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Exam 3 Review Flashcards

1
Q

Which of the following is not a cyanotic lesion?

Tricuspid atresia
TGA
ToF
Coarctation of the Aorta

A

Coarctation of the Aorta

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2
Q

Prostaglandins are used to:

Treat TET Spell
Close VSD
Keep PDA
Reverse Shunting

A

Keep PDA

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3
Q

Describe chest X-ray findings for the following:

D-TGA
L-TGA
ToF
Coarctation of the Aorta
RVH
TAPVR

A

D-TGA: Egg on a string
L-TGA:
ToF: Boot Shaped Heart
Coarctation of the Aorta: Figure 3 sign
RVH:
TAPVR: Snowman (wide superior mediastinum)

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4
Q

Which of the following is not a condition of ToF?

VSD
LVH
RVOT Obstruction
Overriding Aorta

A

LVH

(ToF includes RVH)

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5
Q

What is the BEST way to treat a TET spell?

Knee to chest position
Fentanyl
Fluid Bolus
Propanolol

A

Knee to chest position- increases intrathoracic pressure/reverses shunt

(Know all for exam)

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6
Q

Choanal Atresia
Gastroschisis
Omphalocele
Umbilical Hernia

A

Omphalocele: The WORST one

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7
Q

Recognize the following on an X-RAY:

Esophageal atresia
Volvulus
Esophageal Fistula

A

Esophageal Fistula: NG tube loops in pocket of esophagus

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8
Q

KUB (Abdominal X-RAY)

Midgut Volvulus
Intrussusception

A

Midgut Volvulus: Extensive gas trapping

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9
Q

POCUS Intussusception

A

Midline abdominal view: folded-over appearance

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10
Q

What patient should always be transported in the prone position?

Esophageal atresia
Choanal atresia
Pierre-Robin Syndrome
Guillain-Barre Syndrome

A

Pierre-Robin Syndrome

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11
Q

You have a newborn baby appearing with central cyanosis, grimace, and flexed extremities. Pulse is 86bpm and the baby is not breathing. What is the APGAR score?

A

Appearance, Pulse, Grimace, Activity, Respirations

A- 0
P- 1
G- 1
A- 1
R- 0

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12
Q

Which of the following is TRUE regarding neonates?

PAC’s show CHD
34 weeks gestations means MAP > 34mmHg
Normal neonatal HR is 100-150bpm
Urine output should be 2mL/hg/hr in the first 24 hours

A

A neonate that is 34 weeks gestation should have a MAP of at least 34mmHg.

(MAP = )

PAC’s are normal
HR is 120-160
UO: anuria is normal in the first 24 hours

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13
Q

Which of the following neonatal head bleeds does not cross the suture lines?

Cephalohematoma
Caput succedaneum
Subgaleal hemorrhage
Galea aponeurotica

A
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14
Q

Which of the following, regarding primitive reflexes in neonates, is false?

Palmar grasp disappears at 4 months of age
Moro reflex: Arms abduct at shoulder & extend elbow
Sucking reflex is the earliest reflex; formed at 16 weeks gestation
Extension and fanning of toes is positive Babinski

A

Extension and fanning of toes is positive Babinski
(Opposite of adult response. Flexion and closing of toes is positive; transitions @ 12-18 months when they begin to stand/walk)

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15
Q

What value is considered hypoglycemia in the neonate in the first 4 hours of life?

<40mg/dL
<45mg/dL
<50mg/dL
<60mg/dL

A

<40 mg/dL

(>4 hours: <45mg/dL)

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16
Q

You have a 3 hour old, 1600g neonate with a BGL of 30mg/dL. What is your first line of treatment?

6mL/kg D15
6mg D10
3mL D10
3mL/kg/min D12.5

A

3mL D10

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17
Q

Which of the following pathogens is the most likely cause of congenital pneumonia?

GBS
S. Aureus
H. Influenzae
H. Pylori

A

GBS (Group B Strep)

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18
Q

Which of the following is not part of the classic triad of congenital pneumonia?

Increased WOB
Tachypnea
Hypothermia
Tachycardia

A

Tachycardia

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19
Q

What broad-band antibiotic is first line empiric therapy for congenital pneumonia?

Ampicillin
Vancomycin
Tetracycline
Levaquin

A

Ampicillin

(Tetracycline and Levaquin are not given to neonates)

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20
Q

Which of the following is a sign of respiratory failure in the neonate?

PaCO2 > 60mmHg
Tachypnea
Rales
PaO2 <90mmHg in >90% FiO2

A

PaCO2 >60mHg

(Rales is VERY rare in neonates)

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21
Q

Cervical Palsy
Klompke Palsy
Erb-Duchenne Palsy
Cerebral Palsy

A
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22
Q

Erb-Duchenne Palsy presentation:

A

A form of brachial plexus injury

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23
Q

You’re resuscitating a neonate that Aeneid for 5 minutes. As a general rule, how long should you expect to provide PPV?

10-20 minutes
5-10 minutes
2-4 minutes

A

10-20 minutes

(2-4 minutes of PPV per minute of Apnea)

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24
Q

What FiO2 should be used when resuscitating a neonate?

21-30%
40-50%
>50%
100%

A

21-30%

(100% FiO2 can cause Brocho-Pulmonary Dysplasia, blindness; also closes PDA)

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25
Q

Surfactant is required for all neonates less than ____ weeks gestation?

26
23
30
28

A

26 weeks

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26
Q

Why do we give surfactant?

A

Reduce surface tension to facilitate gas diffusion.

(Surfactant is a detergent!)

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27
Q

What is the most common cause of respiratory failure in the neonate?

Hyaline membrane disease
Narcotic OD
PPHN
Tracheoesophageal fistula

A

Hyaline membrane disease

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28
Q

X-Ray:

Hyaline Membrane Disease
Tracheoesophageal fistula
PPHN

A
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29
Q

What weight range should be transported using a thermoregulated isolette?

<4.5kg
<6.5kg
<10kg
<8kg

A

<4.5kg

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30
Q

What is the final electron acceptor in cellular respiration?

Oxygen
Carbon Dioxide
Pyruvate
NADH

A

Oxygen

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31
Q

What respiratory condition requires increased work during expiration?

Obstructive disease
Restrictive disease
ARDS
Cystic Fibrosis

A

Obstructive Disease

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32
Q

Which of the following causes a very high V/Q ratio?

Pulmonary embolism
Pulmonary shunt
Pulmonary edema
Pulmonary contusion

A

Pulmonary Emobolism

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33
Q

Which of the following is the most common cause of clinical hypoxemia?

Hypoventilation
Diffusion limitation
Shunt
V/Q mismatch

A

V/Q mismatch

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34
Q

Which of the following causes the oxyhemoglobin dissociation curve to shift up?

Blood Transfusion
Hemorrhage
Acidosis
Anemia

A

Blood Transfusion

Hemorrhage: Down
Acidosis: Right
Anemia: Down

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35
Q

Which of the following shifts the oxyhemoglobin dissociation curve to the left?

decreased [H+]
Decreased pH
Increased 2,3-DPG
Acidosis

A

Decreased concentration of protons ([H+]) (alkalosis)

36
Q

Increase in the concentration of CO2 displaces O2 from Hb and binding of O2 to Hb will displace CO2 from the blood due to:

Haldane effect
Bohr effect
HAPE
HACE

A

Haldane effect

(Haldane describes CO2; Bohr describes O2)

37
Q

What is the toxic dose of Acetaminophen?

140mg/kg
240mg/kg
90mg/kg
25mg/kg

38
Q

Which of the following is not absorbed by activated charcoal?

Alcohol
Phenobarbital
Carbamazepine
Aminophylline

39
Q

What is the treatment for APAP OD?

N-Acetylcysteine
Sodium Bicarbonate
Narcan
MeOH

A

N-Acetylcysteine (Mucamyst)

40
Q

Which of the following is not a treatment for HACE?

Hyperventilation
Lasix
Dexamethasone
Oxygen

A

Hyperventilation

(High-altitude Cerebral Edema)

41
Q

Which of the following is a Cation?

K
Cl
O
I

A

K (Potassium, K+)

(Chloride, Oxygen, Iodide; all negative; Anions)

42
Q

Carbonic anhydride facilitates the conversion of:

CO2 and H2O to carbonic acid
Carbonic acid to CO2 and H2O
Carbonic acid to HCO3 and H+
HCO3 and H+ to Carbonic acid

A

CO2 and H2O to Carbonic Acid

Carbonic acid then dissipates to HCO3 and an acid.

Carbonic acid freely dissociates to CO2 and H2O

43
Q

Which of the following conditions will present with a normal anion gap?

Hyperkalemia
Lactic Acidosis
Uremia
DKA

A

Hyperkalemia

all the others are elevated gap metabolic acidosis

MUDPILES
Lactic Acidosis, DKA, and Uremia are the BIG 3 elevated anion gap acidosis’

44
Q

Name that ABG: pH 7.33, PaO2 88, CO2 55, HCO3 23

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

A

Respiratory Acidosis

Uncompensated

45
Q

Name that ABG: pH 7.33, PaO2 88, CO2 36, HCO3 20

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

A

Metabolic Acidosis

Partially Compensated (CO2 trending toward alkalosis)

46
Q

Name that ABG: pH 7.53, PaO2 88, CO2 36, HCO3 30

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

A

Metabolic Alkalosis

pH and Bicarbonate are alkolotic

Uncompensated

47
Q

Using Slovis rule, what do you the PaCO2 will be compensation for with a HCO3 of 30?

45
30
15
50

A

45

Slovis Rule: Bicarb + 15= estimated PaCO2

48
Q

You run a VBG and the patient has a pH of 7.33. Estimate the arterial pH.

7.36
7.33
7.30
Impossible to know

A

7.36

(Approximately 0.03 above the venous pH)

49
Q

Which of the following is anaerobic?

Glycolysis
Citric acid cycle
Electron transport chain
None of these

A

Glycolysis

(Citric acid cycle and electron transport chain are VERY aerobic)

Glycolysis produces lactic acid (NADH + Pyruvate)

50
Q

What plays an essential role in turning Pyruvate into Lactate?

NAD+
CO2
FAD
Acetyl Co-A

51
Q

Which is not an important determinant of oxygen delivery?

PaO2
CO
Hb
SaO2

A

PaO2

Review this equation

52
Q

Which is typical of hypovolemic shock?

High SRV
High CO
High DO2
Normal PCWP

A

High SVR (Catecholamines cause vasoconstriction)

53
Q

Which is typical of cardiogenic shock?

Low DO2
Low SVR
High CO
Low PCWP

A

Low DO2

Catocholamines cause vasoconstriction, increasing afterload, decreasing CO. PCWP=LVEDP, CVP and PCWP increase.

54
Q

Which is not typical of Sepsis?

Low DO2
Low SVR
Low PCWP
High CO

A

Low DO2

High CO, Low SVR, and High DO2 are hallmarks of Sepsis hemodynamics

55
Q

Which of the following is found in obstructive shock?

Low SVR
High Afterload
High Contractility
Low Preload

A

High Afterload

High CVP=High Preload, Obstructed contractility, High SVR (Catecholamines)

56
Q

Which of the following values is low in cardiogenic shock?

SVR
CI
CVP
PCWP

A

CI (Cardiac Index= Cardiac Output/BSA)

57
Q

Which of the following values is high in hypovolemic shock?

SVR
CVP
PCWP

A

SVR (Catecholamines)

58
Q

Which of the following is correct regarding the EGT (end-goal-therapy) of septic shock?

Lactate <4
CI >3.2
SvO2 >75%
Hb >10

59
Q

Which drug is a negative inotrope with vasodilatory properties?

milrinone
Labetalol
Hydralazine
Norepinephrine

A

Labetalol

Negative inotrope, alpha-blocking (vasodilation)

Beta-blockers are the predominant category of negative inotropes

60
Q

Which drug has the strongest alpha properties?

Phenylephrine
Dopamine
Epinephrine
Norepinephrine

A

Phenylephrine

61
Q

Which of the following is excreted from the posterior pituitary gland?

Prolactin
LH
FSH
Oxytocin

62
Q

Which hormones are excreted by the posterior pituitary gland?

A

Oxytocin and Vasopressin

63
Q

Which hormones are excreted by the anterior pituitary gland?

A

LH and FSH

64
Q

As osmolarity increases, secretion of ADH:

Decreases
Remains the same
Increases
Impossible to know

A

Increases

Linear and parallel correlation

65
Q

This severe expression of hypothyroidism is accompanied by hypothermia:

Grave’s disease
NTIS
Myxedema coma
Thyroid storm

A

Myxedema coma

(Thyroid storm is severe expression of hyperthyroidism; presents with hyperthermia)

66
Q

What condition presents with increased action of T3 and T4, exceeding demands of the patient?

NTIS
Myxedema Coma
Grave’s Disease
Thyroid Storm

A

Thyroid Storm

67
Q

What pre-existing condition is seen with DKA?

DM-I
DM-II
Diabetes Incipidus
Nephritis

A

DM-I

(DM-II typically precedes HHS)

68
Q

Which vent mode is a pressure controlled-volume targeted mode, delivering each breath at the lowest possible peak pressure?

SIMV
AC
PRVC
APRV

69
Q

Which of the following is false regarding APRV?

Vt can fluctuate
Pt can breathe spontaneously
Utilizes a high and low pressure
Pt should be paralyzed

A

PT should be paralyzed

PT is preferably awake and able to augment their minute ventilation

70
Q

Which of the following affects CO2?

RR
Vt
PEEP
FiO2

A

Respiratory Rate and Tidal Volume

(Minute Ventilation= RR x Vt)
(Ventilation = CO2)
(Two types of respiratory failure: Hypoxic and Hypercarbic)
(PEEP improves oxygenation and reduces V/Q mismatch)

71
Q

Which of the following affects oxygenation?

FiO2
RR
PEEP
Vt

A

FiO2 and PEEP

72
Q

“The amount of the acceleration of a body is proportional to the acting force, and inversely proportional to the mass of the body.”

Newton’s 1st law of motion
Newton’s 2nd law of motion
Newton’s 3rd law of motion
Newton’s 4th law of motion

A

Newton’s 2nd law of motion

73
Q

How much blood should be drained in a hemothorax injury?

500ml
1000ml
15000ml
2000ml

A

1500ml OR 400/hr x 4 hours

74
Q

Tx of an open pneumothorax includes:

Occlusive dressing, taped 3 sides
place chest tube through opening
High PEEP and Vt
Occlusive dressing, taped 4 sides

A

Occlusive dressing, taped 4 sides

75
Q

Beck’s triad includes all of the following EXCEPT:

Tachycardia
JVD
Narrow pulse pressure
Muffled heart sounds

A

Tachycardia

76
Q

Which of the following is true regarding Beck’s triad?

Early finding
Hypotension is rare
Only 40% show finding
Muffled heat sounds are easy to hear

A

Only 40% show finding

77
Q

In time-cycled pressure limited ventilation, the patient develops and pneumothorax. You should expect the PIP to:

Slowly increase with each breath
Decrease
No Change
Increase

A

No change

(Pressure-limited mode! It’s going to always provide the same pressure. In this scenario, Vt will decrease)

78
Q

In Volume-cycled ventilation, a patient develops a pneumothorax. You would expect the PIP to:

Vary from breath to breath
Increase
Decrease
No Change

79
Q

What size ETT do you use for a 6yo?

6.0
5.5
5.0
6.5

A

5.5

(16+age)/4

80
Q

A disease seen in pediatrics between the age of 3-5 years, caused by H. Influenzae?

RSV
Croup
Laryngotracheobronchitis
Epiglottitis

A

Epiglottitis

(Croup = Laryngotrachealbronchitis)
(H. Influenzae is a bacteria! RSV is a VIRUS)

81
Q

What is the best treatment for a TET spell?

Morphine
Knee to chest position
Versed
Fentanyl

A

Knee to chest position

82
Q

This condition starts with abdominal pain + diarrhea, then the child gets ill w/ renal failure:

Meningitis
DH
HUS
Bronchopulmonary Dysplasia

83
Q

A patient with a Hb of 7.0 receives 4 unit of PRBC. What is the post-transfusion Hct?

33
11
25
40

A

33

(Hb increases by 1.0 per unit transfused)
(Hct is ~3x the Hb)

84
Q

Which of the following is used in the treatment of DIC?

Albumin
Platelets
FFP
Whole Blood

A

FFP

(Heparin and FFP are the standard first line treatment for DIC)

85
Q

What does mixing blood with D5W cause?

Hemolysis
Clotting
Increased Osmolarity
No Reaction

86
Q

Rule of 9’s: 2nd° burn, full face and anterior left arm.

10.5%
8.5%
12.5%
9.5%

A

8.5%

Anterior left arm = 4.5%
Full face= ~4%

CCP (5 decks)

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