ACE 6B

Question 0

What are the common GI manifestations of cerebral palsy in children?

Answer 0

GERD
increased salivation
impaired ability to handle pharyngeal secretions
malnutrition

Question 1

What are the common motor manifestations of cerebral palsy in children?

Answer 1

Spasticity
Athetoid movements
Rigidity
Ataxia
Tremors
Atonia

Question 2

What are the common pulmonary manifestations of cerebral palsy in children?

Answer 2

Recurrent pneumonia (due to chronic aspiration)
Impaired cough
Reactive airway disease (due to chronic aspiration)

Question 3

What are the common CNS manifestations of cerebral palsy in children?

Answer 3

Seizures (30% of CP kids)
Developmental delay / MR
Visual impairment
Speech impairment
Auditory impairment
Behavioral abnormalities

Question 4

What are the common orthopedic manifestations of cerebral palsy?

Answer 4

Progressive spinal deformities

Question 5

Define cerebral palsy.

Answer 5

A non-specific term that refers to several (usually nonprogressive) motor disorders caused by insult to the CNS generally before 2 years of age.

Question 6

Cerebral palsy is more common in what category of infant?

Answer 6

Low-birth-weight infants

Question 7

Describe succinylcholine use in a patient with cerebral palsy in terms of safety of use and sensitivity to the effects of the drug.

Answer 7

Succinylcholine is commonly used in patients with cerebral palsy without the development of life-threatening hyperkalemia despite the presence of extrajunctional Ach receptors. Patients with CP demonstrate a slightly increased sensitivity to succinylcholine.

Question 8

Describe non-depolarizing neuromuscular blocker (NDNMB) use in a patient with cerebral palsy in terms of sensitivity to the effects of the drug and dosing.

Answer 8

Patients with CP have decreased sensitivity to NDNMBs that manifests as requiring higher doses to achieve the intended level of relaxation as well as decreased duration of action requiring more frequent dosing.

Question 9

Describe the effect of cerebral palsy on minimum alveolar concentration requirements.

Answer 9

Patients with CP generally have decreased MAC requirements of about 20% that is reduced even further if the patient is taking anticonvulsant medications.

Question 10

Are patients with cerebral palsy more sensitive, equally sensitive, or less sensitive to opioids than the general population?

Answer 10

They are more sensitive to the effects of opioids.

Question 11

What effect will a cyanotic heart lesion have on the rate of induction using inhalational agents?

Answer 11

A cyanotic heart lesion is one defined as there being a right-to-left shunt. A right-to-left shunt will slow down the rate inhalational inductions.

Question 12

What effect will a cyanotic heart lesion have on the rate of induction using intravenous agents?

Answer 12

A cyanotic heart lesion is defined as a lesion with predominantly right-to-left shunting. Right-to-left shunting INCREASES the rate of IV induction by decreasing pulmonary metabolism of the intravenous agents.

Question 13

What effect does left-to-right shunting have on the rate of inhalational inductions?

Answer 13

Left-to-right shunts have MINIMAL effect on the rate of inhalational inductions.

Question 14

What is the recommended fasting interval for an infant who had clear liquids prior to elective surgery?

Answer 14

2 hours

Question 15

What is the recommended fasting interval for an infant who had breast milk prior to elective surgery?

Answer 15

4 hours

Question 16

What is the recommended fasting interval for an infant who had formula prior to elective surgery?

Answer 16

6 hours

Question 17

What is the recommended fasting interval for an adult who had McDonald’s prior to elective surgery?

Answer 17

8 hours