ACE Review - Peds Flashcards
1
Q
Questions
A
Answers
2
Q
What drug is used in Peds Resuscitation in American Heart Assoc
A
Epi
3
Q
What is the most common congenital heart problem of downs patients
A
Atrial/ventricular septal wall defects.
4
Q
What endo problem are downs patients more prone to have
A
Hypothyroidism
5
Q
What are downs patients most prone to have as a complication of anesthesia
A
Upper airway obstruction.
6
Q
What is the highest risk factors for infant postoperative apnea
A
Preterm infants born before 44weeks
7
Q
Does Small birth weight increase the risk of postoperative apnea
A
No. It actually is beneficial to have a smaller birthweight.
8
Q
What risk factor shows to have similar risk of postoperative apnea like small gestational age?
A
Anemia. Both risks are so high that it is hard to tell which has a higher relative risk.
9
Q
what is the normal blood sugar of neonates
A
50-90
10
Q
when should you consider blood glucose treatment in neonates for hypoglycemia
A
40
11
Q
why are neonates prone to hypoglycemia
A
their livers are low on glycogen stores
12
Q
what is the main type of hemoglobin in neonates
A
hemoglobin f in neonates
13
Q
what is the hg range for neonates
A
15-20
14
Q
is neonate urine creatinine low or high
A
urine creatinine is low because they are unable to concentrate urine
15
Q
how are the plateletes in neonates
A
actually they are normal count
16
Q
does a neonate have more or less tidal volume per weight
A
it has more tv per weight than adults
17
Q
does a neonate have more frc than adult per weight
A
it has the same 30cc/kg
18
Q
does a neonate have more oxygen consumption per weight than adult
A
it has more 6-8cc/kg/min versus 3-4cc/kg/min for adult
19
Q
does a neonate have more total lung capacity per weight than adult?
A
no, adult has a greater total lung capacity per weight than neonates
20
Q
does a neonte have more or less compliant lungs than adults
A
more compliant because it has less boney structures
21
Q
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A
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22
Q
what does a right to left shunt do to anesthesia gas induction
A
it slows it down by bypassing the lungs
23
Q
what does a left to right shunt do to anesthesia gas induction
A
it has no rate change of induction by gas
24
Q
what are pediatric examples of right to left shunt
A
tricuspid atresia, transposition of great arteries with asd/vsd, truncus arteriousus
25
what are examples of left to right shunt in peds
asd, vsd, and pda
26
does aortic coarctation cause a shunt
no
27
where does aortic coarctatin usually occur
it occurs near the pda
28
what is the most common cause of childhood genetic lifethreatening airway disease
praderwilli syndrome
29
what is prader willi syndrome
genetic mutation in chromosome 15 that causes fat and carbs metabolism malfunx
30
what are symptoms of prader willi
short, obese, weak muscle tone, difficulty swallowing, endocrine abnormalities
31
what is the cause of obesity in prader willi
hyperphagia…increase amount of eating
32
what is the pulmonary condition that prader willi develops
pickwickian syndrome
33
what is pickwickian
chronic hypoxemia, pulmonary hypertension, right sided heart failure, severe obesity
34
what perioperative concern is there for prader willi syndrome
post operative airway obstruction…obstructive sleep apena
35
what intraoperative airway concern is there for praderwilli
micrognathia, viscous saliva, high arched palate, poor dentition
36
why does prader willi have poor dentition
bc poor swallowing ability>>regurge>>acidic regurge>>erode teeth
37
is MAC considered for prader willi
No…viscous saliva may cause airway obstruction
38
what post operative airway concern has been assoc w/ prader willi
pna
39
how do prader willi handle pain control
they have an increase threshold for handling pain
40
what endo abnormality is seen in prader willi syndrom
they may be very labile with post operative glucose levels
41
why is glucose levels labile in prader willi
they use serum glucose to make fat rather than supply metabolic needs…they may run hypoglycemic
42
what neurological endocrine problem is associated with prader willi
they are hypothyroid…2ndry to hypothalamus problem…they will have decreased tsh trh
43
what endocrine problem of prader willi may cause a small underdeveloped airway
prader willi assoc w/ decreased growth hormone
44
what is done in peds prader willi to prevent small airway (underdevelopment)
FDA has approved use of growth hormone for this
45
would a prader willi pt need cortisol stress dose in operative setting
no…they are not cortisol deficient
46
how is the temp regulation in prader willi pt
they run hyperthermic
47
how should muscle relaxant be dosed for prader willi pt
they are hyptonic…even after past 4 yrs of age, when hypotonia improves…less mm relaxant is needed
48
why is the eating habbits of prader willi difficult for anesthesia
these pts are hard to keep npo
49
what habbitual behavior dose prader willi have that may complicate anesthesia
they have skin picking behavior and pick out IV'
50
since prader willi has such dangerous post op outcomes…what is recommeded for pws
post op admit to picu or peds stepdown, 24hr pulse ox monitor, direct supervision to watch for iv picking and food foraging, decrease admin of opiods, judicious admin of post op feeding 2ndry to ileus
51
What is the estimated weight formula based on age
Age x 2 + 10
52
What is the neonate Hg
About 16
53
When does pediatric anemia occur
8-12 weeks after delivery
54
What is the Hg for pediatric anemia
8/9/2014
55
Why is Hg high in neonates.
The hypoxemia state promotes epo
56
Why does polycythemia decline in neonates
As the patient breaths, hypoxemia decreases and thus less drive for epo, along with short duration of HgF lifespan
57
Do premature babies have higher or lower nadir in Hg
Premis have lower Hg at the nadir of the pediatric anemia
58
If a premature is transfused blood initially, what happens to the Hg level at the nadir?
It actually becomes even lower because the HgA is right shifted versus the HgF. This gives more oxygen to cells and thus suppresses epo even more
59
What common problems with Downs patient
Hypothyroid atlantoaxial Instability Cardiac issues
60
What cardiac issues are involved with downs patient
endocardial cushin disease 40%, vsd 27, pda12, tof 8
61
What drugs are down Patients not really sensitive to
Atropine
62
Non-bilious projectile vomiting at 3 to 6 weeks of life
Pyloric stenosis
63
What is the metabolic derangement in pyloric Stenosis
Hypokalemic hypochloremic metabolic alkalosis
64
What is the preferred method of diagnosis For pyloric stenosis
Ultrasound ...over barium swallow
65
What should be placed in a patient Before giving atropine for pyloric stenosis patient
Orogastric tube for decompression
66
Why are opiates avoid in pyloric stenosis patients postoperatively
The compensation mechanism for metabolic alkalosis as respiratory acidosis Giving opioids would further increase the chance for respiratory acidosis respiratory depression
67
congenital diaphram hernia....what are the main treatments
Intubation and gi decompress
68
Congenital diaphragm hernia... What side is it more likely in
Hernia usually on the left side
69
Congenital diaphragm, hernia...what is risk of hyperinflation of the lungs.
Risk for pneumothorax on the contraleteral side
70
Pyloric stenosis. What age shows this
3-6 weeks
71
Pyloric stenosis. What electrolytes do u get depleted
HypoNaKClH
72
Pyloric stenosis. What is the metabolic derangement
Metabolic alkalosis
73
Pyloric stenosis. What is the diagnosis
Physical exam confirmed by ultrasound or barium study
74
Pyloric stenosis. What is the treatment
Pyloromyotomy
75
Pyloric stenosis. What is seen on barium study
String sign
76
Pyloric stenosis. What is avoided in surgery
Opioids. Because of respiratory depression. Resp depression is a compensation technique for metabolic alkalosis
77
Pyloric stenosis. Can u use succinylcholine
Yes. This is an acceptable disease for use of this muscle relaxant
78
Pyloric stenosis. How can u treat postoperative pain.
Incision local anesthetic and rectal acetaminophen
79
Tetralogy fallot. What kind of congenital heart disease is it
Cyanotic. Heart disease.
80
Tetralogy of fallot. What are the causes of hypoxemia.
Increase right to left shunt.
81
Tetralogy of fallot. What is the cause of increase right to left shunt.
Decrease svr or severity of right ventricular outflow track occlusion
82
Tetralogy of fallot. What is a good induction agent.
Ketamine...because it does not decease svr.
83
caudal block. what is the first sign in spinal block in peds pt
apnea
84
caudal block. when do u see bradycardia if intrathecal injection is done
this is a late symptom and is usually due to the hyoxemia 2ndry to apnea
85
caudal block. what is the treatment
supportive ventilatin till it resumes
86
persistent fetal circulation. what is the mechanisms that causes reversion back to a fetal circulation
when there is an increase in PVR
87
persistent fetal circulation. what physiologic conditions will cause an increase in PVR
hypoxemia. hyerkalemia, acidosis, hypOthermia
88
persistent fetal circulation. why disease systems causes hypoxemia, hyperkalemia, acidosis, hypothermia, that increase pvr
sepsis, acidosis, meconium aspiration, pulm disease, prematurity, meconium aspiration
89
hyperoxia. what is associated with this in neonates
retinopathy of prematurity
90
iv caffiene. when given to a peds patient...what is the most common symptomt
severe irritability...
91
iv caffiene. what is its purpose for peds patients
it is to preve post operative apnea
92
preop URI. how many times a year do peds pts get a cold
6-8 times a year
93
preop uri. how long do peds cods last
2-4 weeks
94
preop uri. what to do to determin if the case should proceed in peds pts
determine if there is a lower resp infection
95
preop uri. what are signs that it is an uncomplicated uri
rhinorrhea clear, ctabl, no fever, no hypoxemia, no fever, good activity level, good appearance
96
caudal block. adding clonidine to the block...what side effect is most commonly seen
increase sedation
97
caudal block. clonidine. does it cause respiratory changes
no
98
caudal block. clonidine. does it cause hemodynamic changes
no
99
hemoglobin. wht is the p50 of fetal hemoglobin
nineteen
100
hemoglobin. what is the hct of neonates
45 to 65%
101
hemoglobin. list the hemoglobins from least to greatest p50
carboxyhemoglbin, methhemoglobin, fetal hemoglobin, adult hemoglobin
102
croup. what age does it occur at
1-3 yo kids...most likely at age 2
103
croup. what symptoms do u see
stridor and cough
104
croup. what kind of stridor
inspiratory
105
croup. what kind of cough
barking
106
croup. what is seen in neck xray
steeple sign
107
croup. what symptoms do u see instead in epiglottis
drooling and sniffing position (hunched forward)
108
croup. where is the obstruction
subglottic
109
croup. what is the initial treatment
neb racemic EPI (not albuterol)
110
croup. what to watch out if tx with racemic epi
must monitor pt bc up to 4 hours later, pt can get rebound-edema of subglottic airway
111
PDA. what is the PVR if there is a diaphragmatic hernia
PVR is increased...can lead to hypoxemia
112
umbilical artery catheters. how are they classified
high or low
113
umbilical artery catheters. what classfiies a high
in the decending aorta between the diaphram and left subclavian aa
114
umbilial artery catheter. what classifies it as low
in the descending aorta between the renal arteries and aortic bifurcation
115
umbilical artery catheter. is it preductal or post ductal blood sampling
it is post ductal blood sampling
116
tof. what is tetralogy of fallot
ventricular septal defect, overriding aorta, rvot obstruction. right ventricular hypertrophy
117
tof. what is a tet spell
when crying leads to hypoxemia
118
tof. what is the mechanism of action of a tet spell
crying leads to a decrease in svr and tachycardia. the decrease in svr promotes r>L shunt through the vsd and the tachycardia increases rvot obstruction
119
tof. what vasopressor is good for tof tet spell
phenylephrine
120
tof. what is an alternative to phenylephrine
beta blocker to slow hr down and volume!
121
downs. what percentage of pts have cardiac problems
about 44%
122
downs. what is the most common type of cardiac lesion
atrioventricular septal defects aka endocardial cushion defects
123
downs. in adults. what is the most common type of valve problem
mitral regurge...occurs in 55 percent of pts
124
downs. what is more common, hyper or hypothyroid
hypOthyroid...found in 30% of pts
125
downs. what is increased in these pt with ett
post extubation stridor is high prevalence
126
downs. what is more common asd or vsd
vsd...up to 35%....endocardial cusion defect is still the top cardiac lesion though...vsd is 2nd lesion
127
lung volumes. neonates. frc increase or decrease
decrease
128
lung volumes. neonates. closing capacity. increase or decrease
increase
129
lung volumes. neonates. tidal volume increase or decrease
same as adult cc/kg
130
lung volumes. neonates. dead space. increase or decrease
same as adult cc/kg
131
lung volumes. neonates. what causes them to desaturate faster
higher metabolic rate. less alveoli. increase closing capacity
132
lung volumes. neonates. what is closing capacity
the lung volume at which you start to find small airway closure
133
lung volumes. neonates. how does increase in closing capacity cause desaturation in neonates
when closing capacity is higher than functional residual capacity. atelectasis forms...this leads to desatuation. since neonates have decrease frc and increase cc...it makes the cc/frc ratio even worse for atelectasis compared to adult values
134
lung volumes. neonates. when do you expect adult values in the number of alveoli per kg wt
when pt reach 8 years old.
