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Mar: Sem 6 - Adv. Principles B > Pediatric General Surgery Part 5 > Flashcards

Pediatric General Surgery Part 5 Flashcards

1
Q

Scoliosis surgery is considered in all children with progressive curves greater than _____ to ______ degrees.

A

40 to 50 degrees

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2
Q

Define Scoliosis

A

Lateral deviation of the normal vertical spine greater than 10 degrees

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3
Q

Define Kyphosis

A

(Humpbacked) posterior angulation of the spine

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4
Q

Define Lordosis

A

(Bent backward) anterior angulation of the spine

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5
Q

Differentiate primary and secondary curves

A
  • Primary curves: appear early and most frequently in thoracic and lumbar regions
  • Secondary curves: (compensatory) develop above or below the primary curve and evolve to maintain alignment
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6
Q

What method is most commonly used to measure the magnitude of the curve from anteroposterior radiographs?

A

Cobb Method

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7
Q

What is congenital scoliosis caused by?

A

Spinal anomaly caused by failure of formation and segmentation that results in scoliosis or kyphosis (Hemivertebra is the most common cause)

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8
Q

Are bracing/casting effective for congenital scoliosis?

A

No

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9
Q

What are the surgical options for congenital scoliosis?

A
  • Fusion
  • Convex hemiepiphysiodesis
  • Hemivertebra excision
  • Growing rods
  • Vertical expandable prosthetic titanium rib (VEPTR)
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10
Q

Infantile scoliosis occurs b/w what age?

A

Occurs b/w birth - 3 years old

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11
Q

Bracing for infantile scoliosis is considered when spine reaches _______ degrees

A

30 degrees

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12
Q

Treatment for infantile scoliosis starts as early as _______ months

A

4-5 months

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13
Q

Juvenile scoliosis is diagnosed b/w _________ and ________years

A

4-10 years

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14
Q

Juvenile scoliosis represents _________ % of idiopathic scoliosis

A

10-15%

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15
Q

What percentage of juvenile idiopathic scoliosis has an underlying spinal condition (i.e., Arnold Chiari Malformation)

A

20%

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16
Q

Juvenile Scoliosis > ________ degrees will require surgical intervention

A

30 degrees

17
Q

Adolescent Idiopathic Scoliosis occurs after age _______.

A

10 years

18
Q

Adolescent Scoliosis may have _________ impairment disproportionate to the severity of their scoliosis.

A

Pulmonary Impairment

19
Q

Does bracing decrease curve progression in adolescent scoliosis?

A
  • Bracing will decrease curve progression
  • BUT bracing is associated with worse PFT results at the time of surgery.
20
Q

What is neuromuscular scoliosis caused by?

A
  • Caused by disorders of the brain, spinal cord, and muscular system
  • Pts have deteriorating muscle function and mechanical distortion.
21
Q

How does scoliosis affect the lungs?

A

↑ Restrictive lung defects

22
Q

What problems can arise long term if scoliosis is untreated?

A
  • Hypoxemia
  • Hypercarbia
  • Recurrent infections
  • Pulmonary hypertension
23
Q

What is the most significant predictor of impaired respiratory function for a scoliosis patient?

A
  • The number of vertebrae affected
  • Degree of thoracic curve
24
Q

Scoliosis Surgery Anesthetic Management

A
  • SSEP (Somatosensory evoked potentials)
  • MEP (Motor evoked potentials)
  • EMG (Electromyography)
  • Pumps
  • Bite block
  • Foley Cath (long surgery)
  • A-line
  • 2 PIV
25
Q

Define SSEP

A

Monitored from a peripheral nerve through dorsal column of spinal cord to somatosensory cortex. (Proprioception/Vibration)

Measures brain activity in response to sensory stimulation.

26
Q

Define MEP

A

Monitored from a peripheral muscle through corticospinal tract to motor cortex

Measures muscle activity in response to motor cortex stimulation.

27
Q

Define EMG

A

Direct nerve root monitoring (commonly during pedicle screw placement)

Measures the electrical activity of muscles at rest and during contraction, used to diagnose muscle and nerve disorders.

28
Q

Evoked potential monitoring is affected by these factors.

A
  • Neural injury
  • VA
  • Muscle relaxants
  • Hypercbia
  • Hypoxia
  • Hypotension
  • Hypothermia
29
Q

How does scoliosis affect end-expiration and end-inspiration on the concave side?

How does scoliosis affect end-expiration and end-inspiration on the convex side?

A

Mar: Sem 6 - Adv. Principles B (14 decks)

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