Peds Exam 1-S5 Flashcards
1
Q
Preterm baby classification
< 2500 grams?
A
Low birth weight
2
Q
Preterm baby classification
< 1500 grams?
A
Very low birth weight
3
Q
Preterm baby classification
< 1000 grams?
A
Extremely low birth
4
Q
Preterm baby classification
< 750 grams?
A
Micropremies
5
Q
Baby A is born 28 4/7 weeks. He is currently 5 months old what is corrected age?
A
40-28 =12 weeks early
5 months -3 months (12 wks)
=2 months corrected
He should be reaching milestones of a 2 month old even tho he is 5 months
6
Q
Head lift associated with what milestone?
A
3 month milestone
7
Q
Milestone age correction calculation?
A
Actual age - # of weeks premature
= actual age
8
Q
Glottic opening of Preterm infant is at what cervical vertebrae?
A
C3
9
Q
Glottic opening of Full term infant is at what cervical vertebrae?
A
C3-C4
10
Q
Glottic opening of an Adult is at what cervical vertebrae?
A
C4-C5
11
Q
The epiglottis of an Infant is what shape and what angle?
A
Omega shaped
Floppy angle away from trachea
Use Miller to lift epiglottis
12
Q
What are these age developmental?
- Understand more words than they say
- Aware of surroundings through all 5 senses
- Stranger anxiety
- Dont like to be on back
A
Toddlers
1-3 years
13
Q
What are these age developmental?
- Understand the world in subjective/self referential ways.
- No capacity for abstract thought
- Know 1200 words by end of term
- Fear of bodily harm
- “magical thinking”
- Offer choices/ roleplay
A
Preschool age
3-6 years
14
Q
What are these age developmental?
- Hypothetical thinking
- Fear of pain or bodily harm
- Can understand basic physiological concepts
- School/social circles
- Encourage choices and reassurance
A
Grade school age
7-12 years
15
Q
What are these age developmental?
- Self conscious about how perceived by others
- Explore independence from parents
- worried about what friends think
- address patient primarily
A
Adolescents
11-12+ years
16
Q
Solid food and cereal should be stopped how long before surgery ?
A
8 hours
17
Q
Cows milk and formula should be stopped how long before surgery ?
A
6 hours
18
Q
Breast milk should be stopped how long before surgery ?
A
4 hours
19
Q
Clear fluids should be stopped how long before surgery ?
A
2 hours
20
Q
ETT size calculation for uncuffed?
A
Age/4 +4 = tube size
Age divided by 4 +4
21
Q
ETT depth calculation?
A
Tube size x 3 for depth
22
Q
Surfactants are produced at what week in utero?
A
22-26 weeks gestation
Peak at 36 weeks
23
Q
Surfactant is produced by what?
A
Type II pneumocytes
24
Q
____ stabilizes the alveoli and prevents their collapse on expiration. It _____ the surface tension and recruits alveoli?
A
Surfactant
Reduces
25
What can be given in effort to accelerate the biochemical processes in lung maturation?
Corticosteroids
26
A patient with a history of what is prone to laryngospasm?
URI in past 2 weeks
wheezing
cough
smoke exposure
asthma
eczema
27
Elective surgery is postponed for how long in a patient with URI and symptoms of
- mucopurulent secretions
- lower respiratory tract infection
- pyrexia >100.4
- change in sensorium (not acting normal)
2-4 weeks
28
Treatment for laryngospasm in infant/peds surgery?
#1 Larsons manuever with positive pressure in "laryngospasm notch"
Succinycholine 4mg/kg IM
Treat bradycardia with catecholamines
29
A child with uncomplicated URI who is afebrile with clear secretions and otherwise healthy may proceed with surgery?
T/F
True
Can proceed
30
What is the most common lower respiratory tract infection?
RSV
Respiratory syncytial virus
31
What are some common types of lower airway diseases?
RSV
Croup/Laryngotracheobronchitis
32
What chronic disease in children is complex associated with airway obstruction, inflammation and hyperresponsiveness of the airways?
Asthma
33
What is the most common clinical manifestation of asthma?
Chronic dry cough
34
Severe respiratory distress during acute asthma exacerbation are associated with what clinical symptoms?
-Chest wall retractions
-Accessory muscle use
-prolonged expiration
-pneumothorax
35
What is the best IV induction agent for children with asthma?
Ketamine
it is a bronchodilator
36
Which anesthetic agent is associated with increased risk of bronchospasm in asthmatics?
Desflurane
37
Treatment for bronchospasm in pediatric patients?
1st- remove triggering stimulus
- deepen anesthesia
- Increase Fi02
- Decrease PEEP
- Increase expiratory time to minimize air trapping
38
This condition is an autosomal recessive disorder involving disregulation of chloride?
- Causes increased sweat chloride conc
- viscous mucus production
- recurrent exacerbations with airway obstruction
- congenital absence of vas deferens
- Hyperventilation is compensatory
- end stage cor pulmonale
- exercise tolerance and fitness are predictors of survival
- must have complete reversal of NMBA
Cystic Fibrosis
39
This condition is an inherited hemoglobinopathy cause by point mutation on chromosome 11
- acute episodes of pain
- acute/chronic pulmonary disease
- hemorrhagic/occlusive stroke
- Hemoglobin S
Sickle cell disease
40
Acute chest syndrome (ACS) is caused by what?
- precipitated by infection, fat embolism and pulmonary infarction
Sickle cell disease
41
___ are historically considered obligate nose breathers?
Neonates
42
The airway is most narrow at the level of the ____ _____?
Cricoid cartilage, just below the vocal cords
43
Neonates born via cesarean section do not experience what?
Same thoracic squeeze as vaginal birth and therefore retain more fluid in lungs
44
T/F
The sniffing position will help you visualize the glottis in peds patients?
NO
due to high cervical position at C3
need shoulder roll
45
Closing volumes are _____ in infants and young children?
Greater
due to lack of chest wall muscle
46
Children have a higher closing capacity than ____?
FRC
47
Which 2 nerves supply sensory and motor innervation to the larynx?
Superior and Recurrent laryngeal nerves
48
Which nerve branch provides sensory innervation to the supraglottic region?
Internal Branch of superior laryngeal
49
Which nerve branch supplies motor innervation to the cricothyroid muscle?
External Branch of superior laryngeal
50
Which nerve branch provides sensory innervation to the subglottic larynx and motor innervation to all other laryngeal muscles?
Recurrent laryngeal
51
Cuffed ETT calculation?
Age/4 + 3.5
or -0.5 of uncuffed
52
What is the uncuffed and cuffed ETT size for a 5 year old?
Uncuffed= 5
Cuffed= 4.5
53
What is the uncuffed ETT size for a neonate-6 months?
3 or 3.5
54
What is the treatment for postextubation croup?
Nebulized epinephrine, dexamethasone
55
Infants require which ventilator mode when intubated?
Pressure controlled ventilation
with rapid RR and PEEP
56
Ventilator guidelines for infants?
RR- ?
PIP-?
PEEP-?
Fi02-?
RR- 30
PIP- 16-30 based on weight
PEEP- 4
Fi02- 0.4-1
57
Normal tidal volumes for infants?
6-8 ml/kg
Same as adults
58
Deadspace is ___% of tidal volume?
30% or 3ml/kg
59
Chest wall retractions and abdomen rises with inspiration is known as ____ respiration in infants?
Seesaw
60
Atlantooccipital abnormalities
- small oral cavity
- macroglossia, difficult mask
- transesophageal fistula (aspiration risk)
- bradycardia during induction are associated with what syndrome?
Trisomy 21
Down syndrome
61
The ideal mask size extends from the bridge of the nose to the chin?
T/F
True
E-C hold
62
A leak around the ETT is necessary to reduce the risk of edema and obstruction?
T/F
True
leak should be 20-22 cmH2o
63
Normal resistance to airway narrowing in peds increases by how much ____?
16 fold increase in normal resistance
due to 75% decrease in diameter
64
What should be used for FB removal in peds?
Rigid bronchoscope
65
Which size LMA for neonate/infant up to 5kg?
1
66
Which size LMA for Infant 5-10kg?
1.5
67
Which size LMA for Infant 10-20kg?
2
68
Which size LMA for Children 20-30kg?
2.5
69
Which size LMA for Children 30-50kg?
3
70
Which size LMA for Children 50-70kg?
4
71
Which size LMA for Children 70-100kg?
5
72
What is the most common and most severe X-linked recessive disorder?
Duchenne's muscular dystrophy
73
This condition includes waddling gait, frequent falling, mitral regurgitation, chronic weakness of respiratory muscles, and delayed gastric emptying/ weak laryngeal reflexes?
Muscular dystrophies
74
Which drug is an absolute contraindication in patients with muscular dystrophy?
Succinycholine
Have MH cart/dantrolene on standby
75
This condition is characterized by joint hypermobility, skin hyperelasticity, vascular complications?
- Mitral regurgitation
- Cardiac conduction abnormalities
- DO NOT do regional anesthesia
Ehlers-Danlos syndrome
76
Where is the "laryngospasm notch located?
Middle finger of each hand behind the pinna of the ears
77
The fetal heart tube forms when?
Which position does it normally bend?
During the 3rd week.
Days 23-38
Bends to the right
78
The fetal heart looping(formation of 4 chambers and seperation of systemic and venous) is completed when?
Days 27-37
79
The tricuspid and mitral valves form when?
Days 36-38
80
- Normal oxygen saturation
- increased blood flow to the lungs, possible pulmonary HTN or CHF
- Defects include ASD, VSD, AVSD and Patent Ductus Arteriosus
Which Shunt?
Left to Right shunt
Acyanotic
81
- Low oxygen saturation
- Blood bypass the pulmonary circulation
- Defects include Pulmonary Atresia, Transposition of great arteries, Tetralology of Fallot, and Hypoplastic left heart syndrome
Right to Left Shunt
Cyanotic
82
Right to left shunt?
Cyanotic
83
Left to right shunt?
Acyanotic
84
Oxygenated blood is shunted from the left to the right.
- Leading to an increase in blood flow to the pulmonary circulation
- Pulmonary HTN and CHF without treatment
Which lesions?
Acyanotic lesions
85
What is this disorder?
- The pulmonary vascular resistance exceeds the systemic vascular resistance.
- Direction of the shunt reverses from left to right, now right to left.
- Cyanosis and Hypoxemia develops
- Can develop in 2 years or 1 year for patient with down syndrome
Eisenmenger syndrome
86
Acyanotic lesions are diagnosed primarily by what finding?
Heart murmur
87
What is this disorder?
- Hole in the septum between the right and left atria where oxygenated blood is shunted from the left to the right.
- Acyanotic
Atrial Septal Defect (ASD)
Acyanotic
88
What is this disorder ?
- Hole in the septum between the right and left ventricles.
- Oxygenated blood flows via pressure gradient from left to right ventricle.
- Acyanotic
Ventricular Septal Defect (VSD)
89
What is this disorder?
- Endocardial cushion Defect
- Holes in both atrial and ventricular septum.
- A single valve serves both the pulmonary artery and the aorta simultaneously.
- Common with Trisomy 21
Atrioventricular Septal Defect (AVSD)
90
What is this disorder?
- This vessel does not close after birth and remains open resulting in transmission of blood from the aorta to the pulmonary artery resulting in excessive blood flow to the pulmonary system.
- Must wait until 14 days old to fix.
- Acyanotic
Patent Ductus Arteriosis (PDA)
91
These are symptoms of what?
- Cyanosis
- tachypnea
- heart murmur
- Hepatomegaly
- lethargy
- poor feeding
- Hypoxemia
Cyanotic lesions
92
What are the 4 classic defects of Tetralogy of Fallot?
Pulmonary Stenosis
Ventricular Septal Defect
Right Ventricular Hypertrophy
Over-riding Aorta
93
What is this disorder?
It is caused by a right to left shunt across the ventricular septal defect due to decrease in SVR or an increase in PVR?
Tetralogy of Fallot (TOF)
94
Treatment of Tetralogy of Fallot treatment includes what?
Knee-chest to increase SVR
Oxygen therapy
IV fluid bolus
Morphine or beta blockers to improve right ventricle outflow
Neosynephrine to increase afterload
95
What is this disorder?
- Formed when the conotruncal ridges do not spiral during development
- Aorta arises out of the right ventricle
- Pulmonary arteries arise out of left ventricle
- Incompatible with life, need balloon atrial septostomy
Transposition of the Great Arteries (TGA)
96
In Transposition of the Great Arteries where does the aorta arise out of ?
Right ventricle
Deoxygenated blood
97
In Transposition of the Great Arteries where does the pulmonary artery arise out of ?
Left ventricle
Oxygenated blood
98
What is the only remaining true neonatal surgical emergency?
Total anomalous Pulmonary Venous Return (TAPVR)
99
What is the disorder?
- All 4 pulmonary veins do not connect to the left atrium and instead connect to the right atrium.
- emergency
Total anomalous Pulmonary Venous Return (TAPVR)
100
What is the disorder?
- Malformation of the conotruncal ridges during development which cause a common outlet for aorta and pulmonary artery.
- Single valve for both aorta and pulmonary artery.
- Uni-ventricle physiology
Truncus Arteriosus
101
Which disorder is caused by Univentricle physiology?
Truncus Arteriosus
102
What is the disorder?
- Left ventricle is small or absent
- Mitral and Aortic valves are small or absent
- Aorta is small
- often has ASD
Hypoplastic Left heart Syndrome (HLHS)
103
In single ventricle physiology,
High pulmonary blood flow leads to what?
Hypotension
Lactic acidosis
Decreased urine output
High Sp02
104
Normal newborn HR ?
100-150 bpms
105
Normal infant HR?
80-120 bpms
106
What is an autosomal dominant connective tissue disorder?
Marfan syndrome
Osteogenesis Imperfecta
107
Newborns oxyhemoglobin dissociation curve is which direction?
Left
Fetal Hgb binds less with 2,3dpg allowing more loading of oxygen at low partial pressures
108
What happens to the oxyhemoglobin dissociation curve during the first few months of life?
Shifts to the right after the first week as fetal Hgb is replaced by adult hemoglobin
109
What law applies to subglottic stenosis in pediatric patient?
Poiseuille's Law
110
When closing capacity exceeds functional residual capacity what happens?
Some airways close during expiratory phase of normal tidal breathing and less oxygen reserve is avaliable
111
What is the normal respiratory rate for new borns?
30-50 RR
112
The closure of the foramen ovale is due to the ___ in pulmonary vascular resistance and ____ pulmonary flow?
Decrease PVR
Increase flow
113
What causes the ductus arteriosus to close after birth?
Increased arterial oxygen tension (PaO2) and low prostaglandins
114
PDA is what type of shunt and allows blood to flow from what to what?
Left to right shunt
From the aorta to pulmonary artery
115
What are the 4 factors to cause infant to return to fetal circulation?
1. Hypothermia
2. Hypercarbia
3. Acidosis
4. Hypoxemia
116
What is the most common premedication in pediatric patient?
Midazolam
117
What is the treatment for pediatric endocarditis?
Amoxicilin 50mg/kg,
Ampicillin 50mg/kg
Cefazolin 50mg/kg
30-60 mins prior to incision
118
Why is nasal congestion a serious threat to young infants?
a. Infants are obligatory nose breathers.
b. Their nares are small in diameter.
c. Infants become dehydrated when mouth breathing.
d. Their epiglottis is proportionally greater than the epiglottis of an adult’s.
a. Infants are obligatory nose breathers.
119
The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks of gestation?
a. 16 and 20
b. 20 and 24
c. 24 and 30
d. 30 and 36
d. 30 and 36
120
What is the primary cause of respiratory distress syndrome (RDS) of the newborn?
a. Immature immune system
b. Small alveoli
c. Surfactant deficiency
d. Anemia
c. Surfactant deficiency
121
What is the primary problem resulting from respiratory distress syndrome (RDS) of the newborn?
a. Consolidation
b. Pulmonary edema
c. Atelectasis
d. Bronchiolar plugging
c. Atelectasis
122
Bronchiolitis tends to occur during the first years of life and is most often caused by what type of infection?
a. Respiratory syncytial virus (RSV)
b. Influenza virus
c. Adenoviruses
d. Rhinovirus
a. Respiratory syncytial virus (RSV)
123
A 7 year-old-child presents to the clinic where parents report signs and symptoms consistent with asthma. What does the healthcare professional do in order to confirm this diagnosis?
a. Assess for a parental history of asthma
b. Draw serum levels of immunoglobulin E (IgE) and eosinophil levels
c. Measure expiratory flow rate with spirometry testing
d. Give a trial of asthma medication and check for improvement
c. Measure expiratory flow rate with spirometry testing
124
What is the most common predisposing factor to obstructive sleep apnea in children?
a. Chronic respiratory infections
b. Adenotonsillar hypertrophy
c. Obligatory mouth breathing
d. Paradoxical breathing
b. Adenotonsillar hypertrophy
125
Most cardiovascular developments occur between which weeks of gestation?
a. Fourth and seventh weeks
b. Eighth and tenth weeks
c. Twelfth and fourteenth weeks
d. Fifteenth and seventeenth weeks
a. Fourth and seventh weeks
126
The presence of the foramen ovale in a fetus allows what to occur?
a. Right-to-left blood shunting
b. Left-to-right blood shunting
c. Blood flow from the umbilical cord
d. Blood flow to the lungs
a. Right-to-left blood shunting
127
The student studying pathophysiology learns which fact about circulation at birth?
a. Systemic resistance and pulmonary resistance fall.
b. Gas exchange shifts from the placenta to the lung.
c. Systemic resistance falls and pulmonary resistance rises.
d. Systemic resistance and pulmonary resistance rise.
b. Gas exchange shifts from the placenta to the lung.
128
When does systemic vascular resistance in infants begin to increase?
a. One month before birth
b. During the beginning stage of labor
c. One hour after birth
d. Once the placenta is removed from circulation
d. Once the placenta is removed from circulation
129
Which event triggers congenital heart defects that cause acyanotic congestive heart failure?
a. Right-to-left shunts
b. Left-to-right shunts
c. Obstructive lesions
d. Mixed lesions
b. Left-to-right shunts
130
Older children with an unrepaired cardiac septal defect experience cyanosis because of which factor?
a. Right-to-left shunts
b. Left-to-right shunts
c. Obstructive lesions
d. Mixed lesions
a. Right-to-left shunts
131
A baby has been born with Down syndrome. What congenital heart defect does the healthcare professional assess this baby for?
a. Coarctation of the aorta (COA)
b. Tetralogy of Fallot
c. Atrial septal defect (ASD)
d. Ventricular septal defect (VSD)
d. Ventricular septal defect (VSD)
132
An infant has a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole. The healthcare professional suspects a congenital heart disorder. What other assessment finding is inconsistent with the professional’s knowledge about this disorder?
a. Bounding pulses
b. Active precordium
c. Thrill on palpation
d. Signs of heart failure
c. Thrill on palpation
133
An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. The healthcare professional suspects an atrial septal defect (ASD). For what other manifestation does the healthcare professional assess to confirm the suspicion?
a. Wide, fixed splitting of the second heart sound
b. Loud, harsh holosystolic murmur
c. Cyanosis with crying and feeding
d. Rapid deterioration with acidosis
a. Wide, fixed splitting of the second heart sound
134
An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?
a. Atrial septal defect (ASD)
b. Ventricular septal defect (VSD)
c. Patent ductus arteriosus (PDA)
d. Atrioventricular canal (AVC) defect
b. Ventricular septal defect (VSD)
135
A parent asks the healthcare professional to explain why a child diagnosed with Tetralogy of Fallot squats frequently. What explanation by the professional is best?
a. Reduces the chest pain
b. Controls dizziness
c. Relieves hypoxia
d. Improves headache
b. Controls dizziness
136
An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom?
a. Intermittent murmur
b. Lack of symptoms
c. Rapid decompensation
d. Triad of congenital defects
b. Lack of symptoms
137
Which condition is consistent with the cardiac defect of transposition of the great vessels?
a. The aorta arises from the right ventricle.
b. The pulmonary trunk arises from the right ventricle.
c. The right ventricle pumps blood to the lungs.
d. An intermittent murmur is present.
a. The aorta arises from the right ventricle.
138
Which scenario describes total anomalous pulmonary venous return?
a. The foramen ovale closes after birth.
b. Pulmonary venous return is to the right atrium.
c. Pulmonary venous return is to the left atrium.
d. The left atrium receives oxygenated blood.
b. Pulmonary venous return is to the right atrium.
139
Which heart defect results in a single vessel arising from both ventricles, providing blood to both the pulmonary and systemic circulations?
a. Coarctation of the aorta
b. Tetralogy of Fallot
c. Total anomalous pulmonary connection
d. Truncus arteriosus
d. Truncus arteriosus
140
Rheumatic fever and heart disorder are associated with which autosomal dominant pediatric syndrome?
Marfan Syndrome
141
What is the normal HR for a premature fetus?
120-170
142
What is the normal HR for a 0-3 month old?
100-150
143
What is the normal HR for a 3-6 month old?
90-120
144
What is the normal HR for a 6-12 month old?
80-120
