Prod...Anatomy Flashcards
What is the normal awake blood pressure range for a full term infant?
65-85/45-55 mm Hg
When does the anterior fontanelle normally close? Prior to its closure, what information can be ascertained by palpating it?
- Anterior fontenelle closes between 9 to 18 months of age
- Sunken fontenelle indicates dehydration
- Bulging fontenelle indicates increased intracranial pressure from: hydrocephalus, intracranial hemorrhage, infection or increased PaCO2
Does a fetus form urine while inutero?
YES
A 12 lead EKG of a new born reveals upright T waves in all the chest leads. Is this normal?
YES. The T waves will become isoelectric or inverted in V1-V4 by one week and will return in adolescence (Upright)
Failure for leads V1-V4 waves to invert by one week of age can indicate right ventricular ______.
Hypertrophy
How does the QRS axis appear in an infant?
Right sided until one month of age.
How does the PR interval in an infant compare to that of an adult?
The PR interval is 10 msecs and lengthens with age.
How does the normal resting cardiac output of an infant compare to that of an adult?
- Healthy full term infant has a cardiac output that is about 2-3 times that of an adult
What is the normal range for cardiac output in pediatric patients?
200 - 325 ml/min/kg
What ECG rhythms are considered normal in healthy newborns? Why is this?
- About 50 % of health newborns exhibit ECG rhythms that resemble comple, 2:1, or Wenchebach sinoatrial block.
- This is due to the parasympathetic nervous system that is in control, but after birth the sympathetic nervous system begins to take controls over the next 24 hours.
Preterm infants less than 1000 grams often display hyperkalemia. What is the cause of this?
This is due to the immature distal tubule function and a relative hypoalosteronism.
What is the normal blood pressure range for a 6-12 month old?
80-100/55-65
What is the predominant serum protein in fetal blood?
Alpha Fetoprotein
What is the normal range for the heart rate in a full term, then a six month old, and a one year old.
- Premature is 120-170
- 0 to 3 month old 100- 150
- 3 to 6 month old 90 -120
- 6 to 12 month old 80 -120
- 1 to 3 years 70 - 110
- 3 to 6 years 65 -110
- 6 to 12 years 60 - 95
How does the resting oxygen consumption of an infant compare to that of an adult?
Twice the rate of an adult
How does the presence of fetal hemoglobin affect the oxyhemoglobin dissociation curve? When does this change normally resolve?
- Causes a left shift
- Usually corrects itself with adult form of hemoglobin within the first week of life.
Infants younger than what post conceptual age have the greatest associated risk for post anesthetic respiratory depression?
< 55 weeks postconceptual age
What is the difference between periodic breathing and apnea of prematurity?
- Periodic breathing consist of pauses of breathing no more than 5 to 10 seconds
- Apnea of prematurity is prolonged pauses of breathing which cause arterial hypoxemia and bradycardia
What is the Hering Breuer reflex?
- Cessation of inspiration
- Develops within the first few weeks of life
What would you expect to be the normal respiratory rate for a newborn? A 6 month old? 12 month old? 5 year old?
- Newborn 50
- 6 month = 30
- 12 month = 24
- 5 years = 24
What is transient tachypnea of the newborn?
-Delay in the removal of fluid through the interstitium, producing a tachypnea that can last between 24 and 72 hours
How does the number of alveoli in a full term infant compare to that of adults?
- full term has 20 million alveoli (The number continues to increase for three month until it matches an adults)
- adult has 300 million alveoli
What is the normal blood pressure range for a 1-3 year old?
90-105/55-70 mm Hg
What is bronchopulmonary dysplasi?
-Respiratory distress syndrome in premature infants
-It involves lung parenchyma that involves hyperplasia of the smooth muscle tissue of the airways, peribronchiolar fibrosis, enlarged alveoli, and abnormalities in the pulmonary vasculature.
-
Elective surgery on a preterm infant should be delayed until they reach what postconseptual age?
> 50 weeks
What is a meningomyelocele?
- MOST COMMON CONGENITAL NEURAL TUBE DEFECT
- Neural tube fails to close in the 4th week of development
- Folate can prevent this problem
What is gastroschisis?
Occurs as a result of interruption of the omphalomesenteric artery which causes ischemia of the abdominal wall and herniates the abdominal content. There is no protective cover for the content herniated.
What is omphalocoele?
Failure of the abdominal content to migrate back into the abdomen in the 10th week of development. The content are surrounded be a membrane.
The dural sac in a neonate terminates at what level? At what level does it terminate in a on e year old?
- neonate = S3
- one year = S1
In patients with cyanotic heart disease, how accurately does the ETCO2 reflect the AaCO2?
-Patient with cyanotic heart disease the EtCO2 underestimate AaCO2 because venous blood passes directly into the arterial system without passing through the lungs.
Where is the diameter of the neonatal airway the most narrow?
-Cricoid cartilage (Just below the glottis
How does liver blood flow in the neonate compare to liver blood flow in the adult?
Liver blood flow in the neonate is decreased.
What is Potter syndrome?
-Disfigured facial attributes
-pulmonary hypoplasia
-skeletal deformities
RESULT from a lack of amiotic fluid
What premature neonates are at the highest risk for postoperativeapnea and bradycardia? When is the risk the highest? what monitoring standards should you employ?
- Premature neonate
- multiple congenital anomalies
- lung disease
- Hx of apnea and bradycardia
In the preterm infant, arterial blood gases are measured in which arteries?
- Preductal is measured in right radial or temporal artery
- Postductal is measured in the umbilical artery or lower limbs
What temperature regulation compensatory mechanism does the neonate possess? What are the disadvantages of this?
- Nonshivering thermogenesis
- Increased oxygen consumption and the production of ketone bodies and water
A healthy 5 year old is presenting for tonsillectomy. What diagnostic tests should be performed on this patient?
None. A healthy child for a minor procedure does not need any labs.
A pediatric patient presenting for tonsillectomy and adenoidectomy has a markedly elevated body mass index. What condition should the patient be evaluated for prior to the induction of anesthesia and hy?
Obstructive sleep apnea
What patient in particular are at a higher risk of a significant morbidity from anesthesia complication related to an upper respiratory infection?
- Sickle cell
- Asthma
How long after resolution of an upper respiratory infection does bronchial hyper reactivity still present a potential problem
7 weeks
A pediatric patient presenting for surgery currently has an upper respiratory infection. What complication does this place him at a risk for
- Laryngospasm
- postextubation croup
- bronchospasm
- oxygen desaturation
- atelectasis
Which asthma medication should be continued up until the day of surgery?
All asthma treatment
What are the five major causes of jaundice in neonates?
- Excess bilirubin production
- Impaired bilirubin uptake
- impaired bilirubin conjugation
- impaired bilirubinexcretion
- increased enterohepatic bilirubin circulation
Where does hematopoesis occur in the fetus?
Where does it occur in a six week old infant?
- Fetus = liver
- Six week old infant = bone marrow unless pathologic condition such as hemolytic anemia
Where does the spinal cord typically end in the neonate?
Neonate = L3
