Pediatrics

Question 1

Ductus venosus

Answer 1

Umbilical vein to IVC (bypassing liver)

Question 1

Ductus Arterios

Answer 1

Aorta to pulmonary artery

Question 2

Umbilical arteries (2)-

Answer 2

carries deoxygenated blood from fetus back to mother

Question 3

Umbilical vein

Answer 3

carries oxygenated blood

Question 4

CO dependent on HR

Answer 4

does not tolerate bradycardia
SV fixed

always have glyco/atropine

Question 5

The baroreceptor reflex is not completely developed

Answer 5

Limiting ability to compensate for hypotension with reflex tachycardia

Question 6

Autonomic innervation of the neonatal heart is predominately controlled by the

Answer 6

parasympathetic nervous system

Bradycardia with minor interventions (suctioning/DL)

Question 7

total body water of preterm infant

Answer 7

80%

Question 8

total body water of term infant

Answer 8

70

Question 9

total body water of 6m-1y

Answer 9

60

Question 10

VOD

Answer 10

Vd = Dose / plasma concentration of drug

Question 11

Loading dose =

Answer 11

Vd x ( desired plasma concentration/bioavailability)

Question 12

Acidic drugs are favortable absorbed where?

Answer 12

stomach (Non-ionized)

Question 13

Basic drugs are best absorbed where?

Answer 13

alkaline intestines
(most oral drugs)
Slower in neonates and young children-delayed gastric emptying

Question 14

Time in weeks between the first day of the last menstrual period and the day of delivery (weeks).

Answer 14

Gestational age

Question 15

Time that has elapsed since birth (days, weeks, months or years)

Answer 15

Chronological Age

Question 16

Gestational age + chronological age (weeks)

Answer 16

Post Menstrual Age

Question 17

At what age does a baby need to stay overnight for apnea monitoring?

Answer 17

60 weeks post gestational age or PMA

Question 18

Chronological age is reduced by the number of weeks born before 40 weeks of gestation (weeks, months).

Answer 18

Corrected Age

dictates mile stones

Question 19

pvr in utero

Answer 19

elevated

Diverts a majority of RV output to the descending aorta via ductus arteriosus.

Question 20

describe Transitional Circulation

Answer 20

Lungs: fluid is replaced by air (raising alveolar O2 tension) and fluid is resorbed
↓ PVR

Hypoxic vasoconstriction in lungs reverses

↑ flow of blood in lungs → Path of least resistance
↑ blood return to LA (↑ pressure)-PFO closes (closes pop off)
↑ flow out LVOT, DA senses ↑ pO2, PGE from placenta ↓ & DA closes

PGE keeps DA open during transposition, HLHS

Question 21

Persistent Pulmonary Hypertension of the Newborn

Answer 21

PDO / PDA might not close because of high right-sided pressure

Rapid desaturation: FiO2 won’t help → Phenylephrine and Nitric Oxide

Question 22

Managing PPHN

Answer 22

O2, correct acidosis, normothermia, nitric oxide, surfactant, HFV, remodulin, sildenafil, milrinone, bosentan

Question 23

Can peds patients adjust their SV?

Answer 23

no. SV fixed, CO is dependent on HR

CO = HR x SV

Question 24

baroreceptor is not developed

Answer 24

Limiting ability to compensate for hypotension with reflex tachycardia

Question 25

fetal hemoglobin causes a what shift?

Answer 25

left (love) 19 vs 27

Question 26

when is physiologic nadir of hgb

Answer 26

3-4 months

Question 27

what Clotting factors are 20-50% of adult levels?

Answer 27

2, 7, 9, 10

Question 28

neonatal airway caviats

Answer 28

epiglottis longer/ narrower Larynx anterior/cephalad/smaller shorter neck tongue/adenoids larger telescopic subglottic area

Question 29

FRC in neonate

Answer 29

Lower

Question 30

diaphram in neonate

Answer 30

flat instead of dome

Question 31

metabolic rate / O2 consumption in neonate

Answer 31

increased

Question 32

Hypoglycemia can cause

Answer 32

apnea hypotension bradycardia convulsions brain injury

Question 33

Exposure to noxious stimuli/pain with inadequate or absent pain control can have physiologic consequences

Answer 33

→ Intraventicular Hemorrhage & PHTN Lack of development of inhibitory tracts may increase the intensity and duration of painful stimuli

Question 34

when do fontanelles close

Answer 34

Anterior fontanelle closes at 2 years Posterior fontanelle closes at 4 months

Question 35

most common heat loss

Answer 35

Radiant (majority): loss to environment (air) cover head

Question 36

Neonate lacks ability to regulate body temperature due to

Answer 36

Large surface area Lack of SQ tissues Inability to shiver

Question 37

where to maintain sats to prevent ROP?

Answer 37

O2 sats- 92-98% atropine increases IOP --> use glyco

Question 38

All infants less than how many PCA should be monitored

Answer 38

<62 weeks PCA

Question 39

coarctation high BP

Answer 39

Coarc: high BP on L upper extremity

Question 40

NPO status Current recommendations from ASA

Answer 40

2: clear liquids 4: breast milk 6: formula, fortified breast milk 8: solids

Question 41

Size of ETT

Answer 41

2 & up: Uncuffed (age in years/4) + 4 or (Age +16)/4 Cuffed to cuffed drop ½ size Leak desirable between 15-25 cm H2O

Question 42

Depth of ETT:

Answer 42

3x ID of ETT Nasal + 1-1.5cm Uncuffed ETT have double black line (place at VC)

Question 43

preterm baby ETT and Miller

Answer 43

ETT 2.0 - 3.0 Miller 0

Question 44

full term ETT

Answer 44

ETT 3-3.5 Miller 1 - WIS 1.5

Question 45

3mo - 1 year ETT

Answer 45

ETT 4.0 Miller 1 - WIS 1.5 or WIS 1.5 - Miller 2

Question 46

po dose of midazolam

Answer 46

Midazolam (0.25-1 mg/kg PO)​

Question 47

IM & PO dose ketamine

Answer 47

Ketamine (6 mg/kg PO)

Question 48

IN dose dexmede

Answer 48

Dexmedetomidine (2mcg/kg IN)

Question 49

dose of succinylcholine

Answer 49

2mg/kg

Question 50

Atropine

Answer 50

0.02 mg/kg

Question 51

epi dose

Answer 51

0.01mg/kg

Question 52

propofol induction dose

Answer 52

2.5-3.5 mg/kg

Question 53

why are peds sensitive to NDMB?

Answer 53

Low levels of Ach at the motor nerves but counterbalanced by increased VOD. Increased dosing of Sux d/t large VOD.

Question 54

Intravenous Induction indications

Answer 54

full stomach hx GERD disease state (illness)

Question 55

what is emla ?

Answer 55

2.5% lido/prilocaine apply 30-60 m

Question 56

emla risk?

Answer 56

methemoglobinemia (rare side effect of prilocaine toxicity)

Question 57

Methemoglobinemia review

Answer 57

S/S: hypoxia, cyanosis, tachycardia, tachypnea, Benzocaine >300mg, prilocaine, cetacaine, ELMA decreased O2 carrying capacity by changing the binding of O2 to hemoglobin Left shift Pulse ox will be 85% with a normal PaO2 75-100 >70: dialysis and exchange transfusion Methylene Blue: 1-2 mg/kg over 5-10min

Question 58

MAC _____ in neonatal period & ____ in infants (1-6m)

Answer 58

lower; highest

Question 59

Adverse respiratory events with Iso/Des:

Answer 59

breath holding laryngospasm coughing increased secretions

Question 60

Reversal

Answer 60

0.05 mg/kg of Neostigmine (same as adults) 0.02 mg/kg Atropine 0.01 mg/kg Glyco

Question 61

BRIDION® (sugammadex) is indicated for the reversal of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adults and pediatric patients aged

Answer 61

2 years and older undergoing surgery

Question 62

sugammadex dose in peds

Answer 62

2 mg/kg intentionally avoided in males and teenagers

Question 63

Laryngospasm

Answer 63

PPV Succ (4mg/kg) and Atropine IM ( 0.02 mg/kg, with a maximum dose of 0.5 mg)