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Peds > Peds week 2 > Flashcards

Peds week 2 Flashcards

1
Q

Neonate: Hct (__%) and Hgb (__g/dl)

A

Neonate: Hct (60%) and Hgb (18]19 g/dl)

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2
Q

At birth: 50]70% of Hgb is Hgb __ which has higher affinity for O2 . picks]up more O2 but does not deliver it to the tissues (Oxygen]Hemoglobin Dissociation]Curve shifts to
__)

A

Hgb F as in Fetal

shifts curve to the left

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3
Q

Age 2-3 mo: H&H decline steadily. Hgb 9-11 g/dl and HgbF is largely replaced by Hgb __

A

9-11

Hgb A as in adult

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4
Q

After age 3 mo -1 yr: HgbA increases to __ g/dl

A

12-13 g/dl

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5
Q

__earlier and greater fall in Hgb (7-8g/dl)

A

Preterms

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6
Q

The oxyhemoglobin dissociation curve is shifted left or right?

A

Left! Fetal hgb does not bind with 2,3 DPF, thus shifted to the left. This gives the fetus the advantage of loading more oxygen at low fetal oxygen partial pressures (fetal arterial PO2 of 20-30 mmHg

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7
Q

What happens to the oxyhemoglobin dissociation curve during the first few months of life?

A

During the first few months it shifts to the right as fetal hgb is replaced by adult hgb,

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8
Q

What are Dubowitz and Ballard scoring system?

A

estimate gestational age, most accurate 30-42 hours after delivery and less accurate in very small, preterm infants

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9
Q

What is the most accurate means of assessing gestational age?

A

crown-rump length of the fetus during first trimester ultrasound

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10
Q

What is the hgb concentration at 2 weeks, 2 months, and 2 years?

A

13-19
10-11
12.5

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11
Q

Hemoglobin levels bottom out earlier and lower in __

A

preterm infants

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12
Q

When should you cancel elective surgery in the neonate and infant?

A

Hgb less than 13 in the newborn

less than 10 in the infant older than 3 months

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13
Q

Children exhibit different pharmacokinetics from adults because of their:

  • altered protein binding
  • larger volume of distribution (Vd)
  • smaller proportion of fat and muscle stores
  • immature renal and hepatic function
A

__ protein binding
__ larger Vd
__ proportion fat and muscles
__ renal and hepatic function

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14
Q

These factors and individual differences in drug metabolic enzymes may __ a drug’s metabolism and/or delay elimination

A

reduce

except for some that have increased metabolism like propranolol, morphine, and midazolam

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15
Q

Liver metabolism is decreased in the neonate until __ month(s) of age

A

one

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16
Q

the cytochrome p450 enzyme system is fully functional at __ months of age

A

one

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17
Q

What is the most common cause for liver transplantation in children?

A

cholestatic liver disease secondary to biliary atresia

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18
Q

What is the etiology of jaundice?

A

breakdown of RBC’s releases bilirubin into the blood, but the immature liver cannot effectively conjugate it with glucuronic acid for excretion into the urine

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19
Q

What is Kernicterus (bilirubin

encephalopathy):

A

A grave form of jaundice of the newborn
characterized by very high levels of unconjugated bilirubin in the blood and by yellow staining and degenerative lesions in the cerebral gray matter

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20
Q

What are some s/s of kernicterus?

A

hypertonicity, opisthotonus, spasticity

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21
Q

unconjugated bili doesn’t normally cross the blood brain barrier, but neonates have an immature BBB

A

yep

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22
Q

What drugs may contribute to developing kernicterus?

A

Any drugs that compete for albumin binding sites including furosemide, sulfonamides, and the benzyl alcohol in diazepam

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23
Q

__ is one of a number of conditions associated with apnea and bradycardia in
preterm infants.

A

Gastroesophageal reflux

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24
Q

The placenta is impermeable to both insulin and glucagon. The islets of Langerhans in the fetal pancreas, however, secrete insulin from the __th week of fetal life.

A

11th

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25
Q

Hyperinsulemia of the fetus persists after birth and may lead to rapid development of serious hypoglycemia (<__ mg/dL) which could lead to irreversible CNS
damage.7

A

<30 mg/dL

26
Q

Hyperglycemia (plasma glucose >150 mg/dL) occurs in stressed neonates, particularly LBW infants infused with glucose containing solutions. Hyperglycemia has been associated with infection as well as increased morbidity and mortality.

A

Use LR

27
Q

Maintenance fluid requirements may be replaced with glucose]containing solutions (D5 /0.45 NS) administered with a continuous infusion pump to avoid bolus glucose administration

A

monitor

intraoperative glucose levels.1

28
Q

Insensible fluid losses are relatively __ during infancy ] major factors being high level of alveolar ventilation and the thin skin of LBW infants

A

high

29
Q

Because of the infant’s proportionally higher water turnover and the limited ability to concentrate urine and conserve water __)

A

dehydration develops rapidly

when intake is restricted or losses occur.

30
Q

Identify two limitations of kidney function in the newborn.

A

GFR at birth is 15-30% of the normal adults on weight basis, thus the ability to concentrate urine is diminished. Hence infants tolerate water and salt loads poorly because of low GFR and decreased tubular concentrating ability.

31
Q

NPO recs for clear liquids and chewing gum

A

2 hours

32
Q

NPO recs for breast milk

A

4 hours

33
Q

NPO recs for infant formula and light meals without fat or protein

A

6 hours

34
Q

NPO recs for solid foods that are fatty

A

8 hours

35
Q

4-2-1 Rule: calculate the fluid requirement per hr

A

4 ml/kg for the first 10 kg
2 ml/kg for the second 10 kg
1 ml/kg for the remaining kg of weight

36
Q

Pediatric fluid replacement for blood loss is best determined by which method of monitoring?

A

Hematocrit, replace lost blood with 3mls of LR or 1ml of 5% albumin per ml of blood loss

37
Q

At what age is basal metabolic rate the highest?

A

Peaks between 6-12 months of age

38
Q

Kcal requirements for infants, children, and adults

A

under 1 year = 100 kcal/kg/day
children = 75 kcal/kg/day
adults 35 kcal/kg/day

39
Q

During fetal circulation:
– the PVR is __ (the lungs are bypassed)
– SVR is __

A

During fetal circulation:
– the PVR is high (the lungs are bypassed)
– SVR is low

40
Q 
Foramen ovale (“hole” in the \_\_ septum =
connecting \_\_ with \_\_)  because PVR is high, blood shunts from Right to Left (bypassing the lungs)
A 
Foramen ovale (“hole” in the atrial septum =
connecting RA with LA)  because PVR is high, bloodshunts from Right to Left (bypassing the lungs)
41
Q

Ductus Arteriosus (connection between __ and __ = Blood bypasses the lung again to take the short‐cut to the aorta (systemic circulation).

A

Ductus Arteriosus (connection between PA (Pulm. Artery) and Aorta = Blood bypasses the lung again to take the short‐cut to the aorta (systemic circulation).

42
Q

After birth, the neonate takes its first breaths, the lungs inflate and PVR __ while the placenta is disconnected and blood is “not drained back to mom” – __ SVR.

A

After birth, the neonate takes its first breaths, the lungs inflate and PVR reduces while the placenta is disconnected and blood is “not drained back to mom” – increasing SVR.

43
Q

After birth, __ pressure in the LA (compared with RA) pushes the flap of the foramen ovale shut.

A

After birth, increased pressure in the LA (compared with RA) pushes the flap of the foramen ovale shut.

44
Q

The increased pressure in the aorta allows some “back flow” of blood via the ductus arteriosus back into the pulm. artery (PA) which causes additional oxygenation of the blood

A

Eventually, the pressure changes within the two circulations and the reduced levels of
prostaglandins causes the closure of the ductus arteriosus (DA) and foramen ovale (FO) within days after birth.

45
Q

What causes the foramen ovale to close in the newborn?

A

decrease in PVR and increased pulmonary flow as the infant takes its first breaths and the alviloi expand.

46
Q

What could cause the neonate to return to fetal circulation?

A

hypoxemia, acidosis, preterm, hypothermia (all equal increased PVR and right to left shunt)

47
Q

Left‐to‐Right shunt = due to higher pressures in the
left heart, blood flows back to the right heart via
ASD/VSD, causing

A

increased blood flow in the lungs =

pulm. congestion – pulm. HTN

48
Q

Right‐to‐Left shunt = blood bypasses the lungs
because of obstruction to the lungs (pulm.stenosis) –
blood flows through ASD/VSD or both to the
systemic side =

A

cyanosis

49
Q

“Simple” Left‐to‐Right Shunt

A

Increased Pulmonary

Blood Flow

50
Q

“Simple” Right‐to‐Left Shunt

A

Decreased Pulmonary

Blood Flow = Cyanosis

51
Q

TOF (Tetrology of Fallot)

A

Pulmonary atresia
• Tricuspid atresia
• Ebstein anomaly (congenital malformation of tricuspid
valve)

52
Q

Obstructive Lesions

A
  • Pulmonary stenosis
  • Aortic stenosis
  • Mitral stenosis
  • Coarctation of aorta
53
Q

Complex Shunts:  Mixing of Pulmonary and Systemic

Blood Flow with Cyanosis

A
  • TGA (Transposition of great arteries)
  • Truncus arteriosus
  • DORV (Double‐outlet right ventricle)
  • HLHS (Hypoplastic left heart syndrome)
  • TAPVD (Total anomalous pulmonary venous drainage)
54
Q

Secundum ASD

A

is causing a Leftto‐
Right shunt
through the
defect

55
Q

VSD

A

Most common congenital defect in children

20% of CHD in children

56
Q

Patent ductus

arteriosus

A

Blood flow from
aorta to PA, PDA extends from the descending aorta to the
main PA and usually closes soon after birth.
• PDA is common in preterm infants – requiring
often mechanical ventilation
• Before birth:
 high PVR directs blood flow toward aorta
• After birth:
 PVR decreases and SVR increases, causes Left‐to‐
Right shunt

57
Q

What is the physiologic factor most responsible for closure of the ductus arteriosus after birth?

A

increased arterial oxygen tension, reduction in circulating prostaglandins following separation of the placenta

58
Q

Is PDA right to left or left to right?

A

left to right, from aorta to pulmonary artery

59
Q

What is the probable problem if the peds patient has a systolic and diastolic murmur?

A

PDA

60
Q 
PDA‐ Ligation & Monitoring in NICU
• Standard monitoring, A‐line preferred, ETCO2
• Two pulse oximeters
 preductal = right hand
 postductal = lower limb
A

If the pulse is lost from the lower limb during
a test clamping of the duct, this might indicate
that the aorta has been clamped inadvertently

61
Q

Where to measure art pressure in PDA repair?

A

peripheral artery such as femoral

Peds (8 decks)

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