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Pediatric Physiology - B. Stevens/Bernstein 2017 > Common Pediatric Surgeries - Quiz 2, Part 1 > Flashcards

Common Pediatric Surgeries - Quiz 2, Part 1 Flashcards

1
Q

Disease most associated with human dwarfism; its have slight to mod obesity, large heat, short extremities, height of ~4 ft, delayed motor milestones, blowing of lower legs, freq ear infections, and dyspnea r/t airway restriction; they commonly suffer from depression

A

Achondroplasia

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2
Q

What is characterized by an “olive-shaped mass” that may be palpated b/t midline and RUQ?

A

Hypertrophic pyloric stenosis

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3
Q

What is commonly seen on barium swallow in a pt with hypertrophic pyloric stenosis?

A

a high degree of obstruction of the gastric outflow tract with a “wisp” of barium escaping through the pylorus

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4
Q

What is the renal response to the protracted vomiting of hypertrophic pyloric stenosis?

A

alkaline urine with Na and K loss and eventually acidic urine after the electrolytes are depleted resulting in worse metabolic alkalosis

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5
Q

Fluid loss and pre renal azotemia (elevated BUN and Cr) may indicate which two adverse events seen in hypertrophic pyloric stenosis?

A

hypovolemic shock

metabolic acidosis

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6
Q

protracted vomiting in hypertrophic pyloric stenosis leads to what 3 electrolyte/acid-base imbalances?

A

HypoK
HypoCl
alkalosis

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7
Q

What is the priority in its with Hypertrophic Pyloric Stenosis

A

Intravascular volume and metabolic stabilization/correction

NOT SURGERY

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8
Q

In a pt with duodenal and/or ileal obstruction, what is often given to clear viscid meconium plugs, and how does this affect the baby?

A

Hyperosmolar enemas

may result in SERIOUS SHIFTS IN INTRAVASC VOL –> hypovolemia

Hypovolemia must be treated before anesthetic induction

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9
Q

What disorder is associated with bilious vomiting beginning within the first 24-48 hrs after birth and notoriously shows the “double bubble sign” on radiographs?

A

Duodenal atresia

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10
Q

You have just administered a spinal for an infantile hernia repair. You have laid the child flat post spinal. The infant suddenly stops crying and becomes apenic. What just happened?

A

high spinal

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11
Q

Until what age should elective cases on premature babies be postponed? Why?

A

55 weeks post-conceptual age

premies have a high risk for apnea

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12
Q

Occurs in association with an unborn baby’s gastroschisis and intestinal atresia

A

Polyhydramnios

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13
Q

What is the difference between the location of an omphalocele vs gastroschisis?

A

omphalocele is within the umbilical cord

gastroschisis is peri-umbilical (usually to the R or the umbilical cord)

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14
Q

Infants with giant ombpaloceles typically have which two respiratory characteristics?

A
  1. small, bell-shaped thoracic cavities

2. minimal pulm reserve

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15
Q

Why might a parent be concerned that their infant undergoing repair of an omphalocele will need a tracheostomy?

A

repair of omphalocele may –> resp fail which may become chronic–> trach, long-term vent, and ECMO

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16
Q

What measures should be taken pre-op to decrease evaporative volume losses and hypothermia in a gastroschisis pt?

A

plastic wrap around the exposed bowel

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17
Q

Formation of a silo containing intestine until inflammation has resolved occurs following the correction of which disorder?

A

Gastroschisis

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18
Q

True or False: Respiratory distress in a neonate with gastroschisis may be treated by gastric decompression.

A

True

although ETT may still be needed

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19
Q

what fluid regimen should be used to minimize/correct ongoing fluid losses in a gastroschesis pt?

A
  1. LR or NS IV bolus 20 mL/kg
    then
  2. D10 / 0.25NS at 2-3x MIV rate
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20
Q

Defects in the spine are known as _________

A

Spina bifida

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21
Q

What is the difference b/t a meningocele and a meningomyelocele?

A

Meningocele contains CSF but no spinal tissue

Meningomyelocele is a meningocele that contains neural tissue

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22
Q

A pt who has a VP shunt for hydrocephalus decompression has a high risk of developing hypersensitivity and/or anaphylaxis to _______

A

Latex

VP shunts usually require many revisions/repeat operations

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23
Q

2 major anesthetic considerations for pts with myelodysplasia

A
  1. Position for intubation (doughnut vs lateral decubitus)

2. Blood loss from skin graft to close defect

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24
Q

Major post op concern for a pt with myelodysplasia?

A

Pt may have diminished or absent ventilatory responses to hypoxia and hypercarbia if a Chiari malformation coexists

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25
Consists of a bony abnormality in the posterior fossa and upper C-spine with caudal displacement of the cerebellar vermis, 4th ventricle, and lower brainstem below the plane of the foramen magnum
Arnold-Chiari Malformation
26
Most common fatal inherited disease among white people
cystic fibrosis
27
Diagnostic sign of cystic fibrosis
elevated sweat chloride concentrations
28
main cause of morbidity and mortality in cystic fibrosis pts
lung disease
29
Pathophys of cystic fibrosis that leads to respiratory problems
1. lack of regulation of Na absorption and Cl secretion --> decreased liq on airway luminal surfaces --> viscous mucus --> slowed mucus clearance --> mucus plugging --> 2. chronic infection --> 3. inflammation --> 4. epithelial injury
30
Efficacy of clearance secretions in normal lung function is dependent on _________
adequate hydration of the mucus
31
Why is a cystic fibrosis pt at increased risk for pneumothorax?
Bullae formed by progressive chronic lung damage
32
2 pulm characteristics of Cystic Fibrosis that may be noted by an anesthetist
1. bronchial hyperreactivity | 2. increased airway resistance
33
Pulm fx abnormalities in CF are commonly obstructive or non obstructive in nature?
obstructive
34
How would one expect the following values to deviate from normal in a cystic fibrosis pt? 1. FRC 2. FEV1 3. peak exp flow rate 4. VC
1. increased FRC 2. decreased FEV1 3. decreased PEFR 4. decreased VC
35
2 characteristics that are closely associated with and may even predict poor lung fx in a CF pt
1. low weight | 2. low BMI
36
What 2 factors lead to coagulation issues in a CF pt?
1 Hepatic dysfunction (causes decreased plasma cholinesterase and clotting factors II, VII, IX, and X) 2. malabsorption of vit K
37
Why might inhalation induction be prolonged on a CF pt?
large FRC small tidal volumes V/Q mismatch
38
What is the isothermal saturation point?
the point just below the carina at which inspired gases are warmed to body temp and saturated with water vapor
39
True or False. Humidified warmers should be used during GA of a CF pt
true
40
What can an anesthetist do to enhance clearance of secretions and minimize atelectasis in a CF surgical pt?
1. physiotherapy 2. airway humidification 3. pay close attention to analgesia 4. early mobilization
41
True or False: A CF pt should always be kept in the hospital after surgery or at least one night to monitor for post-op complications
False. Ambulatory surgery is optimal if feasible
42
Which type of ETT is preferable in a child with epiglottitis: oral or nasal?
oral | may be changed to nasal later if desired
43
Why should an anesthetist be sure the tube is well secured in a pt with epiglottitis?
"Accidental extubation" is almost always FATAL
44
What is the medical management for Croup?
nebulizer racemic epi
45
What is another name for croup?
laryngotracheobronchitis
46
Why is tracheostomy a preferred tx in a pt with croup?
prolonged intub has a high incidence of subglottic stenosis
47
Cleft palate repair is usually delayed until ________
~ 1 y/o
48
Cleft lip repair is usually done when the child is how old? Why?
4-6 weeks To facilitate feeding and growth
49
2 major concerns for cleft lip/palate surgery
1. Intubation (laryngoscope and tube tend to slip into the defect) 2. post op airway mgmt
50
What type of tube should be used for a cleft lip/palate repair? Why?
RAE tube taped midline on the lower lip for stability and visual reference for the surgeon
51
What terribly uncomfortable-sounding procedure may be valuable in maintaining the airway after cleft lip/palate repair?
Tongue suture
52
Why is laryngospasm a major problem after cleft palate/lip repair?
it can destroy the repair and be difficult to break
53
Common pediatric surgeries
1. hernia and hydrocele 2. tonsillectomy and adenoidectomy 3. myringotomy (tubes in ears)
54
What is intusseption?
condition in which part of the intestine telescopes onto itself
55
Koplick spots are associated with which disease? (also skin rash)
Measles (rubeola)
56
What is the difference b/t bronchitis and bronchiolitis?
Bronchitis occurs in the primary and secondary bronchi bronchiolitis occurs in the bronchioles
57
What anesthesia concerns are associated with arachnodactyly and Marfan Syndrome?
1. Congenital heart defects 2. aortic insufficiency/aortic dissection 3. precuts excavatum/kyphosis Fun fact: Marfan pts are commonly on B-blokers
58
Disorder characterized by fixation or fusion of joints in extremities and vertebrae with crippling/distortion and reduced muscle strength? Associated anesthesia concerns
Arthrogryposis 1. IV access (fixed joint position) 2. airway/intub (fixed jaw and neck 3. some have cardiac defects
59
Disorder characterized by impaired osteoblast activity that leads to poor calcification of bones Associated anesthesia concerns
Osteogenesis imperfecta 1. positioning can cause fractures 2. hyperthermia is common (from hypermetab) 3. Plt dysfx --> increased bleeding
60
Disease characterized by an anterior horn cell lesion; results in "flaccid" infant Associated anesthesia concerns
Werdnig-Hoffmann disease 1. difficulty swallowing - aspiration risk 2. tolerance of relaxants unpredictable
61
Disorder characterized by nonprogressive myotonia that improves with activity Associated anesthesia concerns
Myotonia Congenita prolonged tonicity with NDNMBs; sometimes just with stimulation
62
Disorders characterized by progressive atrophy of muscles Associated anesthesia concerns
Muscular dystrophies 1. aspiration risk 2. resp insufficiency 3. avoid/minimize relaxants
63
Syndrome characterized by atrophy of the perineal muscle due to degeneration of perineal nerve Associated anesthesia concerns
Charcot-Marie-Tooth Syndrome None =) surgery is musc transfer to compensate
64
Disease characterized by softening of the fem head from inadeq blood supply; often occurs at times of rapid growth Associated anesthesia concerns
Legg-Perthes disease None =) surgery is for hip nailing
65
Disorder characterized by fibromatous nodules that arise from the nerve sheaths all over the body; while many are benign, others can invade the airway, spinal cord, brain, etc. Associated anesthesia concerns
Neurofibromatosis 1. location of other fibromas than those operated upon and their significance 2. increased blood loss - ? etiology
66
Is a Septic hip joint an emergency for a child?
Nope. It is urgent but not emergent.
67
How does a child with a septic hip joint often present?
febrile and dehydrated
68
What can you often call a surgeon who states that he is going to do a "15 minute" aspiration of a septic hip joint?
a liar. It can become an open procedure with blood loss and take 90 min
69
What are the anesthesia concerns for a pt with a slipped femoral capital epiphysis?
1. IV access 2. blood loss 3. need good relaxation 4. slow emergence
70
anesthesia concerns assicated with club foot repair
1. long operation 2. post-op pain w castings 3. child stressed by serial castings
71
Anesthesia concerns r/t congenital hip dislocation
1. spica cast application 2. spica table supports shoulder and coccyx only 3. need placement of "belly pad" to allow breathing room post op
72
Severe Pectus Excavatum is concerning because it may cause:
cardiac and pulm development problems
73
most common reason for children to come to the OR
Fractures
74
All fractures are???
FULL STOMACHS
75
Why is no waiting period safe when taking a pediatric fx to the OR? (for aspiration risk) Therefore there is no need to delay surgery.
pain of the fx will often completely stop gastric emptying and can do so for DAYS
76
Safest way to induce a peds fx pt
RSI followed by OG decompression

Pediatric Physiology - B. Stevens/Bernstein 2017 (7 decks)

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