is located **subglottically**, the patient is most likely to present with __________. A. Wheezing B. Absent breath sounds C. Stridor D. Productive cough

Answer 58

A. Wheezing ## Footnote sldie 18

Question 59

Foreign bodies aspirated into the airway are most commonly found in the __________ main bronchus. A. anterior B. superior C. left D. right

Answer 59

D. right "a lot of times when kids eat things it goes in their esophagus instead of their airway. Usually it ends up going down into their right main bronchus and causes some air trapping" ## Footnote slide 18

Question 60

Which anesthesia considerations are important for rigid bronchoscopy for foreign body removal? (Select 3) A. Maintain spontaneous ventilation B. Maintain positive pressure ventilation C. Give large boluses of narcotics D. Consider using TIVA E. Increase fresh gas flow

Answer 60

A. Maintain spontaneous ventilation D. Consider using TIVA E. Increase fresh gas flow "we'll do a mask conduction still with just a very gentle slow induction, making sure we keep them spontaneously breathing, make sure we're not giving them too much positive pressure." ## Footnote slide 18

Question 61

Lithium button battery ingestion causes rapid damage by raising the tissue pH to around __________. A. 5–6 B. 7–8 C. 10–11 D. 12–13

Answer 61

D. 12–13 Severly alkalotic ## Footnote 19

Question 62

In cases of button battery ingestion, necrosis of tissue can begin within __________ minutes. A. 5 B. 15 C. 45 D. 90

Answer 62

B. 15 ## Footnote slide19

Question 63

What is the target timeframe for removal of a button battery after ingestion? A. Within 2 hours B. Within 6 hours C. Within 24 hours D. Wihtin 48 hours

Answer 63

A. Within 2 hours ## Footnote slide 19

Question 64

Which action by parents is encouraged prior to arrival in the hospital after suspected battery ingestion? A. Give milk and toast B. Give a weak acid C. Force vomiting D. Keep the child completely NPO

Answer 64

B. Give a weak acid **like honey, juice, or soda** "these neutralize this alkalitic environment...it's noted to the anesthesia providers **we don't want to delay for NPO status**" ## Footnote Slide 19

Question 65

What is a lethal complication of button battery ingestion if not promptly managed? A. Aspiration pneumonia B. Pulmonary embolism C. Pneumothorax D. Aorto-esophageal fistula

Answer 65

D. Aorto-esophageal fistula with **massive hemorrhage** ## Footnote Slide 19

Question 66

What is the most common cause of epiglottitis in children? A. Viral infection B. Bacterial infection C. Fungal infection D. Allergic reaction

Answer 66

B. Bacterial infection **Supra**glottica ## Footnote Slide 20

Question 67

Which symptom combination is most characteristic of epiglottitis? A. Barking cough and mild fever B. Hoarseness, mild cough, nasal congestion C. Drooling, dysphagia, high fever, dyspnea D. Diarrhea, dehydration, high fever

Answer 67

C. Drooling, dysphagia, high fever, dyspnea "the kids will sit in like a tripod sort of position with their head tilted forward because they are having a hard time breathing." ## Footnote Slide 20

Question 68

The onset of epiglottitis symptoms is usually __________. A. rapid B. gradual over days C. intermittent D. delayed by a week Answer: B. rapid

Answer 68

A. rapid ## Footnote Slide 20

Question 69

What is the typical age group affected by epiglottitis? A. Less than 2 years old B. 2–6 years old C. 5–8 years old D. 8–12 years old

Answer 69

B. 2–6 years old ## Footnote Slide 20

Question 70

In managing epiglottitis, which considerations are critical? (Select 3) A. Ensure ENT surgeon is available B. Oxygen administration C. Steroids D. Racemic Epi E. Administer IV antibiotics

Answer 70

A. Ensure ENT surgeon is available B. Oxygen administration E. Administer intravenous antibiotics ## Footnote Slide 20

Question 71

Which clinical signs are more typical of croup? (Select 3) A. Inspiratory stridor B. Drooling C. Barking cough D. Mild fever E. Severe dysphagia

Answer 71

A. Inspiratory stridor C. Barking cough D. Mild fever ## Footnote slide20

Question 72

The usual cause of croup in pediatric patient is a laryngeal __________________? A. Bacterial infection B. Parasitic infection C. Fungal infection D. Viral infection

Answer 72

D. Viral infection ## Footnote Slide 20

Question 73

What is the typical onset time for symptoms of croup? A. Sudden, within minutes B. Gradual, over 24–72 hours C. Immediately following ingestion D. Rapid, within 1 hour

Answer 73

B. Gradual, over 24–72 hours ## Footnote Slide 20

Question 74

What is the typical age group affected by croup? A. Less than 2 years old B. 2–6 years old C. 5–8 years old D. 8–12 years old

Answer 74

A. Less than 2 years old ## Footnote Slide 20

Question 75

In managing epiglottitis, which considerations are critical? (Select 3) A. Ensure ENT surgeon is available B. Humidified oxygen C. Steroids D. Racemic Epi E. Administer IV antibiotics

Answer 75

B. Humidified oxygen C. Steroids D. Racemic Epi ## Footnote Slide 20

Question 76

In pediatric anesthesia, children with autism often struggle most with which of the following? A. Pain management B. Changes in routine and sensitivity to stimuli C. Postoperative nausea D. Allergic reactions to anesthesia

Answer 76

B. Changes in routine and sensitivity to stimuli ## Footnote Slide 23

Question 77

Which factors are important to consider when preparing to anesthetize a child with autism? (Select 3) A. Preoperative discussion with parents B. Allowing parental presence during induction when appropriate C. Maintaining a highly stimulating environment D. Using Child Life services for support E. Not allowing parental presence during induction

Answer 77

A. Preoperative discussion with parents B. Allowing parental presence during induction when appropriate D. Using Child Life services for support ## Footnote Slide 23

Question 78

One key strategy for managing autistic patients is **premedication** and to __________ them with their parents in the PACU as soon as possible. A. medicate B. separate C. reunite D. discharge

Answer 78

C. reunite ## Footnote Slide 23

Question 79

What airway characteristics in Trisomy 21 contribute to difficult ventilation and intubation? (Select 3) A. Large mouth B. Large tongue C. Subglottic stenosis D. Wide open vocal cords E. Narrow high-arched palate

Answer 79

B. Large tongue C. Subglottic stenosis E. Narrow high-arched palate ## Footnote Slide 24

Question 80

Which features increase the risk of difficult ventilation in patients with Trisomy 21? (Select 3) A. Small tongue B. Atlantoaxial instability C. Wide high-arched palate D. Large tonsils and adenoids E. Small mouth

Answer 80

B. Atlantoaxial instability D. Large tonsils and adenoids E. Small mouth ## Footnote Slide 24

Question 81

What are important anesthesia considerations for a Trisomy 21 patient? (Select 3) A. Size down the endotracheal tube B. Expect obstructive sleep apnea C. Anticipate severe hypertension D. Be cautious of chronic pulmonary infections E. Increase neck extension aggressively during intubation

Answer 81

A. Size down the endotracheal tube B. Expect obstructive sleep apnea D. Be cautious of chronic pulmonary infections ## Footnote Slide 24

Question 82

What is the **most common** congenital heart defect seen in patients with Trisomy 21? A. Tetralogy of Fallot (TOF) B. Atrioventricular septal defect (AVSD) C. Patent ductus arteriosus (PDA) D. Ventricular septal defect (VSD)

Answer 82

B. Atrioventricular septal defect (AVSD) ## Footnote Slide 25

Question 83

What is the SECOND most common congenital heart defect seen in patients with Trisomy 21? A. Tetralogy of Fallot (TOF) B. Atrioventricular septal defect (AVSD) C. Patent ductus arteriosus (PDA) D. Ventricular septal defect (VSD)

Answer 83

D. Ventricular septal defect (VSD) PDAs or tetralogy of flow are common as well.. ## Footnote Slide 25

Question 84

What factors explain the bradycardia seen in Trisomy 21 patients during inhalational induction? (Select 2) A. High sensitivity to volatile agents B. Congenital pulmonary stenosis C. Lower circulating catecholamines D. Decreased vagal tone

Answer 84

A. High sensitivity to volatile agents C. Lower circulating catecholamines "Bradicardia is also very very common with these patients during an inhalation induction and this is **independent of them having a heart condition**. Instead of just going straight to 8% sevo, we might dial it a little slower, maybe go to 4, 6, then 8" ## Footnote Slide 25

Question 85

What conditions are seen in Trisomy 21 patients when thinking about positioning considerations on the OR table: (Choose 2) A. Hypertonia B. Hyperflexible joints C. Diabetes mellitus D. Hypotonia E. Asthma

Answer 85

B. Hyperflexible joints D. Hypotonia "They have a lot of hypotonia hyperflexibility in their joints so you want to make sure they're well padded and well positioned so you're not hurting any joints." ## Footnote Slide 26

Question 86

Which of the following are additional clinical considerations in patients with Trisomy 21? (Select 3 answers) A. Increased risk of GERD B. Decreased risk of thyroid disease C. Higher risk of varicella-zoster D. Higher incidence of leukemia E. Epilepsy

Answer 86

A. Increased risk of GERD D. Higher incidence of leukemia E. Epilepsy ## Footnote Slide 26

Question 87

Which of the following are additional clinical considerations in patients with Trisomy 21? (Select 3 answers) A. Long neck B. Increased risk thyroid disease C. Strabismus D. Heat intolerance E. Intellectual disabilities

Answer 87

B. Increased risk thyroid disease C. Strabismus E. Intellectual disabilities. ## Footnote Slide 26

Question 88

If a patient with developmental delays is uncooperative in taking PO midazolam, what is another option for premedication? A. IM ketamine B. IV propofol C. Nitrous D. IV fentanyl

Answer 88

A. IM ketamine ## Footnote slide 26

Question 89

What is the dose of IM ketamine you would give for preop medication? A. 15-20mg/kg B. 5-7mg/kg C. 5-10mg/kg D. 2-3mg/kg

Answer 89

C. 5-10mg/kg ## Footnote slide 26

Question 90

What is a risk factor with a dose of IM ketamine? A. apnea B. bradycardia C. hypotension D. increase oral secretions

Answer 90

D. increase oral secretions increased risk of laryngospasm or bronchospasm during induction ## Footnote slide 26

Question 91

What is the most common cardiac anomaly associated with down syndrome? A. Atrioventricular septal defect B. first degree heart block C. bicuspid aortic valve D. single ventricle

Answer 91

A. Atrioventricular septal defect ## Footnote slide 27

Question 92

What does the VAC stand for in Vacterl association? (select 3) A. Vomiting B. Vertebral anomalies C. Anal atresia D. Cardiovascular anomalies E. Anemia F. Cerebral vascular events

Answer 92

B. Vertebral anomalies C. Anal atresia D. Cardiovascular anomalies ## Footnote slide 28

Question 93

What does the TERL stand for in VACTERL association (select 4) A. Tracheoesophageal fistula B. tracheal enlongation C. esophageal atresia D. eccentric movement E. Renal and or radial anomalies F. Limb defects

Answer 93

A. Tracheoesophageal fistula C. esophageal atresia E. Renal and or radial anomalies F. Limb defects ​ ## Footnote slide 28

Question 94

What is the cause thought to be for VACTERL (select 2) A. gender B. parental C. enviromental D. genetic

Answer 94

C. environmental D. genetic Exact cause is unknown but normally a combination of genetic and enviornmental typically it will not be passed from parent to child ## Footnote slide 28

Question 95

How many characteristics with VACTERAL association patient typically have? A. 3 B. 2 C. 4 D. 1

Answer 95

A. 3 ## Footnote slide 28

Question 96

Which 2 symptoms are the most common of VACTERL A. spine B. cardiac C. renal D. tracheal

Answer 96

A. spinal D. tracheal Which affect about 70% of the children with VACTERL ## Footnote slide 28

Question 97

What does CHARGE syndrome stand for? A. cardiac anomalies, heart defects, choanal atresia, respiratory obstruction, genitourinary problems, esophageal anomalies B. coloboma, heart defects, choanal atresia, restriction of growth and development, genitourinary problems, ear anomalies C. coloboma, heart defects, cardiac anomalies, restriction of growth and development, gastrointestinal problems, ear anomalies D. coloboma, hearing difficulties, choanal atresia, restriction of growth and development, genitourinary problems, ear anomalies

Answer 97

B. coloboma(defect to the eye), heart defects, choanal atresia (blockage of nasal passage), restriction of growth and development, genitourinary problems, ear anomalies ## Footnote slide 29

Question 98

DiGeorge syndrome or ________ has 3 major symptoms which include? A. Latch 55; abnormal face, thymoc hypoplasia, cleft palate B. Catch 22; hypercalcemia, hypotension, absent thymus C. Latch 55; Laryngospasm, hypotension, cleft palate D. Catch 22; cardiac issues, hypocalcemia, absent thymus

Answer 98

D. Catch 22; cardiac issues, hypocalcemia, absent thymus need irradiated blood if recieving blood products ## Footnote slide 30

Question 99

With Catch 22 the patient may also have______ and _______ (select 2) A. hyperthyroidism B. hyper-parathyroidism C. cleft palate/lip D. small ears/ hooded eyes

Answer 99

C. cleft palate/lip D. small ears/ hooded eyes ## Footnote slide 30

Question 100

Patients with down syndrome, cerebral palsy, developmental delays, and severe autism are a common occurance in which procedures A. hernia repair B. dental restoration C. spinal surgery D. orthodedic surgery

Answer 100

B. dental restoration Sometimes its just kids that really dont tolerate going to the dentist well. **These patients will almost always require premedication** ## Footnote slide 32

Question 101

What type of anesthesia plan will patients undergoing dental restoration need? A. Nasal intubation B. oral rae tube C. Mask case D. LMA

Answer 101

A. Nasal intubation with nasal rae tube ## Footnote slide 32

Question 102

# True or false With dental restoration procedures, even if the patient has a clotting disorder you should proceed with nasal intubation

Answer 102

False; if you're just unable to nasally intubate them because sometimes it can be challenging or if they have a bleeding disorder and it's not advised to instrument the nasal passage because passing the nasal tube can cause some bleeding of the adenoids and so if they have a **clotting disorder we don't really want to mess with their nasal passage.** ## Footnote slide 32

Question 103

# Put the following steps in order Afrin nose spray IV insertion Mask induction Nasal intubation nasal dilation securing tube

Answer 103

Mask induction IV insertion Afrin (oxymetazolin) nose spray Dilation of nasal passaage nasal intubation securing tube ## Footnote slide 33

Question 104

_______ and ______ are important for dental restoration procedures. A. suction well after extubation B. antiemetics C. thoat pack placed by CRNA D. pain management

Answer 104

B. antiemetics D. pain management suction well BEFORE extubation throat pack placed by DENTIST to keep the extra blood and irrigation that they're using from going into the airway ## Footnote slide 33

Question 105

What does strabismus repair surgery do? A. corrects misalignment to the extraocular muscles and re-establishes the visual axis B. corrects color C. corrects the lid of the eye to paralyze the muscles D. corrects fixation

Answer 105

A. corrects misalignment to the extraocular muscles and re-establishes the visual axis ## Footnote slide 34

Question 106

What type on anesthetic is typically used for strabismus repair (select 2) A. LMA, ET B. inhalation C. IV D. MAC

Answer 106

A. LMA, ET B. inhalation ## Footnote slide 34

Question 107

What is a risk for strabismus repair? (select 2) A. hypertension B. PONV C. tachycardia D. bradycardia

Answer 107

B. PONV D. bradycardia- oculocardiac reflex FIRST alert the surgeon so they can stop pressing on the eye might have to give some glyco ## Footnote slide 34

Question 108

Besides bradycardia, what does traction on the extraocular muscle cause? (select 2) A. ventricular ectopy B. tachycardia C. AV block D. junctional rythm

Answer 108

A. ventricular ectopy C. AV block- it can even cause asystole ## Footnote slide 35

Question 109

The oculocardiac reflex will _______ with repeated stimulation A. exaggerate B. fatigue C. remain unchanged D. increase

Answer 109

B. fatigue Ask surgeon to stop pulling on the muscle, they'll release the muscle the heart rate will come back and hopefully it won't happen again ## Footnote slide 35

Question 110

What is the first step in managing OCR? A. turn down anesthesia B. glycopyrolate C.atropine D. communication with surgeon

Answer 110

D. communication with surgeon (this has been mentioned a lot just FYI) ## Footnote slide 35

Question 111

What 2 risk factors contribute to retinopathy of prematurity A. increased birth weight B. <30weeks gestation C. <1000g birth weight D. prolonged labor

Answer 111

B. <30weeks gestation C. <1000g birth weight ## Footnote slide 36

Question 112

Retinopathy of prematurity is linked to _____ A. increased nutrition intake B. lack of oxygen C. decreased nutrition intake D. liberal oxygen use

Answer 112

D. liberal oxygen use "when you get patients from the NICU you'll notice they're almost never on 100% FiO2. They also set their parameters on their pulse ox lower than 100% being the high. If the patient gets usually greater than about 90% 95% on their pulse ox they will decrease the FiO2. They do not want their babies on 100% They don't like when we put their babies on 100% FiO2." ## Footnote slide 36

Question 113

When is retinal maturation is complete? A. 44 weeks B. 33weeks C. 40 weeks D. 28weeks

Answer 113

A. 44 weeks post conception ## Footnote slide 36

Question 114

What do you want oxygen saturation at for preemies? A. 92-98% B. 94-100% C. 96-99% D. 89-94%

Answer 114

D. 89-94% ## Footnote slide 36

Question 115

Where should you place the O2 probe? A. left hand B. right foot C. right hand D. left foor

Answer 115

C. right hand (preductal) preductal O2 better correlates with O2 sats of retinal vessels ## Footnote slide 36

Question 116

What is a common procedure for children for OSA? A. appenectomies B. Tonsils and adneoids C. hypoglossal nerve stimulator D. ear tubes

Answer 116

B. Tonsils and adneoids ## Footnote slide 37

Question 117

What can OSA be caused by in children (select 4) A. low birth weight B. tonsillar hypertrophy C. obesity D. neuromusclar disease E. craniofacial abnomalies G. prematurity

Answer 117

B. tonsillar hypertrophy C. obesity D. neuromusclar disease E. craniofacial abnomalies ## Footnote slide 37

Question 118

We would like to to be cautious with ________ and ______ due to not wanting to disrupt their normal breathing or worsen their apnea A. inhalation inductin B. propofol C. titration of opioids D. premedication

Answer 118

C. titration of opioids- monitor response and adjust dose accordingly D. premedication ## Footnote slide 37

Question 119

How do we dose children with obesity A. total body weight B. ideal body weight C. actual body weight D. age

Answer 119

B. ideal body weight "I just say go lighter than you normally would instead of giving one milligram per kilo of fentanyl I'll give half a milligram per kilo. It's also great if you can supplement with a non-opioid." ## Footnote slide 37

Question 120

What are 3 indications for Adenotonsillectomy? select 3 A. obstruction B. acute infection C. chronic infection D. mass/lesion E. redness

Answer 120

A. obstruction - OSA C. Chronic infection D. mass/lesion ## Footnote slide 38

Question 121

A patient coming in for adenotonsillectomy is at risk for _____ A.dehydration B. infection C. difficult IV access D. reactive airway

Answer 121

D. reactive airway ## Footnote slide 38

Question 122

For an adenotonsillectomy what is especially important to assess preop (select 2) A. bleeding disorder B. airway C. nutrition D. neurological assessment

Answer 122

A. bleeding disorder- tonsils can bleed very easily and rebleed easily B. airway ## Footnote slide 38

Question 123

What type of airway is typically used for a T&A? A. LMA B. Mask (no airway) C. oral RAE tube D. nasal intubation

Answer 123

C. oral RAE tube ## Footnote slide 39

Question 124

What is the anesthetic plan for a T&A (select 2) A. Inhalation with IV placment after B. smooth induction and emergence C. IV induction D. Mask management

Answer 124

A. Inhalation with IV placment after B. smooth induction and emergence ## Footnote slide 39

Question 125

What medications will we be giving to our T&A patient? (select 3) A. succinycholine B. analgesics C. antiemetics D. dexamethasone (0.5mg/kg)

Answer 125

B. analgesics C. antiemetics D. dexamethasone (0.5mg/kg)- because of airway swelling and PONV ## Footnote slide 39

Question 126

# True or false You can do awake or deep extubation but deep extubations is at increase risk for laryngospasm so make sure you suction really well before extubation

Answer 126

true ## Footnote slide 39

Question 127

Most facilities for a T&A use morphine and fentanyl. However with the use of opioids there is an increased incidence for _____ and _______ A. laryngospasm B. PONV C. respiratory depression D. pain

Answer 127

B. PONV C. respiratory depression tylenol is a great choice for these patients ## Footnote slide 40

Question 128

Which meds are controversial in T&A procedures A. NSAIDS B. albuterol C. glycopyrolate D. dexmedetomidine

Answer 128

A. NSAIDS - increased risk for bleeding precedex is a good choice for these patients ## Footnote slide 40

Question 129

Primary bleeding for a T&A comes within ______ hours post op and secondary bleeding comes _____ days after surgery A. 12-36; 4-6 B. 8-16; 8-10 C. 2-4; 5-8 D. 6-24; 5-10

Answer 129

D. 6-24; 5-10 ## Footnote slide 40

Question 130

T&A is high risk for airway fire. In order to control airway fire it is best to keep FiO2 below _____ and avoid N2O A. 20% B. 30% C. 50% D. 21%

Answer 130

B. 30% she said 35% during lecture but slide says 30% ## Footnote slide 40

Question 131

A post tonsillar bleed is a surgical emergency and the patient will be considered full stomach. The best anesthetic for these patients is an RSI or ________ A. nasal intubation B. awake intubation C. mask case D. neuraxial anesthesia

Answer 131

B. awake intubation ## Footnote slide 41

Question 132

Considering a post tonsillar bleed patient had just been intubated, what should we consider in our anesthesia plan? A. mask caase B. nasal intubation C. half size up on ETT D. half size down on ETT

Answer 132

D. half size down on ETT ## Footnote slide 41

Question 133

Some possible considerations for anesthesia providers for a post tonsillar bleed include all the following except A. large bore IV B. IV fluids C. Blood products D. H&H E. awake extubation F. increase FiO2 during sugery G. OGT H. antiemetics

Answer 133

F. increase FiO2 during sugery ## Footnote slide 41

Question 134

# True or false Cleft lip and palate is a defect in palatal growth in the first timester of pregnancy and is associated with things like pierroven, trisomy 21, fetal alcohol syndrome, but never just clept lip and palate. It will always be associated with a syndrome

Answer 134

False! 1/3 is associated with a disorder but it CAN be just cleft lip and palate ## Footnote slide 43

Question 135

When is cleft lip repaired? A. 6-12 months B. 3-6 months C. 2-4 months D. 1-3 months

Answer 135

B. 3-6 months ## Footnote slide 43

Question 136

When is cleft palate repaired? A. 6-12 months B. 3-6 months C. 2-4 months D. 1-3 months

Answer 136

A. 6-12 months ## Footnote slide 43

Question 137

When intubating a child with a cleft palate it is important to be careful to not go into the cleft palate so the patient could be considered to have A. wide mouth opening B. easy airway C. enlongated soft palate D. difficult airway

Answer 137

D. difficult airway ## Footnote slide 43

Question 138

Children coming in for a cleft palate/ lip repair will recieve a _________ anesthetic with a/an_________ tube A. regional; Nasal RAE B. regional; oral RAE C. general; oral RAE D. general; nasal RAE

Answer 138

C. general; oral RAE ## Footnote slide 43

Question 139

Patients with a cleft lip/palate will be at risk for post op obstruction and will require a A. deep extubation B. awake extubation C. oral airway D. avoid analgesics

Answer 139

B. awake extubation a nasal trumpet to prevent any upper airway obstruction and you really want to avoid putting an oral airway in as well because the hard oral airway can can rub against the suture lines. Analgesia is really important for these kids- acetaminophen and opioids are common ## Footnote slide 43

Question 140

Pyloric stenosis is an obstructive olive shaped lesion below the xiphoid process we commonly see in ________ A. second born males B. second born females C. firstborn males D. firstborn females

Answer 140

C. firstborn males ## Footnote slide 44

Question 141

When is pyloric stenosis typically diagnosed A. 2-12 weeks of age B. 2-4 months of age C. 6-12 months of age D. 14-20 weeks of age

Answer 141

A. 2-12 weeks of age ## Footnote slide 44

Question 142

Common symptoms of pyloric stenosis include all the followign except A. nonbilous postprandial emesis B. palpable pylorus C. diarrhea D. visible peristatic waves E projectile vomiting

Answer 142

C. diarrhea often non-bilious because the bile isn't able to get back up into the stomach ## Footnote slide 44

Question 143

What surgery is performed to correct pyloric stenosis A. gastric bypass B. pylomyotomy C. hiatal repain D. duodenectomy

Answer 143

B. pylomyotomy commonly laproscopic ## Footnote slide 44

Question 144

With pyloric stenosis, all the following are anesthetic considerations except A. acid base balance B. hypovolemia C. hypochloremic D. hypokalemic metabolic acidosis E. hypernatremia F. full stomach G. post op apnea

Answer 144

E. hypernatremia HYPOnatremia full stomach- RSI or awake intubation, extubate awake , suction stomach prior to induction until clear ## Footnote slide 46

Question 145

Inguinal hernias are prevalent in A. children over the age of 6 months B. infants born at 38 weeks C. preterm neonates D. late term neonates

Answer 145

C. preterm neonates ## Footnote slide 47

Question 146

Concerns for inguinal hernia repair include (select 2) A. bilateral testicular injury B. small bowel incarceration C. large bowel incarceration D. ipsilateral testicular injury

Answer 146

B. small bowel incarceration D. ipsilateral testicular injury ## Footnote slide 47

Question 147

What is the typical anesthetic plan for patients undergoing inguinal hernia repair A. mask case B. spinal anesthesia C. general with a caudal D. mac witha caudal

Answer 147

C. general with a caudal GETT or LMA inhalation induction We'll do an inhalation induction, place an LMA or ET tube, and then place the caudal. If they're a little bit older you could do a spinal. Typically we don't do the spinal. If the caudal doesn't work or they're too old for a caudal, they'll just inject a local at the site, but the spinal is an option. ## Footnote slide 47

Question 148

What is a post op concern for inguinal hernia repair A. obstruction B. PONV C. pain D. apnea

Answer 148

D. apnea There's also concern for postop apnea with these patients because it's not super stimulating. A lot of times it's more prevalent in pre-term neonates, so again those patients are at risk for apnea. ## Footnote slide 47

Question 149

Inguinal hernia is most commonly seen in which patient population? A. Full-term infants B. Preterm neonates C. School-aged children D. Adolescents

Answer 149

B. Preterm neonates ## Footnote Slide 48

Question 150

What are the primary clinical concerns associated with inguinal hernias in neonates? A. Infection and sepsis B. Pain and fever C. Small bowel incarceration and ipsilateral testicular injury D. Diarrhea and vomiting

Answer 150

C. Small bowel incarceration and ipsilateral testicular injury ## Footnote Slide 48

Question 151

Which surgical approaches may be used for inguinal hernia repair in neonates? A. Robotic-assisted and percutaneous B. Open or laparoscopic C. Endoscopic only D. Transabdominal and thoracoscopic

Answer 151

B. Open or laparoscopic ## Footnote Slide 48

Question 152

Which of the following are factors that influence the anesthetic technique for inguinal hernia repair? (Select 3) A. Spinal or caudal anesthesia B. Choice between inhalational vs. IV induction C. Use of high-flow nasal cannula during emergence D. LMA or ETT based on surgical technique E. Availability of nitrous oxide in the OR

Answer 152

A. Spinal or caudal anesthesia B. Choice between inhalational vs. IV induction D. LMA or ETT based on surgical technique ## Footnote Slide 48

Question 153

Which of the following is a key postoperative concern in preterm infants undergoing inguinal hernia repair? A. Postoperative bleeding B. Pulmonary embolism C. Postoperative apnea D. Hypertensive crisis

Answer 153

C. Postoperative apnea ## Footnote Slide 48

Question 154

Which congenital conditions result from abdominal wall defects that occur during gestation when the visceral organs fail to return from the yolk sac into the abdominal cavity? A. Diaphragmatic hernia and malrotation B. Tracheoesophageal fistula and duodenal atresia C. Omphalocele and gastroschisis D. Pyloric stenosis and Hirschsprung disease

Answer 154

C. Omphalocele and gastroschisis ## Footnote Slide 49

Question 155

Match the characteristic to the correct condition: A. Omphalocele B. Gastroschisis 1. Central defect through umbilical ring 2. No covering membrane present 3. Defect located lateral to the umbilicus (usually right) 4. Viscera covered by a thin membranous sac (may rupture)

Answer 155

1. Central defect through umbilical ring - Omphalocele (A) 2. No covering membrane present - Gastrochisis (B) 3. Defect located lateral to the umbilicus (usually right) - Gastrochisis (B) 4. Viscera covered by a thin membranous sac (may rupture) - Omphalocele (A) ## Footnote Slide 49

Question 156

# True or False Omphalocele and gastroschisis are often associated with other anomalies such as cardiac, genitourinary, metabolic, malrotation, Meckel diverticulum, and intestinal atresia.

Answer 156

True ## Footnote Slide 49

Question 157

# True or False Omphalocele outcomes are typically excellent with minimal complications.

Answer 157

FALSE!! Omphalocele outcomes remain poor ## Footnote Slide 49

Question 158

The abdominal wall defect in ____ occurs midline and involves the umbilicus, whereas in ____, the defect is typically off-midline, usually to the right of the umbilicus. A. Omphalocele and Gastroschisis B. Gastroschisis and Omphalocele C. Omphalocele and Trisomy 21 D. Gastroschisis and Beckwith-Wiedemann

Answer 158

A. *Omphalocele* occurs midline and involves the umbilicus and *Gastroschisis* defect is typically off-midline, usually to the right of the umbilicus. ## Footnote Slide 50

Question 159

While ____ involves only the bowel, ____ often involves the bowel and sometimes the liver A. Gastroschisis and Omphalocele B. Omphalocele and Gastroschisis C. Trisomy 21 and Omphalocele D. Omphalocele and Beckwith-Wiedemann

Answer 159

A. *Gastroschisis* involves only the bowel and *Omphalocele* involves the bowel and sometimes the liver ## Footnote Slide 50

Question 160

A membranous covering is absent in ____, but is present in ____. A. Omphalocele and Gastroschisis B. Gastroschisis and Omphalocele C. Beckwith-Wiedemann and Omphalocele D. Trisomy 21 and Gastroschisis

Answer 160

B. *Gastroschisis* membranous covering is absent and *Omphalocele* membranous covering is present ## Footnote Slide 50

Question 161

Coexisting anomalies such as Trisomy 21, Beckwith-Wiedemann and cardiac defects are associated with ____, while ____ is more commonly associated with prematurity. A. Omphalocele and Gastroschisis B. Gastroschisis and Omphalocele C. Meckel diverticulum and Gastroschisis D. Gastroschisis and intestinal atresia

Answer 161

A. *Omphalocele *oexisting anomalies such as Trisomy 21, Beckwith-Wiedemann and cardiac defects and *Gastroschisis* more commonly associated with prematurity ## Footnote Slide 50

Question 162

Surgery for ___ is more urgent and should be performed within 24 hours, while surgery for ____ is less urgent due to the need for cardiac workup. A. Gastroschisis and Omphalocele B. Omphalocele and Gastroschisis C. Beckwith-Wiedemann and Omphalocele D. Trisomy 21 and Gastroschisis

Answer 162

A. *Gastroschisis* more urgent and should be performed within 24 hours and *Omphalocele* less urgent due to the need for cardiac workup. ## Footnote Slide 50

Question 163

# True or False Both Omphalocele and Gastroschisis may require staged repair with a prosthetic silo.

Answer 163

TRUE *Omphalocele has an incidence of 1 in 5,000, while Gastroschisis is more common with an incidence of 1 in 2,000* ## Footnote Slide 50

Question 164

Which of the following is a common postoperative concern in patients with Omphalocele and Gastroschisis? A. Hyperthermia B. Postoperative apnea C. Postoperative ventilation requirements D. Hypertension

Answer 164

C. Postoperative ventilation requirements *Dr.M: Post-op ventilation is often required for these patients because they've had this open abdomen...because they're used to this open abdomen, and their lungs have more freedom to move. Now you're closing it up, so now they don't have as much room for their lungsto be moving, so usually we'll keep these intubated afterwards with post-op ventilation and good pain control.* ## Footnote Slide 51

Question 165

Hypothermia and severe dehydration are concerns in neonates with omphalocele and gastroschisis because: A. They are often premature B. They lose heat through exposed abdominal contents C. They are placed in cold OR rooms D. They receive large volumes of cold IV fluids

Answer 165

B. They lose heat through exposed abdominal contents ## Footnote Slide 51

Question 166

Which of the following are key anesthetic concerns in the perioperative management of neonates with omphalocele or gastroschisis? (Select 2) A. Risk of pulmonary embolism B. Potential for sepsis C. Associated anomalies D. Hyperthyroidism E. Elevated hematocrit

Answer 166

B. Potential for sepsis C. Associated anomalies ## Footnote Slide 51

Question 167

What is a common postoperative complication following abdominal wall closure when ventilatng neonates with omphalocele or gastroschisis? A. Increased intraabdominal pressure B. Hyperkalemia C. Renal hypertrophy D. Pulmonary embolism

Answer 167

A. Increased intraabdominal pressure ## Footnote Slide 51

Question 168

Which of the following medications or interventions are commonly used in the anesthetic management of neonates with omphalocele or gastroschisis? (Select 2) A. Colloids for volume replacement B. Nitrous oxide for analgesia C. Neuromuscular blockade D. Inhaled corticosteroids

Answer 168

**A. Colloids for volume replacement** *Dr. M: our neonates have less albumin, and so treating them with albumin will treat their hypovolemia but also help with their low albumin.* **C. Neuromuscular blockade** ## Footnote Slide 52

Question 169

Which of the following monitoring devices or placements are recommended during surgery for omphalocele or gastroschisis? (Select 3) A. Arterial line for blood pressure and labs B. Pulse oximeter on lower extremity C. Central venous catheter D. Pulse oximeter on upper extremity only E. IV access

Answer 169

**A. Arterial line for blood pressure and labs** **B. Pulse oximeter on lower extremity** *Dr. M: but also as they're closing the abdomen, as they're putting extra pressure in the abdomen, you can have some decreased perfusion to the lower extremities, so you want to monitor what their perfusion is like by doing a pulse ox on the lower extremities.* **E. IV access** ## Footnote Slide 52

Question 170

# True or False Using nitrous oxide (N₂O) is routinely recommended in the anesthetic management of neonates with omphalocele or gastroschisis.

Answer 170

False *Avoid N2O* ## Footnote Slide 52

Question 171

. What population is most at risk for necrotizing enterocolitis (NEC)? A. Term infants with congenital diaphragmatic hernia B. Preterm infants < 32 weeks and <1500g C. Neonates born via cesarean section D. Infants exposed to maternal diabetes

Answer 171

B. Preterm infants < 32 weeks and < 1500g ## Footnote Slide 53

Question 172

Which of the following are associated with the pathophysiology and risk factors of Necrotizing Enterocolitis (NEC)? (Select 4( A. Bowel ischemia B. Prematurity C. Patent ductus arteriosus (PDA) D. Advanced oral feeding in term infants E. Bacterial invasion

Answer 172

A. Bowel ischemia B. Prematurity C. Patent ductus arteriosus (PDA) E. Bacterial invasion * and premature oral feeding ## Footnote Slide 53

Question 173

__ is an intestinal inflammatory condition that presents as a life-threatening emergency, primarily affecting preterm infants. A. Hirschsprung’s disease B. Meconium ileus C. Necrotizing Enterocolitis (NEC) D. Intussusception

Answer 173

C. Necrotizing Enterocolitis (NEC)

Question 174

Diagnosis of NEC is confirmed by ____. A. Urinalysis B. Abdominal X-ray C. Liver ultrasound D. Spinal MRI

Answer 174

B. Abdominal X-ray ## Footnote Slide 53

Question 175

Which of the following is NOT typically associated with necrotizing enterocolitis (NEC)? A. Hyperkalemia B. Hyponatremia C. Hyperglycemia D. Respiratory alkalosis E. Hypoglycemia F. Metabolic acidosis G. Disseminated intravascular coagulation (DIC)

Answer 175

D. Respiratory alkalosis ## Footnote Slide 53

Question 176

Which of the following NEC symptoms reflect gastrointestinal involvement? A. Increased gastric residuals with feedings B. Abdominal distention C. Bilious vomiting D. Occult/gross rectal bleeding

Answer 176

All of the above ## Footnote Slide 55

Question 177

Which of the following NEC symptoms reflect neurologic compromise? A. Jaundice B. Lethargy C. Fever D. Hypothermia

Answer 177

B. Lethargy ## Footnote Slide 55

Question 178

Which NEC symptom is associated with renal involvement? A. Oliguria B. Bradycardia C. Abdominal distention D. Rectal bleeding

Answer 178

A. Oliguria ## Footnote Slide 55

Question 179

Which NEC symptoms indicate cardiopulmonary compromise? (Select 2) A. Apnea B. Bradycardia C. Jaundice D. Vomiting

Answer 179

A. Apnea B. Bradycardia ## Footnote Slide 55

Question 180

Which NEC symptoms are indicative of systemic inflammatory or hematologic response? (Select 3) A. Fever B. Hypothermia C. Apnea D. Jaundice

Answer 180

A. Fever B. Hypothermia C. Apnea ## Footnote Slide 55

Question 181

Which of the following is NOT an appropriate initial medical intervention for necrotizing enterocolitis (NEC)? A. Withhold enteral feeding B. Administer antibiotics (Abx) C. Encourage oral feeding to promote gut function D. Nasogastric (NG) decompression E. Manage hypovolemia and acidosis F. Ensure oxygenation

Answer 181

C. Encourage oral feeding to promote gut function ## Footnote Slide 55

Question 182

Which of the following is the most appropriate surgical intervention for necrotizing enterocolitis (NEC)? A. Laparoscopic cholecystectomy B. Appendectomy with washout C. Exploratory laparotomy with resection of dead bowel, colostomy, and peritoneal lavage D. Nissen fundoplication E. Umbilical hernia repair

Answer 182

C. Exploratory laparotomy with resection of dead bowel, colostomy, and peritoneal lavage ## Footnote Slide 55

Question 183

Which of the following is NOT a recommended anesthetic management strategy for neonates undergoing surgery for NEC? A. Avoiding nitrous oxide (N₂O) B. Cautious use of volatile anesthetics C. Routine administration of high-dose opioids without monitoring D. Assessing hydration status E. Early colloid administration

Answer 183

C. Routine administration of high-dose opioids without monitoring ## Footnote Slide 56

Question 184

What is the most common clinical presentation of malrotation and midgut volvulus in a neonate? A. Projectile non-bilious vomiting B. Bilious vomiting with abdominal distention C. Fever and bloody stools D. Constipation and failure to thrive

Answer 184

B. Bilious vomiting with abdominal distention *increasing HD instability* ## Footnote Slide 57

Question 185

Place the following events in the correct order to describe the progression of complications in midgut volvulus: A. Infant at risk for aspiration of gastric/intestinal contents B. Intestinal obstruction C. Abdominal distention D. Impeded diaphragmatic movement

Answer 185

B → C → D → A Intestinal obstruction → abdominal distention → impedes diaphragmatic movement → infant at risk for aspiration of gastric/intestinal contents ## Footnote Slide 57

Question 186

When the intestine becomes twisted and ischemic, the condition is referred to as a ____. A. Malrotation B. Ladd's band C. Volvulus D. Intussusception

Answer 186

C. Volvulus ## Footnote Slide 57

Question 187

Which surgical intervention is typically performed for intestinal malrotation with volvulus? A. Nissen fundoplication B. Kasai procedure C. Ladd procedure D. Roux-en-Y

Answer 187

C. Ladd procedure ## Footnote Slide 57

Question 188

Which of the following are anesthetic concerns in the management of malrotation with midgut volvulus? (Select 3) A. Airway management B. Hypoglycemia treatment C. Fluid and electrolyte replacement D. Treatment of sepsis E. Administration of beta blockers

Answer 188

**A. Airway management** **C. Fluid and electrolyte replacement** * At risk for hypovolemia * Crystalloids & colloids **D. Treatment of sepsis** ## Footnote Slide 58

Question 189

Which of the following are important postoperative considerations for infants undergoing surgery for malrotation with midgut volvulus? (Select3) A. Postoperative pain management B. Continuous enteral feeding C. Possible need for postoperative mechanical ventilation D. Total parenteral nutrition (TPN) in severely compromised infants E. Immediate discharge from the hospital

Answer 189

A. Postoperative pain management C. Possible need for postoperative mechanical ventilation D. Total parenteral nutrition (TPN) in severely compromised infants ## Footnote Slide 58

Question 190

# True or False Rapid sequence induction (RSI) with cricoid pressure is the preferred anesthetic technique for patients with malrotation and midgut volvulus.

Answer 190

True *Dr. M: You might need to treat **them like a full stomach**. Also with these little guys having a distended abdomen will compress on the lungs, decreasing your FRC even more. So these patients can potentially desat a lot faster than just a normal healthy infant.* ## Footnote Sldie 58

Question 191

Which of the following are appropriate vascular access considerations for a neonate undergoing surgery for malrotation with volvulus? (Select 3) A. Central line B. A-line C. Small peripheral IV D. Large bore IV E. IO access

Answer 191

A. Central line *Dt. M: The NICU often will put in PIC lines for us.* B. A-line D. Large bore IV *Dr. M: Remember, a large bore IV for these kids is like a **22 gauge**.* ## Footnote Slide 58

Question 192

Which congenital condition is characterized by abdominal content protrude into thoracic cavity and act as a space-occupying lesion? A. Omphalocele B. Gastroschisis C. Congenital diaphragmatic hernia (CDH) D. Tracheoesophageal fistula

Answer 192

C. Congenital diaphragmatic hernia (CDH) ## Footnote Slide 59

Question 193

Which of the following complications is most directly caused by congenital diaphragmatic hernia (CDH)? A. Increased renal filtration B. Normal lung development C. Prevents normal lung growth and development D. Delayed gastrointestinal maturation

Answer 193

C. Prevents normal lung growth and development * Reduced size of bronchi, less bronchial branching, decreased alveolar SA, abnormal pulmonary vasculature * Thickening of arteriolar smooth muscle extending to the capillary level **increased PAP → R-to-L shunt** *Dr. M: usually one of their lungs is small. Therefore, they can have a lot of respiratory compromise and they might be really difficult to ventilate. Sometimes these kids end up on ECMO* ## Footnote Slide 59

Question 194

What is the most common side for abdominal contents to herniate in congenital diaphragmatic hernia? A. Right side through the foramen of Morgagni B. Left side through the foramen of Bochdalek C. Midline through the diaphragm D. Right side through the foramen of Bochdalek

Answer 194

B. Left side through the foramen of Bochdalek *80% experience herniation of abdominal contents* ## Footnote Slide 59

Question 195

In congenital diaphragmatic hernia (CDH), which lung is most commonly affected? A. Contralateral lung B. Bilateral lungs equally C. Ipsilateral lung D. Upper lobe of the right lung

Answer 195

C. Ipsilateral lung (Left side) ## Footnote Slide 59

Question 196

Which of the following are common presenting signs and symptoms of congenital diaphragmatic hernia (CDH) at birth? (Select all that apply) A. Dyspnea B. Tachypnea C. Cyanosis D. Absence of breath sounds on the affected side

Answer 196

All of the above ## Footnote Slide 60

Question 197

Which of the following are physical exam findings associated with congenital diaphragmatic hernia (CDH)? (Select 3) A. Severe retractions B. Protuberant abdomen C. Scaphoid abdomen D. Barrel chest E. Hyperactive bowel sounds

Answer 197

A. Severe retractions C. Scaphoid abdomen D. Barrel chest ## Footnote Slide 60

Question 198

What is the most common method of diagnosing congenital diaphragmatic hernia (CDH)? A. MRI after birth B. Chest X-ray post-delivery C. Prenatal ultrasound D. CT scan during labor

Answer 198

C. Prenatal ultrasound *Dr. M: So typically we knew about this beforehand, but not always. Not everyone gets prenatal care.* ## Footnote Slide 60

Question 199

What is the primary goal of prenatal surgical intervention for CDH? A. Improve fetal circulation B. Reverse pulmonary hypoplasia C. Prevent bowel herniation D. Increase fetal heart rate

Answer 199

**B. Reverse pulmonary hypoplasia** * Median age of operation **~ 4 days** * May be done **at the bedside in NICU** * May require **One Lung Ventilation** of the good lung *Dr.M: There have been some incidents of prenatal surgical intervention. This would help remove those contents, fix it. That way the lung is less hypoplasic so the lung has more room to grow.* ## Footnote Slide 60

Question 200

To prevent bradycardia during induction and intubation of a neonate with congenital diaphragmatic hernia, _____ is often administered intravenously prior to the procedure. A. Epinephrine B. Glycopyrrolate C. Atropine D. Midazolam

Answer 200

**C. Atropine** *Dr. M: These kids are probably going to come to you already intubated, already with an IMV, but they're still going to be hemodynamically pretty unstable, especially when we start adding general anesthesia to it* ## Footnote Slide 61

Question 201

In the anesthetic management of a neonate with congenital diaphragmatic hernia (CDH), which of the following best guides the choice of volatile agents and adjunct medications? A. Patient temperature B. Urine output C. Hemodynamic stability D. Oxygen saturation alone

Answer 201

C. Hemodynamic stability *Ensure adequate IV access & a-line* ## Footnote Slide 61

Question 202

Which of the following are important ventilatory strategies and considerations for neonates with congenital diaphragmatic hernia (CDH)? (Select 3) A. Permissive hypercarbia with high-frequency oscillatory ventilation B. Inflating the stomach with air to decompress the lungs C. Maintain peak inspiratory pressure (PIP) < 25–30 cmH₂O D. Prevent hypoxia, hypothermia, and acidosis E. Use high tidal volumes to recruit collapsed alveoli

Answer 202

A. Permissive hypercarbia with high-frequency oscillatory ventilation C. Maintain peak inspiratory pressure (PIP) < 25–30 cmH₂O D. Prevent hypoxia, hypothermia, and acidosis * factors that increase PVR ## Footnote Slide 61

Question 203

# True or False In the management of CDH, inflating the stomach with air during ventilation is recommended to improve oxygenation.

Answer 203

FALSE **Avoid inflating the stomach with air** ## Footnote Slide 61

Question 204

Postoperative management includes maintaining PaO₂ above ___ and gradually weaning FiO₂ over 48–72 hours. A. 80 mmHg B. 100 mmHg C. 120 mmHg D. 150 mmHg

Answer 204

D. 150 mmHg ## Footnote Slide 61

Question 205

Which of the following are common postnatal signs of tracheoesophageal fistula and/or esophageal atresia? (Select 3) A. Inability to pass OGT into stomach B. Recurrent pneumonia with feedings C. Stridor at rest D. Coughing or choking after first feed E. Visible stomach bubble on X-ray

Answer 205

A. Inability to pass OGT into stomach B. Recurrent pneumonia with feedings D. Coughing or choking after first feed ## Footnote Slide 61

Question 206

Which prenatal finding is most suggestive of a tracheoesophageal fistula with esophageal atresia? A. Oligohydramnios and absent stomach bubble B. Polyhydramnios and stomach bubble on ultrasound C. Increased nuchal translucency D. Ventriculomegaly and echogenic bowel

Answer 206

B. Polyhydramnios and stomach bubble on ultrasound ## Footnote Slide 61

Question 207

Which type of tracheoesophageal fistula is most common? A. Type A B. Type B C. Type C D. Type D

Answer 207

**C. Type C** * 5 types (A, B, C, D, E) – Type C is most common *Dr. M: The different types depend on where the esophagus connects to the trachea* * High survival rate *Dr. M: They tend to do okay once they are repaired.* ## Footnote Slide 62

Question 208

Which of the following best describes the standard surgical approach for repairing a tracheoesophageal fistula with esophageal atresia (TEF/EA)? A. Laparoscopic repair with esophageal bypass B. Left-sided thoracotomy with primary gastrostomy tube placement C. Right-sided thoracotomy with fistula ligation and esophageal anastomosis D. Midline laparotomy with esophageal dilation

Answer 208

C. Right-sided thoracotomy with fistula ligation and esophageal anastomosis ## Footnote Slide 63

Question 209

Which of the following are important postoperative considerations for infants undergoing surgery for malrotation with midgut volvulus? (Select3) A. Postoperative pain management B. Continuous enteral feeding C. Possible need for postoperative mechanical ventilation D. Total parenteral nutrition (TPN) in severely compromised infants E. Immediate discharge from the hospital

Answer 209

A. Postoperative pain management C. Possible need for postoperative mechanical ventilation D. Total parenteral nutrition (TPN) in severely compromised infants ## Footnote Slide 58

Question 210

# True or False Rapid sequence induction (RSI) with cricoid pressure is the preferred anesthetic technique for patients with malrotation and midgut volvulus.

Answer 210

True *Dr. M: You might need to treat **them like a full stomach**. Also with these little guys having a distended abdomen will compress on the lungs, decreasing your FRC even more. So these patients can potentially desat a lot faster than just a normal healthy infant.* ## Footnote Sldie 58

Question 211

Which of the following are appropriate vascular access considerations for a neonate undergoing surgery for malrotation with volvulus? (Select 3) A. Central line B. A-line C. Small peripheral IV D. Large bore IV E. IO access

Answer 211

A. Central line *Dt. M: The NICU often will put in PIC lines for us.* B. A-line D. Large bore IV *Dr. M: Remember, a large bore IV for these kids is like a **22 gauge**.* ## Footnote Slide 58

Question 212

Which congenital condition is characterized by abdominal content protrude into thoracic cavity and act as a space-occupying lesion? A. Omphalocele B. Gastroschisis C. Congenital diaphragmatic hernia (CDH) D. Tracheoesophageal fistula

Answer 212

C. Congenital diaphragmatic hernia (CDH) ## Footnote Slide 59

Question 213

Which of the following complications is most directly caused by congenital diaphragmatic hernia (CDH)? A. Increased renal filtration B. Normal lung development C. Prevents normal lung growth and development D. Delayed gastrointestinal maturation

Answer 213

C. Prevents normal lung growth and development * Reduced size of bronchi, less bronchial branching, decreased alveolar SA, abnormal pulmonary vasculature * Thickening of arteriolar smooth muscle extending to the capillary level **increased PAP → R-to-L shunt** *Dr. M: usually one of their lungs is small. Therefore, they can have a lot of respiratory compromise and they might be really difficult to ventilate. Sometimes these kids end up on ECMO* ## Footnote Slide 59

Question 214

What is the most common side for abdominal contents to herniate in congenital diaphragmatic hernia? A. Right side through the foramen of Morgagni B. Left side through the foramen of Bochdalek C. Midline through the diaphragm D. Right side through the foramen of Bochdalek

Answer 214

B. Left side through the foramen of Bochdalek *80% experience herniation of abdominal contents* ## Footnote Slide 59

Question 215

Which of the following preoperative evaluations is essential due to the frequent association of TEF with other congenital anomalies? A. Liver ultrasound B. Pediatric cardiologist consult with echocardiogram C. Renal biopsy D. Bone age assessment

Answer 215

B. Pediatric cardiologist consult with echocardiogram ## Footnote Slide 63

Question 216

Which of the following is NOT an appropriate intervention to minimize pulmonary complications in an infant with tracheoesophageal fistula (TEF) and esophageal atresia (EA)? A. Discontinue oral feedings B. Place the infant in a semi-recumbent position C. Insert a balloon-tipped catheter to suction nasopharyngeal secretions D. Place a gastrostomy tube E. Encourage breastfeeding to stimulate esophageal motility

Answer 216

E. Encourage breastfeeding to stimulate esophageal motility ## Footnote Slide 63

Question 217

TEF and EA Anesthetic induction technique: 1. Head ___ position, frequent ___ A. up / suctioning B. tilt / intubation C. elevation / oxygenation D. incline / auscultation 2. ___ intubation, ___ induction & maintenance of ___ A. Rapid / intravenous / apnea B. Awake / inhalational / SV C. Delayed / ketamine / paralysis D. Elective / sevoflurane / paralysis 3. May have difficulty ____ lungs A. perfusing B. oxygenating C. ventilating D. inflating 4. May perform ____ after induction A. Laryngoscopy B. CT scan C. Bronchoscopy D. ECHO

Answer 217

1. A. Head **up** position, frequent **suctioning** 2. B. **Awake** intubation, **inhalational** induction & maintenance of **Stroke Volume** 3. C. May have difficulty **ventilating** lungs 4. C. May perform **bronchoscopy** after induction ## Footnote Slide 64

Question 218

Which of the following are appropriate monitoring strategies for a neonate undergoing surgery for tracheoesophageal fistula (TEF) and esophageal atresia (EA)? (Select 3) A. Arterial line placement B. Preductal and postductal pulse oximetry C. Foley catheter for urine output D. Intracranial pressure monitoring

Answer 218

A. Arterial line placement B. Preductal and postductal pulse oximetry ## Footnote Slide 64

Question 219

Which of the following are appropriate intraoperative management strategies for a neonate undergoing TEF/EA repair? A. Monitor ventilation B. Ensure adequate oxygenation C. Minimize PIP (Peak Inspiratory Pressure) D. Monitor for signs of airway obstruction

Answer 219

All the above ## Footnote Slide 64

Question 220

Patient may be extubated in the OR but If postoperative ventilation is required, how far from the suture line should the ETT be placed? A. 0.5 cm B. 1 cm C. 2 cm D. Directly at the repair site

Answer 220

B. 1 cm *At risk for esophageal stricture or diverticulum at the site* ## Footnote Slide 65

Question 221

Which of the following are true regarding imperforate anus? A. May be associated with VACTERL anomalies B. Diagnosed when neonate fails to pass meconium in the first few days of life C. Surgery in male neonates is typically delayed until 6 months of age D. Female neonates may have rectovaginal fistula, allowing urgent surgery E. It only occurs in patients without other anomalies

Answer 221

A. May be associated with VACTERL anomalies B. Diagnosed when neonate fails to pass meconium in the first few days of life ## Footnote Slide 66

Question 222

Match each statement to the appropriate patient group: 1. Rectovaginal fistula is commonly present 2. Surgery is urgent to allow meconium passage via colostomy A. Male neonates B. Female neonates

Answer 222

1. Rectovaginal fistula is commonly present - Female neonates (B) *the procedure can be delayed a few weeks* 2. Surgery is urgent to allow meconium passage via colostomy - Male neonates (A) ## Footnote Slide 66

Question 223

Which of the following are important anesthetic considerations for neonates with imperforate anus? (Select 2) A. Maintenance of fluid and electrolyte balance B. Management of hypoglycemia with insulin C. Evaluation for coexisting anomalies D. Strict fasting for 48 hours preoperatively

Answer 223

A. Maintenance of fluid and electrolyte balance C. Evaluation for coexisting anomalies ## Footnote Slide 66

Question 224

What is the most common cause of neonatal hydrocephalus? A. Excessive CSF production B. Obstructed CSF flow within the brain C. Inadequate brain growth D. Decreased CSF absorption

Answer 224

B. Obstructed CSF flow within the brain *causes increased ICP* ## Footnote Slide 67

Question 225

Which of the following is NOT a typical sign or symptom of increased intracranial pressure (ICP) in a neonate? A. Bulging anterior fontanelle B. Irritability C. Polyuria D. Somnolence E. Vomiting F. Loss of consciousness (LOC) G. Cardiovascular collapse

Answer 225

C. Polyuria ## Footnote Slide 67

Question 226

What is the primary surgical treatment for neonatal hydrocephalus? A. Burr hole drainage B. Lumbar puncture C. Ventriculoperitoneal (VP) shunt D. Endoscopic sinus surgery

Answer 226

C. Ventriculoperitoneal (VP) shunt ## Footnote Slide 67

Question 227

Select 2 preoperative assessments for a neonate with hydrocephalus: A. Assess for signs and symptoms of increased intracranial pressure (ICP) B. Assess for associated congenital conditions C. Administer mannitol as routine premedication D. Delay surgery until fontanelle closure E. Monitor for electrolyte imbalance

Answer 227

A. Assess for signs and symptoms of increased intracranial pressure (ICP) B. Assess for associated congenital conditions ## Footnote Slide 67

Question 228

What is a significant risk of delaying surgical treatment in a neonate with hydrocephalus? A. Respiratory alkalosis B. Seizure activity C. Brain herniation D. Hypovolemia

Answer 228

C. Brain herniation ## Footnote Slide 67

Question 229

What is the primary goal of anesthesia management in a neonate with hydrocephalus? A. Minimize blood pressure B. Maximize cerebral perfusion pressure C. Control ICP and relieve obstruction D. Induce hypoventilation

Answer 229

C. Control ICP and relieve obstruction ## Footnote Slide 68

Question 230

What is the recommended induction technique for a neonate undergoing VP shunt placement, and goal when to extubate? A. Inhalational induction with sevoflurane; extubate before incision B. RSI (Rapid Sequence Induction); extubate at the end of the procedure C. Spinal anesthesia; extubate in the NICU D. Deep sedation with ketamine; extubate after 24 hours of observation

Answer 230

B. RSI (Rapid Sequence Induction); extubate at the end of the procedure ## Footnote Slide 68

Question 231

Inhalational agents cause cerebral vascular dilation at concentrations greater than ____, which can lead to an increase in intracranial pressure (ICP). A. 0.5 MAC B. 1 MAC C. 1.5 MAC D. 2 MAC

Answer 231

B. 1 MAC ## Footnote Slide 68

Question 232

Myelomeningocele is best described as which of the following? A. Herniation of abdominal organs through a diaphragmatic defect B. Herniation of spinal cord and meninges through a spinal column defect C. Absence of cerebral hemispheres D. Fusion of the spinal vertebrae without neurologic involvement

Answer 232

B. Herniation of spinal cord and meninges through a spinal column defect * *due to failure of the neural tube to close* * *Form of spina bifida* ## Footnote Slide 69

Question 233

Myelomeningocele is the most common CNS defect that occurs during the ____ of gestation A. 2nd week B. 1st month C. 3rd trimester D. 5th month

Answer 233

B. 1st month ## Footnote Slide 69

Question 234

Which region is most commonly affected in myelomeningocele? A. Thoracic B. Sacral C. Cervical D. Lumbosacral

Answer 234

D. Lumbosacral ## Footnote Slide 69

Question 235

Which of the following are true regarding the surgical repair of myelomeningocele? (Select 2) A. It may be repaired in utero. B. It must be delayed until after 6 months of life. C. It is often repaired within the first 24 hours of life. D. Repair is only performed if Arnold-Chiari malformation is present.

Answer 235

A. It may be repaired in utero. C. It is often repaired within the first 24 hours of life. ## Footnote Slide 69

Question 236

Which neurological anomaly is most commonly associated with myelomeningocele and may require a ventriculoperitoneal shunt? A. Holoprosencephaly B. Arnold-Chiari malformation C. Dandy-Walker malformation D. Hydrocephalus

Answer 236

B. Arnold-Chiari malformation ## Footnote Slide 69

Question 237

Which of the following are appropriate preoperative evaluations or considerations for a patient with myelomeningocele? (Select 4) A. Thorough review of systems B. Assess for additional congenital anomalies C. Supine positioning for airway management D. CBC and type & screen E. Avoid IV access to reduce infection risk F. Assess for neurological defects below the level of the lesion

Answer 237

A. Thorough review of systems B. Assess for additional congenital anomalies D. CBC and type & screen F. Assess for neurological defects below the level of the lesion ## Footnote Slide 70

Question 238

Which of the following are appropriate anesthetic considerations during induction for a patient with myelomeningocele? (Select 3) A. Invasive monitoring is patient dependent B. Ensure adequate IV access C. Only IV induction should be used D. Inhalational induction is acceptable E. Supine positioning is mandatory

Answer 238

A. Invasive monitoring is patient dependent B. Ensure adequate IV access D. Inhalational induction is acceptable ## Footnote Slide 70

Question 239

Which of the following is the primary concern during airway management & surgical procedure of a neonate with myelomeningocele? A. Risk of aspiration B. Use of RSI C. Fluid overload D. Positioning considerations

Answer 239

D. Positioning considerations ## Footnote Slide 70

Question 240

What is the typical anesthetic goal regarding extubation for a neonate undergoing myelomeningocele repair? A. Maintain mechanical ventilation for 48 hours B. Perform tracheostomy post-procedure C. Goal to extubate at the end of the procedure D. Delay extubation until post-op MRI is completed

Answer 240

C. Goal to extubate at the end of the procedure ## Footnote Slide 70

Question 241

Patients with myelomeningocele have increased sensitivity to ________. A. Antibiotics B. Latex C. Anesthetic gases D. Iodine

Answer 241

B. Latex ## Footnote Slide 70

Question 242

Which of the following is NOT an appropriate strategy to prevent hypothermia in a neonate with myelomeningocele? A. Warm OR B. Radial heat lamps during line placement and induction C. Forced air warmer underneath the neonate D. Use of humidified anesthetic gases E. Ambient room temperature of 18°C F. IVF warmer

Answer 242

E. Ambient room temperature of 18°C ## Footnote Slide 71