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Peds Anesthesia - Summer 2013 > First Lecture by Dr. Bernstein > Flashcards

First Lecture by Dr. Bernstein Flashcards

1
Q

What is the most frequent cause of cardiac cyanosis in the first week of life?

A

D-transposition of the great arteries

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2
Q

What is levocardia?

A

The heart sits reversed of where it should be in the chest.

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3
Q

What is dextrocardia?

A

Heart is situated on the right side of the body

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4
Q

What is mesocardia?

A

The apex of the heart sits midline in the throrax.

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5
Q

What does solitus mean

A

Normal arrangement

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6
Q

T/F: Right ventricle delivers blood to both pulmonary and systemic circulation.

A

TRUE

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7
Q

T/F: Left ventricle delvers blood to the systemic and placental circulation.

A

TRUE

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8
Q

What is the normal Po2 from the plecenta?

A

32-35 mmHg

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9
Q

What is the normal O2 sat from the placenta?

A

80 %

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10
Q

T/F: Over 3/4 of the umbilical vein bybpasses the hepatic veins and portal venous system via the ductus venosus into the inferior vena cava (IVC).

A

FALSE (Over 1/2 of the umbilical vein….)

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11
Q

T/F: Fetal pulmonary vascular resistance is low.

A

FALSE

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12
Q

How much blood bypasses the pulmonary circulation from the right ventricle to the ductus arterioles to the descending aorta?

A

90 %

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13
Q

T/F: Right ventricle has a higher output than the left ventricle in FETAL circulation.

A

TRUE

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14
Q

AFTER birth which atrium of the heart has higher pressure?

A

LEFT atrium

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15
Q

Left atrium pressure _________ the right atrium pressure, the flap valve of the ______ _____ closes against the septum secundum, eliminating shunting at the atrial valve

A

exceeds, foramen, ovale

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16
Q

What does the ductus arteriosus connect?

A

The pulmonary arteries to the aorta

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17
Q

The functional closure of the muscular wall of the ductus arteriosus usually takes how long?

A

10-15 hours

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18
Q

What causes closure of the ductus arteriosus?

A

Increase

  • Arterial O2 tension
  • Bradykinin

Decrease
-prostaglandins

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19
Q

What can cause the foramen ovale to reopen after birth?

A
  • Crying
  • Pain
  • hypoxia,
  • hypercarbia
  • acidosis,
  • lung diseaase,
  • sepsis
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20
Q

How long until anatomic closure of the foramen ovale?

A

3 months to 1 year

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21
Q

How long until the anatomical closure of the ductus arteriosus?

A

-1 month to 3 months

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22
Q

What would be used to keep the ductus arteriosus open after birth?

A
  • Prostaglandin E1 infusion

- Alprostadil 50-100 ng/kg/min (0.1 mcg/kg)

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23
Q

What would be used to close ductus arteriosus?

A

-Indomethacin (potent prostaglandin inhibitor)

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24
Q

What is the blood volume of a premature?

A

100-120 ml/kg

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25
Q

What is the blood volue of <3 month old?

A

90 ml/kg

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26
Q

What is the blood volume of a 3 - 12 month old?

A

80 ml/kg

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27
Q

What is the blood volume of a > 12 month old?

A

70 ml/kg

28
Q

T/F: Increase in preload causes little or no change in cardiac output?

A

TRUE

29
Q

Which autonomic system is fully functional at birth?

A

parasympathetic

30
Q

Which autonomic system in a newborn is still incomplet.

A

Sympathetic

31
Q

What is the normal vital signs for an infant

A

-HR 120
-RR: 30 -60
-Blood pressure
Premature : 50/20
Neonate : 70/40

32
Q

T/F: The pulmonary arteries are thick medial smooth muscle layer.

A

TRUE

33
Q

When does peripheral vascular resistance reach adult levels?

A

6 months

34
Q

What environmental factors can cause congenital heart disease?

A
  • Chronic Maternal Disease
  • Maternal Medication
  • Drug Abuse
  • Maternal Diabetes
  • Rubella
  • SLE
  • Phenylketonuria
35
Q

What drugs can cause congenital heart disease?

A
  • Lithium
  • Retinoic acid
  • Phenytoin
  • Trimethadione
  • Thalidomide
36
Q

If a lesion is proximal to mitral valve the _____ heart dilatation will occur.

A

right

37
Q

If a lesion is distal to the mitral valve then the ______ heart dilatation will occur.

A

Left

38
Q

What is the treatment for volume overload lesions?

A
  • Diuretic therapy
  • Afterload circulation to help control pulmonary overcirculation
  • Surgery
  • Transcatheter approach
39
Q

An opening in the atrial septum permitting free communication of blood between the atria is _________.

A

Atrial Septal Defect (ASD)

40
Q

What are the major types of atrial septal defect?

A
  • Secundum ASD
  • Primum ASD
  • Sinus Venous ASD
41
Q

What is the most common type of atrial septal defect? anou

A

Secundum ASD

42
Q

T/F: Cyanosis is present in all atrial septal defects.

A

False: Cyanosis does not occur unless pulmonary HTN is present.

43
Q

If elective, when will a atrial septal defect be closed?

A

-2 to 5 years of age

44
Q

An abnormal opening in the ventricular septum, which allows gree communication between the right and left ventricle is called?

A

Ventricular Septal Defect

45
Q

What percent does ventricular septal defect happen in congenital heart defects?

A

25%

46
Q

What types of ventricular septal defect are there?

A
  • Perimembranous
  • Infundibular (Subpulmonary ofr supracrital)
  • Muscular VSD
  • AVSD
47
Q

What is the most common type of ventricular septal defect?

A

Perimembranous VSD

48
Q

T/F: Small to moderate VSD are usually asymptomatic and half will close by age two of life.

A

TRUE

49
Q

T/F: Moderate to large VSD are usually asymptomatic and half will close by age two of life.

A

FALSE (Moderate to large almost always have symptoms and will require surgical repair)

50
Q

What S/S will be seen with VSD?

A
  • CHF
  • FTT
  • Respiratory infections,
  • exercise intolerance
  • hyperactive precordium
51
Q

_____ is Incomplete fusion the endocardial cushions, which help to form the lower portion of the atrial septum, the membranous portion of the ventricular septum and the septal leaflets of the tricuspid and mitral valves.

A

atrial ventricular septal defect (AVSD

52
Q

What is a complete form of AVSD?

A
  • Low primum ASD continous with a posterior VSD
  • Cleft in both septal leaflets of TV/MV
  • Results in a large L to R shunt at both levels
  • TR/MF, Pulm HT w/ increase in PVR
53
Q

What is the treatment of AVSD?

A
  • Surgery
  • Treat congestive symptoms
  • Pulmonary banding maybe required in premature infants
  • Correction done in infancy to avoid irreversible pulmonary vascular disease
54
Q

What is coarctation of the aorta?

A

is narrowing of the aorta at varying points anyewhere from the transverse arch to the iliac bifuration.

55
Q

Where are most coarctation of the aorta found?

A

Juxtaductal

56
Q

What are the S/S of coarctation of the aorta?

A

-Absence of femoral pulses
-higher BP in the upper extremities compared to lower extremities
-Systolic hypertension of the upper extremities
-pulse discrepancy from R to L arms
-Cardiomegaly
-rib notching on x-ray
-Heart failure
-shock
acidosis

57
Q

What is the treatment of coarctation of the aorta?

A
  • Maintian the ductus arteriosis with prostaglandin E
  • Surgery
  • angioplasty
58
Q

Shunts resistance depends on?

A
  • PVR
  • SVR
  • Ventricular compliance
  • Anatomic obstruction
59
Q

Who receives endocarditis prophylaxis?

A
  • Prosthetic cardiac valve
  • previous infective endocarditis
  • congenital heart disease
  • cardiac transplantation revipients who develop cardiac valvulopathy
60
Q

What antibiotics are used for infant endocarditis?

A
  • Amoxicillin 50 mg/kg
  • ancef of ampicillin 50 mg/kg
  • clindamycin 20 mg/kg
61
Q

What disease has mucocutaneous lymph node syndrome, vasculitis, coronary arteries resulting dilation, aneurysm formation, and MI?

A

Kawasaki Disease

62
Q

T/F: A patient with trisomy 21 will have tachycardia with anesthesia due to the disease.

A

FALSE: (Bradycardia will be seen with trisomy 21 under anesthesia)

63
Q

Describe the S/S of Williams Syndrome?

A
  • Chromosome 7, deletion in the elastin gene
  • Elfin facies
  • Endocrine abnormalities:Hypercalcemia and hypothyroidism
  • growth deficiency
  • altered neurodevelpment
64
Q

T/F: A supra valve aortic stenosis is a major concern in anesthesia for people with WIlliams Syndrome.

A

TRUE

65
Q

What is important to do with a patient prior to anesthesia that has William Syndrom?

A

-Cardiac Evaluation

Peds Anesthesia - Summer 2013 (14 decks)

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