Peds Exam 1-S5 Flashcards
Preterm baby classification
< 2500 grams?
Low birth weight
Preterm baby classification
< 1500 grams?
Very low birth weight
Preterm baby classification
< 1000 grams?
Extremely low birth
Preterm baby classification
< 750 grams?
Micropremies
Baby A is born 28 4/7 weeks. He is currently 5 months old what is corrected age?
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
Head lift associated with what milestone?
3 month milestone
Milestone age correction calculation?
Actual age - # of weeks premature
= actual age
Glottic opening of Preterm infant is at what cervical vertebrae?
C3
Glottic opening of Full term infant is at what cervical vertebrae?
C3-C4
Glottic opening of an Adult is at what cervical vertebrae?
C4-C5
The epiglottis of an Infant is what shape and what angle?
Omega shaped
Floppy angle away from trachea
Use Miller to lift epiglottis
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
Toddlers
1-3 years
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
Preschool age
3-6 years
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
Grade school age
7-12 years
What are these age developmental?
- Self conscious about how perceived by others
- Explore independence from parents
- worried about what friends think
- address patient primarily
Adolescents
11-12+ years
Solid food and cereal should be stopped how long before surgery ?
8 hours
Cows milk and formula should be stopped how long before surgery ?
6 hours
Breast milk should be stopped how long before surgery ?
4 hours
Clear fluids should be stopped how long before surgery ?
2 hours
ETT size calculation for uncuffed?
Age/4 +4 = tube size
Age divided by 4 +4
ETT depth calculation?
Tube size x 3 for depth
Surfactants are produced at what week in utero?
22-26 weeks gestation
Peak at 36 weeks
Surfactant is produced by what?
Type II pneumocytes
____ stabilizes the alveoli and prevents their collapse on expiration. It _____ the surface tension and recruits alveoli?
Surfactant
Reduces
What can be given in effort to accelerate the biochemical processes in lung maturation?
Corticosteroids
A patient with a history of what is prone to laryngospasm?
URI in past 2 weeks
wheezing
cough
smoke exposure
asthma
eczema
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
Treatment for laryngospasm in infant/peds surgery?
1 Larsons manuever with positive pressure in “laryngospasm notch”
Succinycholine 4mg/kg IM
Treat bradycardia with catecholamines
A child with uncomplicated URI who is afebrile with clear secretions and otherwise healthy may proceed with surgery?
T/F
True
Can proceed
What is the most common lower respiratory tract infection?
RSV
Respiratory syncytial virus
What are some common types of lower airway diseases?
RSV
Croup/Laryngotracheobronchitis
What chronic disease in children is complex associated with airway obstruction, inflammation and hyperresponsiveness of the airways?
Asthma
What is the most common clinical manifestation of asthma?
Chronic dry cough
Severe respiratory distress during acute asthma exacerbation are associated with what clinical symptoms?
-Chest wall retractions
-Accessory muscle use
-prolonged expiration
-pneumothorax
What is the best IV induction agent for children with asthma?
Ketamine
it is a bronchodilator
Which anesthetic agent is associated with increased risk of bronchospasm in asthmatics?
Desflurane
Treatment for bronchospasm in pediatric patients?
1st- remove triggering stimulus
- deepen anesthesia
- Increase Fi02
- Decrease PEEP
- Increase expiratory time to minimize air trapping
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
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
Acute chest syndrome (ACS) is caused by what?
- precipitated by infection, fat embolism and pulmonary infarction
Sickle cell disease
___ are historically considered obligate nose breathers?
Neonates
The airway is most narrow at the level of the ____ _____?
Cricoid cartilage, just below the vocal cords
Neonates born via cesarean section do not experience what?
Same thoracic squeeze as vaginal birth and therefore retain more fluid in lungs
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
Closing volumes are _____ in infants and young children?
Greater
due to lack of chest wall muscle
Children have a higher closing capacity than ____?
FRC
Which 2 nerves supply sensory and motor innervation to the larynx?
Superior and Recurrent laryngeal nerves
Which nerve branch provides sensory innervation to the supraglottic region?
Internal Branch of superior laryngeal
Which nerve branch supplies motor innervation to the cricothyroid muscle?
External Branch of superior laryngeal
Which nerve branch provides sensory innervation to the subglottic larynx and motor innervation to all other laryngeal muscles?
Recurrent laryngeal
Cuffed ETT calculation?
Age/4 + 3.5
or -0.5 of uncuffed
What is the uncuffed and cuffed ETT size for a 5 year old?
Uncuffed= 5
Cuffed= 4.5
What is the uncuffed ETT size for a neonate-6 months?
3 or 3.5
What is the treatment for postextubation croup?
Nebulized epinephrine, dexamethasone
Infants require which ventilator mode when intubated?
Pressure controlled ventilation
with rapid RR and PEEP
Ventilator guidelines for infants?
RR- ?
PIP-?
PEEP-?
Fi02-?
RR- 30
PIP- 16-30 based on weight
PEEP- 4
Fi02- 0.4-1
Normal tidal volumes for infants?
6-8 ml/kg
Same as adults
Deadspace is ___% of tidal volume?
30% or 3ml/kg
Chest wall retractions and abdomen rises with inspiration is known as ____ respiration in infants?
Seesaw
Atlantooccipital abnormalities
- small oral cavity
- macroglossia, difficult mask
- transesophageal fistula (aspiration risk)
- bradycardia during induction are associated with what syndrome?
Trisomy 21
Down syndrome
The ideal mask size extends from the bridge of the nose to the chin?
T/F
True
E-C hold
A leak around the ETT is necessary to reduce the risk of edema and obstruction?
T/F
True
leak should be 20-22 cmH2o
Normal resistance to airway narrowing in peds increases by how much ____?
16 fold increase in normal resistance
due to 75% decrease in diameter
What should be used for FB removal in peds?
Rigid bronchoscope
Which size LMA for neonate/infant up to 5kg?
1
Which size LMA for Infant 5-10kg?
1.5
Which size LMA for Infant 10-20kg?
2
Which size LMA for Children 20-30kg?
2.5
Which size LMA for Children 30-50kg?
3
Which size LMA for Children 50-70kg?
4
Which size LMA for Children 70-100kg?
5
What is the most common and most severe X-linked recessive disorder?
Duchenne’s muscular dystrophy
This condition includes waddling gait, frequent falling, mitral regurgitation, chronic weakness of respiratory muscles, and delayed gastric emptying/ weak laryngeal reflexes?
Muscular dystrophies
Which drug is an absolute contraindication in patients with muscular dystrophy?
Succinycholine
Have MH cart/dantrolene on standby
This condition is characterized by joint hypermobility, skin hyperelasticity, vascular complications?
- Mitral regurgitation
- Cardiac conduction abnormalities
- DO NOT do regional anesthesia
Ehlers-Danlos syndrome
Where is the “laryngospasm notch located?
Middle finger of each hand behind the pinna of the ears
The fetal heart tube forms when?
Which position does it normally bend?
During the 3rd week.
Days 23-38
Bends to the right
The fetal heart looping(formation of 4 chambers and seperation of systemic and venous) is completed when?
Days 27-37
The tricuspid and mitral valves form when?
Days 36-38
- 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
- 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
Right to left shunt?
Cyanotic
Left to right shunt?
Acyanotic
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
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
Acyanotic lesions are diagnosed primarily by what finding?
Heart murmur
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
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)
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)
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)
These are symptoms of what?
- Cyanosis
- tachypnea
- heart murmur
- Hepatomegaly
- lethargy
- poor feeding
- Hypoxemia
Cyanotic lesions
What are the 4 classic defects of Tetralogy of Fallot?
Pulmonary Stenosis
Ventricular Septal Defect
Right Ventricular Hypertrophy
Over-riding Aorta
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)
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
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)
In Transposition of the Great Arteries where does the aorta arise out of ?
Right ventricle
Deoxygenated blood
In Transposition of the Great Arteries where does the pulmonary artery arise out of ?
Left ventricle
Oxygenated blood
What is the only remaining true neonatal surgical emergency?
Total anomalous Pulmonary Venous Return (TAPVR)
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)
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
Which disorder is caused by Univentricle physiology?
Truncus Arteriosus
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)
In single ventricle physiology,
High pulmonary blood flow leads to what?
Hypotension
Lactic acidosis
Decreased urine output
High Sp02
Normal newborn HR ?
100-150 bpms
Normal infant HR?
80-120 bpms
What is an autosomal dominant connective tissue disorder?
Marfan syndrome
Osteogenesis Imperfecta
Newborns oxyhemoglobin dissociation curve is which direction?
Left
Fetal Hgb binds less with 2,3dpg allowing more loading of oxygen at low partial pressures
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
What law applies to subglottic stenosis in pediatric patient?
Poiseuille’s Law
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
What is the normal respiratory rate for new borns?
30-50 RR
The closure of the foramen ovale is due to the ___ in pulmonary vascular resistance and ____ pulmonary flow?
Decrease PVR
Increase flow
What causes the ductus arteriosus to close after birth?
Increased arterial oxygen tension (PaO2) and low prostaglandins
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
What are the 4 factors to cause infant to return to fetal circulation?
- Hypothermia
- Hypercarbia
- Acidosis
- Hypoxemia
What is the most common premedication in pediatric patient?
Midazolam
What is the treatment for pediatric endocarditis?
Amoxicilin 50mg/kg,
Ampicillin 50mg/kg
Cefazolin 50mg/kg
30-60 mins prior to incision
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.
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
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
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
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)
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
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
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
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
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.
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
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
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
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)
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
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
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)
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
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
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.
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.
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
Rheumatic fever and heart disorder are associated with which autosomal dominant pediatric syndrome?
Marfan Syndrome
What is the normal HR for a premature fetus?
120-170
What is the normal HR for a 0-3 month old?
100-150
What is the normal HR for a 3-6 month old?
90-120
What is the normal HR for a 6-12 month old?
80-120
