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Peds Anesthesia - Summer 2013 > Prod...Anatomy > Flashcards

Prod...Anatomy Flashcards

1
Q

What is the normal awake blood pressure range for a full term infant?

A

65-85/45-55 mm Hg

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2
Q

When does the anterior fontanelle normally close? Prior to its closure, what information can be ascertained by palpating it?

A
  • 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
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3
Q

Does a fetus form urine while inutero?

A

YES

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4
Q

A 12 lead EKG of a new born reveals upright T waves in all the chest leads. Is this normal?

A

YES. The T waves will become isoelectric or inverted in V1-V4 by one week and will return in adolescence (Upright)

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5
Q

Failure for leads V1-V4 waves to invert by one week of age can indicate right ventricular ______.

A

Hypertrophy

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6
Q

How does the QRS axis appear in an infant?

A

Right sided until one month of age.

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7
Q

How does the PR interval in an infant compare to that of an adult?

A

The PR interval is 10 msecs and lengthens with age.

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8
Q

How does the normal resting cardiac output of an infant compare to that of an adult?

A
  • Healthy full term infant has a cardiac output that is about 2-3 times that of an adult
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9
Q

What is the normal range for cardiac output in pediatric patients?

A

200 - 325 ml/min/kg

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10
Q

What ECG rhythms are considered normal in healthy newborns? Why is this?

A
  • 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.
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11
Q

Preterm infants less than 1000 grams often display hyperkalemia. What is the cause of this?

A

This is due to the immature distal tubule function and a relative hypoalosteronism.

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12
Q

What is the normal blood pressure range for a 6-12 month old?

A

80-100/55-65

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13
Q

What is the predominant serum protein in fetal blood?

A

Alpha Fetoprotein

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14
Q

What is the normal range for the heart rate in a full term, then a six month old, and a one year old.

A
  • 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
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15
Q

How does the resting oxygen consumption of an infant compare to that of an adult?

A

Twice the rate of an adult

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16
Q

How does the presence of fetal hemoglobin affect the oxyhemoglobin dissociation curve? When does this change normally resolve?

A
  • Causes a left shift

- Usually corrects itself with adult form of hemoglobin within the first week of life.

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17
Q

Infants younger than what post conceptual age have the greatest associated risk for post anesthetic respiratory depression?

A

< 55 weeks postconceptual age

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18
Q

What is the difference between periodic breathing and apnea of prematurity?

A
  • 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
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19
Q

What is the Hering Breuer reflex?

A
  • Cessation of inspiration

- Develops within the first few weeks of life

20
Q

What would you expect to be the normal respiratory rate for a newborn? A 6 month old? 12 month old? 5 year old?

A
  • Newborn 50
  • 6 month = 30
  • 12 month = 24
  • 5 years = 24
21
Q

What is transient tachypnea of the newborn?

A

-Delay in the removal of fluid through the interstitium, producing a tachypnea that can last between 24 and 72 hours

22
Q

How does the number of alveoli in a full term infant compare to that of adults?

A
  • full term has 20 million alveoli (The number continues to increase for three month until it matches an adults)
  • adult has 300 million alveoli
23
Q

What is the normal blood pressure range for a 1-3 year old?

A

90-105/55-70 mm Hg

24
Q

What is bronchopulmonary dysplasi?

A

-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.
-

25
Q

Elective surgery on a preterm infant should be delayed until they reach what postconseptual age?

A

> 50 weeks

26
Q

What is a meningomyelocele?

A
  • MOST COMMON CONGENITAL NEURAL TUBE DEFECT
  • Neural tube fails to close in the 4th week of development
  • Folate can prevent this problem
27
Q

What is gastroschisis?

A

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.

28
Q

What is omphalocoele?

A

Failure of the abdominal content to migrate back into the abdomen in the 10th week of development. The content are surrounded be a membrane.

29
Q

The dural sac in a neonate terminates at what level? At what level does it terminate in a on e year old?

A
  • neonate = S3

- one year = S1

30
Q

In patients with cyanotic heart disease, how accurately does the ETCO2 reflect the AaCO2?

A

-Patient with cyanotic heart disease the EtCO2 underestimate AaCO2 because venous blood passes directly into the arterial system without passing through the lungs.

31
Q

Where is the diameter of the neonatal airway the most narrow?

A

-Cricoid cartilage (Just below the glottis

32
Q

How does liver blood flow in the neonate compare to liver blood flow in the adult?

A

Liver blood flow in the neonate is decreased.

33
Q

What is Potter syndrome?

A

-Disfigured facial attributes
-pulmonary hypoplasia
-skeletal deformities
RESULT from a lack of amiotic fluid

34
Q

What premature neonates are at the highest risk for postoperativeapnea and bradycardia? When is the risk the highest? what monitoring standards should you employ?

A
  • Premature neonate
  • multiple congenital anomalies
  • lung disease
  • Hx of apnea and bradycardia
35
Q

In the preterm infant, arterial blood gases are measured in which arteries?

A
  • Preductal is measured in right radial or temporal artery

- Postductal is measured in the umbilical artery or lower limbs

36
Q

What temperature regulation compensatory mechanism does the neonate possess? What are the disadvantages of this?

A
  • Nonshivering thermogenesis

- Increased oxygen consumption and the production of ketone bodies and water

37
Q

A healthy 5 year old is presenting for tonsillectomy. What diagnostic tests should be performed on this patient?

A

None. A healthy child for a minor procedure does not need any labs.

38
Q

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?

A

Obstructive sleep apnea

39
Q

What patient in particular are at a higher risk of a significant morbidity from anesthesia complication related to an upper respiratory infection?

A
  • Sickle cell

- Asthma

40
Q

How long after resolution of an upper respiratory infection does bronchial hyper reactivity still present a potential problem

A

7 weeks

41
Q

A pediatric patient presenting for surgery currently has an upper respiratory infection. What complication does this place him at a risk for

A
  • Laryngospasm
  • postextubation croup
  • bronchospasm
  • oxygen desaturation
  • atelectasis
42
Q

Which asthma medication should be continued up until the day of surgery?

A

All asthma treatment

43
Q

What are the five major causes of jaundice in neonates?

A
  • Excess bilirubin production
  • Impaired bilirubin uptake
  • impaired bilirubin conjugation
  • impaired bilirubinexcretion
  • increased enterohepatic bilirubin circulation
44
Q

Where does hematopoesis occur in the fetus?

Where does it occur in a six week old infant?

A
  • Fetus = liver

- Six week old infant = bone marrow unless pathologic condition such as hemolytic anemia

45
Q

Where does the spinal cord typically end in the neonate?

A

Neonate = L3

Peds Anesthesia - Summer 2013 (14 decks)

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