SPECIALIZED PEDIATRIC CARE (NELSONS)

Question 1

What is the most important factor influencing drug dosing in neonates?

Answer 1

Organ maturation (especially liver and kidney function).

Question 2

Why are neonates more susceptible to drug toxicity?

Answer 2

Because of immature liver metabolism and renal excretion.

Question 3

What pharmacokinetic parameter is significantly prolonged in neonates?

Answer 3

Drug half-life.

Question 4

How does total body water affect drug distribution in neonates?

Answer 4

Higher total body water increases volume of distribution for water-soluble drugs.

Question 5

Which enzyme system is immature in neonates affecting drug metabolism?

Answer 5

Cytochrome P450 system.

Question 6

Which class of drugs should be used cautiously in neonates due to risk of kernicterus?

Answer 6

Sulfonamides.

Question 7

What is a common method to calculate pediatric drug dosages?

Answer 7

Weight-based dosing (mg/kg).

Question 8

What is Clark’s rule for pediatric dosing?

Answer 8

Child’s dose = (weight in lbs / 150) × adult dose.

Question 9

What is Young’s rule for pediatric dosing?

Answer 9

Child’s dose = (age in years / (age + 12)) × adult dose.

Question 10

What is the preferred route of medication administration in pediatric emergencies?

Answer 10

Intravenous (IV) route.

Question 11

What is the advantage of the intramuscular route in children?

Answer 11

Rapid absorption for certain drugs.

Question 12

Which pediatric drug formulation improves palatability and compliance?

Answer 12

Liquid or chewable formulations.

Question 13

Why is rectal administration sometimes used in pediatrics?

Answer 13

For unconscious, vomiting, or seizing patients.

Question 14

What is the primary concern with transdermal drug use in infants?

Answer 14

Enhanced absorption and risk of toxicity due to thin skin.

Question 15

Name one important side effect of corticosteroids in children.

Answer 15

Growth suppression.

Question 16

Why is medication adherence challenging in pediatric patients?

Answer 16

Due to taste, dosing frequency, and caregiver administration errors.

Question 17

What is a common technique to minimize distress during blood sampling in children?

Answer 17

Use of topical anesthetics like EMLA cream.

Question 18

Which gauge needle is preferred for venipuncture in infants?

Answer 18

23-25 gauge butterfly needle.

Question 19

What is the most common site for intraosseous access in children?

Answer 19

Proximal tibia.

Question 20

When is intraosseous access indicated?

Answer 20

When IV access cannot be quickly obtained in emergencies.

Question 21

How is nasogastric tube placement confirmed in children?

Answer 21

Auscultation of air insufflation and/or X-ray.

Question 22

Name a contraindication for nasogastric tube placement.

Answer 22

Facial trauma.

Question 23

What is the most appropriate size of endotracheal tube for a term newborn?

Answer 23

3.5 mm internal diameter.

Question 24

How is endotracheal tube size estimated in older children?

Answer 24

(Age/4) + 4.

Question 25

What is the preferred site for lumbar puncture in infants?

Answer 25

L3-L4 or L4-L5 interspace.

Question 26

What position is ideal for lumbar puncture in children?

Answer 26

Lateral decubitus with spine flexed.

Question 27

What is a major complication of lumbar puncture?

Answer 27

Post-lumbar puncture headache or traumatic tap.

Question 28

What is the most important pre-procedure assessment before pediatric sedation?

Answer 28

Airway evaluation.

Question 29

Name a common local anesthetic used in pediatric procedures.

Answer 29

Lidocaine.

Question 30

What is the main complication associated with central venous catheter placement?

Answer 30

Infection or thrombosis.

Question 31

What is the best practice to reduce infection risk during central line insertion?

Answer 31

Maximal sterile barrier precautions.

Question 32

What is a key difference between pediatric and adult responses to anesthesia?

Answer 32

Children have faster respiratory and cardiovascular changes.

Question 33

What is the minimum fasting time before elective surgery for breast milk?

Answer 33

4 hours.

Question 34

What is the minimum fasting time before elective surgery for clear liquids?

Answer 34

2 hours.

Question 35

Why are children at higher risk of airway obstruction during anesthesia?

Answer 35

Due to smaller, more compliant airways and larger tongue.

Question 36

What is laryngospasm and when is it a concern in pediatric anesthesia?

Answer 36

Reflex closure of the vocal cords, common during induction or extubation.

Question 37

What anesthetic agent is commonly used for rapid induction in children?

Answer 37

Sevoflurane.

Question 38

Which premedication can help reduce separation anxiety before pediatric surgery?

Answer 38

Midazolam.

Question 39

What is the most serious complication of inhalational anesthetics in susceptible children?

Answer 39

Malignant hyperthermia.

Question 40

What genetic mutation is associated with malignant hyperthermia?

Answer 40

RYR1 gene mutation.

Question 41

What is the antidote for malignant hyperthermia?

Answer 41

Dantrolene.

Question 42

Why is temperature monitoring crucial in pediatric anesthesia?

Answer 42

Children are prone to hypothermia.

Question 43

What is emergence delirium in pediatric anesthesia?

Answer 43

Agitation and confusion during recovery from anesthesia.

Question 44

Which age group is at highest risk for emergence delirium?

Answer 44

Toddlers and preschoolers (2-5 years old).

Question 45

What is the most sensitive indicator of adequate ventilation during anesthesia?

Answer 45

End-tidal CO₂ monitoring.

Question 46

Which neuromuscular blocker has the shortest duration of action and is commonly used for rapid sequence intubation?

Answer 46

Succinylcholine.

Question 47

What is the recommended method to manage a full stomach in emergency pediatric surgery?

Answer 47

Rapid sequence induction and intubation.

Question 48

A 2-year-old child with meningitis requires IV antibiotics. What key pharmacokinetic change should be considered when dosing?

Answer 48

Increased volume of distribution for water-soluble drugs like aminoglycosides.

Question 49

A preterm neonate on gentamicin develops nephrotoxicity. What is the likely cause?

Answer 49

Prolonged half-life and immature renal clearance leading to accumulation.

Question 50

A 4-year-old undergoing surgery has been NPO for 3 hours after apple juice intake. Can the surgery proceed?

Answer 50

Yes, clear liquids require only 2 hours fasting; surgery can proceed.

Question 51

A 6-month-old infant is receiving medication through a nasogastric tube. The drug is crushed and diluted. What must be confirmed before administration?

Answer 51

Proper tube placement (by auscultation or X-ray) to avoid aspiration.

Question 52

A 3-year-old child is in septic shock and IV access is unobtainable. What is the next best route for vascular access?

Answer 52

Intraosseous access (proximal tibia).

Question 53

During an appendectomy, a 5-year-old develops sudden masseter muscle rigidity after inhalational anesthesia. What is the diagnosis?

Answer 53

Malignant hyperthermia.

Question 54

What immediate steps should be taken when malignant hyperthermia is suspected?

Answer 54

Discontinue triggering agents, administer dantrolene, cool the patient, hyperventilate with 100% oxygen.

Question 55

A 7-year-old is sedated for MRI and develops hypoxia. What is the most likely cause?

Answer 55

Airway obstruction due to sedation-related hypopharyngeal collapse.

Question 56

A neonate needs a lumbar puncture. During the procedure, the infant suddenly becomes apneic. What is the most concerning complication?

Answer 56

Brainstem herniation due to increased intracranial pressure.

Question 57

A 2-year-old child is given lidocaine for a procedure and then develops seizures. What toxicity must be suspected?

Answer 57

Local anesthetic systemic toxicity (LAST).

Question 58

A 1-year-old scheduled for surgery has a URI with mild fever and nasal congestion. What is the anesthetic risk?

Answer 58

Increased risk of perioperative airway complications (laryngospasm, bronchospasm).

Question 59

A child presents with a femur fracture needing emergency surgery. What is the best induction method for anesthesia?

Answer 59

Rapid sequence induction to minimize aspiration risk.

Question 60

A pediatric patient undergoing procedural sedation for fracture reduction suddenly becomes bradycardic. What should you immediately assess?

Answer 60

Oxygenation and ventilation; hypoxia is the most common cause.

Question 61

An 8-year-old has severe burns and requires sedation for dressing changes. Which sedation agent is ideal for providing analgesia and minimal respiratory depression?

Answer 61

Ketamine.

Question 62

After placement of a central venous catheter in a child, there is acute respiratory distress. What is the first investigation to order?

Answer 62

Chest X-ray to rule out pneumothorax.

Question 63

A 2-year-old scheduled for elective hernia repair vomits clear fluid 3 hours before surgery. What is the next best step?

Answer 63

Postpone surgery unless emergent; ensure full fasting time is observed.

Question 64

A neonate receiving phenytoin shows subtherapeutic levels despite correct dosing. What is a possible explanation?

Answer 64

Reduced protein binding and altered metabolism in neonates.

Question 65

A 5-year-old is undergoing anesthesia. After extubation, he has inspiratory stridor and desaturation. What is the diagnosis?

Answer 65

Laryngospasm.

Question 66

During anesthesia, a child’s temperature drops to 34°C. What are the physiologic effects?

Answer 66

Bradycardia, impaired drug metabolism, increased oxygen consumption.

Question 67

A 4-year-old is sedated with midazolam for a procedure but becomes difficult to arouse. What is the reversal agent?

Answer 67

Flumazenil.

Question 68

A 9-month-old infant under general anesthesia has sudden hypotension and flushing after antibiotic administration. What is the likely diagnosis?

Answer 68

Anaphylaxis.

Question 69

A 5-year-old has difficulty extubating after surgery and shows generalized weakness. Which anesthetic complication should be suspected?

Answer 69

Residual neuromuscular blockade.

Question 70

An infant receiving a high dose of ceftriaxone develops jaundice. What is the mechanism?

Answer 70

Ceftriaxone displaces bilirubin from albumin, increasing free bilirubin levels.

Question 71

A 3-year-old child undergoing MRI under sedation with propofol develops apnea. What is the management?

Answer 71

Immediate airway support with bag-mask ventilation and consider intubation if necessary.

Question 72

A child with cerebral palsy is planned for anesthesia. What preoperative assessment is crucial?

Answer 72

Assessment of airway abnormalities and risk of gastroesophageal reflux.

Question 73

A 1-year-old is sedated with dexmedetomidine. What advantage does this drug have compared to benzodiazepines?

Answer 73

Minimal respiratory depression and natural sleep-like sedation.