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Fall'20 Final Exam Prep > Peds > Flashcards

Peds Flashcards

1
Q

Oxygenated blood from placenta enters through ?

A

umbilical veins

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2
Q

Most of the blood bypass fetal liver via the _________ and mix with deoxygenated blood in _________

A

ductus venosus

inferior vena cava

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3
Q

Foramen ovale shunts blood from

A

right atrium (high pressure pressure) directly into left atrium (low pressure pressure)

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4
Q

Ductus arteriosus connects

A

pulmonary artery directly to aorta

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5
Q

Deoxygenated blood returns to placenta via

A

the umbilical arteries

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6
Q

Most of the oxygenated blood reaching the heart via the umbilical vein and inferior vena cava is

A

diverted through the foramen ovale and pumped out the aorta to the head.

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7
Q

Pathway of blood through fetal circulation

A

Umbilical vein-> ductus venosus -> inferior vena cava -> right atrium ->left atrium (through foramen ovale) -> left ventricle -> aorta -> body

Some blood does not pass to left atrium (through foramen ovale), but enters the right ventricle and pumped into the pulmonary artery. From pulmonary artery blood pass to aorta through ductus arteriosus by passing lungs that are solid rock (infinite pulmonary resistance) during fetal life

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8
Q

Blood in umbilical vein is ________ saturated with O2. Umbilical arteries have low O2 sat.

A

80%

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9
Q

Indomethacin helps______ PDA. Prostaglandins E1 and E2 helps ______ PDA.

A

Indomethacin helps close PDA. Prostaglandins E1 and E2 keep PDA open

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10
Q

Fetal blood
PaCO2 = ______
PaO2 = ______

A

48 mmHg

30 mmHg (+10 increase if mother is on 100% O2)

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11
Q

Ductus arteriosus closes in __________ period

A

2-3 weeks

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12
Q

Foramen ovale closes in _________period

A

takes months to close

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13
Q

Is right to left shunt normal?

A

Normally occur to a small extent because 2% of the cardiac output bypasses the lungs- physiologic shunt

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14
Q

Prematurity is defined as

A

Birth before 37 weeks

< 1000 g

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15
Q

What are the complications of prematurity

A 
Hyaline membrane disease
Apneic spells
Bronchopulmonary dysplasia
Respiratory distress syndrome
PDA
Retinopathy
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16
Q

What are the anesthetic considerations of prematurity

A

Avoid excessive inspired O2

Risk of post-anesthetic apnea

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17
Q

Gut herniate into thorax through ‘hole’ in diaphragm

A

Congenital Diaphragmatic Hernia

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18
Q

Foramen of Bochdalek or Morgagni is

A

Hole in diaphragm through which gut herniate into thorax in CDH

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19
Q

What is the incidence and mortality for patients with CDH

A

1:5,000

Mortality 40-50%

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20
Q

In a Congenital Diaphragmatic Hernia, hypoxia is due to?

A

R to L shunt, from persistent fetal circulation

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21
Q

Physical examination for a patient with CDH

A

Scaphoid abdomen
Bowel sound in chest
Pulmonary hypoplasia and hypertension
Severe retractions

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22
Q

What is the treatment for Congenital Diaphragmatic Hernia

A 
Stabilization  
Postductal PCO2 < 65mmHg and preductal O2 saturation >85%
ECMO is useful 
Surgical decompression 
Intrauterine surgery
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23
Q

Anesthetic consideration for CDH

A 
NG tube
Avoid high pressure PPV
Pre-oxygenation
Decrease conc. of VA, muscle relaxant
Nitrous oxide (N2O) is contraindicated 
High risk of pneumothorax  avoid barotrauma. Treat with chest tube
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24
Q

What are the 3cs of Tracheoesophageal fistula

A

Cyanosis, chocking and coughing with feeding

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25
Q

Esophagus is a blind pouch attached by a fistula to the trachea in this congenital abnormality

A

Tracheoespophageal Fistula

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26
Q

What other defects are associated with Tracheoespophageal fistula

A

VATER syndrome

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

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27
Q

Cx findings in a patient with Tracheoespophageal fistula show

A

NG tube coiled in esophagus

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28
Q

Surgical repair is must for petients with Tracheoespophageal fistula because?

A

high risk of aspiration leading to aspiration pneumonia

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29
Q

Tracheoespophageal Fistula is associated with polyhydramnios T/F

A

True

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30
Q

What are the anesthetic considerations for Tracheoespophageal Fistula

A

Need frequent suction due to high secretion
Avoid PPV
Awake intubation

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31
Q

Hypertrophy of pyloric smooth muscles

A

Pyloric Stenosis

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32
Q

Features of pyloric stenosis

A

Palpable ‘olive’ shaped mass

Projectile vomiting resulting in metabolic alkalosis and shock

Loss of Na+, K+, H+, Cl-

Paradoxic aciduria -Trading off sodium with hydrogen

Present in the first two weeks to four months

1:1000 birth

‘String sign’ on barium study

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33
Q

Treatment of pyloric stenosis

A

Correct dehydration

NaCl and K+ supplement

Avoid Ringers lactate as lactate is metabolized to bicarb by liver

Surgical correction

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34
Q

Anesthetic consideration for patient with pyloric stenosis

A

Fix fluid and lytes first

Suction

High risk of aspiration

High risk of respiratory depression due to prolonged alkalosis

Awake intubation and rapid induction

Urinary output 1-2 ml/kg/hour

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35
Q

Assessment findings in a patient with acute epiglottitis

A 
High grade fever
Inspiratory stridor
Tachypnea
SOB
Cyanosis
Drooling
Respiratory acidosis
Sore throat leading to dysphagia then obstruction
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36
Q

Acute epiglottitis is caused by

A

Haemophilus influenzae type B

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37
Q

Acute epiglottitis is commonly seen at what age

A

2-6 year of age

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38
Q

Edema of supraglottic structures

A

Acute epiglottitis

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39
Q

Describe the treatment of Acute epiglottitis

A

ET and antibiotics are life-saving
Ampicillin
Vaccination

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40
Q

Anesthesia consideration in a patient with Acute epiglottitis

A

Lateral neck X-ray to determine extent of obstruction

Prepare for tracheostomy

Avoid laryngoscopy

Inhalation induction in sitting position

Intubation with smaller size tubes

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41
Q

Child in ER prefers to sit and appears anxious. The child assumes the characteristic sniffing position to maximize the patency of her airway. What is the diagnosis

A

epiglottitis caused by Haemophilus influenzae type B

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42
Q

Features of Laryngotracheal bronchitis

A 
Low grade fever
Less airway obstruction
Barking cough
RSV
3 months to 3 years
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43
Q

Treatment of Laryngotracheal bronchitis

A

Oxygen and mist therapy

Nebulized epi

IV dex

Intubate if signs of respiratory depression appear

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44
Q

Anesthetic consideration in Laryngotracheal bronchitis

A

Usually no intubation

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45
Q

What is the onset of epiglottitis compared to croup and tracheitis

A

Epiglottitis: rapid onset

Croup: develops in 2-3 days

Tracheitis: gradual onset

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46
Q

What is the age group of epiglottitis compared to croup and tracheitis

A

Epiglottitis: 2-7 yrs

Cropup: 3m-5y

Tracheitis: any age

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47
Q

What is the response to recemic epi of epiglottitis compared to croup and tracheitis

A

Epiglottitis: no response

Croup: Stridor improves

Tracheitis: no response

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48
Q

What is the severity of respiratory distress in epiglottitis compared to croup and tracheitis

A

Epiglottitis: Severe respiratory distress

Croup: Mild to moderate

Tracheitis: Severe respiratory distress

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49
Q

What is the xr finding of epiglottitis compared to croup and tracheitis

A

Epiglottitis: Subglottic narrowing (steeple sign) on AP neck

Croup: Thumbprint sign on Lateral neck

Tracheitis: Subglottic narrowing

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50
Q

What is the severity of fever in epiglottitis compared to croup and tracheitis

A

Epiglottitis: High grade

Croup: Low grade fever

Tracheitis: High grade fever

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51
Q

What is the causative microorganism in epiglottitis compared to croup and tracheitis

A

Epiglottitis: Haemophilus influenzae B

Croup: Parainfluenza virus

Tracheitis: Staph aureus

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52
Q

Pierre-Robin Syndrome and Treacher-Collins Syndrome present with difficult intubation and awake intubation is recommended. Differentiate between the two.

A

Pierre-Robin syndrome patient has: Cleft palate, Small face and glottis

Treacher-Collins syndrome patient has: Small lower jaw and Absent or malformed ear. It’s More severe than Pierre-Robins

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53
Q

Patient has Small lower jaw and Absent or malformed ear.

A

Treacher-Collins syndrome

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54
Q

Patient has Cleft palate, Small face and glottis

A

Pierre-Robin syndrome

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55
Q

What is the incidence of Omphacele compared to gastroschisis

A

Ompacele 1:5000

Gastroschisis: 1: 15000

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56
Q

What are the features of Omphacele compared to gastroschisis

A

Omphalocele is associated with other congenital anomalies e.g. Down’s whereas gastroschisis is not

Omphalocele have a hernia sac whereas gastroschisis do not

Omphalocele results from herniation of abdominal contents into umbilical cord, covered with peritoneum whereas; gastroschisis extrusion of abdominal contents through abdominal folds

Omphalocele occurs at the base of umbilicus, whereas gastroschisis occurs as a result of failure of lateral body folds to fuse

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57
Q

Failure of lateral body folds to fuse leading to extrusion of abdominal contents through abdominal folds

A

Gastroschisis

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58
Q

Persistence of herniation of abdominal contents into umbilical cord, covered with peritoneum

A

Omphalocele

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59
Q

Anesthetic consideration for Omphalocele and Gastroschisis

A

NG decompression

Awake intubation

Nitrous oxide (N2O) is contraindicated ; avoid further distension

Muscle relaxation for reduction

Staged closure if:
Intragastric pressure > 20 cm H2O
Peak inspiratory pressure > 35 cm H2O
End-tidal CO2 > 50 mmHg

Replace third space fluid loss with salt solution and 5% albumin

Intubation for 1-2 days postop

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60
Q

Staged closure of Omphalocele and Gastroschisis is performed if?

A

Intragastric pressure > 20 cm H2O

Peak inspiratory pressure > 35 cm H2O

End-tidal CO2 > 50 mmHg

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61
Q

What are the anesthesia considerations of Prune Belly Syndrome

A

Risk of aspiration; cannot cough

Awake intubation

Treat as full stomach

No muscle relaxant

Bad kidneys

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62
Q

Congenital deficiency of abdominal muscles with thin weak abdominal wall. Will have mass of wrinkled skin on abdomen

A

Prune Belly Syndrome

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63
Q

A remnant of the omphalomesenteric duct that can contain ectopic (usually gastric or pancreatic mucosa)

A

Meckel’s Diverticulum

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64
Q

Features of Meckel’s Diverticulum (Rule of 2’s)

A 
2 time male as often as female
2 years and under for symptoms 
2 cm long
2 feet proximal to ileocecal valve
2 types of ectopic tissues
2% of population
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65
Q

PE findings of Meckel’s Diverticulum

A

Unremarkable
Rectal bleeding
Abdominal pain
Umbilical cellulitis

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66
Q

Treatment of Meckel’s Diverticulum

A

surgical resection

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67
Q

Abnormal rotation of the midgut around mesentery (SMA)

A

Intestinal Malrotation and Volvulus “twist”

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68
Q

Midgut volvulus can cut the blood supply leading to infarction that is a surgical emergency. What are the signs and symptoms

A

Billious vomiting

Progressive abdominal distension and tenderness

Metabolic acidosis

Bloody diarrhea is indicative of infarction

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69
Q

What is the incidence and mortality of Intestinal Malrotation and Volvulus “twist”

A

1:500 incidence
High mortality

Symptoms of acute or chronic bowel obstruction

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70
Q

A patient with Intestinal Malrotation and Volvulus “twist” May develop “bowel compartment syndrome” which may (4)

A

Impair ventilation
Obstruct venous return
Impair renal functions
High mortality

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71
Q

Anesthetic considerations for patient with Intestinal Malrotation and Volvulus “twist” include?

A

Preop stabilization, NG, fluid/lyte balance, antibiotics

Rush to OR

Preoxygenation , awake intubation, rapid induction

Hypovolemia

Poor tolerance to GA

Ketamine may be agent of choice

Fluid resuscitation

Blood products

May develop “bowl compartment syndrome”

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72
Q

Telescoping of a segment of bowl into itself

A

Intussusception

73
Q

MCC of bowel obstruction in first 2 years

A

Intussusception

74
Q

Risk factors of Intussusception are?

A

Meckel’s diverticulum
Intestinal lymphoma
Viral infection

75
Q

H&P for a patient with Intussusception

A

Abrupt onset of abdominal pain in a healthy child

Colicky pain, vomiting, blood in stool “current jelly stool”

Pallor , sweating

“Sausage-shape abdominal mass”

76
Q

Treatment for a patient with Intussusception

A

Correct fluid and electrolyte

Air contrast enema is diagnostic and
curative

Surgical resection

77
Q

Hereditary disease of exocrine glands of lungs and G.I.T. Result from a defect in Cl- channels that is caused by mutation

A

Cystic fibrosis

78
Q

Most common recessive disorder in Caucasians [defective CFRT gene on chromosome 7]

A

Cystic fibrosis

79
Q

Features of Cystic fibrosis

A

Thick and sticky mucus builds up in lungs and intestine forming cysts.

Inability to clear secretions leading to bronchiectasis

Is associated with a deficiency of pancreatic enzymes resulting in malabsorption and steatorrhea

80
Q

____________ is associated with a deficiency of pancreatic enzymes resulting in malabsorption and steatorrhea

A

Cystic fibrosis

81
Q

Clinical presentation of cystic fibrosis

A

Low RV, high airway resistance, decreased VC, decreased expiratory flow rate

Recurrent resp. infections , pneumonias
Fat malabsorption leading to deficiency of A,D,E, K

Fluid and electrolyte imbalance due to malabsorption

Failure to thrive

Death in early adulthood

82
Q

Elevated Sweat chloride test is diagnostic for?

A

Cystic fibrosis

83
Q

Anesthetic consideration for cystic fibrosis

A

Anticholinergic drugs are controversial

Prolong inhalation induction

Deep anesthesia for intubation

Avoid hyperventilation; may lead to shallow postop respiration

Respiratory therapy: Bronchodilators, incentive spirometry, postural drainage and proper antibiotics

84
Q

Lateral curvature of vertebra and deformity of rib cage

A

Scoliosis

85
Q

Anesthetic considerations of scoliosis

A

Peop PFTs, ABG and ECG

Significant blood loss and risk of paraplegia during surgery

Monitor sensory and motor EP

Predispose to MH, arrhythmia, and adverse effects of sux i.e. hyperkalemia, myoglobinuria and sustained muscle contraction

86
Q

Anesthetic consideration for Tonsillectomy and Adenoidectomy

A

No surgery if infection or clotting defects

Give preop atropine to dry-up secretions

Use reinforced or preformed ET tube

Awake intubation

Post op vomiting is common

Rapid-sequence induction with cricoid pressure

87
Q

Anesthetic consideration for Tonsillectomy and Adenoidectomy

A

No surgery if infection or clotting defects

Give preop atropine to dry-up secretions

Use reinforced or preformed ET tube

Awake intubation

Post op vomiting is common

Rapid-sequence induction with cricoid pressure

88
Q

Features of patient undergoing Tonsillectomy and Adenoidectomy

A

Enlarged tonsils leading to mouth breathing, obstruction, pulmonary hypertension

Perioperative airways problems

89
Q

Pathophysiology of patient undergoing Myringotomy and insertion of Tympanostomy Tubes

A

Recurrent otitis media

Hemophilus influenzae, streptococci, pneumococcus, mycoplasma are common pathogens

Myringotomy is making a hole for drainage of any fluid in middle ear cavity
Tubes provide long term drainage

90
Q

common pathogens that cause recurrent otitis media

A

Haemophilus influenzae
Streptococcus
Pneumococcus
Mycoplasma

91
Q

Anesthesia concerns of patient undergoing Myringotomy and insertion of Tympanostomy Tubes

A

Inhalation induction with nitrous oxide (N2O) is safe due to short duration (10-15 min)

92
Q

47 chromosomes with 3 copies of chromosome 21 seen in 1 in 700 births

A

Down’s Syndrome

93
Q

Signs and symptoms of down syndrom

A

Flat face

Short neck, Upslanting eyes

Brushfield spots- dark lines in iris

Epicanthal folds

Protruding large tongue

Irregular dentition

hypotonia

Associated with mental retardation, TE fistula, subglottic stenosis, pul infections

94
Q

Anesthetic consideration for down syndrome

A

Difficult airways

Smaller ET tubes are required

Watch for post op apnea and stridor

Atlanto-axial dislocation

Paradoxical embolism due to ‘hole’ in heart ; VSD

95
Q

Patient presents with facial muscle and shoulder girdle weakness and AD. Likely diagnosis is?

A

Facioscapulohumeral dystrophy

96
Q

Characteristic facies, cataract, testicular atrophy and muscle weakness and wasting

A

Myotonic dystrophy

97
Q

X-linked disorder similar but less severe to Duchenne

A

Becker muscular dystrophy

98
Q

X-linked disorder due to deficiency of dystrophin- a cytoskeletal protein (like glue)

A

Duchenne Muscular Dystrophy

99
Q

Most common and most lethal muscular dystrophy

A

Duchenne Muscular Dystrophy

100
Q

Duchenne Muscular Dystrophy occurs____ of age; death by _____ age

A

2-6 years

20 years

101
Q

What are the presenting features of Duchenne Muscular Dystrophy

A

Progressive clumsiness

Fatigability

Difficulty in standing, waking, proximal muscle weakness

Respiratory insufficiency

Possible mental retardation

102
Q

Evaluation of Duchenne Muscular Dystrophy shows?

A

Elevated CK

Degeneration seen in biopsy

103
Q

Physiological jaundice is seen when?

A

after first day of life and within 3-5 days of birth

104
Q

Jaundice in first day of life in NOT ?

A

physiological

105
Q

fetal deposition of bilirubin in basal ganglia with bilirubin > 20 mg/dl

A

Kernicterus

106
Q

In neonatal Jaundice, Bilirubin rises to _______ then falls

A

9 mg/dl

107
Q

Diagnosis and Differentials of neonatal jaundice

A 
Physiological jaundice 
Breast milk jaundice 
Crigler-najjar syndrome
Gilbert’s syndrome
Hemolysis
Neonatal hepatitis
Biliary atresia
Alpha-1 antitrypsin deficiency
Metabolic disorders
Hypothyroidism
108
Q

The most common motor disability in childhood is

A

Cerebral palsy

109
Q

A non-progressive, non-hereditary disorder of impaired motor function and posture

A

Cerebral palsy

110
Q

Cerebral palsy Most commonly results from

A

a perinatal neurologic insult

111
Q

Risk factors of Cerebral palsy include?

A 
Prematurity- strongest risk factor
Mental retardation
Low birth weight
Fetal malformation
Neonatal cerebral hemorrhage / leukomalacia 
Perinatal hypoxia- Reduce umbilical or uterine blood flow 
Advance maternal age ( >35 years)
Metabolic / endocrine disorders
Malnutrition 
Perinatal hypoxia
Alcohol and tobacco use during pregnancy 
Trauma 
Infections (TORCH)
112
Q

Identify TORCH infections

A 
Toxoplasmosis
Others (syphilis, chicken pox. listeria)
Rubella
Cytomegalovirus 
Herpes
113
Q

Signs and Symptoms of cerebral palsy

A

Tone abnormality – hyper or hypo tonic ; fluctuating

Signs of upper motor neuron lesions ??

Reflex abnormality:

  • Enhanced reflexes(hyperreflexia), clonus
  • Absence of primitive reflexes e.g. stretch reflex, asymmetrical tonic neck reflex (ATNR), grasp reflex

Atypical posture
-Spasticity of upper and lower extremities

Delayed motor development
-Inability to sit or crawl

Atypical motor performance

Ataxia

114
Q

The most common form of cerebral palsy is?

A

Spastic 80%

115
Q

Cerebral palsy caused by lesion of cerebral cortex

A

Spastic

Presents as an Upper motor neuron type lesions and
Contractures

116
Q

Spastic cerebral palsy can be categorize further into

A

Spastic hemiplegia (one entire side of the body)

Spastic diplegia (both lower extremities with lordosis or kyphosis)

Spastic quadriplegia (entire body)- Associated with scoliosis

117
Q

3 types of cerebral palsy

A

Spastic
Athetosis
Ataxia

118
Q

Athetosis (dyskinesia) cerebral palsy presents with what symptoms

A

Slow, writhing involuntary movements
Choreiform
Dysarthria
Difficult eating

119
Q

Cerebral palsy caused by lesions of basal ganglia

A

Athetosis (dyskinesia)

120
Q

Cerebral palsy caused by lesions of cerebellum

A

Ataxia

121
Q

Ataxia type cerebral palsy presents with what symptoms

A

Wide based, staggering and unsteady gait

Intentional tremors

122
Q

Cognitive impairment associated with CP

A

Most common in spastic quadriplegic

Spastic CP is associated with normal IQ

123
Q

Seizure disorders associated with CP

A

Occurs in 25 to 60% of cases
Most common in spastic hemi/quadriplegic
Partial seizures

124
Q

Visual (strabismus/nystagmus) and hearing impairment

is associated with CP

A

True

125
Q

Oral motor disorders associated with CP

A

Leads to difficulty in eating and talking
Drooling
Tooth decay
Periodontal diseases

126
Q

G.I.T pathologies

A

GERD
Constipation
Malnutrition
Dehydration

127
Q

Pulmonary pathologies associated with CP

A

Shortness of breath

Poor cough reflex leading to aspiration

128
Q

Diagnosis of CP

A

Is Mainly clinical

129
Q

Treatment for CP

A

Muscle relaxants e.g. Diazepam, Dantrolene, Baclofen for spasticity

Physical therapy

Orthotics and splinting to prevent contractures

Bracing, surgical release

130
Q

The most common congenital heart disease is?

A

VSD

131
Q

Large ASD will result in which symptoms

A 
SOB
Hyperdynamic pericardium
RV heave
Systolic ejection murmur
Fixed splitting of S2
Paradoxical embolism
132
Q

Large VSD will result in which symptoms

A

Pulmonary HTN
Growth failure
CHF
Infection

133
Q

Childhood ASD will have no symptoms. T/F

A

True

134
Q

Avoid the following during repair of VSD

A

Arrhythmia
RV dysfunction
Pulmonary vascular obstructive disease
Paradoxical embolus

135
Q

Mechanical obstruction ‘kink’ between proximal and distal aorta, usually after the origin of left subclavian artery

A

Coarctation of aorta

136
Q

Most Coarctation of aorta patients are asymptomatic, ______% will lead to CHF in infancy

A

10%

137
Q

Male: female ratio in patients with Coarctation of aorta

A

2:1

138
Q

Physical exam finding in patient with Coarctation of aorta

A

Weak or absent femoral pulse. Always compare radial and femoral pulse

Upper extremity hypertension; lower extremity hypotension

Cold extremities, claudication with exercise, leg fatigue

Rib notching, “3” sign

EKG normal or LVH

139
Q

Compare type of hypertrophy in different Congenital abnormalities

A 
ASD: RVH
VSD: CHF
PDA: LVH, CHF
CoA: LVH
ToF: RVH
TA: Biventricular Hypertrophy
140
Q

Continuous murmur “machinery” is heard on?

A

PDA

141
Q

Symptoms of large PDA include

A

CHF
Delayed growth
Infections

142
Q

Treatment of PDA

A

Surgical ligation

COX-1,COX-2 inhibtors and indomethacin “medical ligation”

143
Q

Preductal (right hand) and Postductal (foot) O2 saturation difference =

A

3%

High >10% in Increase right to left shunt (Pulmonary hypertension)

144
Q

MC congenital heart disease causing cyanosis

A

Tetralogy of Fallot

145
Q

Four features of Tetralogy of Fallot

A

Pulmonary stenosis – RV outflow obstruction

Overriding aorta (aorta comes out both from left ventricle and right ventricle ( BIG AORTA)

Large VSD

Right ventricular hypertrophy

146
Q

Clinical presentation of a patient with ToF

A

Cyanosis

Squatting

Dyspnea

Hypercyanotic and hypoxic spells ( TET spells) PO2 < 50 mmHg during feeding or crying unresponsive to supplemental O2.

147
Q

PO2 < 50 mmHg during feeding or crying unresponsive to supplemental O2 in ToF refers to?

A

Hypercyanotic and hypoxic spells ( TET spells)

148
Q

PE findings in ToF

A

RV heave

Harsh systolic ejection murmur

149
Q

EKG findings in ToF

A

Right axis deviation

RVH

150
Q

Conditions that increase R to L shunt

A

Increase in pulmonary vascular resistance OR decrease in SVR

Acidosis

Hypercarbia

Hypotension

151
Q

X-ray findings in ToF

A

Boot shaped heart

Decreased pulmonary markings

152
Q

Squatting is preferred in patients with ToF because?

A

It is a position that increases systemic vascular resistance and aortic pressure, which decreases right-to-left ventricular shunting and thus increase arterial O2saturation.

153
Q

Treatment of ToF

A

For symptomatic patient , PGE1 infusion

ForTETspells, knee-chest positioning, calming, O2, and vasoconstrictors

154
Q

ToF surgery

A

Blalock-Taussing shunt; connects subclavian artery to pulmonary artery

Closing VSD

Resecting obstruction

155
Q

Anesthetic management for ToF

A

Maintain intravascular volume and SVR

Avoid high in pulmonary vascular resistance (e.g. by N2O)

Ketamine is used because it maintains or increases SVR and therefore does not aggravates R to L shunt

VA and histamine-releasing drugs lower SVR and increase shunt

Phenylephrine increases SVR and decreases shunt

156
Q

Missing tricuspid valve

A

Tricuspid atresia

157
Q

Missing tricuspid valve

A

Tricuspid atresia

158
Q

Blood flow in a patient with Tricuspid atresia

A

Blood can flow out of right atrium only via PFO or ASD

PDA is necessary for blood to flow from LV into pulmonary circulation

159
Q

__________ is needed for survival in a patient with Tricuspid atresia

A

PGE1

160
Q

Treatment of a patient with Tricuspid atresia

A

Septostomy

B.T. shunt

Fontan procedure: Anastomosis of right atrium with right pulmonary artery

Glen shunt: SVC to pulmonary artery

Heart transplant

161
Q

Conotruncal separation does not occur, one trunk

A

Truncus Arteriosus

162
Q

In a patient with Truncus Arteriosus, When pulmonary resistance falls it leads to _______ flow to lungs causing ____________

A

increase

CHF , tachypnea

163
Q

EKG findings in a patient with Truncus Arteriosus

A

biventricular hypertrophy

164
Q

Surgery for Truncus Arteriosus

A

close VSD with trunk in LV, connect RV and pulmonary artery

165
Q

Blood flow in a patient with Transposition of great vessels

A

RV flows to the aorta

LV flows to the pulmonary artery

166
Q

Patient with Transposition of Great vessels must have mixing to survive. This can be in the form of?

A

ASD
VSD
PDA
Infuse PGE1 to keep open

167
Q

Egg shaped heart on CXR

A

Transposition of Great vessels

168
Q

3 sign on cxr

A

Coarctation of aorta

169
Q

Boot shaped heart on CXR

A

ToF

170
Q

Surgery for Transposition of Great Vessels ( TGV)

A

atrial septostomy if no connection, whole atrial switch in neonatal period

171
Q

Pulmonary veins drains into RA instead of going to left atrium

A

Total Anomalous Pulmonary Venous Return(TAPVR)

172
Q

Blood flow in Total Anomalous Pulmonary Venous Return(TAPVR)

A 
Coronary sinus to RA
Innominate to SVC
Portal vein to IVC
Combination of routes
R to L shunt across ASD
173
Q

Clinical presentation of a patient with Total Anomalous venous return

A

Cyanosis
Tachypnea
Dyspnea

174
Q

Snowman shaped heart on XR

A

Total Anomalous venous return

175
Q

Surgery for Total Anomalous venous return

A

redirection of veins

176
Q

Hypoplastic left heart syndrome

A

Hypoplasia of left ventricle, mitral valve and ascending aorta

Mixing of pulmonary and systemic blood in single ventricle

Systemic flow is dependent on PDA. Give PG-E1 infusion to keep the duct open*

High or low pulmonary vascular resistance lead to cardiovascular collapse

177
Q

String sign on barium study

A

Pyloric stenosis

178
Q

Incidence of pyloric stenosis

A

1:1000

179
Q

Pyloric stenosis occurs at what age

A

First 2 weeks to four Months

Fall'20 Final Exam Prep (6 decks)

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