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Patho > Peds > Flashcards

Peds Flashcards

1
Q

Most of the blood bypasses fetal liver via the _____ and mixes w/ deoxygenated blood in inferior vena cava

A

Ductus venosus

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2
Q

Why is blood shunted away from fetal lungs?

A

High resistance

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3
Q

Connects pulm artery to aorta

A

Ductus arteriosus

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4
Q

Fetal circulation

A

Umb vein > ductus venosus > IVC > RA > LA (through foremen ovale) > LV > aorta > body

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5
Q

What closes ductus arteriosus? What helps close PDA?

A

Increase in O2 from respiration and decrease in prostaglandins d/t placental separation; Indomethacin

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6
Q

Keep PDA open

A

Prostaglandins E1 & E2

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7
Q

Fetal PaCO2? PaO2?

A

PaCO2 = 48; PaO2 = 30 (+10 if mom on 100% O2)

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8
Q

Pulm resistance increases in:

A

Hypoxia, hypercarbia, & hypothermia

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9
Q

Large VSD cause:

A

PHTN, growth failure, CHF, infection

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10
Q

Large ASD

A

SOB, hyper dynamic pericardium, RV heave, systolic ejection murmur, fixed splitting of S2, paradoxical embolism

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11
Q

I corrected VSD, ASD, or PDA leads to PHTN. Increased pulm resistance causes shunt to reverse from L>R to R>L causing late cyanosis (clubbing & polycythemia)

A

Eisenmenger’s Syndrome

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12
Q

Blood flows from aorta to pulm artery. Additional blood is deoxygenated in lungs & returns to LA & LV -> increased work load -> LVH.

A

PDA

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13
Q

PDA tx

A

Surgical ligation. COX1 & 2 inhibitors & indomethacin “medical ligation”

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14
Q

A difference of ___ in pulse ox suggests marked pulmonary HTN w/ PDA

A

10%

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15
Q

4 features of Tetralogy of Fallot

A
  1. Pulm stenosis (RV outflow obstruction);
  2. Overriding aorta (comes from LV and RV);
  3. Large VSD;
  4. RV hypertrophy
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16
Q

Most common CHD causing cyanosis

A

TOF

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17
Q

RV outflow obstruction + VSD result in

A

Ejection of mixed blood into aorta

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18
Q

The _____ infusion will keep PDA open allowing mixed blood to circulate to lungs to get more oxygenated

A

PGE1

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19
Q

How does squatting help with TOF

A

Increases SVR & aortic pressure, which decreases R -> L shunt so lungs can get more blood. -> increase arterial O2 sat

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20
Q

TET spells

A

Hypercyanotic & hypoxic spells. PO2 < 50 mmHg during feeding or crying. Unresponsive to supplemental O2

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21
Q

TOF physical findings

A

RV heave, harsh systolic ejection murmur, boot shaped heart on X-ray, right axis deviation/RVH

22
Q

Conditions that increase R -> L shunt

A

Increase PVR or decrease SVR, acidosis, hypercardbia, hypotension

23
Q

TOF surgery

A

Blalock-Taussing shunt (connects subclavian artery to pulm artery “creating duct”, more blood to lungs);
Closing VSD;
Resecting obstruction

24
Q

Foramen of Bochdalek or Morgagni

A

Gut herniates into thorax in diaphragm

25
Q

Most common type of tracheoesophageal fistula

A

Type IIIB

26
Q

3C’s with tracheoesophageal fistula

A

Cyanosis, choking, coughing with feeding

27
Q

Other defects with tracheoesophageal fistula (VATER syndrome)

A

Vertebral defect, Anal atresia, TE fistula, Esophageal atresia, Radial dysplasia

28
Q

Why avoid LR with pyloric stenosis?

A

Met alkalosis and LR is metabolized to bicarb by liver

29
Q

Anesthetic considerations for pyloric stenosis

A

Fix fluid & lytes first, suction/high risk aspiration, high risk resp depression d/t prolonged alkalosis, awake intubation and rapid induction, UO 1-2ml/kg/hr

30
Q

Anesthetic considerations for acute epiglottitis

A

Lateral neck X-ray to determine extent of obstructions, prepare for trach, avoid laryngoscope, inhalation induction in sitting position, intubation with smaller size tube

31
Q

Steeple sign on AP neck film. Strider improves with aerosolized racemic epi

A

Croup

32
Q

Thumbprint sign on lateral neck film

A

Epiglottitis

33
Q

Subglottic narrowing

A

Tracheitis

34
Q

Cleft palate, small face and glottis

A

Pierre-robin syndrome

35
Q

Small lower jaw, absent or malformed ear, more severe

A

Treacher-collins syndrome

36
Q

1:5000; persistence of herniating of abd contents into umbilical cord, covered w/ peritoneum.
Occurs at base of umbilicus;
Have hernia sac; associated w/ Down syndrome & increased maternal a-fetoprotein

A

Omphalocele

37
Q

1:15000; failure of lateral body folds to fuse -> extrusion of abd contents through abd folds.
Does NOT have hernia sac

A

Gastroschisis

38
Q

Staged closure of omphalocele and gastroschisis if:

A

Intragastric pressure > 20 cmH2O;
Peak inspiratory pressure > 35 cmH2O;
ETCO2 > 50 mmHg

39
Q

Bowel compartment syndrome may:

A

Impair ventilation, obstruct venous return, impair renal functions, high mortality

40
Q

Telescoping of bowel segment into itself. MCC of bowel obstruction in first 2 yrs. Colicky pain, vomiting, blood in stool, “current jelly stool”, sausage shape mass

A

Intussuception

41
Q

Hereditary dz of exocrine glands of lungs and GIT. Result form a defect in Cl channels caused by mutation

A

Cystic fibrosis

42
Q

Diagnosis CF by

A

Sweat chloride test

43
Q

Clinical presentation of CF

A

Increased Residual volume, increased airway resistance, decreased vital capacity, decreased expiratory flow rate

44
Q

Making a hole for drainage of any fluid in middle ear cavity

A

Myringotomy

45
Q

Is N2O safe during myringotomy?

A

Yes d/t short duration (10-15 min)

46
Q

Duchenne Muscular Dystrophy is x-linked disorder d/t deficiency of _____ - a cytoskeletal protein (like glue)

A

Dystrophin

47
Q

Fetal deposition of bilirubin in basal ganglia w/ bilirubin > 20mg/dl

A

Kernicterus

48
Q

If ______ bilirubin is elevated, check blood smear for hemolysis

A

Indirect

49
Q

If ______ bilirubin is elevated, check liver enzymes

A

Direct

50
Q

Murmur associated with PDA

A

Continuous (systolic & diastolic) murmur “machinery”

51
Q

Omphalocele is a/w?

A

Down syndrome & increased maternal a-fetoprotein

52
Q

Midsystolic harsh blowing murmur

A

VSD

Patho (13 decks)

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