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Apex Flashcards > across the lifespan: pediatrics > Flashcards

across the lifespan: pediatrics Flashcards

1
Q

epiglottitis versus laryngotracheobronchitis (croup) organism

A

epiglottitis: bacterial
croup: usually viral

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2
Q

epiglottitis versus laryngotracheobronchitis (croup) age affected

A

epiglottitis: 2-6y
croup: <2y

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3
Q

epiglottitis versus laryngotracheobronchitis (croup) onset (hours/days)

A

epiglottitis: rapid (<24h)
croup: gradual (24-72h)

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4
Q

epiglottitis versus laryngotracheobronchitis (croup) region affected

A

epiglottitis: supraglottic structures (epiglottis, vallecula, aretynoids, aryepiglottic folds)
croup: laryngeal structures below cords

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5
Q

epiglottitis versus laryngotracheobronchitis (croup) neck xray

A

epiglottitis: swollen epiglottis = thumb sign (lateral XR)
croup: supraglottic narrowing= steeple sign (front XR)

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6
Q

epiglottitis versus laryngotracheobronchitis (croup) clinical presentation

A

epiglottitis: high grade fever, tripod position, 4 d’s (drooling, dyspnea, dysphonia, dysphagia)

croup: low grade fever, barking cough, vocal hoarseness, inspiratory stridor, retractions

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7
Q

epiglottitis versus laryngotracheobronchitis (croup) treatment

A

epiglottitis: urgent aw management (tracheal intubation, tracheostomy), abx if bacterial, induction with spontaneous RR (CPAP 10-15cmH2O to prevent aw collapse), ENT surgeon must be present, postop ICU care

croup: O2, racemic epi, corticosteroids, humidification, fluids, intubation rarely required

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8
Q

inspiratory stridor presentation is most likely

A

croup

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9
Q

preferred tx for post intubation laryngeal edema (post intubation croup) and other tx’s

A

racemic epi preferred

cool and humidified O2, dexamethasone .25-.5mg/kg IV, heliox (mixture of O2 and helium) reduces raynauds number

NO abx, its not infectious

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10
Q

dose of racemic epi for child 0-20kg

A

.25mL of 2.25% racemic epi diluted in 2.5mL

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11
Q

dose of racemic epi for child 20-40kg

A

.5mL of 2.25% racemic epi diluted in 2.5mL

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12
Q

dose of racemic epi for child >40kg

A

.75mL of 2.25% racemic epi diluted in 2.5mL

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12
Q

dose of racemic epi for child >40kg

A

.75mL of 2.25% racemic epi diluted in 2.5mL

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13
Q

what age will you see post intubation laryngeal edema

A

<4y

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14
Q

if you’ve given racemic epi, how long should you observe them before discharge

A

4 hours

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15
Q

good reason to cancel elective surgery: child presentation

A

purulent nasal drainage
fever >38c
lethargic
persistent cough
poor appetite
wheezing and rales that do not clear with cough
child <1y or previous preemie

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16
Q

presentation of subglottic obstruction

A

wheezing

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17
Q

presentation of supraglottic obstruction

A

stridor

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18
Q

choice of anesthesia for a patient who has a possible foreign body onstruction

A

inhalation induction with spontaneous RR
also TIVA may be best or addition of propofol because there will be a leak around the rigid bronchoscope

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19
Q

conditions associated with large tongue (and therefore difficult airway)

A

big tongue
beck with syndrome
trisomy 21

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20
Q

conditions associated with small/ under developed mandible (and therefore a difficult aw)

A

please get that chin
pierre robin
goldenhar
treacher collins
cri du chat

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21
Q

conditions associated with cervical spine anomaly (and therefore a difficult aw)

A

kids try gold
klippel feil
trisomy 21
goldenhar

22
Q

pathophysiologic anatomy of pierre robin

A

small/under developed mandible
tongue that falls down and backwards (glossoptosis)
cleft palate
neonate often requires intubation

23
Q

pathophysiologic anatomy of treacher collins

A

small mouth
small/under developed mandible
choanal atresia (nasal blockage of tissue)
ocular and auricular anomalies

24
Q

pathophysiologic anatomy of trisomy 21

A

small mouth
large tongue
Atlanto axial instability
sublottic stenosis

25
Q

pathophysiologic anatomy of klippel feil

A

congenital fusion of neck vertebrae which causes neck rigidity

26
Q

pathophysiologic anatomy of goldenhar

A

small/under developed mandible
cervical spine abnormality

27
Q

pathophysiologic anatomy of beck with syndrome

A

large tongue

28
Q

pathophysiologic anatomy of cri du chat

A

small/under developed mandible
laryngomalacia
stridor

29
Q

airway specific risks of patient with cleft lip and palate include

A

airway obstruction
difficult laryngoscopy
difficult mask ventilation
aspiration

30
Q

first and second most common cardiac anomalies associated with down syndrome

A

first: atrioventricular septal defect
second: VSD

31
Q

VACTERL

A

vertebral defects
imperforated Anus
cardiac anomalies
tracheoesophageal fistula
esophageal atresia
renal dysplasia
limb abnormalities

32
Q

CHARGE association

A

Coloboma
heart defects
choanal atresia
restriction of growth and development
GU problems
ear anomalies

33
Q

catch 22

A

Cardiac defects
abnormal face
thymic hypoplasia
hypocalcemia (d/t hypoparathyroidism)
22 (22q11.2 gene deletion- cause of syndrome)

aka DiGeorge

34
Q

tx for DiGeorge

A

thymus transplant or mature T cell infusion

35
Q

type of blood to transfuse to DiGeorge patient

A

transfusion of leukocyte depleted irradiated blood

36
Q

most common coagulation DO in patients undergoing adenotonsillectomy

A

vWF (administer DDAVP and decrease hourly rate to 1/2 or 1/3 of normal r/t HoNatremia then monitor postop sodiums)

37
Q

anesthetic management of patient with OSA under going adenotonsillectomy

A

emergence is slower, tx like any other OSA patient (less opioids)
dont give codeine for postop pain
monitor post procedure for 23h

38
Q

how to oxygenate child actively bleeding from adenotonsillectomy

A

pre oxygenate in left lateral and head down position
RSI and OGT hoe, blood in tummy. i repeat, blood in tummy.

39
Q

most common indication for liver transplantation in children less than 2 years of age?
s/sx
tx

A

biliary atresia
s/sx: persistent jaundice >14d, dark urine, acholic stool (pale or clay colored), hepatomegaly, splenomegaly
surgical correction: kasais operation (portoenterostomy), liver transplant

40
Q

how to combat the following for kids during surgery:
conduction
evaporation
radiation

A

conduction: place a foam pad on OR table
evaporation: humidify anesthetic gases
radiation: cover head with plastic (where they lose most of their heat)

41
Q

what does the fetal nicotinic receptor include

A

gamma, delta, beta, and 2 alpha sub units

42
Q

in the neonate, what are the most reliable indicators of recovery from NMB

A

flexion of knees to chest and a maximum inspiratory force > -25cmH2O

43
Q

match the following respiratory component developments to their timeline:
1. all structures distal to terminal bronchus begin developing
2. spontaneous fetal breathing begins
3. alveoli development begins
4. bronchial tree proximal to the terminal bronchus begin developing

A
  1. all structures distal to terminal bronchus begin developing after 16 weeks gestation
  2. spontaneous fetal breathing begins as early as 11 weeks gestation
  3. alveoli development begins immediately after birth
  4. bronchial tree proximal to the terminal bronchus begin developing before 16 weeks gestation
44
Q

what conditions are associated with childhood obesity

A

asthma
HTN
OSA
(not RVH)

45
Q

most sensitive indicator of positive test dose in anesthetized child receiving IV epi test dose is

A

peaked t wave (then increased SBP then increased HR)

46
Q

in an infant, what risks are associated with bronchiopulmonary dysplasia on induction

A

intraop bronchospasm, subglottic narrowing

47
Q

inhalation agents respond more rapidly in children than adults. why is this

A

increased distribution of CO to vessel rich group
increased alveolar ventilation to FRC ratio

48
Q

disadvantages of brachial arterial catheter cannulation in pediatric patient includes

A

risk of median nerve injury
poor collateral BF

49
Q

indications for leukocyte reduced blood component administration in children

A

prevention of leukocyte alloimmunization
decreasing risk of CMV transmission

50
Q

the oculocardiac reflex most often manifests

A

as brady cardia or sinus arrest

51
Q

what signs are typically present in a child with intrathoracic airway obstruction

A

prolonged expiration
expiratory stridor

52
Q

what actions are favored in the anesthetic management of a pediatric patient with a cleft palate

A

perform awake extubation
introduce ring adair elsyn (RAE) tube into trachea

Apex Flashcards (71 decks)

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