Pediatrics, ENT, & MH

Question 1

How long should you wait for elective procedure if patient has recently had a URI?

Answer 1

4-6 weeks (otherwise, higher risk of increased airway reactivity)

Question 2

LMA or ETT in children with URIs?

Answer 2

LMA (ETT has higher risk of bronchospasm)

Question 3

True or false: incidence of airway complications with children with active vs. recovery period of URI are almost identical?

Answer 3

True

Question 4

Formula for calculating ETT size in children

Answer 4

4 + (Age/4)

Question 5

Formula for estimating correct depth of ETT in children

Answer 5

12 + (Age/2) or weight in kg/5 + 12 or 3x diameter of ETT

Question 6

What nerve stimulation causes laryngospasms?

Answer 6

Superior laryngeal nerve

Question 7

Treatment for kid with high pitched inspiratory noises in PACU

Answer 7

Post-intubation croup: racemic epinephrine nebulization

Question 8

Steeple sign on X-ray

Answer 8

Croup

Question 9

Thumb sign on X-ray

Answer 9

Epiglottitis

Question 10

Treatment of croup

Answer 10

Racemic epinephrine, steroids for long-term

Question 11

Best ETT for laryngeal polyp excision using a CO2 laser?

Answer 11

Metal ETT or intermittent intubation and ventilation

Question 12

What to do when you notice smoke from ETT during CO2 laser?

Answer 12

Extubate the trachea, flood the field with saline, then examine with fiberoptic

Question 13

Scoliosis is associated with which of the following: seizure disorder, mental retardation, hirsutism, MV stenosis, pulmonary HTN

Answer 13

Pulmonary HTN (restrictive lung disease from rotated, constricted thorax)

Question 14

Why do wake-up tests and MEPs together?

Answer 14

MEPs are prone to false positives, but are continuous monitors; wake-up tests are definitive but non-continuous

Question 15

Risks of a wake-up test during spine surgery?

Answer 15

Unintentional extubation, dislodgement of lines and instruments, air embolism (inspiration drawing in air through vertebral veins)

Question 16

4 year old with OSA, which is likely associated with this condition? Peritonsillar abscess, cor pulmonale, choanal atresia, subglottic hemangioma, laryngomalacia

Answer 16

Cor pulmonale (cardiorespiratory syndrome): right heart failure

Question 17

Major concerns for peritonsillar abscesses?

Answer 17

Obstruction of glottic opening; rupture of abscess; therefore, spontaneous breathing is important on induction

Question 18

Extrathoracic variable obstructions have what flow volume pattern?

Answer 18

Limited ability to pull air in on inspiration

Question 19

Intrathoracic variable obstructions have what flow volume pattern?

Answer 19

Limited ability to push air out on expiration

Question 20

Tracheomalacia flow-volume pattern?

Answer 20

Extrathoracic variable obstruction

Question 21

Laryngomalacia flow-volume pattern?

Answer 21

Extrathoracic variable obstruction

Question 22

Mediastinal masses flow volume pattern?

Answer 22

Intrathoracic variable obstruction

Question 23

Choanal atresia flow volume pattern?

Answer 23

Normal or fixed obstruction on both inspiration and expiration

Question 24

OSA flow volume pattern?

Answer 24

Intrathoracic variable obstruction (sawtoothing on expiration)

Question 25

Which of the following congenital conditions are associated with a difficult intubation? Pierre-Robin syndrome, Treacher Collins syndrome, Carpenter syndrome, Crouzon disease, Niemann-Pick?

Answer 25

Pierre-Robin and Treacher-Collins (micrognathia and cleft palate), Carpenter, Crouzon

Question 26

What do you worry about a patient with DiGeorge syndrome?

Answer 26

HypoPTH with hypocalcemia

Question 27

DiGeorge syndrome clinical presentation?

Answer 27

CATCH-22: cardiac (tetrology), abnormal facies, thymic aplasia (increased infections), cleft palate, hypocalcemia, deletion on chromosome 22

Question 28

Main risk of craniosynostosis surgery?

Answer 28

Bleeding (dividing skull along suture lines above the venous sinuses which can bleed)

Question 29

When do you worry about Propofol infusion syndrome?

Answer 29

After 48 hours + use of propofol infusion

Question 30

Landmark for caudal anesthesia?

Answer 30

Sacral hiatus

Question 31

Minimum dose of 0.25% bupivicaine via caudal epidural injection helps with post-op pain after perineal surgery? upper abdominal surgery?

Answer 31

0.5cc/kg of anything greater than 0.175% bupivicaine for perineal surgical pain; 1.25cc/kg for upper abdominal

Question 32

Morphine epidural dose in children?

Answer 32

0.1mg/kg

Question 33

Which is associated with MH? Duchenne’s, ataxia telangiectasia, treacher-collins, central-core disease, osteogenesis imperfecta

Answer 33

Central-core disease (muscle dystrophy without muscle wasting)

Question 34

Triggering agents for MH

Answer 34

Halogenated volatiles and succinylcholine

Question 35

Mechanism for MH?

Answer 35

Calcium induced release of calcium (ryanodine receptors are stuck open, allowing for calcium to freely enter the cell from the sarcoplasmic reticulum)

Question 36

Dose of dantrolene for MH?

Answer 36

2.5mg/kg

Question 37

Which lab value is consistent with MH? hyperPO4, decreased CK, hemoglobinuria, hypokalemia, thrombocytopenia

Answer 37

Thrombocytopenia: tissues thromboplastin release leads to DIC with thrombocytopenia

Question 38

Do muscle relaxants help with masseter muscle spasms of MH?

Answer 38

No (since calcium-induced release of calcium happens without a motor end-plate activation)

Question 39

Halothane-caffeine contracture test is what?

Answer 39

Highly sensitive test for MH

Question 40

What meds increase triggering threshold for MH?

Answer 40

Pancuronium and thiopental

Question 41

What condition would you see an elevated mixed venous sat?

Answer 41

Severe sepsis (in early sepsis, may be decreased)

Question 42

How long do you monitor a kid with known MH after anesthesia?

Answer 42

6 hours

Question 43

Child with remote family hx of MH gets succ for an elective case and has masseter muscle spasm… what do you do?

Answer 43

Give dantrolene