Focus

Question 1

What is PAOP equal to?

Answer 1

Left atrial pressure and PAOP and LVEDP should all be equal

Question 2

Which conditions have a big tongue ?

Answer 2

Big Tongue

B - Beckwith syndrome

T - Trisomy 21

Question 3

Which conditions have a small or underdeveloped mandible?

Answer 3

Please Get That Chin

P - Peirre Robin
G - Goldenhar
T - Treacher Collins
C - Cri du Chat

Question 4

What is Pierre Robin?

Answer 4

Think of a Robin

• Small chin
• Usually need to be intubated
• Tongue that falls backward
• Cleft Palate

Question 5

What is Treacher Collins?

Answer 5

Look like a teacher?

No chin
Small mouth
Nasal airway blocked

Question 6

Physical signs of Trisomy 21

Answer 6

Small mouth
Large Tongue
Atlantoaxial instability
Small subglottic diameter

Question 7

What is Klippel-Feil ?

Answer 7

Neck rigidity from fusion of cervical vertebrae

Question 8

What is Goldenhar?

Answer 8

Small mandible
Cervical instability

Question 9

What is Beckwith syndrome?

Answer 9

Large tongue

Question 10

What is Cri du chat?

Answer 10

Small mandible
Laryngomalacia
Stridor

Question 11

Airway specifics for Cleft Lip/Palate?

Answer 11

-Poor airway
-Aspiration
-Difficult DL
-Difficult mask
-Obstruction
-Failure to thrive

Question 12

When is Cleft lip usually repaired?

Answer 12

1 month

Question 13

When is Cleft palate usually repaired?

Answer 13

12 months

Question 14

What is the Dingman-Dott retractor?

Answer 14

Reduces venous drainage and cause tongue engorgement

At risk for post extubation airway obstruction

Question 15

Most common cardiac anomaly with Down syndrome?

Answer 15

Atrioventricular septal defect

Second is VSD

Question 16

What is Vacterl association?

Answer 16

VACTERL

V - Vertebral defects
A - Imperforated anus
C - Cardiac anomalies
T - Tracheoesophageal fistula
E - Esophageal atresia
R - Renal Dysplasia
L - Limb anomalies

Question 17

What is charge association?

Answer 17

CHARGE

C- Coloboma (hole in eye)
H - Heart defects
A -Choanal atresia (nasal blockage)
R - Restriction of growth
G - Genitourinary problems
E - Ear problems

Question 18

What is catch 22? Another name?

Answer 18

CATCH 22
DeGeorge syndrome

C - Cardiac defects
A - Abnormal face
T - Thymic hypoplasia
C - Cleft Palate
H - Hypocalemia
22 - 22 gene deletion

Question 19

What are the two facts about DiGeorge Syndrome ?

Answer 19

May have hypocalemia

High risk for infection due to thymus being absent

Question 20

What type of blood is best to be transfused to DiGeorge syndrome?

Answer 20

Leukocyte-depleted irradiated blood

Question 21

What is the most common coagulation disorder for kids undergoing a T&A?

Answer 21

wvF disease

Question 22

What drug is used to treat wVF?

Answer 22

DDAVP

Question 23

What are kids at risk for when receiving DDAVP?

Answer 23

Hyponatremia

Question 24

What is the most common cause of OSA in kids? What is the most common cause of indication for removing tonsils?

Answer 24

Tonsil hypertrophy

1. OSA ( sleep disorder )
2. Recurrent infections

Question 25

What drug should kids undergoing a T&A not receive ?

Answer 25

Codeine (FDA warning) Risk of resp depression and death

Question 26

How long should kids be admitted to the hospital for a T&A?

Answer 26

23 hours

Question 27

Do kids undergoing a T&A have a longer or shorter emergence?

Answer 27

Longer

Question 28

Should kids undergoing a T&A receive lower or higher opioids?

Answer 28

Lower Use precedex and ketamine

Question 29

How should fluids be calculated for a kid getting DDAVP?

Answer 29

Cut the fluid rate in half

Question 30

What drug should be given for a T&A? Why?

Answer 30

1mg/kg dexamethasone Reduces swelling, pain, and PONV

Question 31

Is there a risk for airway fire during a T&A?

Answer 31

Yes turn FiO2 < 40% Avoid nitrous

Question 32

Okay to suction after a T&A?

Answer 32

Yes but be careful, stay midline

Question 33

Highest risk for primary postop bleeding after a T&A?

Answer 33

Within 24 hours 75% happen within 6 hours

Question 34

Highest risk for secondary postop bleeding?

Answer 34

5-10 days postop when the scar covering contracts

Question 35

Post op T&A bleed? How should they be managed?

Answer 35

RSI Treat as full stomach from swallowing blood Left later, head down Give fluids OGT to decompress the stomach

Question 36

Lowest acceptable age in weeks for same day surgery

Answer 36

60 weeks

Question 37

Most common metabolic disturbance in the newborn?

Answer 37

Hypoglycemia

Question 38

Which two conditions should be looked for in a preoperative interview for a T&A?

Answer 38

OSA Bleeding disorder (Most common is Von willebrand)

Question 39

Most common indication for a liver transplant <2 years old?

Answer 39

Biliary atresia