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Pediatric ACNP > Gastrointestinal & Pain/Sedation > Flashcards

Gastrointestinal & Pain/Sedation Flashcards

1
Q

Pain will be present with passive extension or flexion of the right lower extremity

A

Psoas Sign

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2
Q

Pain present with internal rotation of the right thigh

A

Obturator sign

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3
Q

Pain reported in the right lower quadrant with palpation of the left lower quadrant

A

Rovsing Sign

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4
Q

Antibiotic coverage targeted toward what bacterial flora in appendix

A
  • E. coli
  • Strep. milleri
  • Anaerobes
  • P. aeruginosa
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5
Q

Differential diagnoses for abdominal masses

A
  • Organomegaly
  • Constipation
  • Umbilical hernia
  • Benign cystic lesion (choledochal cyst, polycystic kidney disease, duplication cyst, cystic teratoma)
  • Neuroblastoma
  • Wilms tumor
  • Hepatoblastoma
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6
Q

Most common extracranial tumor in children, age at presentation is 18 months, with the prevalence greatest in children <4 years

A

Neuroblastoma

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7
Q

Most common renal tumor and the 5th most common pediatric malignancy, with a common presentation age of 1-5 years

A

Wilms tumor

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8
Q

Most common malignant tumor of liver with a mean age at diagnosis 1 year, occurring in the right lobe of liver and associated with extreme prematurity, low birth weight, Beckwith-Wiedemann syndrome, Gardner syndrome, and familial adenomatous polyposis disease

A

Hepatoblastoma

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9
Q

Absence or obstruction (due to fibrosis) of the biliary tree, leading to intrahepatic bile duct obstruction and proliferation

A

Biliary Atresia

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10
Q
  • Obstruction of bile flow from liver due to inflammatory process
  • Fibrosis or scarring obliterates the ducts and prevent bile from being transported from liver to GI tract
  • Resultant cirrhosis and eventual development of liver failure
A

Pathophysiology of biliary atresia

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11
Q

Physical exam findings of biliary atresia

A

Jaundice, acholic stool, dark urine

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12
Q

Management of Biliary Atresia

A
  • Kasai procedure
  • Nutrition (130-150% recommended daily allowance and 150kcal/kg/day)
  • Treatment of cholestasis (actigal, questran, phenobarbital)
  • Treatment of portal hypertension
  • Liver transplantation
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13
Q

Most common indication for liver transplantation

A

Biliary Atresia

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14
Q

Pain on deep inspiration when the inflamed gallbladder is palpated

A

Murphy sign

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15
Q

Five Types of Esophageal Atresia

A

Type A: EA w/out fistula
Type B: EA w/ proximal fistula
Type C: EA with distal fistula; most common type
Type D: EA w/ proximal and distal fistula
Type E: Tracheoesophageal fistula w/out atresia

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16
Q
  • Newborn with excessive oral secretions, drooling, accompanied by coughing, choking, or sneezing
  • Feeding can cause cyanosis, choking, emesis
A

clinical presentation of EA

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17
Q
  • Obstruction of proximal duodenum secondary to failure of recanalization
  • Associated with T21
A

Duodenal Atresia

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18
Q

Bilious emesis in the first hours of life

A

clinical presentation of duodenal atresia

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19
Q

Abdominal radiograph with a double bubble sign representing the stomach and proximal duodenum

A

diagnostic evaluation of duodenal atresia

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20
Q

Antidiarrheal medications often contain aspirin, which contributes to Reye syndrome and show be avoided. True or False

A

True

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21
Q

Reasons for upper GI bleeding

A
  • Ulcers (gastric or dodenal)
  • Helicobacter pylori
  • Esophageal varices
  • Liver disease
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22
Q

Reasons for lower GI bleeding

A
  • Infectious colitis
  • Colonic polyps
  • Allergic colitis/milk-protein enteropathy
  • Anal fissure
  • IBD (Crohn, UC)
  • Ischemia (intussusception, obstruction)
  • Meckel diverticulum
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23
Q
  • Hematemesis/bright red blood from GT
  • coffee-ground emesis/output from gastric tube
A

clinical presentations of upper GI bleeding

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24
Q
  • Melena: hemoccult positive stool with black, tarry appearance
  • Hematochezia (painful vs painless)
A

clinical presentations of lower GI bleeding

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25
Q
  • metabolism of glucose, lipid, nitrogen, drugs, toxins
  • synthesis of albumin and coagulation factors
  • formation of bile and bile acids
A

Functions of the liver

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26
Q

Hepatitis A

A

fecal-oral; common in child care centers; contaminated food/water

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27
Q

Hepatitis B

A

blood, saliva, semen, transplacental; infants especially susceptible

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28
Q

Hepatitis C

A

mother to infant, blood, saliva, semen

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29
Q

Labs that can help distinguish if source is liver or other muscle/tissue etiology

A
  • Fractionated alkaline phosphatase
  • GGT
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30
Q

Rapid decrease in AST/ALT with increased coagulation and bilirubin suggests worsening hepatic failure. True or False.

A

True

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31
Q

Hepatitis Pearls

A
  • Vaccination is available and part of the recommended immunization schedules for Hep A and B
  • Diagnosis of Hep A does not lead to chronic infection
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32
Q

Unconjugated/indirect bilirubin levels suggest

A

hemolytic cause
- Physiologic (newborns): increased erythrocyte breakdown, enzyme deficiency, increased extrahepatic circulation
- Pathologic: infection, G6PD deficiency, ABO incompatibility, Gilbert syndrome

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33
Q

Conjugated/direct bilirubin levels suggest

A

hepatobiliary disease
- anatomic/obstruction: BA, choledochal cyst, gallstones/sludge, CF
- Infectious: sepsis, UTI, viral
- Metabolic/Genetic: Alagille syndrome, Down syndrome

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34
Q

Irreversible, bilirubin-induced brain dysfunction as a result of bilirubin deposition into gray matter of brain

A

Kernicterus

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35
Q

Hyperbilirubinemia Pearls

A
  • Physiologic: total bilirubin e14mg/dL; resolves in 2 weeks
  • Hyperbilirubinemia in children >2 weeks of age requires further investigation
  • Direct bilirubin level e1.5mg/dL requires further evaluation
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36
Q
  • nonmechanical obstruction of the intestines
  • disruption of peristalsis that can be partial or complete, results in dilation of proximal intestines
A

Ileus

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37
Q

Management of Ileus

A
  • bowel rest, NGT for decompression
  • Postop pain management w/out narcotics
  • Ambulation and time
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38
Q

inflammatory process that can affect any portion of the GI tract; most commonly affects the terminal ileum; inflammation is the entire lumen of the intestines

A

Crohn Disease

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39
Q

inflammatory process that affects the colon and rectum; inflammation is the mucosal layer of the intestinal wall

A

Ulcerative Colitis

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40
Q

feeling that you need to pass stools, even though your bowels are already empty

A

tenesmus

41
Q

clinical presentation of Crohn disease

A

pain, diarrhea, weight loss, perirectal inflammation with fistula

42
Q

clinical presentation of ulcerative colitis

A

bloody, watery diarrhea, weight loss, tenesmus, urgency

43
Q

gold standard diagnosis of IBD

A

endoscopy of intestinal tract w/ bx and histology

44
Q

Liver transplant management

A
  • Immunosuppression therapy (tacrolimus)
  • Ppx antibiotic/antiviral meds
  • Close monitoring for infection
  • Fluid management
  • Anticoagulants (aspirin)
45
Q

small bowel twists around the superior mesenteric artery, resulting in vascular compromise to large portions of the midgut

A

volvulus

46
Q

asymptomatic anatomical variant that occurs as a result of incomplete rotation of the intestine during fetal development

A

malrotation

47
Q

The diagnosis of malrotation can be made on plain films alone. True or False

A

False

48
Q

Preferred study to evaluate the position of the ligament of Trietz in malrotation

A

Upper GI series

49
Q

Purpose of the Ladd procedure is not to return the bowel to a normal configuration, which is anatomically impossible, but to minimize future risk of volvulus by widening the mesentery, and placing the bowel in a nonrotation position. True or False

A

True

50
Q

Bilious vomiting in a neonate is highly suspicious for…

A

malrotation

51
Q

most common congenital abnormality of the small intestine, caused by an incomplete obliteration of the omphalomesenteric duct

A

Meckel Diverticulum

52
Q

Painless GI bleeding is the most common symptom of what GI disorder

A

Meckel Diverticulum

53
Q

Gold standard for diagnosing Meckel diverticulum

A

Meckel scan or scintigraphy

54
Q

Meckel Diverticulum Pearl

A

Although the hallmark of Meckel diverticulum is painless rectal bleeding, other symptoms may predominate. Bowel obstruction, appendicitis-like symptoms, or an acute abdomen with bleeding may represent a symptomatic Meckel diverticulum

55
Q

Hallmark sign of necrotizing enterocolitis

A

pneumatosis intestinalis on abdominal radiograph

56
Q
  • Metabolic acidosis (dehydration)
    or
  • Metabolic alkalosis (vomiting)
  • Hypochloremia, hypokalemia, hyperbilirubinemia
  • Peristaltic waves across abdomen
  • Olive-sized mass in RUQ
A

Pyloric Stenosis

57
Q

Bowel resection that can lead to decreased cholecystokinin and gastric hypersecretion

A

Jejunal resection

58
Q

Bowel resection that can lead to overgrowth of bacteria in small intestine

A

Ileocecal valve resection

59
Q

Bowel resection that can lead to malabsorption, steatorrhea, secretory diarrhea, decreased transit time

A

Ileal resection

60
Q

Bowel resection that can lead to increased gastric emptying

A

colonic resection

61
Q

acute pain defined as either somatic (skin, bone, connective tissue) or visceral (internal organs)

A

nociceptive

62
Q

pain due to nerve damage

A

neuropathic

63
Q

pain due to the abnormal presence of, or inappropriate activation of, abnormal pain pathways within the nervous system

A

functional

64
Q

short lived and occurs with an injury or near the injured tissue due to an adverse chemical, thermal, or mechanical stimulus

A

acute

65
Q

any pain (nociceptive, neuropathic, or functional) that lasts longer than 1 month

A

chronic

66
Q

state of sedation that provides anxiolysis

A

minimal sedation

67
Q

drug-induced depressed consciousness, but patient is able to respond purposefully to verbal commands or light physical stimulation

A

moderate sedation

68
Q

drug-induced depressed consciousness from which patient is not easily aroused, and has partial or complete loss of protective reflexes

A

deep sedation

69
Q

drug-induced loss of consciousness; patient is not arousable even to painful stimuli

A

general anesthesia

70
Q

Sedatives (5)

A

Midazolam, lorazepam, diazepam, etomidate, pentobarbital

71
Q

Midazolam (versed) uses and side effects

A

Uses: anxiolysis/amnesia, procedural sedation, mechanical ventilation
Side effects: hypotension, bradycardia, cardiac arrest, respiratory depression or arrest

72
Q

Lorazepam (ativan) uses and side effects

A

Uses: sedation, procedural sedation, mechanical ventilation
Side effects: respiratory depression, apnea, bradycardia, and circulatory collapse; high dose/long-term use of parenteral formulation may result in toxicity (lactic acidosis, osmotic gap, and renal failure) as related to formulation with polyethylene glycol

73
Q

diazepam (valium) uses and side effects

A

Uses: procedural sedation, sedation/anxiolysis
Side effects: sudden hypotension, cardiac arrest, laryngospasm, apnea or respiratory depression may result from rapid IV push

74
Q

Pentobarbital uses and side effects

A

Uses: procedural sedation, hypnotic
Side effects: respiratory depression, apnea, laryngospasm, arrhythmias, bradycardia, hypotension, syncope, angioedema

75
Q

Analgesics

A

Morphine, hydromorphone, fentanyl, methadone, dexmedetomidine, clonidine, ketamine, Propofol

76
Q

Morphine, Hydromorphone, Fentanyl side effects

A

Respiratory depression, orthostatic hypotension, CNS depression, increased ICP, histamine release, chest wall rigidity (fentanyl)

77
Q

Methadone side effects

A

Respiratory depression, prolonged QT or torsade de pointes, death, cardiac arrhythmias, increased ICP, histamine release

78
Q

Dexmedetomidine (Precedex) uses and side effects

A

Uses: sedation (ICU/procedural)
Side effects: respiratory acidosis, pulmonary edema, bradycardia, sinus arrest, hypotension, and hypertension

79
Q

Ketamine side effects

A

Respiratory depression, laryngospasm, hypersalivation, tachycardia, hypertension, hypotension, increased cerebral blood flow, postanesthetic delirium

80
Q

Propofol side effects

A

Continuous infusion not recommended in pediatrics to risk of Propofol infusion syndrome (severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac failure, kidney failure)

81
Q

Neuromuscular Blocking Agents (5)

A

Succinylcholine, Cisatracurium, Pancuronium, Rocuronium, Vecuronium

82
Q

Reversal agent for benzodiazepine

A

Flumazenil

83
Q

Reversal agent for narcotics

A

Naloxone

84
Q

Reversal agent for neuromuscular blocking agents

A

Neostigmine

85
Q

Neostigmine side effects

A

Severe salivation (administer with atropine or glycopyrrolate)

86
Q

Pre-procedure Fasting Guidelines

A

Clear liquids - 2hr
Human breast milk - 4hr
Infant formula or milk - 6hr
Solid - 8hr

87
Q

Decrease in drug’s effect over time or the need to increase the dose to achieve the same effect

A

Tolerance

88
Q

Continued need for the drugs’ administration to prevent withdrawal

A

Dependence

89
Q

Constellation of physical symptoms that occurs when an opioid or benzodiazepine is abruptly discontinued in a patient who has developed tolerance

A

Withdrawal

90
Q

Pediatric patient’s receiving sedation and/or analgesic agents 5 days are at risk for withdrawal. True or False

A

True

91
Q

Withdrawal is seen in 100% of pediatric patients receiving opioids or benzodiazepines for >9days and will require a slow sedation taper. True or False

A

True

92
Q

Fentanyl, unlike morphine, is not associated with histamine release, making it useful in children with bronchospasm and those with hemodynamic instability. True or False

A

True

93
Q

Which NMBA pharmacokinetics are independent of kidney and liver functions to reduce inadvertent prolongation of NMBA

A

Cisatracurium

94
Q

Train of four (TOF)

A

Used to measure the degree of neuromuscular blockade with a nerve stimulator; assists in preventing complications of prolonged neuromuscular blockade and allows for minimal medication administration; facial and ulnar nerves are most commonly used for TOF evaluation

95
Q

What is the desired number of elicited twitches in a TOF evaluation

A

at least 1/4

96
Q

If chest wall rigidity occurs from administering fentanyl too fast, it is treated with…

A

narcotic antagonists or NMBAs

97
Q

Four features of delirium

A

1) inattention and disturbance in consciousness
2) change in cognition (memory deficits, disorientation, language disturbances
3) acute onset
4) fluctuating course

98
Q

Physical status classification scale was developed to assist in determining the status of patients prior to surgery, thus offering information on anesthesia risk

A

ASA (American Association of Anesthesiologist)

Pediatric ACNP (4 decks)

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