Pediatrics, ENT, & MH Flashcards

1
Q

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

A

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

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2
Q

LMA or ETT in children with URIs?

A

LMA (ETT has higher risk of bronchospasm)

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3
Q

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

A

True

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4
Q

Formula for calculating ETT size in children

A

4 + (Age/4)

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5
Q

Formula for estimating correct depth of ETT in children

A

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

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6
Q

What nerve stimulation causes laryngospasms?

A

Superior laryngeal nerve

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7
Q

Treatment for kid with high pitched inspiratory noises in PACU

A

Post-intubation croup: racemic epinephrine nebulization

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8
Q

Steeple sign on X-ray

A

Croup

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9
Q

Thumb sign on X-ray

A

Epiglottitis

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10
Q

Treatment of croup

A

Racemic epinephrine, steroids for long-term

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11
Q

Best ETT for laryngeal polyp excision using a CO2 laser?

A

Metal ETT or intermittent intubation and ventilation

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

Why do wake-up tests and MEPs together?

A

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

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15
Q

Risks of a wake-up test during spine surgery?

A

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

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16
Q

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

A

Cor pulmonale (cardiorespiratory syndrome): right heart failure

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17
Q

Major concerns for peritonsillar abscesses?

A

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

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18
Q

Extrathoracic variable obstructions have what flow volume pattern?

A

Limited ability to pull air in on inspiration

19
Q

Intrathoracic variable obstructions have what flow volume pattern?

A

Limited ability to push air out on expiration

20
Q

Tracheomalacia flow-volume pattern?

A

Extrathoracic variable obstruction

21
Q

Laryngomalacia flow-volume pattern?

A

Extrathoracic variable obstruction

22
Q

Mediastinal masses flow volume pattern?

A

Intrathoracic variable obstruction

23
Q

Choanal atresia flow volume pattern?

A

Normal or fixed obstruction on both inspiration and expiration

24
Q

OSA flow volume pattern?

A

Intrathoracic variable obstruction (sawtoothing on expiration)

25
Q

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

A

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

26
Q

What do you worry about a patient with DiGeorge syndrome?

A

HypoPTH with hypocalcemia

27
Q

DiGeorge syndrome clinical presentation?

A

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

28
Q

Main risk of craniosynostosis surgery?

A

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

29
Q

When do you worry about Propofol infusion syndrome?

A

After 48 hours + use of propofol infusion

30
Q

Landmark for caudal anesthesia?

A

Sacral hiatus

31
Q

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

A

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

32
Q

Morphine epidural dose in children?

A

0.1mg/kg

33
Q

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

A

Central-core disease (muscle dystrophy without muscle wasting)

34
Q

Triggering agents for MH

A

Halogenated volatiles and succinylcholine

35
Q

Mechanism for MH?

A

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

36
Q

Dose of dantrolene for MH?

A

2.5mg/kg

37
Q

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

A

Thrombocytopenia: tissues thromboplastin release leads to DIC with thrombocytopenia

38
Q

Do muscle relaxants help with masseter muscle spasms of MH?

A

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

39
Q

Halothane-caffeine contracture test is what?

A

Highly sensitive test for MH

40
Q

What meds increase triggering threshold for MH?

A

Pancuronium and thiopental

41
Q

What condition would you see an elevated mixed venous sat?

A

Severe sepsis (in early sepsis, may be decreased)

42
Q

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

A

6 hours

43
Q

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

A

Give dantrolene