Pediatrics 2 Flashcards by Hannah Garrison

Which congenital condition is associated with macroglossia?
a. glucose-6-dehydrogenase deficiency
b. Klippel-Feil
c. Treacher Collins
D. Trisomy 21

D. trisomy 21

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Which conditions present with small/underdeveloped mandible?

Pierre Robin
Goldenhar
Treacher Collins
Cri du Chat
Please Get that chin

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Which conditions present with cervical spine anomaly?

Klippel-Feil
Trisomy 21
Goldenhar
(Kids Try Gold)

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Which conditions present with large tongue?

Beckwith syndrome
Trisomy 21
(Big Tongue)

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Anesthetic considerations for cleft lip and palate include

airway obstruction
difficult laryngoscopy
difficult mask ventilation
aspiration

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__________________ can reduce venous drainage and cause tongue engorgement

the Dingman-Dott mouth retractor

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The Dingman-Dott mouth retractor can lead to

post-extubation airway obstruction

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Neonates with Pierre Robin syndrome often require

intubation

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Pierre robin syndrome is made up of

small/underdeveloped mandible
cleft palate
tongue that falls back and downwards (glossoptosis)

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Treacher collins is composed of

small mouth
small/underdeveloped mandible
choanal atresia
ocular and auricular anomalies

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Trisomy 21 is composed of

small mouth
large tongue
atlantoaxial instability
subglottic stenosis

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Klippel-Feil is composed of

congenital fusion of cervical vertebrae–> neck rigidity

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Beckwith syndrome is composed of

large tongue

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Goldenhar syndrome is composed of

cervical spine abnormality
Small/underdeveloped mandible

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Cri du Chat is composed of

small/underdeveloped mandible
laryngomalacia
stridor

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Cleft lip repair is typically performed at

~1 month of age

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Cleft palate repair is typically performed at

~12 months of age

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What is the MOST common cardiac anomaly associated with Down syndrome?
a. atrioventricular septal defect
b. 1st degree heart block
c. bicuspid aortic valve
d. single ventricle

a. atrioventricular septal defect

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_______________ is the most common chromosomal disorder.

Trisomy 21 (down syndrome)

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The patient with down syndrome is at an increased risk for

difficult ventilation and intubation

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Reasons the patient with down syndrome is at an increased risk of difficult ventilation and intubation include

small mouth
large tongue
midface hypoplasia
palate is narrow with a high arch
atlantoaxial instability
subglottic stenosis
obstructive sleep apnea
chronic pulmonary infection

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Co-existing issues with trisomy 21 include

congenital heart disease
low muscle tone
GERD
intellectual disability

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__________ are most likely to give birth to a child with down syndrome

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Older mothers

Trisomy 21 results from

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the addition of a 3rd copy of chromosome 21

What should be avoided during laryngoscopy of the patient with trisomy 21?

neck flexion

Due to their subglottic stenosis in patients with down syndrome,

use a smaller ETT they have increased risk of postintubation croup

The most common co-existing congenital heart disease in patients with trisomy 21 is

AV septal defect VSD is second most common

___________ is very common during induction with trisomy 21

bradycardia with sevoflurane induction (give anticholinergic)

Match each congenital condition with its MOST likely presentation. Catch 22 (DiGeorge) syndrome VACTERL Association CHARGE association Choanal atresia renal dysplasia hypocalcemia

Catch 22- hypocalcemia CHARGE- Choanal atresia VACTERL- Renal dysplasia

Describe VACTERL association.

Vertebral defects imperforated anus Cardiac anomalies tracheoesophageal fistula esophageal atresia renal dysplasia limb anomalies

Describe CHARGE association.

Coloboma Heart defects Choanal Atresia Restriction of growth and development Genitourinary problems Ear anomalies

Describe CATCH 22

Cardiac defects abnormal face thymic hypoplasia cleft palate hypocalcemia 22q11.2 gene deletion (the cause of the syndrome)

What is coloboma?

a hole in one of the eye structures

What is choanal atresia?

back of nasal passage is obstructed

For the child with DiGeorge syndrome, if the thymus is absent

the child is at a high risk for infection

Treatment for an absent thymus consists of

thymus transplant or mature T cell infusion

Transfusion of ______________ for DiGeorge syndrome is best

leukocyte-depleted irradiated blood

What factors lower ionized Ca2+?

hyperventilation albumin citrated blood products

What is the MOST common coagulation disorder in children undergoing adenotonsillectomy? a. Hemophilia A b. Heparin-induced thrombocytopenia c. Sickle cell disease d. von Willebrand disease

d. Von willebrand disease

The most common pediatric surgical procedures are

tonsillectomy and adenoidectomy

Indications for tonsillectomy and adenoidectomy include

nocturnal upper airway obstruction and chronic and/or recurrent infections

The most common cause of OSA in kids is

adenotonsillar hypertrophy

The most common coagulation disorder in patients undergoing tonsillectomy is

Von Willebrand disease

_________ may reduce postoperative airway swelling, pain, and PONV with tonsillectomy.

Decadron 1 mg/kg up to 25 mg

With tonsillectomy and adenoidectomy there is a risk of

airway fire (maintain FiO2 <40% and avoid nitrous oxide)

Children with OSA undergoing adenotonsillectomy should be

admitted to the hospital for 23 hours and receive monitoring for airway obstruction

_________________ is a surgical emergency

Post-tonsillectomy bleeding

Key anesthetic risks for post-tonsillectomy bleeding include

hypovolemia aspiration

Patients with post-tonsillectomy bleeding should receive

volume resuscitation & a RSI

Children with OSA undergoing adenotonsillectomy have a ______________________ & should receive

longer emergence from anesthesia; a lower intraoperative opioid dose

_____________ should not be given to children with OSA undergoing adenotonsillectomy because__________

codeine for postop pain d/t an increased risk of death d/t respiratory depression

Children with OSA undergoing adenotonsillectomy have an increased incidence of

postop airway obstruction prolonged oxygen requirements greater need for airway instrumentation

Patients who receive DDAVP are at risk for

hyponatremia (use isotonic crystalloids at 1/2-2/3rds calculated maintenance values)

Primary bleeding occurs within

the first 24 hours (post-tonsillectomy) with 75% occurring within the first 6 hours after surgery

Secondary bleeding typically occurs

5-10 days after tonsillectomy when the scar covering the tonsil bed contracts

____________ and ____________ are suggestive of a >20% loss of circulating volume

Dizziness and orthostatic hypotension

How should the post-tonsillectomy bleeding patient be induced

preoxygenated in the left-lateral and head down position helps drain blood from the airway RSI OGT after induction

Pediatrics 2 Flashcards

(57 cards)