Peds week 6

Question 0

With an omphalocele, the intestines ___ covered with amnion, and the defect is at the __ of the umbilicus

Answer 0

intestines are covered

base of umbilicus

Question 1

Necrotizing enterocolitis is an anomaly or an illness?

Answer 1

illness

Question 2

with gastroschisis, the intestines ___ covered, and the defect is ___

Answer 2

intestines are not covered

defect is periumbilical

Question 3

Omphalocele memory bridge OBBB

Answer 3

omphalocele
base of umbilicus
bag (of amnion covering)
bad news (other anomalies probable)

Question 4

Is dehydration, hypothermia, and infection more serious with gastroschisis or omphalocele?

Answer 4

Gastroschisis, because it has no amnion covering

Question 5

VACTERL syndrome includes

Answer 5

vertebral abnormalities
anus (imperforate)
congenital heart disease
tracheal esophageal fistula
radial aplasia / renal abnormalities
limb abnormalities

Question 6

The most common form of TEF is a dilated proximal esophageal pouch and a fistula between the distal trach and esophagus

Answer 6

type C

Question 7

neonates with TEF present with excessive oral secretions, feeding leads to __

Answer 7

choking, coughing, cyanosis because they are aspirating their food into their lungs

Question 8

With a TEF, avoid __ prior to induction to prevent gastric inflation, right mainstem then withdraw until bilateral breath sounds are heard.

Answer 8

avoid positive pressure ventilation

Question 9

After TEF repair, avoid __ and __

Answer 9

avoid instrumentation of esophagus (like an esophageal temp probe) or extension of head which may tear the repair

Question 10

Epiglottitis is a life-threatening condition presenting with upper airway obstruction (characterized by this sound __ __), DO NOT TOUCH the epiglottis and downsize the ETT by ___, extubate in the OR

Answer 10

inspiratory stridor

downsize by 0.5 mm

Question 11

Croup is an upper airway VIRAL infection, causes a barking cough

Answer 11

treat with nebulized epi and decadron

Question 12

With foreign body aspiration, positive pressure can force the foreign body deeper, so…

Answer 12

keep pt breathing spont during induction and spray cords with 2-4% lidocaine 5mg/kg max

Question 13

what is the pathophys of a chiari malformation?

Answer 13

elongated cerebellar vermis that herniates through the foramen magnum due to obliteration of the cisterna magna from downward displacement and hypoplasia of the cerebellum

Question 14

spina bifida makes me think about __

Answer 14

latex allergy

Question 15

most commons shock in peds?

Answer 15

hypovolemic

Question 16

best fluid for the hypovolemic ped?

Answer 16

crystalloid

Question 17

peds with long-standing sleep apnea show what anatomic changes in the heart?

Answer 17

pulm artery hypertension and RV hypertrophy

Question 18

prune-belly syndrome is associated with __

Answer 18

Grant Watt

j/k
cryptorchidism
club foot
genitourinary tract abnormalities

Question 19

Pierre Robin sequence

Answer 19

cleft soft palate, micrognathia/retrognathia, and glossoptosis (tongue further back)

Pierre spoke french fluently because of his cleft palate and small mandible that pushed his tongue posterior.

Question 20

Treacher Collins syndrome

Answer 20

down-slanting eyes, notched lower eyelids, underdeveloped or absent cheekbones, mandible small and receeding

When the “teacher calls” on you and you don’t know the answer, your eyes look down, you wish your cheekbones were absent instead of turning red, and it feels like a cat’s got your small mandible.

Question 21

What congenital heart disease is associated with Treacher-Collins?

Answer 21

VSD

Question 22

Treacher-Collins is associated with macroglossia and mental retardation?

Answer 22

NO NO NO the teacher is not retarded and does not have a big tongue

Question 23

Goldenhar syndrome includes

Answer 23

unilateral or bilateral underdevelopment of the mandible, small ears, narrow eyes, +/- cleft tongue, cleft palate, = difficult intubation

possibly d/t vascular accident in the fetus

If you stroke as a fetus, you might have “golden hair”, small jaw, ears, and eyes, and maybe a cleft palate.

Question 24

Mandibular hypoplasia is associated with what three congenital diseases?

Answer 24

Pierre Robin, Treacher Collins, and Goldenhar

Who has a small jaw? Frenchmen named Pierre, when the teacher calls on you, and if you have golden hair.

Question 25

Beckwith-Wiedemann syndrome =

Answer 25

microcephaly, macroglossia, umbilical hernia

Wideman has a narrow head but a wide tongue and an umbilical hernia poking out of his wide belly.

Question 26

How long does it take a 10kg infant to desaturate?

Answer 26

4 mins

Question 27

three syndromes associated with craniosynostosis (premature fusion of cranial sutures)

Answer 27

apert, pfeiffer, crouzon

my head almost fell “apart” when michelle “pfeiffer” ordered “croutons” on her salad.

Question 28

trisomy 21/Down syndrome associated with

Answer 28

small mouth, hypoplastic mandible, protruding tongue, 50% cardiac issue, hypotonia, ATLANTO-OCCIPITAL INSTABILITY avoid hyperextension

Question 29

Down syndrome is associated with a __ crease

Answer 29

simian

Question 30

VACTERL syndrome patients have __ development and __ intelligence

Answer 30

normal development and normal intelligence

Question 31

cerebral palsy is caused by brain damage caused during pregnancy, labor, delivery, or shortly after birth.

Answer 31

group of disorders, not sure what else to say

Question 32

signs of fetal alcohol syndrome

Answer 32

small eyes, thin upper lip, short upturned nose, smooth philtrum

heart defects, slow growth, microcephaly

Question 33

Nine signs of fetal cocaine toxicity

Answer 33

4 low - oxygen, CO, SV, conduction (delay)

4 high - BP, HR, CBF, RV (hypertrophy)

ST and T wave changes

Question 34

At what age is cleft palate usually repaired?

Answer 34

12-18 months

Question 35

What to do special before intubating a cleft palate?

Answer 35

put a piece of gauze in the cleft to prevent blade getting stuck

tape ETT to lower lip

use a RAE tube to prevent occlusion by the palate retractor

Question 36

Name four conditions with a large tongue

Answer 36

down’s, pierre robin, acromegaly, hypothyroid

Very few people know about “Robin” Hood’s large tongue. His “thyroid” was “down” and he won the “mega” millions jackpot.