Peds Ch 13 (Respiratory)

Question 1

when does saccular stage begin and what forms

Answer 1

The saccular stage begins at approximately 24 weeks, when terminal air sacs begin to form.

Question 2

The vast majority of alveolar formation occurs…

Answer 2

after birth

Question 3

The abrupt transition to extrauterine gas exchange at birth involves …

Answer 3

• the rapid expansion of the lungs
• increased pulmonary blood flow
• initiation of a regular respiratory rhythm.

Question 4

things that cause an acute decrease in pulmonary vascular resistance and a consequent increase in pulmonary blood flow (2)

Answer 4

Changes in the partial pressures of

• oxygen (PO2) and carbon dioxide (PCO2)
• hydrogen ion concentration (pH)

Question 5

what reverses the pressure gradient across the foramen ovale, causing functional closure of this left- to-right one-way flap valve

Answer 5

• increased left atrial pressure
• decreased right atrial pressure

Question 6

function of the Hering-Breuer reflexes

Answer 6

prevent overdistention or collapse of the lung

Question 7

function of parenchymal receptors

Answer 7

respond to hyperinflation of the lungs, to various chemical stimuli in the pulmonary circulation, and possibly to interstitial congestion.

Question 8

chest wall receptors include (2)

Answer 8

mechanoreceptors and joint proprioceptors

Question 9

The ____________ produces the majority of tidal volume during quiet inspiration

Answer 9

diaphragm

Question 10

The ____________ produces expiration

Answer 10

elastic recoil of the lungs and thorax

Question 11

During vigorous breathing or with airway obstruction, both inspiration and expiration become ________ processes.

Answer 11

active

Question 12

infant chest wall compliance

Answer 12

In infants the chest wall is more compliant, so the tendency of the lung to collapse is not adequately counterbalanced by chest wall rigidity.

Question 13

infants stop expiration at a lung volume (greater/ less than) FRC

Answer 13

greater than

Question 14

possible complications of prematurity and prolonged intubation that may be exacerbated in the perioperative period (3)

Answer 14

• apneic episodes
• subglottic stenosis
• tracheomalacia

Question 15

use of PFT in children

Answer 15

Question 16

Spirometry measures …

Answer 16

• the volume of air inspired and expired as a function of time

by far the most frequently performed test of pulmonary function in children

Question 17

An obstructive process is characterized by …

Answer 17

decreased velocity of airflow through the airways

Question 18

a restrictive defect produces…

Answer 18

decreased lung volumes

Question 19

Restrictive lung disease is associated with…

Answer 19

a loss of lung tissue or
a decrease in the lung’s ability to expand

Question 20

most common obstructive disease in children

Answer 20

asthma

Question 21

Restrictive lung disease can arise from …

Answer 21

limitations to chest wall movement, such as chest wall deformities, scoliosis, or pleural effusions, or from space-occupying intrathoracic pathology such as large bullae or congenital cysts

Question 22

what can spirometry be used for

Answer 22

to assess the indication for, and efficacy of, treatment (usually asthma)

Question 23

____________ account for most of the perioperative morbidity in children and cause almost one-third of perioperative pediatric cardiac arrests

Answer 23

Respiratory problems

Question 24

The work of breathing is also greater in young infants as a result of (4)

Answer 24

• high-resistance
• small-caliber airways
• increased chest wall compliance
• reduced lung parenchymal compliance.

Question 25

____________ cause the majority of URIs

Answer 25

viruses

Question 26

Children with a recent or current URI have an increased incidence of

Answer 26

- perioperative laryngospasm - bronchospasm - arterial hemoglobin desaturation - severe coughing - breath holding compared with uninfected children

Question 27

For children with symptoms of an uncomplicated URI who are afebrile with clear secretions and who are otherwise healthy...

Answer 27

anesthesia may proceed as planned

Question 28

Elective surgery is usually postponed for children with more severe symptoms that include at least one of the following:

Answer 28

- mucopurulent secretions - lower respiratory tract signs that do not clear with a deep cough - pyrexia >100.4°F (38°C) - a change in sensorium

Question 29

The decision to proceed with surgery becomes much more difficult when the signs of the URI are ...

Answer 29

between the extremes of mild and severe.

Question 30

The ____________ is associated with fewer episodes of respiratory events

Answer 30

laryngeal mask airway (LMA)

Question 31

The optimal time when an anesthetic can be given to a child after a URI without increasing the risk of adverse respiratory events remains contentious, but most clinicians wait ____________ after resolution of the URI before proceeding.

Answer 31

2 to 4 weeks

Question 32

Acute inflammation of the small airways may result in ____________ with edema of the small airways leading to desaturation, hypercapnia, and acute respiratory failure

Answer 32

bronchiolitis

Question 33

first-line treatment for bronchospasm involves:

Answer 33

- removing the triggering stimulus if possible - deepening anesthesia - increasing the fraction of inspired oxygen (FIO2) if appropriate - decreasing the positive end-expiratory pressure (PEEP) - increasing the expiratory time to minimize alveolar air trapping

Question 34

in severe status asthmaticus, ventilations strategy focuses primarily on...

Answer 34

achieving adequate oxygenation, rather than attempting to normalize PaCO2 at the potential cost of inducing pulmonary barotrauma

Question 35

All children who experience anything more than minor bronchospasm should also receive ____________ , if they have not already done so.

Answer 35

corticosteroids

Question 36

first-line therapy for all children and is the most effective way of reversing airflow obstruction

Answer 36

short-acting β-agonists

Question 37

For severe exacerbations unresponsive to the treatment listed earlier, ____________ may decrease the likelihood of intubation, although the evidence is limited

Answer 37

IV magnesium

Question 38

how is bronchospasm from anaphylaxis differentiated from that due to asthma?

Answer 38

it produces additional systemic signs such as angioedema, flushing, urticaria, and cardiovascular collapse.

Question 39

what is Cystic Fibrosis

Answer 39

an autosomal recessive disorder that is caused by one of more than 1500 mutations in the gene coding for the CF transmembrane conductance regulator (located on chromosome 7), a protein that regulates chloride and other ion fluxes at various epithelial surfaces

Question 40

most common fatal inherited disease in Caucasians?

Answer 40

CF

Question 41

where is electrolyte transport disrupted with CF

Answer 41

in the epithelial cells of the sweat ducts, airways, pancreatic ducts, intestine, biliary tree, and vas deferens

Question 42

s/s of CF

Answer 42

- increased sweat chloride concentrations - viscous mucus production - lung disease - intestinal obstruction - pancreatic insufficiency - biliary cirrhosis - congenital absence of the vas deferens

Question 43

main cause of morbidity and mortality in CF, and consequently it is the focus of anesthetic concern

Answer 43

lung disease

Question 44

lung disease in CF patho

Answer 44

involves mucus plugging, chronic infection, inflammation, and epithelial injury

Question 45

recurrent exacerbations of CF are associated with...

Answer 45

- progressive airway obstruction - bronchiectasis - emphysema - ventilation/perfusion mismatching - hypoxemia

Question 46

pulmonary function abnormalities in CF typically follow what kid of pattern?

Answer 46

obstructive

Question 47

pulmonary function test findings in patients with CF?

Answer 47

increased FRC, decreased FEV1, decreased peak expiratory flow rate, and decreased vital capacity *compensatory hyperventilation typically produces a reduced PaCO2*

Question 48

The most common indications for anesthesia in children are

Answer 48

nasal polypectomy and ear, nose, and throat surgery *as a result of the frequency of upper airway pathologic processes such as chronic sinusitis and nasal polyps*

Question 49

Inhalation of ____________ in CF patients accelerates mucus clearance, increases lung function, and improves quality of life

Answer 49

hypertonic saline (7% sodium chloride)

Question 50

SCD patho

Answer 50

inherited hemoglobinopathy that results from a point mutation on chromosome 11

Question 51

what does the mutant gene of SCD code for ?

Answer 51

production of hemoglobin S, a mutant variant of the normal hemoglobin A.

Question 52

clinical manifestations of SCD

Answer 52

- acute episodes of pain - acute and chronic pulmonary disease - hemorrhagic and occlusive stroke - renal insufficiency - splenic infarction

Question 53

acute lung injury caused by SCD

Answer 53

Acute Chest Syndrome (ACS)

Question 54

diagnosis of ACS

Answer 54

a new pulmonary infiltrate involving at least one lung segment on the radiograph (excluding atelectasis) combined with one or more symptoms or signs of: - chest pain - pyrexia greater than 101.3°F (38.5°C) - tachypnea, wheezing, or cough