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SNRAObPedGer > Exam 2 Review Cards > Flashcards

Exam 2 Review Cards Flashcards

1
Q

Vasoactive substances: Vasodilators (PDN)

A

Prostaglandins E and I2
Dopamine
Nictric Oxide

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2
Q

Vasocative Substances: Vasoconstrictors (ATEA)

A

Angiotensin II
Thromboxane
Endothelin
Adrenergic Stimulation

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3
Q

Types of Acute kidney Failure

Prerenal is ______%, Intra-renal _____% and Post renal _______

A

70
20-30
10

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4
Q

In pre-renal the BUN/Cr ratio is

A

> 20 (greater than)

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5
Q

In Intral renal the BUN/Cr ratio is

A

< 20

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6
Q

The FENA is prenal when it’s _______in adults and _____in infants

A

<1% in adults and 2.5% in infants

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7
Q

The FENA is renal if it’s __________

A

2%

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8
Q

Pre-Renal Failure is caused by (LEDD)

A

Loss of ECF , cardiac failure, sepsis
Diminished perfusion
Decreased GFR
Exacerbated by NSAIDs, ACEI, ARBs

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9
Q

IntraRenal Failure in infants? adults?

A 
Infants = Birth asphyxia, sepsis, cardiac surgery
Older= trauma, sepsis, hemolytic uremic syndrome
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10
Q

Pre-Renal AKI can cause intrarenal

A

AKI

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11
Q

Intrarenal Obstruction can be caused by _______

A

Acute Glomerulonephritis

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12
Q

Drugs causing intrarena failure (3)

A

Aminoglycosides
Amphotericin B
Nephrotoxins including radiocontrasts

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13
Q

POST RENAL FAILURE is characterized by

A

Characterized by SUDDEN ANURIA

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14
Q

POSTRENAL Failure –> Intrarenal cause

A

Tumor Lysis syndrome
Myoglobinuria
hemoglobinuria
Meds (Acyclovir, ciclofovir)

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15
Q

Ureter failure causes by

A

Stones
External compression from lymph nodes/ tumor
urethra

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16
Q

Urethra obstruction caused by

A

BPH , kidney stones, obstructed urinary catheter, Bladder stone, Bladder, Ureter or renal malignancy.

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17
Q

For dialysis know

A

Input and output from last dialysis

Know dry weight and Actual weight

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18
Q

What should you assess after surgery?

A

Assess pulmonary function

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19
Q

When should dialysis be?

A

The day before and NOT THE DAY OFF

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20
Q

Indications for dialysis (VOPS)

A

Volume overload refratory to DIURETICS
Overt signs of uremia, Pericarditis, and Encephalopathy
Persistent Hyperkalemia
Severe Metabolic Acidosis

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21
Q

When is dialysis recommended?

A

BUN approaching 100mg/dL

Studies showed 60mg/DL may be better

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22
Q

Peritoneal dialysis ________compared with HD

A

Less effective compared with HD

Risk of PERITONITIS

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23
Q

What is the primary cause of Metabolic acidosis?

A

the INABILITY of PROXIMAL RENAL TUBULE to increase AMMONIUM FORMATION

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24
Q

Kidney is unable to form ________in metabolic acidosis?

A

New bicarbonate

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25
Q

With kidney issues, there is EXCESS

A

Phosphate
Sulfate
Organic acids

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26
Q

In kidney, there is __________

A

SECONDARY HYPERPARATHYROIDISM

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27
Q

Hypocalcemia is defined by

A

Decreased CALCIUM absorption because of deficiency of Vitamin D

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28
Q

Infants are unable to Increase this electrolytes

A

PHOSPHATE EXCRETION

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29
Q

Do not give to infants ________enema? why?

A

Phosphate containing enema

Can lead to Life threatening

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30
Q

Phosphate containing enema can cause

A

HYPERPHOSPHATEMIA + HYPOCALCEMIA

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31
Q

Most common complication of CRF

A

hypertension

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32
Q

Infants with CRF are at risk for both

A

Hypertension and Hypotension

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33
Q

Renin activates

A

Angiotensin I –> Converted to Angitotensisn II –> A powerful vasoconstrictor –> may need more antihypertensive or less

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34
Q

TX of HTN with nicardipine

A

0.5- 5 mcg/kg/min max 20mg/hr

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35
Q

Pt with chronic HTN have a tendency of _______ you must _______

A

Tanking BP after induction ; Preload with NS

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36
Q

HTN –> Volume Afterloard

A

Increase Preload + Afterload

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37
Q

Kidney issues lead to what type of Anemia

A

Normocytic Normochromic Anemia

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38
Q

Fenoldopam will

A

Increase GFR without the HTN associated

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39
Q

Fenoldopam is a

A

dopamine-1 receptor agonist

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40
Q

1st line therapy for Acute HTN dose and (max)

A

Labetalol 0.1-0.4 mg/kg/hr q 10min Max 40mg

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41
Q

Renal Hormones

A

Renin, Angiotensin, ANP (vasopressin)

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42
Q

What is serum osmolality tightly regulated by?

A

Vasopressin (ADH)

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43
Q

ADH is released in response to

A

INCREASED PLASMA OSMOLALITY

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44
Q

ADH synthesized by

A

Hypothalamus and stored in posterior pituitary

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45
Q

ADH binds to receptors where? Increasing the ____________

A

In collecting duct; permeability of the tubules to water and leading to increased water resorption and concentrated urine

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46
Q

Neonates are unable to

A

Conserve water

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47
Q

Aldosterone binds to receptors on

A

Cells in the distal nephron , increase the secretion of potassium in the urine

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48
Q

NEONEATES are less efficient at

A

excreting potassium loads

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49
Q

Acidosis : an increase in K+ by ________meQ for every decrease in pH of ______

A
  1. 5mEq

0. 1

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50
Q

Dopamine on GFR

A

Increases

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51
Q

Dexmetetomedine on GFR

A

Increases

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52
Q

Fenoldopam on GFR

A

Increases

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53
Q

Meds requiring excretion are

A

Hydrophyllic

Highly ionized

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54
Q

Examples of meds needing excretion

A 
PCN
Aminoglycosides
Cephalosporins
Vanco
Digoxin
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55
Q

Meds dependent on Renal Elimination

A 
Vec
Roc 
Atropine
Glycopyrrolate
Neo
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56
Q

Which medication takes longer to work with renal patients

A

Rocuronium

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57
Q

Meds that do accumulate and HAVE METABOLITES

A

MORPHINE

MEPEREDINE

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58
Q

Meds that do not accumulate and HAVE NO METABOLITES

A

Fentanyl

Sulfentanyl

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59
Q

For patients with renal disease, decrease dose by

A

30-50%

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60
Q

What about reversal Agent –>

A

SUGAMMADEX
Contraindicated with renal failure
RENALLY SECRETED

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61
Q

No Metabolites with this medication

A

PRECEDEX

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62
Q

Which medication is renal protective ?

A

Propofol

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63
Q

The functional unit of the liver is the

A

Hepatic acinus

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64
Q

The hepatic acinus centered in the

A

Portal track and extends into 3 concentric zones (zones of Rappaport)

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65
Q

The central zones are _______are more active in _______

A

1,2 , OXIDATIVE PROCESS

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66
Q

The distal zone is ________ more susceptible to

A

3, Ischemic and toxic injury

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67
Q

The Hepatic triad is the

A

Bile duct
Branch of the portal vein
Hepatic artery

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68
Q

Enzymes inhibition is when

A

Competing for same enzymes

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69
Q

Enzyme inhibitors are (GFQS)

A

Grapefruit juice
Fluoxetine
Quinidine
Sulfaphenazole

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70
Q

Enzymes induction is when

A

There is ENHANCED EXPRESSION

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71
Q

Enzymes inducers are (RPP, TCC)

A 
Rifampin
Phenytoin
Phenobarbital
Tobacco smoke
Chronic Alcoholism
Carbamezapine
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72
Q

What is the most abundant enzymes in the human liver

A

CYP3A4

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73
Q

50% of drugs metabolized by

A

CYP3A4

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74
Q

Halothane induced Hepatitis–> Halothane inhibits______

A

Inhibits PROTEIN SYNTHESIS and SECRETION which is an
Early indicator of HEPATIC cytotoxic injury
Give SEVOFLURANCE

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75
Q

Halothane is broken down to

A

15-20% to TRIFLUOROACETYL Acid Chloride

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76
Q

What does Increases in liver enzymes indicate

A

Drug-induced INJURY

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77
Q

Are liver enzymes good indicators of liver function

A

NO

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78
Q

Indicators of liver functions tests

A

PT> 15 sec
INR> 1.5
or both

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79
Q

Liver enzymes: ALT vs AST which one specific to Liver

A

ALT

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80
Q

Other Tests for enzymes

A

hypoalbuminena
Hypoglycemia
AMS

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81
Q

Clearance

A

Decrease plasma clearance and prolong effects

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82
Q

Ketamine is metablized via

A

Methylation

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83
Q

Metabolism of this drugs is minimally affected by liver dysfunction

A

Ketamine

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84
Q

Pt with liver disorder, best medication to give is

A

Ketamine

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85
Q

What determines the concentration of an opioid?

A

HEPATIC clearance

PROTEIN binding

86
Q

Damaged liver not as efficient because

A

Decrease first pass effect

Decrease drug clearance

87
Q

Liver disease affect _______Which is how _____is metabolized

A

GLUCURONIDATION; morphine

88
Q

Perfusion limited clearance drugs are (MeLiPenMor)

A

Meperidine
Lidocaine
Pentazocine
Morphine

89
Q

When is MAC the highest

A

@ 6 months

90
Q

MAC is highest in ____Than ____

A

Children; adults

91
Q

Age related MAC changes are related to (3) MGD

A 
Maturational changes in CBF
GABA class A receptors changes
Developmental shifts in regulation of chloride transportes
92
Q

IMPORTANT MAC for potent volatile anesthetics is _______in neonates but may be ________

A

Increased in neonates but may less in SICKER NEONATES and premies

93
Q

ETOMIDATE Dose

A

0.2 - 0.3 mg /kg/ IV

94
Q

What is the dose of diazepam

A

0.1 -0.3 mg/kg

95
Q

Diazepam is contraindicated in

A

Less than 6 months

96
Q

What is the half life of Diazepam

97
Q

What is FA/FI

A

the rate of increase or equilibration of the partial pressure of alveolar to inspired anesthetic (wash-in)

98
Q

FA/FI is the function of

A

The Rate of delivery of anesthetics to AND UPTAKE FROM THE LUNGS

99
Q

Six factors that determine the wash-in of inhaled anesthetics

A 
Inspired Concentration
Alveolar Ventilation
Functional Residual Capacity 
Cardiac Output
Solubility 
Alveolar to venous partial-pressure gradient
100
Q

The factors that determine DELIVERY OF ANESTHETICS to the LUNGS

A

Inspired concentration
Alveolar Ventilation
Functional Residual Capacity

101
Q

The factors that determine REMOVAL (UPTAKE) from the lungs

A

Cardiac output
Solubility
Alveolar to venous partial pressure gradient

102
Q

Wash in ______Related

A

inversely related to their solubilities in blood

103
Q

FA/FI is inversely related to

A

Changes in CO

104
Q

There is a rapid

A

rapid rate of increase of FA/FI in neonates

105
Q

What most happen for the rate of FA/FI to increase toward equillibration?

A

For the rate of FA/FI to increase toward equillibration, the RATE OF DELIVERY of ANESTHETIC to the lungs must substantially exceed its UPTAKE FROM THE LUNGS.

106
Q

When the ratio is 1

A

Inspired and alveolar partial pressure have EQUILLIBRATED

107
Q

FA/FI mostly affects

A

Soluble agents

108
Q

Opposite reactions of FA/FI in pediatric

A

Increase CO speeds up FA/FI

More CO goes to vessel rich groups

109
Q

Wash out curve follow

A

Exponentional decay

Exact oppposite of wash in curves

110
Q

Wash out similar in _______and more rapid in ________

A

Children and adults

Neonates and infants.

111
Q

Nonrebreathing circuits lack and there ‘s

A

Unidirectional valves and theres minimal work of breathing

112
Q

In NRB there is no ____________rebreathing is highly dependent on

A

Fresh gas flow

113
Q

Wht is the minimum FGF

A

5L min

2-3 MV

114
Q

Expiration

A

Exhaled gas push down expiratory limb and collects in reservoir bag and open exp valve (APL)

115
Q

All NRB are convenient

A

Lightweight and easily scavenged

116
Q

Use MAPLESON D Circuit in children

117
Q

Bain circuit

A

FGF tubing directed within inspiratory limb
FGF enters NEAR MASK
Add more head and humidity.

118
Q

Minimum ABL calculation

A

MABL = EBV * (Starting Hct - target Hct/ Starting Hct)

119
Q

EBV premature

120
Q

EBV full term

121
Q

EBV 3-12 months

122
Q

EBV 1 year +

123
Q

Which medications is contraindicated for seizure disorder

A

Ketamine (cerebral excitation)

124
Q

Meperidine dose _________–> Long infusions—->_____________ —> Seizures

A

1-2mg/kg

Normeperidine

125
Q

Methohexital dose IV

126
Q

Methohexital dose rectal

A

20-30mg/kg/PR

127
Q

Ketamine IV dose

128
Q

Ketamine PO and rectal dose

129
Q

Ketamine IM dose for sedation

130
Q

Ketamine IM dose for GENERAL INDUCTION

131
Q

Propofol dose

132
Q

Midazolam dose IV/IM

133
Q

Midazolam dose intranasal

134
Q

Fentanyl lollipops

A

15-20 mcg/kg

135
Q

Midazolam PO/ or Per rectum

136
Q

Reglan dose PO , IV

137
Q

Glycopyrrolate dose IV, and IM

A

5-10MCG/kg IV ; 10mcg/kg IM

138
Q

Zofran dose

A

0.1mg/kg IV

139
Q

Fentanyl dose is

140
Q

Succinylcholine dose is

A

1-2mg/kg IV

4mg/kg IM

141
Q

Succinylcholine dose for laryngospasm

A

0.1 mg/kg IV

4 mg/kg IM

142
Q

Atracurium dose is

A

0.5mg/kg IV

143
Q

Cistracurium dose is

A

0.15mg/kg IV

144
Q

Vecuronium dose

145
Q

Rocuronium dose is _______IV and _____IM

A
  1. 6 - 1.2mg/kg IV

1. 8 mg/kg IM

146
Q

Neogstimine dose is

A

0.02-0.025 mg/kg

147
Q

Sugammadex dose is

148
Q

RSI give _______of _____Prior to succinylcholine

A

Atropine

0.02mg/kg

149
Q

Morphine half life

A

2 - 3.5 hours

150
Q

Hydromorphone and oxycodone half life

151
Q

Methadone Half life

A

22-25 hours

152
Q

Meperidine half life

153
Q

Codeine half life

154
Q

Fentanyl half life

155
Q

Atracurium maintenance dose during anesthesia with N2O

156
Q

Atracurium maintenance dose during anestheisia with halothane

157
Q

Atracurium suggested dose for Tracheal intubation

A

0.5 - 0.6 mg/kg

158
Q

Cisatracurium maintenance dose for anesthesia with N2O

A

0.10 mg/kg

159
Q

Cisatracurium dose for tracheal intubation

A

0.10 mg/kg

160
Q

Vecuronium dose for tracheal intubation

A

0.10 - 0.15 mg/kg

161
Q

Vecuroinum maintenance dose for anesthesia with N2O

A

0.08 mg/kg

162
Q

Neogstimine maintenance dose

A

(0.02-0.06mg/kg ) + atropine (0.01 - 0.02mg/kg)

163
Q

2 medications with doses in Mcg

A

Fentanyl

Glycopyrrolate

164
Q

True emergencies list (MINB)

A

NEC –> if free air in abdomen
Bilateral Stenosis with (choanal atreasia)
MALROTATION and MIDGUT VOLVULUS
INCARCERATED or STRANGULATED HERNIA

165
Q

GI pathology not an emergency unless

A

compromised blood flow

166
Q

Fentanyl half life with premies

A

6-32 hours

167
Q

Which opioid has the longest half life

A

Methadone.

168
Q

OMPHALOCELE (FWB) Cause location, associated symptoms)

Bowel is

A

Failure of gut to migrate from yolk sac to abdomen
Within umbilical cord
Beckwith wiedeman syndrome (macroglosia, gigantism, hypoglycemia, hyperviscosity, CHD, estrophy of bladder)

Bowele looks and functions normally

169
Q

GASTROCHItis Causes, location and associated sx (OPE)

Bowel is

A

Occlusion of Omphalomesenteric actery
PERIUMBILICAL
Exposed gut inflammation, edema, dilation and foreshortened

Functionally abnormal

170
Q

Metabolic derangements in GI disorders are (HAT)

A

HypeRKALEMIA

Anemia
Thrombocytopenia

171
Q

Most susceptible injury of micropremie is

A

PERIVENTRICULAR WHITE MATTER

172
Q

Neonatal brain has

A

Greater brain weight in proportion to body weight.

173
Q

Bilious EMesis seen in (DMH)

A 
Duodenal atresia (congenital absecense or complete close of a partion of the lumen of the duodenum)
Malrotation and midgut volvulus
Hirschprung disase : absence of parasympathetic ganglion in large intestine
174
Q

NON-Bilious emesis seen in

A

HYPERTROPHYIC PYLORIS STENOSIS

175
Q

CNS effects : anesthetics

A

Both neuroprotective and neurotoxic

176
Q

Choanal Atresia is Developmental failure of

A

nasal cavity to communicate c/ nasopharynx

177
Q

Choanal Atresia may be• Associated c/ other congenital anomalies
• CHARGE syndrome TP
• VATER

A 
Coloboma
Heart disease
Atresia choanae
Retarded growth
Genital anomalies
Ear anomalies)
  • Treacher-Collins
  • Pfeiffer
Vertebral defects
Anal atresia
Tracheoesophageal fistula c/
Esophageal atresia
Radial and renal anomalies
178
Q

Most common TEF classification

Gross classification and VOGT type:

A

Gross classification C, Vogt type 3B
consists of blind proximal esophageal pouch (atresia) with a distal TEF just above the carina
80%–90% of cases

179
Q

Litigation of PDA Controversial procedure due to conflicting evidence why?
• Ibuprofen works just as well s/complications • Paracetamol being used c/ equal
effectiveness

A

1/3 develop severe cardiovascular instability • Increased risk of chronic lung disease, ROP, and neurosensory impairment after ligation

180
Q

• Medical management of Litigation of PDA:

Class of medication________such as _______and _______

A

cyclooxygenase inhibitor, such as indomethacin or ibuprofen

181
Q

For treatment of PDA, Indomethacin in premies may cause:

A

Thrombocytopenia
Renal failure,
Hyponatremia
Intestinal perforation

182
Q

Surgical correction of PDA

A

Left thoracotomy with manual retraction of lung

183
Q

Hard to distinguish_____From _____

What is done to distinguish?

A

PDA from aorta
Monitoring BP and pulse ox on right arm (preductal) and oximetry on the foot (postductal) will assist surgeon to identify the correct vessel to be ligated

184
Q 
To identify correct vessel ? 
A\_\_\_\_\_\_\_\_\_ placed on perceived PDA
• If aorta is clamped →
• If PA is clamped →
• Successful PDA ligation →
A

Temporary clamp
loss of post ductal oximetry
↓in both oximeters and ↓ETCO2
↑MAP (↑DBP) + NO changes in pulse oximeters

185
Q

Transcatheter occlusion of PDA
Similar _________
Can be done where _________
More _________

A

Coils or occlude device
• Similar efficacy to traditional surgery
• Can be done in NICU c/ echo guidance
• More rapid recovery of resp function

186
Q

Most common complications of Transcatheter occlusion of PDA (FLA)

A
  • Femoral artery thrombosis
  • Left pulmonary artery stenosis
  • Aortic coarctation
187
Q

Appropriate selection of Isoflurane

A

☺ Less myocardial depression than Halothane
☺ PRESERVATION OF HEART RATE
☺ CMRO2 reduction rate

188
Q

DESFLURANE anesthetic selection

A

Increased incidence of coughing, laryngospasm,
secretions
☺ Concern of hypertension and tachycardia from
sympathetic activation

189
Q

Appropriate selection of SEVOFLURANE

A

Can cause bradycardia during induction
less pungent than ISO
MOST SUITABLE FOR INDUCTION

190
Q

Mida + keta

A

100% peaceful separation

191
Q

HR normally unaffected by desflurane unless

• Attenuated by

A

inspired concentration↑ suddenly

opioid administration

192
Q

ETOMIDATE with induction

A

Cardiac stable, less apnea than propofol, quickly redistribute

193
Q

Improve platelet count (DRE)

A
  • DIALYSIS
  • RBCs
  • EPO
194
Q

Ketamine can cause:

A

Decrease ventilation and airway reflexes

obstruction. apnea, aspiration

195
Q

Gastrochisis there is

A

Extreme evaporative volume loss and Hypothermia

KEEP COVERED WITH saline soaked dressings

196
Q

Hypertrophic PYLORIC STENOSIS is associated with

A

HYPOKALEMIA
HYPOCHLOREMIA
Metabolic ALKALOSIS

197
Q

More soluble

198
Q

Less soluble

A

Nitrous Oxide (N2O)

199
Q

From top to bottom chart

200
Q

Lipid soluble agents 3

A

Midazolam
Propofol
Ketamine

201
Q

Concern with giving fentanyl to fast

A

Chest wall rigidity

GLOTTIC rigidity

202
Q

Alfentanyl and sufentanyl can cause

A

Parasympathetic Response

Bradycardia and Hypotension

203
Q

Contraindications for Ketamine

A 
COIS
Can't use for EEG
Open globe injury
Increased ICP
Seizures
204
Q

Patient with LIVER issues give this medication (anest)

A

SEVOFLURANE

205
Q

Dual blood sources of the liver

A

Portal vein 70% drains spleen and intestine

Hepatic Artery

206
Q

Sevo is metabolized to

A

Formyl Fluoride 2-5 %

207
Q

Which medication does not break down to TFA

A

Sevoflurane

208
Q

When a patient has TEF

A

Look for other anomalies as well

209
Q

FROM MOST TO LEAST METABOLIZED (hid)

A

Halothane
Isoflurane
Desflurane

210
Q

Fentanyl lack these needed anesthesia properties

211
Q

Peritubalar secretes in response to hypoxemia

A

Erythropoietin

212
Q

Calculate weight based on age

A

2 x age (yrs) + 9

SNRAObPedGer (25 decks)

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