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DSouza 2015 > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

The narrowest airway area in pediatrics is ….

A

Glottic area

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2
Q

Apgar score are 5 components …

A 
A: Activity  (muscle tone)
P: Pulse
G: Grimas (reflex)
A: Appearance (color)
R: Respiratory effort
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3
Q

Apgar score 0 points are

A 
A: flaccid
P: Absent
G: no response
A: Blue/pale
R: absent
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4
Q

Apgar scores 1 point

A 
A: Flexion
P: <100
G: Grimace
A: pink body, blue ext
R: slow irregular
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5
Q

Apgar scores 2 points

A 
A: Active
P: > 100
G: cough/sneeze
A: pink body &amp; Ext
R: Good, crying
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6
Q

newborns frequently loose a point in Apgar score due to …

A

Peripheral color for being blue.

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7
Q

BLS in neonates with bradycardia & cynosis, difference is

A

starting positive pressure before chest compression

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8
Q

When meconium aspiration suspected….

A

Intubate -> suction -> then ventilate.

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9
Q

Umbilical Arterial ABG in newborn (normal values)

A

7.28/50(CO2)/20

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10
Q

Umbilical Venous ABG in newborn (normal values)

A

7.35/40/30(O2)

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11
Q

Umblical ABG in neoborna at 60 min

A

7.30 - 7.35
30 PaCO2
60 PaO2

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12
Q

Which one has higher PaO2, Ductus venosis or Ductus Atreriosus

A

Ductus Venosis: high PaO2

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13
Q

What nerve risk for damage during PDA ligation

A

Left Recurrent laryngeal (it arches the aorta and close to PDA)

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14
Q

Fetal Thiopental concetration are low during general anesthesia for CS because

A
  • Maternal distirbution

- Metabolism by fetal liver.

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15
Q

Water % of bodyweight in term vs preterm neonates

A

70% Term

80% Preterm

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16
Q

When … the rate of the work of breathing is similar in neonates and adults

A

corrected for weight & metabolic rate

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17
Q

O2 consumption for work of breathing in neonates is …% of total body O2 consumption

A

1-2%

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18
Q

first step when child is breath hodling during induction is

A

positive pressure with 100% O2

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19
Q

the best sign for reversal of NMB is …. and the best clinical sign in infants is … compared to adults …

A

ToF > 0.9
lifting of legs in infants
masseter muscle tone in adults, indicates >0.8 ToF (note the best sign is ToF >0.9)

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20
Q

spinal anesthesia in neonates differ than adults in dose …

A

neonates needs larger doses due to increase in CSF volume compared to adults

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21
Q

spinal anesthesia in neonates differ than adults in duration …

A

shorter block in neonates due to rapid turnover of CSF

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22
Q

High blocks in neonates manifests as

A

Apnea rather than hypotenstion

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23
Q

The most common indication for spinal in pediatrics is

A

ex-premature presenting for inguinal hernia repair

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24
Q

the incidence of PDPH in children is … compared to adult

A

lower

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25
Q

The dural puncture and total spinal is more common in neonates than adults because

A

the anatomy of dural sac ends lower

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26
Q

Dose Mg cross placenta? and whats the antidote?

A

Yes

Calcium

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27
Q

In order to prevent retinopathy of prematurity, the PaO2 should kept below

A

70 mmHg

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28
Q

BP & HR at birth vs at 1 year

A

Birth: 65/40, HR 140

1 year: 95/65, HR 120

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29
Q

Reason for desaturation in neonates & infants

A

increased metabolic rate and O2 consumption (not decreased FRC or FRC/TLC ratio)

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30
Q

The loss of heat is faster in neonates compared to adults because

A

their larger surface area-bodyweight ratio (they also have less SQ fat and therefor have less insulation for heat preservation).

31
Q

Neonates heat production is dependent on

A

metabolism of brown fat

32
Q

Refrance weight for neonates is 3 kg vs 70k in adults. what would be TV, VC, FRV and dead space differnces

A

TV 6 ml/kg in both
VC 35 ml/kg (70ml/kg in adults)
FRC 30 ml/kg (35 ml/k adults)
Dead space is same 0.3xTV

33
Q

When adult breathing circuit is used for infants, TV should be … to compensate for the compliance of tubing

A

Increased

34
Q

Would you proceed to OR if EMLA cream applied to a broken skin unintentionally on neonates?

A

better to postpone and observe for methemoglobenemia (ELMA is eutectic miture of lidocaine & prilocaine, pro;pcaine increase risk of methemoglobenemia)

35
Q

Best option for induction in child with epiglottitis is

A

gental mask induction with sevoflurane + O2 100%

36
Q

Parental presence benefits

A

reducing separation anxiety but wont prevent pr decrease postoperative delirium

37
Q

fasting interval in children for clear liquid

A

2 hours

38
Q

fasting interval in children for human milk

A

4 hours

39
Q

fasting interval in children for non-human milk

A

6 hours same as light meal

40
Q

Fetal Hg can falsely elevate COHb levels upto … in first weeks of life

A

7-8%

41
Q

RFs for postoperative apnea in premature infants are

who should be admitted and monitored (and for how long) after outpatient surgery.

A

The most conservative approach is to admit (for monitored 24 hour observation) all infants younger than 60 weeks post-conceptual age

42
Q

Why Pierre Robin is difficult airway

A

Glossoptosis

43
Q

Why Treacher Collins is difficult airway

A

Micrognathia

44
Q

Why Klippel-Feil is difficult airway

A

Cervical spine immobility

45
Q

Would you proceed to OR with 1 week old African american with hx of SCD in family?

A

Yes, fetal Hb provides protection from sickling

46
Q

when is a physiological decrease in Hb concentration in infants (physiological anemia)

A

at age of 3 months due to declining fetal Hb

47
Q

what needs to be managed before pyloric myotomy?

A

fluid & electrolyte imbalance. its not an acute emergency

48
Q

metabolic abnormalities seen with pyloric stenosis

A

hypoCl-, HypoK, HypoNa, metabolic alkalosis. (metabolic acidosis if untreated)

49
Q

commonest type of Tracheoesophageal fistula is

A

Type C (fistula between the lower esophagus and the trachea (one form of TEF) with a blind esophagus upper pouch)

50
Q

ideal ET position in TE fistula?

A

above carina but belo the fistula. breath sounds should be bilateral, no sounds over stomach, or no leakage of gas through gastrostomy tube

51
Q

Anomalies associated with TE fistula

A

Vertebral, cardiac, renal, radial anomalies

52
Q

MoA of agents used for pulm Htn:

PGE2
NO

A

PGE2 -> cyclic AMP

NO -> cyclic GMP

53
Q

Mgmt of Pulm Htn in CHD

A
  • Increase FiO2
  • Avoid acidosis
  • moderate hyperventilation
  • moderate hypocapnia
  • Avoid hypothermia
  • Inhaled NO
  • PGE2
54
Q

Anesthesia Concern for Congenital diaphragmatic hernia

A
  • Pulm hypoplasia
  • Pulm Htn
  • Risk for PTX due to high airway pressures
  • Bag & mask ventilation (overdistension of stomach & herniation across the midline)
55
Q

Ventilator strategies in Congenital diaphragmatic hernia

A
  • Low TV
  • Peak airway pressures < 25 cm
  • Permissive hypercarbia to achive preductal O2 Sat 90-95%
56
Q

Neonatal Continental defects that associated with CHD?

A
  • Congenital diaphragmatic hernia
  • Omphalocele
  • TE fistula
57
Q

Meningomyelocele is associated with

A

Arnold-CHiari malformation & Hydrocephelus

58
Q

Components of ToF

A 
PROVe
pulm stenosis
RVH
Overriding aorta
VSD
59
Q

preferred induction agent in ToF tetspells

A

Ketamine

tetspells occur when PVR increases or SVR decreases (ketamine maintains or increases SVR)

60
Q

TTx of Tetspells in ToF

A
  • 100% O2
  • BB
  • IVF
  • Phenylephrine to increase SVR
61
Q

Anesthetics goals in ToF reair

A
  • Maintain intravascular volume
  • Higher FiO2
  • Maintain SVR (use Neo)
  • Ketamine induction (maintain SVR)
  • Propranpolol for infundibular spasm
62
Q

Continues machinery murmur best heard at … and its specific for …

A

Left clavicle

PDA

63
Q

Why neonates with PDA would have wide puls pressure

A

reduced diastolic pressure

64
Q

PGE1 … PDA patency

A

keeps it open (indomethacin closes it)

65
Q

Hpoplastic left heart syndrome occurs when parts of left heart is not completely develop, thoses parts are

A

MV
L ventricular AV
and aorta

blood pumped to body through RV which has to pass through PDA to reach systemic circulation

66
Q

Anamoly that both pulm & systemic venis returns to RA is

A

Total Anamolous pulmonary return (TAPVR)

ASD?VSD needed to pass from RA to left

67
Q

Single vessel recives blood from both R & L ventricle and then devised into aorta & pulm artery is

A

Truncus Areriosus

68
Q

do they need PDA in Truncus Areriosus for life?

A

No because mixing has already occurred

69
Q

one CHD in which PDA not essential for life

A

Truncus Areriosus

70
Q

CHD in which ODA essential for life

A 
Pulm stenosis
Aortic stenosis
ToF
Transposition of great vessels
TAPVR
Hypoplastic L heart syndrom
71
Q

whats the name & indications of procedure that diverts venous blood from RA to pulmonary circulation bypassing RV

A

Fontan procedure

  • Hypoplastic L heart syndrome
  • Tricspid atresia with intact ventricular septum
72
Q

Hypothermia or hyperthermia that increases Pulm vasoconstriction and increases R->L shunts

A

Hypothermia

73
Q

A disorder of lung parenchyma that results into hyperinflation of lung & respiratory distress from newborns to 6 months

A

Congintal lobar emphysema

  • Avoid high peal airway pressure with ventilation
  • Avoid NO
  • Assisted ventilation is required
74
Q

NMB overall dose should be reduced in neonates due to

A

their large volume distirbution, NMJ and liver is immature

DSouza 2015 (21 decks)

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