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SEE/NCE Boards CoreConcepts > NEONATES MUST KNOW > Flashcards

NEONATES MUST KNOW Flashcards

1
Q

Calculate the minute volume of a newborn who weighs 3 Kg and has respiratory rate of 40 breaths per minute?
(Was on the SEE)

A

MV = RR x TV
Tidal volume for the adult is the same as in the infant, 7ml/kg
First calculate the TV which is 3kg x 7ml = 21
MV= 21 x 40 = 840 ml/min

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2
Q

Deadspace in the neonate

A

2-2.5 ml/kg

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3
Q

Intracardiac Right to Left shunt disorders are (RL-TEPPET)

A 
Tetralofy of Fallot
Ebstein anomaly
Pulmonary atresia 
Pulmonary Stenosis with atrial or ventricular defects
Eisenmenger syndrome.
Tricuspid atresia
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4
Q

Right to left shunt is associated with cyanosis/ vs acyanosis

A

Cyanosis

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5
Q

Intracardiac LEFT to RIGHT shunt disorders are (LR-AVAPA) think Lactated Ringer’s AVAPA

A 
ASA
VSD
AV Canal defects
PDA
Aortopulmonary Defects
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6
Q

Which intracardiac shunt is associated with outflow tract obstruction?

A

Right to left shunt (RL-TEPE)

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7
Q

Left to right shunt is associated with

A

CHF (no cyanosis) (too much pulmonary blood flow)

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8
Q

Left to right shunt is associated with _________ pulmonary blood flow

A

HIGH pulmonary blood flow.

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9
Q

Right to Left shunt is associated with ________pulmonary blood flow

A

LOW pulmonary blood flow.

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10
Q

Cyanosis defects include

A

Tetralogy

Ebstein anomaly

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11
Q

The primary pathways by which heat is lost in the neonate are via.

A

radiation (39%) and convection (34%). Evaporation accounts for about 24% of neonatal heat loss and conduction accounts for 3%.

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12
Q

What route of administration of midazolam would be least recommended for a five year-old patient?

A

IM (because it can cause sterile abscess)

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13
Q

What is the Intranasal fentanyl dose can be used as a premedication agent for pediatric surgery?

A

1-2 mcg/kg

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14
Q

The administration of intravenous caffeine can reduce the risk of apnea for premature infant. What is the dose?

A

10 mg/kg

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15
Q

What is the lower limit of autoregulation of cerebral blood flow in children of all ages?

A

60

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16
Q

What is the most common significant airway problem in pediatric anesthesia?

A

Laryngomalacia

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17
Q

What happens with laryngomalacia and what is the treatment?

A

In laryngomalacia, the upper airway structures collapse during inspiration. Treatment is focused on positive airway pressure.

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18
Q

What is the most common form of neural tube defect?

A

Myelomeningocele

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19
Q

Myelomeningocele can be prevented in mother take what?

A

Folic acid.

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20
Q

Succinylcholine is metabolized by

A

pseudocholinesterase in the plasma OR PLASMA CHOLINESTERASE

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21
Q

In obese pediatric patients, the initial dose of rocuronium and morphine should be based on

A

ideal body weight.

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22
Q

Propofol and remifentanil should be based on

A

lean body weight.

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23
Q

Over 80 percent of patients with a myelomeningocele will also develop

A

Hydrocephalus

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24
Q

Over 80 percent of patients with a myelomeningocele will also develop

A

Hydrocephalus (so with correction surgery they may also get a shunt placement

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25
Q

Following removal of the amnion of an omphalocele, large amounts of fluid may exude. This fluid constitutes extracellular fluid and should be replaced with a

A

balanced salt solution.

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26
Q

Principal concerns during the surgical repair of an omphalocele or gastroschisis are

A

fluid management and adequate ventilation.

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27
Q

Bradycardia for infants (<1 yr of age) is and for

A

100 bpm;

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28
Q

Bradycardia for young children 1 to 5 years of age is

A

80 bpm;

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29
Q

Bradycardia for children >5 years of age is

A

60 bpm.

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30
Q

What is an appropriate rectal dose of acetaminophen for a pediatric patient for postoperative analgesia?

A

20-30 mg/kg

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31
Q

The baseline mean heart rate ranges between

A

110 and 160 beats per minute in the normal fetus.

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32
Q

Neonate Ketamine IV dosing

A

2mg/kg

33
Q

Neonate Ketamine IM dosing

A

5-10 mg/kg

34
Q

Emergence delirium in children between the ages of 2 and 6 years is most common with

A

Sevoflurane

35
Q

Which APGAR score reflects some flexion of extremities, grimace, heart rate >100 bpm, completely pink color, and crying?

A

8
According to the APGAR scoring method, this patient would receive the following points: some flexion of extremities (1), grimace (1), >100 heart rate bpm (2), completely pink (2), and crying (2).

36
Q

What Can be a sign of Hypoxia in the fetus?

A

Meconium aspiration during the third trimester can be an indicator of fetal hypoxia.

37
Q

Which local anesthetic would be least appropriate for use in an epidural for a patient undergoing a cesarean section?

A

Bupivacaine is no longer used for obstetric epidurals because of the higher risk for local anesthetic systemic toxicity. Ropivacaine 0.5% can also be used as a substitute for bupivacaine as it has a lower risk for toxicity.

38
Q

The induction dose of propofol in infants between 1-6 months of age is

A

3 mg/kg.

39
Q

The induction dose of propofol For children 1-12 yo.

A

1.3-1.6 mg/kg.

40
Q

Hyperglycemia in the parturient can produce _____ in the fetus soon after delivery.

A

Hypoglycemia

41
Q

What is the most common cause of upper GI obstruction in the newborn?

A

Pyloric stenosis

42
Q

What substance is responsible for promoting the continued patency of the ductus arteriosus?

A

prostaglandins

43
Q

The oral dose of dexmedetomidine for pediatric patients is

A

2-4 mcg/kg

44
Q

Common oral agents include 3 and dosing for each ?

A

acetaminophen 10-15 mg/kg, ibuprofen 5-10 mg/kg, and hydrocodone 0.1 mg/kg.

45
Q

The most common causes of desaturation in otherwise healthy children in the post-anesthesia care unit are hypoventilation and

A

airway obstruction

46
Q

Children who have had recent upper respiratory tract infections should not undergo elective anesthesia for at least

A

4 weeks

47
Q

Uncuffed ET tubes can seal effectively up to about

A

8 years old

48
Q

The alveoli and pulmonary vasculature are not mature enough to produce acceptable gas exchange until about _____ weeks gestation.

A

24-26 weeks

49
Q

Ametop consists of

A

Tetracaine 4%
ELA-max is 4% liposomal lidocaine
Synera is a combination of lidocaine and tetracaine.

50
Q

During what period following general anesthesia are premature neonates most likely to exhibit apnea and bradycardia?

A

4-6 hours

51
Q

Which nondepolarizing muscle relaxant has an intermediate duration in adults, but is considered a long-acting agent in neonates?

A

vecuronium

52
Q

Which of the following is an expected characteristic of persistent pulmonary hypertension of the newborn?

A

Hypoxia

53
Q

n children with difficult IV access, what is the intubating dose for IM succinylcholine (mg/kg)?

A

4mg/kg

54
Q

Which of the following explains why pediatric patients tend to desaturate more quickly than adults?

A

they have a higher alveolar ventilation to FRC ratio

55
Q

The potency of rocuronium is inversely related to

A

Age

56
Q

What would be an appropriate preoperative intranasal dose of midazolam for a 10 kilogram pediatric patient?

A

1mg The pediatric dose of intranasal midazolam is 0.1-0.2 mg/kg. For this patient, the range would be 1-2 mg.

57
Q

You would expect that an oral dose of dexmedetomidine would produce sedation in a pediatric patient in about

A

30-60 minutes

58
Q

You are contemplating using ketamine in suppository form for induction of anesthesia. What would be an appropriate dose?

A

5mg/kg

59
Q

You are preparing to anesthetize a pediatric patient with Down syndrome. You know that airway management would most likely be complicated by

A

Macroglossia. Same as Apert and crouton disease

60
Q

Warfarin should not be used past ___weeks gestation

A

36

61
Q

Anticoagulation is a concern for parturients presenting with mechanical prosthetic valves. Current anticoagulation options for pregnancy per the American College of Cardiology are as follows:

A
  1. Warfarin should be continued until week 36; Convert to unfractionated heparin or low molecular-weight heparin at that point
  2. Use low molecular-weight heparin for entire pregnancy
  3. Use low molecular weight heparin or unfractionated heparin from 6 to 12 weeks and also after week 36; use warfarin from 12 to 36 weeks.
62
Q

What is the most rapidly growing tumor of the anterior mediastinum in children?

A

Lymphoblastic T cell lymphoma

63
Q

Which of the following monitors would you anticipate to be most appropriate for an infant undergoing exploratory laparotomy for necrotizing enterocolitis?

A

Arterial line

64
Q

Are all typically repaired within the first week following delivery. GOCHTIM

A 
Gastroschisis
Omphalocele
Congenital diaphragmatic 
Hernia, 
Intestinal obstruction, and 
Tracheoesophageal fistula,

Myelomeningocele

65
Q

Maternally administered meperidine can produce what in fetus?

A

decreased beat-to-beat variability and tachycardia in the fetus.

66
Q

You are preparing to administer ketamine orally to a 33 pound three year-old. Which of the following doses would be appropriate?

A

5-6 mg/kg

67
Q

Newborn exhibits meconium staining. After suctioning the airway, bradycardia develops. What intervention should be done next?

A

Apply PPV

68
Q

You are preparing to perform a deep extubation on a pediatric patient. You know that this generally requires a MAC of

A

1.5-2.0

69
Q

The neonatal response to hypoxia is typically a short period of _____ followed by _____.

A

hyperventilation, hypoventilation

70
Q

In 2013, the FDA issued a black box warning against the use of codeine for postoperative pain for children undergoing _____.

A

tonsillectomy and adenoidectomy

71
Q

In former premature infants, the incidence of apnea increases with (2)

A

Anemia

decreased postconceptual age

72
Q

You plan to administer acetaminophen to a pediatric patient as part of the postoperative analgesia plan. You know that the maximum dose is _____ in a 24 hour period.

A

100MG/KG

73
Q

Premature infant level of glottis

A

C3

74
Q

The first sign of a total spinal in a neonate is

A

Apnea

75
Q

The primary means a newborn infant has to respond to hypothermia is

A

Increase release of norepinephrine

76
Q

The most common surgical procedure in former premature infants is

A

Hernia repair

77
Q

What is the primary anesthetic concern for patients with Emery-Dreifuss syndrome?

A

Conduction

78
Q

What is the conduction in which intracardiac left to right and right to left shunts are equal?

A

Dextro-transposition of the great arteries

SEE/NCE Boards CoreConcepts (49 decks)

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