PEDS

Question 1

Name the acynotic defeacts

Answer 1

1. VSD
2. ASD
3. PDA
4. Pulmonary stenosis
5. Aortic stenosis
6. coartcation of aorta
7. Atriovetricular septal defect

Question 2

cyanotic defects are:

Answer 2

TOF
Transposition of great vesssel
Truncus

“all start with T”

Question 3

what type of shunt are “blue babies”

Answer 3

right to left

all the 3 T’s

Question 4

what type of shunts are “blue kids”?

Answer 4

left to right shunts

Late developing shunting -
VSD
ASD
PDA

Question 5

frequency of Left to right shunt in order:

Answer 5

VSD > ASD > PDA

Question 6

most common congenital cardiac anomaly is?

Answer 6

VSD

Question 7

describe Eisenmenger’s Syndrome:

Answer 7

Uncorrected VSD, ASD, or PDA leads to progressive pulmonary hypertension (too much blood is going to lungs, ultimately lungs clamp down). As pulmonary resistance increases, the shunt reverses from L –> R to R –>L, which causes late cyanosis (clubbing and polycythemia)

Question 8

quick way to describe eisenmenger’s syndrome -

Answer 8

Shunt reversal

Question 9

ASD is a congenital “hole” in the

Answer 9

septum b/w atria

Question 10

what are complications of uncorrected ASD?

Answer 10

Pulm HTN

Eisenmenger’s Disease

Question 11

with ASD, what part of the heart is working harder?

Answer 11

RV - receiving more blood

Question 12

AVOID the during repair of VSD:

Answer 12

-arrhythmia
RV dysfunction
Pulmonary vascular obstructive disease
paradoxical embolus

Question 13

with Coarctation of aorta, which BP is accurate?

Answer 13

radial

femoral would be absent
normal flow to UE; lower flow to LE

Question 14

PDA
Persistence of connection between pulmonary artery and aorta
L–> R shunt
Blood flow from aorta to pulmonary artery.
Additional blood is re-oxygenated in lungs and return to LA and LV –> increase work load –> LVH
Continuous murmur “machinery”
Small defect– No symptoms
Large defects
CHF
Delayed growth
Infections
Treatment
Surgical ligation
COX-1,COX-2 inhibtors and indomethacin “medical ligation”

Answer 14

PDA

Question 15

describe a PDA murmur

Answer 15

Continuous (both systolic and diastolic)

“Machinery”

Question 16

in a child with PDA; how is the SPO2 monitored?

%?

Answer 16

Preductal (right hand) and Postductal (foot) O2 saturation difference = 3%

High >10% in
Increase right to left shunt (Pulmonary hypertension)

Question 17

MC congenital heart disease causing cyanosis
Four features
Pulmonary stenosis – RV outflow obstruction
Overriding aorta (aorta comes out both from left ventricle and right ventricle ( BIG AORTA)
Large VSD
Right ventricular hypertrophy
Right ventricular outflow obstruction + VSD result ejection of mixed blood into the aorta

Answer 17

TOF

Question 18

Clinical presentation
Cyanosis
Squatting
A position that increases systemic vascular resistance and aortic pressure, which  right-to-left ventricular shunting and thus   arterial O2saturation.
Dyspnea
Hypercyanotic  and hypoxic spells ( TET spells) PO2 < 50 mmHg during feeding or crying
Unresponsive to supplemental O2
PE
RV heave
Harsh systolic ejection murmur

Answer 18

tof

Question 19

in TOF, squatting pt. tries to decrease the shunt so

Answer 19

lungs can get more blood

Question 20

Anesthetic management of TOF

Answer 20

Maintain intravascular volume and SVR
Avoid INCREASE in pulmonary vascular resistance (e.g. by N2O)

Ketamine is used because it maintains or INCREASES SVR and therefore does not aggravates R–> L shunt
VA and histamine-releasing drugs DECREASES SVR and INCREASES shunt

Phenylephrine INCREASES SVR and Reducing shunt

Question 21

what is the name of the procedure required to repair tricuspid atresia?

Answer 21

fontan procedure

Question 22

Conotruncal separation does not occur, one trunk

Answer 22

Truncus Arteriosus

Question 23

Pulmonary veins-->RA via; instead of going to left atrium
Coronary sinus --> RA
Innominate--> SVC
Portal vein--> IVC
Combination of routes
R->L shunt across ASD

Clinical presentation:
Cynosis
Tachypnea
Dyspnea

X-ray- Snowman shaped heart
Surgery- redirection of veins

Answer 23

Total anomalous pulmonary venous return TAPVR

Question 24

Gut herniate into thorax through ‘hole’ in diaphragm in CDH is known as:

Answer 24

Foramen of Bochdalek or Morgagni

Question 25

CDH Anesthetic consideration 
NG tube
Avoid high pressure PPV
Pre-oxygenation
Decrease conc. of VA, muscle relaxant
Nitrous oxide (N2O) is contraindicated 
High risk of pneumothorax --> avoid barotrauma 
Chest tube

Answer 25

know what to do and what NOT to do

***Positive pressure ventilation (PPV)

Question 26

Types of Tracheoesophageal fistula. What is the most common

Answer 26

Type IIIB

Question 27

Anesthesia consideration for Tracheoesphageal Fistula

Answer 27

• Need frequent suction due to INCREASE secretion
• Avoid PPV
• Awake intubation

Question 28

cause of polyhydraminos?

Answer 28

excessive amount of amniotic fluid

-eeophageal atresia – baby no swallowing it so an increased level

Question 29

cause of oligohydraminos?

Answer 29

lack of amniotic fluid

- kidney issue or development delay

Question 30

Tell me about paradoxic aciduria

Answer 30

high alkalosis

• low ph of urine
• opposite effect
• extreme alk and extreme shock

… finish