Pediatric Surgery Lecture 2 (Exam 1) Flashcards by Kaitlyn McDow

Which type of Tracheoesophageal fistula is this?
A
B
C
D
E

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Which type of Tracheoesophageal fistula is this?
A
B
C
D
E

slide 36

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Which type of Tracheoesophageal fistula is this?
A
B
C
D
E

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Which type of Tracheoesophageal fistula is this?
A
B
C
D
E

slide 36

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Which type of Tracheoesophageal fistula is this?
A
B
C
D
E

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Which fistula is the most common
A
B
C
D
E

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How common is tracheoesophageal fistula?
A. 1/5000
B. 1/10000
C. 1/1000
D. 1/3000

D. 1/3000

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80-85% of TEF infants have esophageal atresia with a ____ esophageal pouch and a _____ tracheoesophageal fistula
A. proximal; lateral
B. distal; proximal
C. proximal; distal
D. lateral; distal

B. distal; proximal

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Where is the tracheoesophageal fistula USUALLY located?
A. 2-4 tracheal rings below the carina
B. 1-2 tracheal rings below the carina
C. 2-4 tracheal rings above the carina
D. 1-2 trahceal rings above the carina

D. 1-2 trahceal rings above the carina

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true or false
tracheoesophageal fistula occurs more often in hispanic males than females

False
equal in males/females and all races

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When does TEF occur in gestation
A. 4-5th week
B. 8-10th week
C. 7-13th week
D. 24-26th week

A. 4-5th week

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TEF occurs due to error in…
A. separation of esophagus to the liver
B. connection of the esophagus to stomach
C. separation of trachea from floor of foregut
D. connection of the trachea to diaphramatic floor

C. separation of trachea from floor of foregut

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TEF is often associated with
A. second hand smoke exposure
B. VACTERL
C. trisomy 81
D. autism

B. VACTERL

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Review of VACTERL

Vertebral anomalies
Imperforate Anus
Congenital heart disease
tracheoesophageal fistula
renal abnomalities
limb abnormalities

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now back to the grind

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What are the signs of a TEF prenatally? (select 3)
A. polyhydramnios
B. excessive salivation
C. small or absent gastric bubble
D. bling ending upper pouch on fetal neck
E. large bastric bubble

A. polyhydramnios
C. small or absent gastric bubble
D. bling ending upper pouch on fetal neck

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Postnatal symptoms of TEF include all the following EXCEPT
A. excessive salivation
B. choking
C. coughing
D. regurgitation at first feeding leading to cyanosis or respiratory distress
E. distended abdomen from air
F. inability to pass NG tube
G. buldge on the neck of the infant on controlateral side

G. buldge on the neck of the infant on controlateral side

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What are the 3 Cs to look for in TEF (select 3)
A. cognitive impairment
B.choking
C. conginital heart block
D. coughing
E. cyanosis

B.choking
D. coughing
E. cyanosis

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How is the diagnosis made for a TEF (select 2)
A. inability to pass NG tube more than 7cm
B. bilious projectile vomiting
C. coughing with cyanosis
D. dilated proximal esophagus with air in distal stomach

A. inability to pass NG tube more than 7cm
D. dilated proximal esophagus with air in distal stomach

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What can you see in the x-ray? (select 3)
A. TEF with esophageal atresia
B. feeding tube coilied in esophageal pouch
C. large volume of gas in the abdomen
D. pneumonia
E. negative for TEF
F. ET tube pass the carina

A. TEF with esophageal atresia
B. feeding tube coilied in esophageal pouch
C. large volume of gas in the abdomen

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Presurgical considerations for patients with a TEF (select 2)
A. proximal pouch tube secured and placed to continous suction
B. immediate surgery
C. focus on stabilization prior to surgery
D. preoxygenation with mask ventilation

A. proximal pouch tube secured and placed to continous suction
C. focus on stabilization prior to surgery

mask ventilation and tracheal intubation avoided prior to surgery- can exacerbate gastric distension

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Surgery for TEF can be performed via thoracotomy with a thorascopic approach. What position should the infant be placed in
A. supine
B. right lateral decubitus
C. prone
D. left lateral decubitus

D. left lateral decubitus

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True or false
Single lung ventilation is required.
Low flow/ Low pressure will not be adequate

false.
Low flow/low pressure CO2 can be used to collapse the right lung for exposure

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What can aid in identifying proximal pouch
A. peg tube placed prior to surgery
B. nasoesophageal tube
C. in line suction catheter
D. tracheal tube

B. nasoesophageal tube

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For surgical repair of TEF the _____ is ligated first to prevent further air entrapment in the stomch and then primary end to end anatomosis of __________ follows ligation
A. esophagus; trachea
B. fistula; somach
C. fistula ; esophagus
D. esophagus; fistula

C. fistula ; esophagus

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Anesthetic considerations for TEF include (select 4) A. ETT proximal to fistula B. awake intubation if possible C. IV induction with muscle relaxants D. gentle mask ventilation with low peak pressure E. tip of ETT above carina but distal to fistula F. double lumen tube or bronchial blocker

B. awake intubation if possible C. IV induction with muscle relaxants D. gentle mask ventilation with low peak pressure E. tip of ETT above carina but distal to fistula ## Footnote slide 46

The anesthesia provider should keep in mind for a TEF procedure that _______ may be frequent A. ABGs B. valsalva C. ETT suctioning D. single lung ventilation

C. ETT suctioning ## Footnote slide 48

The anesthesia provider for TEF should consider what factors Post op? (select 4) A. post op intubation B. increased I:E ratio C. higher inspiratory time D. head in neutral position E. keep patient in lateral decubatis after surgery F. epidural or intrapleural catheter can be left for post op pain

A. post op intubation - early extubation can help alleviate pressure but most require post op intubation for DAYS to prevent pneumonia, atelectasis, or emergent reintubation and performation of suture lines B. increased I:E ratio- to help reexpand alveoli D. head in neutral position- prevent pulling on surgical esophageal anastomosis F. epidural or intrapleural catheter can be left for post op pain

Pyloric stenosis occurs in every A. 1/1000 births B. 1/600 births C. 1/1500 births D. 1/500 births

D. 1/500 births ## Footnote slide 49

Pyloric stenosis is more frequent in A. second born females B. first born males C. first born females D. second born males

B. first born males ## Footnote slide 49

When is pyloric stenosis usually diagnosed? A. 2-8 weeks of age B. during gesgation C. 1-4 days after birth D. 2-3 months of age

A. 2-8 weeks of age ## Footnote slide 49

What is a unique symptom of pyloric stenosis A. bilious vomiting B. diarrhea C. stomach pain D. non bilious projectile vomiting

D. non bilious projectile vomiting ## Footnote slide 49

Pyloric stenosis is caused by _________ and __________ of the muscular layer of the ______. A. hypertrophy and hyperplasia, duodenum B. hyperthrophy and hypoplasia; stomach C. hypertrophy and hyperplasia ; pylorus D. hypotrophy and hyperplasia; pylorus

C. hypertrophy and hyperplasia ; pylorus ## Footnote slide 50

# True or false Pyloric stenosis caused a gastric outlet obstruction

true ## Footnote slide 50

Pyloric stenosis often causes A. hypochloremic hypokalemic metabolic alkalosis B. hypercholemic hyperkalemic metabolic acidosis C. hypochloremic hyperkalemic metabolic alkalosis D. hypochloremci hypokalemic metabolic acidosis

A. hypochloremic hypokalemic metabolic alkalosis in severe cases may progress to metabolic acidosis ## Footnote slide 50/51

With pyloric stenosis the kidneys excrete ___ to maintain normal blood pH A. lactate B. sodium C. bicarb D. potassium

C. bicarb ## Footnote slide 51

With pyloric stenosis the kidney will excrete __ and ___ to maintain euvolemia and retain sodium (select 2) A. potassium B. hydrogen C. creatinine D. glucose

A. potassium B. hydrogen ## Footnote slide 51

# True or false pyloric stenosis is a medical emergency and should have surgery immediately

false nor a medical emergency so infants are admitted and electrolyte imbalance is medically corrected ## Footnote slide 52

Correction of electrolyte imbalance in pyloric stenosis can take A. 48-72 hours B. 24-48 hours C. 72-96 hours D. 12-24 hours

B. 24-48 hours ## Footnote slide 52

Once admitted infants with pyloric stenosis are started on ___ for maintenance and electrolyte balance A. 3% NS B. 0.45% NS C. LR D. dextrose IVF

D. dextrose IVF ## Footnote slide 52

Infants with pyloric stenosis are ready for surgery when all of the following are met EXCEPT A. good skin turgor B. UOP of 1-2ml/kg/hour C. sodium >130mEq/L D. potassium >3.0mEQ/L E. Chloride > 85mEq/L F. glucose > 200

F. glucose > 200 ## Footnote slide 52

How is pyloric stenosis diagnosed most commonly A. xray B. barium swallow C. ultrasound D. CT

C. ultrasound Rarely with barium swallow and xray ## Footnote slide 53

Which population is less likely to see severe fluid and electrolyte balance from pyloric stenosis? A. infants B. toddlers C. adults D. teenagers

A. infants because they are diagnosed quickly ## Footnote slide 53

The doughnut or bagel sign shows ____________center representing the mucosa and mucus surrounded by circumferential thickened ________ pylroic muscle A. echopenic; echopenic B. echopenic; echogenic C. echogenic; echogenic D. echogenic; echopenic

D. echogenic; echopenic ## Footnote slide 54

A pyloromyotomy for pyloric stenosis repair performed open is done via A. right lower quadrant incision B. periumbilical incision C. lateral abdominal incision D. diaphramatic incision

B. periumbilical incision ## Footnote slide 56

Laparoscopic repair of pyloric stenosis is preferred due to (select 3) A. cosmetically B. less pain C. quicker return to oral feeding D. increased constipation E. reduced hospital stay

A. cosmetically C. quicker return to oral feeding E. reduced hosptial stay ## Footnote slide 56

Anesthesia considerations for pyloric stenosis include all the following except A. RSI B. towels C. nasal intubation D. large red rubber catheter E. preoxygenate F. suction

C. nasal intubation ## Footnote slide 61

# True or False To suction pyloric stenosis patients you should lay patient supine and suction with one pass

false suction turned to the right, center, and left ## Footnote slide61

Which medications are appropriate for pyloric stenosis anesthesia management (select 3) A. lidocaine 3-4mg/kg B. Atropine 0.02mg/kg C. fentanyl 1-2mcg/kg D. propofol 2-4mg/kg E. succinycholine 5mg/kg

A. lidocaine 3-4mg/kg B. Atropine 0.02mg/kg D. propofol 2-4mg/kg ## Footnote slide 63

Which medications are appropriate for pyloric stenosis anesthesia management (select 3) A. Atropine 0.1mg/kg B.Lidocaine 1-2mg/kg C. succinylcholine 2mg/kg D. morphine 0.5mg/kg E. tylenol 30-40mg/kg

B.Lidocaine 1-2mg/kg C. succinylcholine 2mg/kg E. tylenol 30-40mg/kg | NO narcs ## Footnote slide 63

How long does a pyloromyotomy last typically A. <30min B. >45min C. <15min D. >1 hour

A. <30min ## Footnote slide 64

What medications should you avoid in Pyloric stenosis surgery A. alpha 2 agonist B. antimuscarinic C. local anesthetics D. opioids

D. opioids minimal post op pain and local is given in field at surgical sites ## Footnote slide 64

What type of IVF should be maintained until adequate oral intake for pyloric stenosis A. 3% sodium chloride B. dextrose C. LR D. NS

B. dextrose ## Footnote slide 64

Post op considerations for pyloric stenosis are (select 3) A. deep extubation B. apnea monitor for first 24 hours C. awake extubation D. post op respiratory depression E. monitor for hyperglycemia F. morphine strictly prohibited in PACU

B. apnea monitor for first 24 hours C. awake extubation D. post op respiratory depression monitor for hypoglycemia morphine can be used in PACU after extubation ## Footnote slide 65

What dose of morphine can be used in PACU after pyloric stenosis correction A. 0.04mg.kg B. 0.05mg/kg C. 0.03-0.05mg.kg D. 0.02-0.03mg/kg

D. 0.02-0.03mg/kg ## Footnote slide 65

Gastroschisis occurs in every A. 1/5000 births B. 1/500 births C. 1/2000 births D.1/5000 births

C. 1/2000 births ## Footnote slide 67

Gastroschisis is the result of occlusion of the ____________artery during gestation A. omphalomesenteric B. umbilical C. ovarian D. mesenteric

A. omphalomesenteric ## Footnote slide 67

During gastroschisis the herniated viscera and intestines are _________, usually on the ____ A. periumbilical; left B. periumbilical; right C. intraumbilical; left D. intraumbilical ; right

B. periumbilical; right ## Footnote slide 67

True or false Gastroschisis has functionally abnormal dilated and foreshortened bowel because they are exposed to amniotic fluid in utero and air after delivery which results in inflammation and edema

true ## Footnote slide 67

_________ is not associated with other congential anomalies A. vertebral anomalies B. trisomy 21 C. omphalocele D. gastroschisis

D. gastroschisis ## Footnote slide 67

Omphalocele occurs in every ______ births A. 1/1000 B. 1/500 C. 1/5000 D. 1/2000

C. 1/5000 ## Footnote slide 69

Failure of the gut to mitigate from the yolk sac into the abdomen during gestion is known as A. omphalocele B. gastroschisis C. premature gut D. neural tube defect

A. omphalocele ## Footnote slide 69

Omphalocele is often associated with all the following except A. genetic B. cardiac C. urologic D. hepatic E. metabolic abnormalities

D. hepatic ## Footnote slide 69

Omphalocele emerges from the ________ and covered in a membranous sac A. periumbilicus B. hepatic C. umbilicus D. placenta

C. umbilicus ## Footnote slide 69

In omphalocele bowel is morphologically and usually functionally _____ A. small B. normal C. abnormally D. large

B. normal ## Footnote slide 69

# Chart covering what we just went over

## Footnote slide 71

# another visual to help you remeber

## Footnote slide 72/73

The management of omphalocele and gastroschisis is aimed at maintaining _______ and _______ select 2 A. prevention of diarrhea B. Perfusion to the viscera C. reducing fluid loss D. electrolyte balance

B. Perfusion to the viscera C. reducing fluid loss ## Footnote slide 75

What is recommended for covering mucosal surfaces in the management of these conditions? a) Dry gauze dressings b) Sterile saline-soaked dressings c) Petroleum jelly-based dressings d) Antiseptic solutions

b) Sterile saline-soaked dressings ## Footnote slide 75

Why is a plastic wrap placed over the herniated viscera in the management of omphaloceles and gastroschisis? a) To provide structural support for the organs. b) To promote further herniation of abdominal contents. c) To decrease evaporative loss and prevent heat loss and hypothermia. d) To facilitate rapid surgical closure.

c) To decrease evaporative loss and prevent heat loss and hypothermia. ## Footnote slide 75

Which of the following describes a common surgical approach for reducing herniated abdominal contents in these conditions? a)Staged reduction using a Silastic pouch. b) Immediate, complete surgical reduction without any preliminary steps. c) Manual compression of the abdomen until contents are reduced. d) Leaving the herniated viscera exposed to the air.

a)Staged reduction using a Silastic pouch. ## Footnote slide 75

When a Silastic pouch is used for staged reduction, how is the pouch size typically reduced? a) Rapidly to achieve immediate reduction. b) By applying external pressure to the pouch. c) Only once the patient has gained a significant amount of weight. d) Slowly, allowing gradual accommodation of abdominal contents, without compromising ventilation or organ perfusion.

d) Slowly, allowing gradual accommodation of abdominal contents, without compromising ventilation or organ perfusion. ## Footnote slide 75

What ongoing management strategy is crucial for patients with omphaloceles and gastroschisis? a) Limiting fluid intake to prevent edema. b) Continued volume resuscitation. c) Allowing for uncontrolled hypothermia. d) Avoiding all diagnostic measurements.

b) Continued volume resuscitation. ## Footnote slide 77

An intragastric tube can be used to measure pressure. A pressure exceeding 20 mmHg after primary closure can cause: a) Adequate abdominal expansion. b) Normal gastrointestinal function. c) Abdominal ischemia, potentially leading to a surgical emergency. d) Successful healing of the surgical site.

c) Abdominal ischemia, potentially leading to a surgical emergency. ## Footnote slide 77

When the bowel becomes edematous and there is renal congestion, what clinical signs might be observed due to impeded venous return? a) Increased urine output and warm extremities. b) Improved diaphragm function and respiratory effort. c) Elevated blood pressure and strong peripheral pulses. d) Decreased urine output, lower extremity congestion, and cyanosis.

d) Decreased urine output, lower extremity congestion, and cyanosis. ## Footnote slide 77

Which of the following can be an indicator of complications related to abdominal pressure in patients with omphaloceles or gastroschisis? a) Consistent blood pressure readings in all four extremities. b) Absence of any pulse oximetry readings. c) Blood pressure and pulse ox discrepancies from upper and lower extremities. d) Increased diaphragm function.

c) Blood pressure and pulse ox discrepancies from upper and lower extremities. ## Footnote slide 77

Decreased diaphragm function in these patients can lead to what respiratory complication? a) Bilateral lower lobe atelectasis and respiratory failure. b) Improved lung expansion. c) Increased oxygen saturation. d) Reduced need for ventilatory support.

a) Bilateral lower lobe atelectasis and respiratory failure. ## Footnote slide 77

Which of the following measures is crucial for maintaining normothermia during anesthetic management of omphaloceles and gastroschisis? a) Cooling the operating room significantly. b) Using an underbody bear hugger, lights, and a hat. c) Administering cold intravenous fluids. d) Decreasing the room's humidity.

b) Using an underbody bear hugger, lights, and a hat. ## Footnote slide 78

Prior to induction of anesthesia, what immediate action should be taken regarding an in situ gastric tube? a)Aspirate it. b) Remove it completely. c) Clamp it off. d) Advance it further into the stomach.

a)Aspirate it. ## Footnote slide 78

What percentage of oxygen is recommended for preoxygenation in these patients? a) 50% oxygen b) 70% oxygen c) 80% oxygen d) 100% oxygen

d) 100% oxygen ## Footnote slide 78

Which technique is specifically mentioned for rapid sequence induction (RSI) in these cases? a) Without cricoid pressure. b) With cricoid pressure. c) Slow induction. d) Inhalational induction only.

b) With cricoid pressure. ## Footnote slide 78

What gases are typically used to maintain anesthesia in these patients? a) Oxygen and nitrous oxide. b) Oxygen and air. c) Only oxygen. d) Nitrous oxide only.

b) Oxygen and air. ## Footnote slide 78

Which anesthetic gas is specifically not recommended for use in these cases? a) Oxygen b) Air c) Nitrous oxide d) Sevoflurane

c) Nitrous oxide ## Footnote slide 78

What pharmacological agents are typically used for surgical repair in these patients? a) Only local anesthetics. b) Narcotics and muscle relaxation. c) Sedatives without muscle relaxation. d) Antipyretics only.

b) Narcotics and muscle relaxation. ## Footnote slide 78

What fluids should be maintained for gastroschisis and omephalocele patients during anesthsia A. dextrose B. NS C. 5% saline D. LR

A. dextrose should be maintained throughout surgery and postop ## Footnote slide 79

Peak airway pressures should be monitored and maintained _______ during primary closure of omphalocele and gastroschisis A. <30mmHg B. <15mmHg C. <50mmHg D. <25mmHg

D. <25mmHg ## Footnote slide 79

Due to decreased venous return the anesthetic provider should watch for ___________ for gastroschisis and omphalocele A. cyanosis B.hypotension C. bradycardia D. hypertension

B.hypotension ## Footnote slide 79

Anesthetic considerations for omphalocele and gastroschisis include (select 2) A. rehydration with crystalloid and colloid B. post op intubation and controlled ventilation C. deep extubation D. NPO continued after surgery

A. rehydration with crystalloid and colloid B. post op intubation and controlled ventilation ## Footnote slide 79

Pediatric Surgery Lecture 2 (Exam 1) Flashcards

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