Pediatrics

Question 1

Compared to epiglottitis, which findings are MORE likely to occur with laryngotracheobronchitis? (select 3)
a. age affected <2 years
b. high fever
c. tripod position
d. steeple sign
e. onset between 24-72 hours
f. more likely to require anesthesia for urgent airway control

Answer 1

a. age affected <2 years
d. steeple sign
e. onset between 24-72 hours

Question 2

Epiglottitis is _______ in nature.

Answer 2

bacterial

Question 3

Epiglottitis affects ages ________

Answer 3

2-6 yrs

Question 4

Epiglottitis is a _______ onset

Answer 4

rapid

Question 5

Clinical presentation of epiglottitis includes

Answer 5

the 4 D’s: drooling, dyspnea, dysphonia, dysphagia, & high fever
tripod position

Question 6

Treatment of epiglottitis includes

Answer 6

O2
urgent airway management antibiotics

Question 7

With epiglottitis, _______ must be present for induction

Answer 7

ENT

Question 8

Laryngeotracheobronchitis is otherwise known as

Answer 8

croup

Question 9

Croup is _________ in nature

Answer 9

viral

Question 10

Croup affects ages __________

Answer 10

<2 yrs

Question 11

The onset of croup is

Answer 11

gradual

Question 12

Clinical presentation of croup includes

Answer 12

mild fever
inspiratory stridor
barking cough
retractions- suprasternal, substernal, or intercostal

Question 13

Croup should be treated with

Answer 13

O2
racemic epi
steroids
humidification
and fluids

Question 14

________ is rarely required with croup

Answer 14

Intubation

Question 15

The region affected with epiglottitis includes

Answer 15

supraglottic structures: epiglottis, vallecula, arytenoids, aryepiglottic folds

Question 16

The region affected with croup includes

Answer 16

laryngeal structures below the vocal cords

Question 17

Describe the neck XR of epiglottis

Answer 17

Thumb sign (lateral XR)

Question 18

Describe the neck XR of croup

Answer 18

Steeple sign (frontal XR)

Question 19

When diluted into 2.5 mL of 0.9% sodium chloride, what is the most appropriate dose of racemic epinephrine to administer to a 30-kg child with postintubation croup?
a. 0.5 mL of 0.25% solution
b. 0.5 mL of 2.25% solution
c. 5 mL of a 0.25% solution
d. 5 mL of a 2.25% solution

Answer 19

b. 0.5 mL of a 2.25% solution

Question 20

Post-intubation laryngeal edema can occur with

Answer 20

cuffed or uncuffed endotracheal tubes

Question 21

_________ should be maintained to prevent post-intubation laryngeal edema

Answer 21

air leak <25 cmH2O

Question 22

If you are using a cuffed ETT, then you should use a ______ to measure cuff pressure intermittently.

Answer 22

manometer

Question 23

Risk factors for postintubation laryngeal edema

Answer 23

using an ETT that is too large (most common)
age <4 (more common in small children)
cuff pressure too high
prolonged intubation
trauma due to multiple intubating attempts
coughing (cuff rubs against trachea mucosa)
head or neck surgery
head repositioning during surgery
trisomy 21
history of infectious or post-intubation croup

Question 24

Treatment for postintubation laryngeal edema includes

Answer 24

cool and humidified O2
dexamethasone
racemic epinephrine
heliox

Question 25

The patient with post-intubation laryngeal edema presents with

Answer 25

hoarseness a barky cough stridor

Question 26

__________ is the preferred treatment for post-intubation laryngeal edema to reduce welling and improve airflow

Answer 26

Racemic epinephrine

Question 27

What is the volume of 2.25% racemic epinephrine for children 0-20 kg?

Answer 27

0.25 mLs (diluted with 2.5 mLs)

Question 28

What is the volume of 2.25% racemic epinephirne for children 20-40 kg?

Answer 28

0.5 mLs (diluted with 2.5 mls)

Question 29

What is the volume of 2.25% racemic epinephrine for children >40 kg?

Answer 29

0.75 mLs (diluted with 2.5 mLs)

Question 30

The patient should be observed for a minimum of ___________ after the racemic epinephrine treatment is complete

Answer 30

four hours

Question 31

A five year old child presents with surgery with clear rhinorrhea, but she is afebrile and appears active. Rank the following airway techniques from MOST to LEAST favorable to minimize the risk of airway reactivity. LMA Endotracheal tube facemask

Answer 31

Facemask LMA Endotracheal tube

Question 32

A child with an active or recent history of upper respiratory tract infection is

Answer 32

at an increased risk of pulmonary complications

Question 33

Most clinicians _____________ after the onset of URI symtpoms

Answer 33

postpone the procedure for 2-4 weeks

Question 34

Reasons to cancel surgery for upper respiratory infection include

Answer 34

purulent nasal discharge temperature >38.0 C lethargy persistent cough poor appetite wheezing and rales that don't clear with a cough

Question 35

Methods to reduce the risk of pulmonary complications in a child with a recent upper respiratory infection include:

Answer 35

avoid mechanical irritation of the airway (facemask>LMA>>>>ETT) If an ETT is used, use a smaller size than normal Decadron 0.25-0.5 mg/kg will reduce the risk of post-intubation croup propofol attenuates airway reactivity and may reduce the risk of bronchospasm

Question 36

__________ is the best volatile agent with an URI

Answer 36

sevoflurane

Question 37

Pretreatment with an inhaled bronchodilator or glycopyrrolate for URI

Answer 37

does not provide a clear benefit

Question 38

A child with an active history or recent history of URI is more likely to

Answer 38

bronchospasm mucous plug laryngospasm have atelectasis desaturation events postoperative hypoxemia

Question 39

For a patient with URI___________ should be ensured before instrumenting the airway

Answer 39

a deep plane of anesthesia

Question 40

A 3-year-old child aspirated a peanut and presents for rigid bronchoscopy. What is the MOST important anesthetic consideration for this patient? a. inhalation induction b. observing NPO guidelines c. positive pressure ventilation d. rocuronium

Answer 40

a. inhalation induction

Question 41

Over 60% of children with foreign body aspiration present with

Answer 41

the classic triad of cough, wheezing, and decreased breath sounds on the affected side (usually the right)

Question 42

A supraglottic obstruction presents with

Answer 42

stridor

Question 43

A subglottic obstruction presents with

Answer 43

wheezing

Question 44

__________ is the "gold standard" procedure to retrieve the foreign body from the airway

Answer 44

Rigid bronchoscopy

Question 45

What is the best anesthetic for a foreign body aspiration?

Answer 45

sevoflurane induction with spontaneous ventilation TIVA is probably the best maintenance

Question 46

If the patient with a foreign body aspirate coughs or bucks, the

Answer 46

foreign body can move distally

Question 47

__________ can push the foreign body deeper into the bronchial tree

Answer 47

positive pressure ventilation

Question 48

A foreign body most commonly lodges in the

Answer 48

right bronchus

Question 49

Complications of rigid bronchoscopy include

Answer 49

laryngospasm bradycardia during scope insertion pneumothorax post-intubation croup patients may not improve immediately after the foreign body is removed due to residual lung inflammation

Question 50

Alternatives to rigid bronchoscopy for foreign body aspiration include

Answer 50

flexible bronchoscopy or thoracotomy

Question 51

________ is a concern when using a rigid bronchosope.

Answer 51

Some degree of air leak which can dilute concentration of volatile anesthetic (turn up FGF and vaporizer output)