P - Pediatrics

Question 1

Rhabdomyolysis in a pediatric patient who has received succinylcholine is associated with undiagnosed

Answer 1

Duchenne’s muscular dystrophy

The appearance of hyperkalemia and rhabdomyolysis in pediatric patients receiving succinylcholine is associated with undiagnosed Duchenne’s muscular dystrophy.

Question 2

Administration of a large dose of which of the following drugs would be most likely to produce seizures in a pediatric patient?

Answer 2

Flumazenil

Flumazenil can be used to antagonize benzodiazepines in pediatric patients. It should be noted that the short half-life of flumazenil has been associated with re-sedation in children ages one to five. Larger doses of flumazenil have been associated with seizures in pediatric patients.

Question 3

Which of the following agents and doses would be appropriate for the reversal of neuromuscular blockade of rocuronium in an infant?

Answer 3

Neostigmine 50 mcg/kg

Traditional doses of neostigmine (50-60 mcg/kg) or edrophonium (500-1000 mcg/kg) combined with glycopyrrolate 0.2 mg per 1 mg of neostigmine are appropriate for reversing neuromuscular blockade in infants. Physostigmine and pyridostigmine are not traditionally used for reversal of neuromuscular blockade.

Question 4

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

Answer 4

4 mg /kg

The IM intubating dose of succinylcholine is 4 mg/kg.

Question 5

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

Answer 5

Lymphoblastic T cell lymphoma

Lymphoblastic T cell lymphoma is the most rapidly growing tumor in the mediastinum in children.

Question 6

What is the most commonly used IV induction agent in children?

Answer 6

Diisopropylphenol

The most commonly used IV induction agent in children is diisopropylphenol (propofol).

Question 7

The oxyhemoglobin curve of a newborn

Answer 7

is shifted to the left compared to that of an adult

The oxyhemoglobin curve of a newborn is shifted to the left compared to that of an adult because of the presence of fetal hemoglobin, which has a higher affinity for oxygen. During the first 3-6 months of life, the oxyhemoglobin curve begins to shift to the right, which helps compensate for the anemia of infancy.

Question 8

Which reflex would help influence the tidal volume and respiratory rate of an infant by inhibiting deep inspiration?

Answer 8

Hering-Breuer reflex

The Hering-Breuer reflex is the cessation of inspiration in response to lung inflation. Because infants have a Hering-Breuer threshold within their normal tidal volume, it likely plays a big part in control of their tidal volume and respiratory rate.

Question 9

Which of the following would be an appropriate dose of intranasal midazolam in a 20 kg pediatric patient?

Answer 9

10mg

The pediatric dose of intranasal midazolam is 0.1-0.2 mg/kg. For this patient, the range would be 2-4 mg.

Question 10

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

Answer 10

4-6 hours following surgery

Postoperative apnea and bradycardia is most likely to occur in neonates who were premature, those with multiple congenital anomalies, those with lung disease, and those with a history of apnea and bradycardia. The risk is highest in the first 4-6 hours after surgery, but can still occur for up to 12 hours postoperatively. The conservative approach is to monitor all infants younger than 60 weeks postconceptual age overnight.

Question 11

A healthy 5 year-old is presenting for tonsillectomy. Which of the following actions would be appropriate for this patient?

Answer 11

Proceed without ordering labwork

The current standard states that healthy children presenting for minor elective procedures be spared the unnecessary anxiety of blood drawing and have no labwork performed.

Question 12

Which of the following statements is true regarding the cardiac system of the premature infant?

Answer 12

The heart has a greater dependence upon extracellular calcium concentrations

The fetal heart contains more connective tissue, the contractile elements are less organized, and contractility has a greater dependence upon the extracellular calcium concentration. Autoregulation is not yet matured, so the heart rate does not respond sufficiently to hypovolemia. The heart of the premature infant is less sensitive to catecholamines because it is already near the maximum level of beta-adrenergic stimulation. Digitalis is contraindicated in premature infants because no resulting increase in contractility or ventricular ejection occurs, but the heart rate does slow down, resulting in a decrease in cardiac output.

Question 13

Which pediatric condition would require surgical intervention the soonest after delivery?

Answer 13

Gastroschisis

Gastroschisis, omphalocele, congenital diaphragmatic hernia, tracheoesophageal fistula, intestinal obstruction, and myelomeningocele are all typically repaired within the first week following delivery. Pyloric stenosis, necrotizing enterocolitis, ligation of a PDA, and inguinal hernia repair are typically addressed within the first month of life.

Question 14

A pediatric patient with which condition is more likely to develop propofol infusion syndrome?

Answer 14

Mitochondrial disease

Propofol infusion syndrome is associated with prolonged propofol infusions over several days and may appear as lactic acidosis, fever, hepatomegaly, dysrhythmias, hypertriglyceridemia, rhabdomyolysis, and cardiac failure. It is more likely to occur in children with mitochondrial disease and is believed to be the result of impaired mitchondrial function and subsequent uncoupling of oxidative phosphorylation.

Question 15

What is the normal mean fetal heart rate range?

Answer 15

110-160 bpm

The baseline mean heart rate ranges between 110 and 160 beats per minute in the normal fetus.

Question 16

At what age is the MAC for sevoflurane the highest?

Answer 16

3 months old

MAC is higher in pediatric patients. For sevoflurane, it is approximately 3.3% in neonates and 3.2% in infants 1-6 months of age. For children 6-12 months of age it is constant at 2.4%. The MAC for isoflurane in both infants and children is 1.6%.

Question 17

Which of the following explains why children have a faster uptake and more rapid increase in alveolar levels of inhaled anesthetic? (select two)

Answer 17

Increased cardiac output
Increased minute ventilation

Children have a tidal volume that is equivalent to that of adults (5-7 mL/kg), but they have a much higher relative minute ventilation and a higher ratio of tidal volume to FRC. They also have a higher relative cardiac output. Because of the increased cardiac output and increased minute ventilation, they exhibit a faster uptake as well as more rapid alveolar concentration of anesthetic.

Question 18

Which of the following is greater in a healthy two year-old patient than it is in an adult? (select two)

Answer 18

The bioavailability of intramuscular ketamine
The volume of distribution of propofol

Protein binding is decreased in preterm and term infants but is similar between children and adults. The bioavailability of ketamine is high in adults (93%) but is even higher in children. By 6-12 months of age, the clearance of morphine is equal to that of adults. The volume of distribution of propofol is larger in children than adults.

Question 19

Which drug regimen would be the least appropriate as a component of the intravenous induction of a pediatric patient with intracranial hypertension?

Answer 19

Ketamine

Because ketamine can produce increases in intracranial pressure via cerebral vasodilation, it is contraindicated in pediatric patients with intracranial hypertension.

Question 20

Which modalities are commonly used in the treatment of apnea in the premature infant? (select two)

Answer 20

CPAP
Caffeine

The primary treatment modalities for apnea in premature infants are CPAP and methylxanthines such as caffeine.

Question 21

You would expect the MAC for sevoflurane to be highest in which age patient?

Answer 21

1 month-old

MAC is higher in pediatric patients. For sevoflurane, it is approximately 3.3% in neonates and 3.2% in infants 1-6 months of age. For children 6-12 months of age it is constant at 2.4%. The MAC for isoflurane in both infants and children is 1.6%.

Question 22

You administer an intramuscular dose of midazolam to a pediatric patient without an IV who cannot cooperate to take PO midazolam. What is the minimum amount of time should you wait before considering a supplemental dose?

Answer 22

20 minutes

The onset time of IM midazolam is 3-5 minutes and the time to peak effect is 10-20 minutes. You should wait at least 20 minutes before considering giving a supplemental dose of midazolam.

Question 23

Diprivan contains components that are found in what two foods? (select two)

Answer 23

Eggs & soybeans

Diprivan is formulated with 1% propofol, 10% soybean oil, and 1.25% egg yolk phosphatide, glycerol, EDTA, and sodium hydroxide. Although it is controversial whether patients with allergies to eggs or soybeans should receive propofol, there appears to be little evidence that propofol should be avoided in patients with these allergies.

Question 24

All of the following are risk factors for postoperative apnea after surgery in the premature infant except:

Answer 24

regional anesthesia

Regional anesthesia lessens the risk for postoperative apnea in the premature infant. A postconceptual age (gestational age + chronological age) < 60 weeks is associated with a higher risk of postoperative apnea for up to 24 hours after surgery. Other risk factors include hypothermia, anemia (Hct < 30%), low gestational age at birth, necrotizing enterocolitis, neurologic problems, and sepsis.

Question 25

Why are premature infants more susceptible to hypothermia?

Answer 25

Nonshivering thermogenesis is underdeveloped

There is little adipose tissue to act as insulation, and the surface area to mass ratio is very high. Regulation of skin blood flow in response to changes in temperature is not well-developed. Also, the non-shivering mechanism of thermogenesis (the primary method of increasing body temperature in newborns) is underdeveloped.

Question 26

What is the most common congenital neural tube defect?

Answer 26

Meningomyelocele

The most common congenital primary neural tube defect is meningomyelocele.

Question 27

Which chemical is responsible for mediating nonshivering thermogenesis in the newborn?

Answer 27

Norepinephrine

Nonshivering thermogenesis is a norepinephrine-mediated mechanism of heat production that involves uncoupling of oxidative phosphorylation within the mitochondria-rich brown fat cells found over the neck, back, viscera, and great vessels. Nonshivering thermogenesis occurs in premature infants and full-term newborns, but does not occur in adults.

Question 28

At birth, the spinal cord extends to about the level of

Answer 28

L3

At birth, the spinal cord extends to about the level of L3. The vertebral column grows faster than the spinal cord. By adulthood, the spinal cord ends at about L1 in most adults.

Question 29

Which of the following statements regarding the use of succinylcholine in pediatric patients is true?

Answer 29

The IM dose is 4 mg/kg

Succinylcholine is not approved by the Food and Drug Administration for use in children, however, it is often used in pediatrics in specific situations. The IM dose for succinylcholine is 4mg/kg and the IV dose is 1-2 mg/kg. Muscular dystrophy is a contraindication to its use, as is spinal cord transection, immobilization, burn injury, and any family history of malignant hyperthermia. Although pediatric patients have a greater water volume and thus a greater volume of distribution for succinylcholine, they are slightly more sensitive to the drug than adults.

Question 30

What is the IM dose of succinylcholine for a one year-old patient?

Answer 30

4 mg/kg

When IV administration is not possible, succinylcholine may be administered intramuscularly at a dose of 4 mg/kg in pediatric patients to produce intubating conditions.

Question 31

When does the anterior fontanelle normally close?

Answer 31

The anterior fontanelle normally closes between 9 and 18 months of age.

Question 32

Which of the following pediatric conditions is most associated with airway hyper-reactivity?

Answer 32

Bronchopulmonary dysplasia

Bronchopulmonary dysplasia is one of the long-term potential consequences of the respiratory distress syndrome seen in premature infants. It is characterized by a chronic disorder of the lung parenchyma that involves hyperplasia of the smooth muscle tissue of the airways, peribronchiolar fibrosis, enlarged alveoli, and abnormalities in the pulmonary vasculature. Airway hyperreactivity is often present and requires treatment with bronchodilators.

Question 33

A pediatric patient that weighs 66 pounds needs to be administered succinylcholine intramuscularly due to an airway emergency. What is the dose that should be administered in milligrams? (whole number only)

Answer 33

120

Succinylcholine may be administered intramuscularly in emergencies where there is not a way to administer it intravenously. The dose for IM use is 4 mg/kg. This patient weighs 66 pounds. To convert the weight to kilograms, we divide the weight in pounds by 2.2 which gives us 30 kg. 30 X 4 = 120 mg.

Question 34

Which of the following will increase the incidence of postoperative nausea and vomiting in pediatric patients?

Answer 34

The use of ketamine increases the incidence of postoperative nausea and vomiting in pediatric patients.

Question 35

Bradycardia in a three year-old is considered to be any heart rate less than

Answer 35

Bradycardia for infants (<1 yr of age) is 100 bpm; young children 1 to 5 years of age is 80 bpm; and for children >5 years of age is 60 bpm.

Question 36

By what week of gestation is surfactant production sufficient enough to prevent respiratory distress syndrome in most infants?

Answer 36

35 weeks

By 35 weeks gestation, surfactant production is sufficient in most cases. About 5% of all newborns who develop respiratory distress syndrome, however, are delivered at term.

Question 37

You have administered 10 mg of midazolam PO to a 6 year-old pediatric patient who weighs 44 lbs. Thirty minutes later, the patient appears completely unaffected by the drug. How would you assess this situation?

Answer 37

The patient was resistant to a correctly prescribed dose

The normal dose for PO midazolam in pediatric patients ages 6-10 years of age is 0.5 mg/kg. 10 mg is an appropriate dose for this patient. About 14% of all pediatric patients will not respond to this dose and a higher total dose of 0.75 mg/kg may be required.

Question 38

Which of the following is true regarding the administration of midazolam to pediatric patients?

Answer 38

It is the only benzodiazepine approved by the FDA for use in neonates

Midazolam is highly water-soluble and is not painful if administered intravenously. It is the only benzodiazepine approved by the FDA for use in neonates. It is metabolized in the liver and metabolites are excreted in the urine.

Question 39

Which of the following is not a contributing factor to the development of retinopathy of prematurity?

Answer 39

Administration of anesthesia

Retinopathy of prematurity has been shown to be related to supplemental oxygen therapy, low birth weight, postnatal hypotension, the use of surfactant or inotropes, and mechanical ventilation.

Question 40

The most common cause of respiratory distress syndrome in the premature infant is

Answer 40

insufficient surfactant production

Respiratory distress syndrome in premature infants is most commonly caused by a lack of surfactant production. Surfactant is not produced until about 28 weeks of gestation and doesn’t reach normal production until 35 weeks of gestation.

Question 41

All of the following statements regarding pediatric anesthesia are true except:

Answer 41

Hepatic function is typically mature within the first 24 hours after delivery

Hepatic function is immature in the newborn and some hepatic pathways do not mature until after a year of age. Levels of albumin and other serum proteins are low in the full-term infant and result in a higher free fraction of many protein-bound drugs.

Question 42

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

Answer 42

75mg

5-6 mg/kg is the appropriate dose for orally administered ketamine in patients from 1 to 6 years of age. This patient is 15 kilograms which makes the appropriate dose 75 to 90 milligrams.

Question 43

Because preterm infants have a limited ability to perform glucuronidation, they would likely exhibit a prolonged duration of action of which of the following drugs?

Answer 43

morphine

Term and preterm infants cannot metabolize morphine as effectively as children and adults. Neonates have a limited ability to perform glucuronidation. Because morphine undergoes glucuronidation, the active form of the drug will be present in the circulatory system for a longer period of time.

Question 44

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

Answer 44

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).

Question 45

What is the most common cited cause of retinopathy of prematurity?

Answer 45

hyperoxia

Although hypoxemia, hypotension, sepsis, intraventricular hemorrhage, and other stresses have been implicated, hyperoxia is the most common cause of retinopathy of prematurity.

Question 46

All of the following are significant contributing factors for the development of postoperative apnea in the premature infant except

Answer 46

the administration of aminoglycoside antibiotics

The major risk factors contributing to apnea after anesthesia in preterm infants are the type of anesthetic, postconceptual age, and the presence of anemia.

Question 47

Which of the following statements regarding drug responses in term neonates is accurate?

Answer 47

Neonates exhibit resistance to the cardiac effects of dopamine

Infants (both preterm and term) have a higher proportion of water compared to their body mass. As a result, the volume of distribution for water-soluble drugs is greater. Because of this, they often require a higher loading dose of water-soluble drugs such as digoxin, succinylcholine, and some antibiotics (such as aminoglycosides). Myocardial concentrations of digoxin can be as much as 6 times higher than that of adults at the same serum concentration. Term neonates exhibit resistance to the cardiac effects of dopamine and may not exhibit increased blood pressure and urine output until doses of 50 mcg/kg/min are reached.

Question 48

At what age would you expect a pediatric patient to begin to exhibit separation anxiety when transferred from their parents to the operating room staff for surgery?

Answer 48

Separation anxiety begins at about 8-10 months of age.

Question 49

The most common surgical emergency in the neonate is

Answer 49

Necrotizing enterocolitis is the most common surgical emergency in the neonate. Premature infants are at the greatest risk for developing it. Conditions associated with necrotizing enterocolitis include umbilical artery catheterization, systemic infections, perinatal asphyxia, hypotension, exchange blood transfusions, patent ductus arteriosus, cyanotic heart disease, respiratory distress syndrome, and hyperosmolar feedings.

Question 50

Which of the following drugs would be the most appropriate for both hypnosis and pain relief in pediatric patients?

Answer 50

Ketamine
Of the drugs listed above, only ketamine provides both hypnosis and pain relief. It is available in oral, rectal, IM and IV routes.

Question 51

Which compensatory thermoregulatory mechanism does a full-term neonate possess?

Answer 51

non-shivering thermogenesis

A normal neonate cannot shiver, increase activity, or vasoconstrict effectively like an adult can. The only means of responding to heat loss is nonshivering thermogenesis. A 2-degree Celsius difference between the skin and core temperature results in the release of norepinephrine which stimulates the lipolysis of brown fat. The side effects of nonshivering thermogenesis are increased oxygen consumption and the production of ketone bodies and water. This has a tendency to produce a metabolic acidosis and osmotic diuresis, both of which are disadvantageous. Every attempt should be made to regulate the neonate’s core temperature to prevent nonshivering thermogenesis.

Question 52

When should chest compressions be initiated in the neonate?

Answer 52

HR < 60
After ventilation with oxygen for 30 seconds, chest compressions should be initiated in the neonate when the heart rate is less than 60 bpm.

Question 53

What is the appropriate dosage for oral midazolam in pediatric patients?

Answer 53

0.25-0.75 mg/kg

The dose for oral midazolam in children is 0.25 to 0.75 mg/kg which will peak in about 30 minutes and last for 30 minutes. The initial recommended intravenous dose for children is 0.05-0.015 mg/kg.

Question 54

Which statements below indicate a correct understanding of the proper anesthetic care of an infant undergoing surgery to repair a congenital diaphragmatic hernia? (select two)

Answer 54

Nitrous oxide should be avoided
Fentanyl may be administered as tolerated

Anesthesia for the correction of a congenital diaphragmatic hernia in an infant can include inhalation agents and narcotics as tolerated. Nitrous oxide should be avoided as it may make closure of the abdomen difficult or distend a portion of the gut still in the thorax prior to repair, resulting in compression of the heart and lungs. Muscle relaxation is typically required to facilitate closure of the abdomen.

Question 55

What is the caution regarding the use of intranasal ketamine?

Answer 55

it can result in neurotoxicity

Ketamine has been shown to enter the central nervous system directly when given via the intranasal route because it can track along neurovascular tissues in the nasal mucosa. The preservative in ketamine is neurotoxic and the possibility of CNS toxicity exists with the administration of intranasal ketamine.

Question 56

The most common airway problem in pediatric patients is upper airway obstruction due to

Answer 56

laryngomalacia

Upper airway obstruction due to laryngomalacia is the most common airway problem in pediatric patients.

Question 57

Compared to adult patients, you would expect a term neonate to exhibit (select four)

Answer 57

a decreased proportion of body fat
decreased proportion of muscle mass
a higher proportion of body water
decreased responsiveness to dopamine

Term neonates exhibit decreased cardiovascular responsiveness to many drugs. The dose of dopamine required to increase blood pressure and urine output in neonates may be as high as 50 mcg/kg/min. This dose would produce such severe vasoconstriction in adults that it could cause injury to the patient. Infants (both preterm and term) have a higher proportion of water compared to their body mass. As a result, the volume of distribution for water-soluble drugs is greater. Because of this, they often require a higher loading dose of water-soluble drugs such as digoxin, succinylcholine, and some antibiotics. Children and adolescents have fat and muscle masses comparable to that of adults, but term and preterm neonates have a decreased proportion of both. Protein binding is decreased in preterm and term infants but is similar between children and adults

Question 58

Which of the following would be an acceptable intravenous induction dose of ketamine in a healthy 35 kg pediatric patient?

Answer 58

75mg

The intravenous induction dose of ketamine is 1-3 mg/kg. In this patient, an acceptable range would be between 35 mg and 105 mg.

Question 59

When does the foramen ovale typically close?

Answer 59

Within 1 hour of life

The foramen ovale typically closes within 1 hour of life as left atrial pressure exceeds right atrial pressure.

Question 60

A breathing pattern in an infant that consists of recurrent pauses in ventilation that last no longer than 5-10 seconds is consistent with a diagnosis of

Answer 60

periodic breathing
Periodic breathing consists of recurrent pauses in ventilation that last no longer than 5-10 seconds. This pattern of breathing often occurs during REM sleep and is not associated with any physiologic disorder. Apnea of prematurity, however, is associated with prolonged ventilatory pauses that are significant enough to produce arterial hypoxemia and bradycardia. Both are more common in premature infants.

Question 61

In the premature infant, you would expect the glottis to be at the level of

Answer 61

The glottis is at the level of C3 in the premature infant.

Question 62

Which of the following would you expect to be increased in a healthy, 7 year-old child when compared to an adult patient? (select two)

Answer 62

Total body clearance of cisatracurium
The bioavailability of ketamine

The volume of distribution and the total body clearance are both significantly greater in pediatric patients, which accounts for the faster recovery in children. By 6-12 months of age, the clearance of morphine is equal to that of adults. The bioavailability of ketamine is high in adults (93%) but is even higher in children. Premedication with ketamine has been shown to reduce the incidence of emergence delirium in pediatric patients.

Question 63

Which of the following routes of administration of midazolam would be least recommended for a five year-old patient?

Answer 63

IM
Midazolam can be administered oraly, rectally, nasally, intravenously, or intramuscularly. The IM route is not recommended because of pain and the risk of a sterile abscess.

Question 64

Which of the following should take priority in your airway management plan for a pediatric patient with bronchopulmonary dysplasia?

Answer 64

Choose an endotracheal tube that has an internal diameter 0.5-1.0 smaller than normal

Patients with bronchopulmonary dysplasia (BPD) exhibit airway hyperreactivity and need a deep plane of anesthesia prior to intubation. Because subglottic stenosis may be present, you should choose an endotracheal tube that is 0.5-1.0 smaller than normal for the patient’s age. Diuretics are sometimes needed to treat pulmonary edema for these patients, but preventive administration of diuretics would be inappropriate. You should delivery oxygen in a concentration sufficient to maintain a PaO2 of 50-70 mmHg.

Question 65

You administer midazolam rapidly via the IV route to a pediatric patient. The patient begins to exhibit seizure-like activity. What is the most likely cause of this?

Answer 65

myoclonic reaction

Rapid IV or nasal administration of midazolam can produce myoclonus that may have the appearance of seizure-like activity.

Question 66

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

Answer 66

60 mmHg is the lower limit of autoregulation of CBF in children of all ages.

Question 67

Which pathology would explain the administration of indomethacin to a premature infant?

Answer 67

patent ductus arteriosus

Indomethacin, a potent prostaglandin inhibitor is administered to stimulate closure of a patent ductus arteriosus.

Question 68

In the normal, full-term infant, you would expect the glottis to be at the level of

Answer 68

C4

The glottis is at the level of C4 in the normal, full-term infant.

Question 69

In infants, the spinal cord typically ends at

Answer 69

In infants, the spinal cord typically ends at L3. In adults, the spinal cord ends at L1 but extends as far as L3 in about 10 percent of adults.

Question 70

What are the two most commonly used interventions for the treatment of apnea in premature neonates?

Answer 70

The primary treatment modalities for apnea in premature infants are CPAP and methylxanthines such as caffeine.

Question 71

Renal excretion of drugs is less effective in neonates than in older children and adults. Why is this? (select two)

Answer 71

Neonates have a lower perfusion pressure
Neonates have incomplete glomerular development

Neonates have incomplete glomerular development, a low perfusion pressure, and an inadequate osmotic concentration to exert a normal countercurrent effect.

Question 72

Which of the following characteristics are consistent in a neonate with congenital diaphragmatic hernia? (select two)

Answer 72

Tachypnea
Lung hypoplasia

The initial presentation of CDH is respiratory distress due to lung hypoplasia with tachycardia and tachypnea being present at birth. Compression of the vena cava by the intestines can also produce reduced preload and a corresponding decrease in cardiac ouput. The abdomen may appear scaphoid due to its contents being extruded into the thorax.

Question 73

What would be an appropriate intravenous induction dose of propofol in a 7 year-old?

Answer 73

1.5 mg/kg

The induction dose of propofol in infants between 1-6 months of age is 3 mg/kg. For children 1-12 years old, it is 1.3-1.6 mg/kg.

Question 74

What is the most common metabolic disorder seen in newborns and young infants?

Answer 74

The most common metabolic disorder in newborns and infants is hypoglycemia.

Question 75

Select two reasons for low renal blood flow and glomerular filtration rate in utero.

Answer 75

Low glomerular capillary permeability
Small number of glomeruli

The four principal causes for low renal blood flow and GFR in utero are low systemic arterial pressure, high renal vascular resistance, low permeability of the glomerular capillaries, and small size and number of glomeruli.

Question 76

Neonates are most at risk for heat loss via

Answer 76

radiation
The primary pathways by which heat is lost in the neonate are via radiation (39%) and convection (34%). Evaporation accounts for about 24% of neonatal heat loss and conduction accounts for 3%

Question 77

Which of the following hemodynamic patterns is consistent with a diagnosis of sepsis?

Answer 77

The patient with sepsis typically presents with a low pulmonary capillary wedge pressure, a high cardiac output, and a low systemic vascular resistance.

Question 78

What is the only parenteral NSAID medication available for use in children?

Answer 78

The only parenteral NSAID medication available for use in children is ketorolac.

Question 79

Which of the following statements regarding the use of ketamine in children is true?

Answer 79

Ketamine increases the incidence of postoperative nausea and vomiting in pediatric patients

The use of ketamine increases the incidence of postoperative nausea and vomiting in pediatric patients. Oral ketamine has a low incidence of nightmares. Intramuscular ketamine is an effective method for sedating pediatric patients who cannot or will not take oral medications.

Question 80

Which of the following would be an acceptable intramuscular induction dose of ketamine in a 50 kg patient?

Answer 80

400mg

The IM induction dose of ketamine of 5-10 mg/kg. In this patient, the appropriate range would be between 250 mg and 500 mg.

Question 81

What is the predominant serum protein in fetal blood?

Answer 81

Alpha-1 fetoprotein is the predominant serum protein in fetal blood.

Question 82

What infusion dose of propofol is required to produce general anesthesia in pediatric patients?

Answer 82

250 mcg/kg/min is sufficient in the pediatric population to produce general anesthesia for painless medical or radiolologic procedures, but the dose may have to be increased to prevent movement.