Peds

Question 1

Most of the blood bypasses fetal liver via the _____ and mixes w/ deoxygenated blood in inferior vena cava

Answer 1

Ductus venosus

Question 2

Why is blood shunted away from fetal lungs?

Answer 2

High resistance

Question 3

Connects pulm artery to aorta

Answer 3

Ductus arteriosus

Question 4

Fetal circulation

Answer 4

Umb vein > ductus venosus > IVC > RA > LA (through foremen ovale) > LV > aorta > body

Question 5

What closes ductus arteriosus? What helps close PDA?

Answer 5

Increase in O2 from respiration and decrease in prostaglandins d/t placental separation; Indomethacin

Question 6

Keep PDA open

Answer 6

Prostaglandins E1 & E2

Question 7

Fetal PaCO2? PaO2?

Answer 7

PaCO2 = 48; PaO2 = 30 (+10 if mom on 100% O2)

Question 8

Pulm resistance increases in:

Answer 8

Hypoxia, hypercarbia, & hypothermia

Question 9

Large VSD cause:

Answer 9

PHTN, growth failure, CHF, infection

Question 10

Large ASD

Answer 10

SOB, hyper dynamic pericardium, RV heave, systolic ejection murmur, fixed splitting of S2, paradoxical embolism

Question 11

I corrected VSD, ASD, or PDA leads to PHTN. Increased pulm resistance causes shunt to reverse from L>R to R>L causing late cyanosis (clubbing & polycythemia)

Answer 11

Eisenmenger’s Syndrome

Question 12

Blood flows from aorta to pulm artery. Additional blood is deoxygenated in lungs & returns to LA & LV -> increased work load -> LVH.

Answer 12

PDA

Question 13

PDA tx

Answer 13

Surgical ligation. COX1 & 2 inhibitors & indomethacin “medical ligation”

Question 14

A difference of ___ in pulse ox suggests marked pulmonary HTN w/ PDA

Answer 14

10%

Question 15

4 features of Tetralogy of Fallot

Answer 15

1. Pulm stenosis (RV outflow obstruction);
2. Overriding aorta (comes from LV and RV);
3. Large VSD;
4. RV hypertrophy

Question 16

Most common CHD causing cyanosis

Answer 16

TOF

Question 17

RV outflow obstruction + VSD result in

Answer 17

Ejection of mixed blood into aorta

Question 18

The _____ infusion will keep PDA open allowing mixed blood to circulate to lungs to get more oxygenated

Answer 18

PGE1

Question 19

How does squatting help with TOF

Answer 19

Increases SVR & aortic pressure, which decreases R -> L shunt so lungs can get more blood. -> increase arterial O2 sat

Question 20

TET spells

Answer 20

Hypercyanotic & hypoxic spells. PO2 < 50 mmHg during feeding or crying. Unresponsive to supplemental O2

Question 21

TOF physical findings

Answer 21

RV heave, harsh systolic ejection murmur, boot shaped heart on X-ray, right axis deviation/RVH

Question 22

Conditions that increase R -> L shunt

Answer 22

Increase PVR or decrease SVR, acidosis, hypercardbia, hypotension

Question 23

TOF surgery

Answer 23

Blalock-Taussing shunt (connects subclavian artery to pulm artery “creating duct”, more blood to lungs);
Closing VSD;
Resecting obstruction

Question 24

Foramen of Bochdalek or Morgagni

Answer 24

Gut herniates into thorax in diaphragm

Question 25

Most common type of tracheoesophageal fistula

Answer 25

Type IIIB

Question 26

3C’s with tracheoesophageal fistula

Answer 26

Cyanosis, choking, coughing with feeding

Question 27

Other defects with tracheoesophageal fistula (VATER syndrome)

Answer 27

Vertebral defect, Anal atresia, TE fistula, Esophageal atresia, Radial dysplasia

Question 28

Why avoid LR with pyloric stenosis?

Answer 28

Met alkalosis and LR is metabolized to bicarb by liver

Question 29

Anesthetic considerations for pyloric stenosis

Answer 29

Fix fluid & lytes first, suction/high risk aspiration, high risk resp depression d/t prolonged alkalosis, awake intubation and rapid induction, UO 1-2ml/kg/hr

Question 30

Anesthetic considerations for acute epiglottitis

Answer 30

Lateral neck X-ray to determine extent of obstructions, prepare for trach, avoid laryngoscope, inhalation induction in sitting position, intubation with smaller size tube

Question 31

Steeple sign on AP neck film. Strider improves with aerosolized racemic epi

Answer 31

Croup

Question 32

Thumbprint sign on lateral neck film

Answer 32

Epiglottitis

Question 33

Subglottic narrowing

Answer 33

Tracheitis

Question 34

Cleft palate, small face and glottis

Answer 34

Pierre-robin syndrome

Question 35

Small lower jaw, absent or malformed ear, more severe

Answer 35

Treacher-collins syndrome

Question 36

1:5000; persistence of herniating of abd contents into umbilical cord, covered w/ peritoneum. Occurs at base of umbilicus; Have hernia sac; associated w/ Down syndrome & increased maternal a-fetoprotein

Answer 36

Omphalocele

Question 37

1:15000; failure of lateral body folds to fuse -> extrusion of abd contents through abd folds. Does NOT have hernia sac

Answer 37

Gastroschisis

Question 38

Staged closure of omphalocele and gastroschisis if:

Answer 38

Intragastric pressure > 20 cmH2O; Peak inspiratory pressure > 35 cmH2O; ETCO2 > 50 mmHg

Question 39

Bowel compartment syndrome may:

Answer 39

Impair ventilation, obstruct venous return, impair renal functions, high mortality

Question 40

Telescoping of bowel segment into itself. MCC of bowel obstruction in first 2 yrs. Colicky pain, vomiting, blood in stool, “current jelly stool”, sausage shape mass

Answer 40

Intussuception

Question 41

Hereditary dz of exocrine glands of lungs and GIT. Result form a defect in Cl channels caused by mutation

Answer 41

Cystic fibrosis

Question 42

Diagnosis CF by

Answer 42

Sweat chloride test

Question 43

Clinical presentation of CF

Answer 43

Increased Residual volume, increased airway resistance, decreased vital capacity, decreased expiratory flow rate

Question 44

Making a hole for drainage of any fluid in middle ear cavity

Answer 44

Myringotomy

Question 45

Is N2O safe during myringotomy?

Answer 45

Yes d/t short duration (10-15 min)

Question 46

Duchenne Muscular Dystrophy is x-linked disorder d/t deficiency of _____ - a cytoskeletal protein (like glue)

Answer 46

Dystrophin

Question 47

Fetal deposition of bilirubin in basal ganglia w/ bilirubin > 20mg/dl

Answer 47

Kernicterus

Question 48

If ______ bilirubin is elevated, check blood smear for hemolysis

Answer 48

Indirect

Question 49

If ______ bilirubin is elevated, check liver enzymes

Answer 49

Direct

Question 50

Murmur associated with PDA

Answer 50

Continuous (systolic & diastolic) murmur “machinery”

Question 51

Omphalocele is a/w?

Answer 51

Down syndrome & increased maternal a-fetoprotein

Question 52

Midsystolic harsh blowing murmur

Answer 52

VSD