Urology

Question 1

caudal blocks:

1. peds up to how many kg?
2. what is the cap of mLs she gives?
3. what is the mL/kg?
4. what are the 3 LAs? (B,R,R)
5. which one can be given as the sole anesthetic?
6. what age does she usually stop doing caudals?

Answer 1

1. 20 kg
2. 30 mL
3. 1 mL/kg
4. 0.125% bupivacaine with epi, 0.2% ropivacaine with or without epi, 0.375% ropivacaine with epi
5. 0.375% ropivacaine with epi
6. 6 years

Question 2

does 0.375% ropivacaine with provide the sole anesthetic for laparoscopic, open or both?

Answer 2

open

Question 3

caudal block:

1. what gauge needle?
2. locate what spines and palpate what cornu? (PSIS, SC)
3. advance the needle at what degree cephalad or caudal?
4. what ligament are you piercing with the needle? (SL)

Answer 3

1. 22 gauge
2. posterior superior iliac spines, sacral cornu
3. 45 degrees cephalad
4. sacrococcygeal ligament

Question 4

strangulated bowel loop:

1. is this an emergency?
2. what type of intubation technique?
3. do you mask them?

Answer 4

1. yes
2. RSI
3. no

Question 5

posterior urethral valves:

1. spectrum of urethral what that vary from mild to severe? (O)
2. is prenatal or postnatal more severe?
3. ultrasound can diagnosis this prenatal by what 3 signs? (BD, M, H)
4. what are the 3 postnatal signs? (DUO, UR, PUS)

Answer 5

1. obstruction
2. prenatal
3. bladder distention, megaureters, hydronephrosis
4. decreased urine output, urinary retention, poor urine stream

Question 6

avoid anesthesia within how many hours of dialysis to prevent hypovolemia?

Answer 6

12 hours

Question 7

posterior urethral valves:

1. when renal insufficiency occurs, the concentration mechanism is often impaired leading to an increase or decrease in urine output?
2. does this lead to relative hypervolemia or hypovolemia?
3. treatment is primary valve what to decompress the urogenital system? (A)
4. what is anesthesia plan for this procedure?

Answer 7

1. increase
2. hypovolemia
3. ablation
4. GA with LMA

Question 8

what are the 4 anesthesia worries with the primary valve ablation performed under cystoscopy? (AD, H, PNI, EA)

Answer 8

1. airway distance
2. hypothermia
3. peroneal nerve injury
4. electrolyte abnormalities

Question 9

Vesicoureteral reflux:

1. what is happening?
2. what 3 steps can result? (P, RS, DRF)
3. mild forms are treated with what? (A)
4. in severe forms, what is injected into the ureter to prevent reflux? (D)
5. what classic surgery is performed for this? (UR)

Answer 9

1. urine reflux from the bladder to the ureters
2. pyelonephritis, renal scarring, decreased renal function
3. antibiotics
4. deflux
5. ureter reimplantation

Question 10

what is the antibiotic given for vesicoureteral reflux?

Answer 10

bactrim

Question 11

ureteral reimplantation:

1. postop pain is often intense necessitating 2 to 3 days of continuous LA via an indwelling catheter, which can be in what 2 areas? (C, L)
2. what anesthesia technique for this procedure?
3. are neuromuscular blockers needed?

Answer 11

1. caudal, lumbar
2. GETA
3. yes

Question 12

pyeloplasty:

1. what is surgically reconstructed in this procedure? (RP)
2. this procedure is indicated for renal congestion, what is the common junction for renal congestion? (UJ)
3. procedure can be performed in what position and does this position increase or decrease venous return?
4. what is the anesthetic technique for this procedure and is it with or without paralytics?

Answer 12

1. renal pelvis
2. ureteropelvic junction
3. jackknife, decrease
4. GETA with paralytic

Question 13

what are pts who undergo a ureteral reimplantation on that pts who undergo a pyeloplasty not on?

Answer 13

antibiotics

Question 14

what is the main anesthetic implications difference between pts undergoing a ureteral reimplantation and pyeloplasty? (P)

Answer 14

positioning

Question 15

pyeloplasty:

1. what 2 positions can this be performed in?
2. where is the epidural catheter placed for this procedure? (HL, LT)
3. what LA is given after catheter insertion to set the block before the table is jackknifed?
4. what 2 LAs can be given after as an infusion? (B, R)

Answer 15

1. prone, lateral
2. high lumbar, low thoracic
3. 2% lidocaine with epi
4. bupivacaine, ropivacaine

Question 16

laparoscopic pyeloplasty:

1. mean retroperitoneal pressure of how much can increase PETCO2, increase peak inspiratory pressure and decrease BP?

Answer 16

1. 12 mmHg

Question 17

what are the 5 anesthesia concerns with cystoscopy pyelograms? (DFA, PND, H, CA, AA)

Answer 17

1. distance from airway
2. peroneal nerve damage
3. hypothermia
4. contrast allergy
5. amoxicillin allergy

Question 18

why can’t we use a lower bair hugger for cystoscopy pyelograms? (B)

Answer 18

burns

Question 19

what are 5 ways to increase pts temp? (H, FA, IRT, HOH, WF)

Answer 19

1. HME
2. forced air
3. increase room temp
4. hat on head
5. warm fluids

Question 20

nephrectomy:

1. does a partial or total have more blood loss?
2. what 3 labs should be checked?
3. these peds are often anemic possibly d/t decrease what concentration? (E)
4. what 2 things can be given 3-6 weeks before surgery to help improve anemia? (FS, VC)
5. if pt is being staged for a transplant, what should be avoided? (BT)

Answer 20

1. partial
2. H&H, electrolytes, coags
3. erythropoietin
4. ferrous sulfate, vitamin C
5. blood tranfusions

Question 21

nephrectomy:

1. blood transfusion should be given to increase what and not as a what? (OCC, VE)
2. size of these pts should be considered when setting up anesthesia equipment, are these children larger or smaller in size?
3. what anesthesia technique no matter open or laparoscopic?
4. what 2 IV catheters do you want? (LP, AL)

Answer 21

1. oxygen carrying capacity, volume exander
2. smaller
3. GETA
4. large PIV, art line

Question 22

nephrectomy:

1. for open procedure, what are the 2 neuraxial approaches? (LT, CCTTTL)
2. is a neuraxial block necessary for a laparoscopic approach?

Answer 22

1. lower thoracic, caudal catheter threaded to thoracic level
2. no

Question 23

myelomeningocele:

1. AKA for this? (SB)
2. what 2 things do not close at birth? (B, SC)
3. these pts often have neurogenic dysfunction of what 2 things? (B, B)
4. do these pts get neuraxial anesthesia?

Answer 23

1. spina bifida
2. backbone, spinal canal
3. bowel, bladder
4. no

Question 24

myelomeningocele:

1. what 2 procedures require GETA d/t longer procedure length? (MA, MACE)
2. what 3 procedures are okay to get an LMA d/t shorter procedure length? (C, BBI, V)
3. these pts often have what malformations? (CM)
4. these malformations are associated with what 2 things? (H, CSA)

Answer 24

1. mitrofanoff appendicovesicostomy, malone antegrade continence enema
2. cystoscopy, bladder botox injection, vesicostomy
3. chiari malformations
4. hydrocephalus, central sleep apnea

Question 25

chiari malformations are brain tissue extended into where?

Answer 25

spinal cord

Question 26

sexaual development disorders definition: a heterogenous group of conditions characterized by aberrant what, what and/or what with widely varying what 2 types of manifestations? (C, G, AS; G,P)

Answer 26

chromosomal, gonadal and/or anatomic sex; genotypic and phenotypic

Question 27

sexaual development disorders: 1. these can affect the production of what meaning these pts may need a stress dose of what? (C, S) 2. these disorders are associated with anomalies in what 3 areas? (S, C, A) 3. are these pts genotypically and phenotypically correct? 4. is this the same as transgender?

Answer 27

1. cortisol, steroids 2. spinal, cardiac, airway 3. no 4. no

Question 28

Testicular torsion: 1. children with acute testicular torsion should be considered "an acute abdomen" requiring what type of intubation and to be intubated with what? 2. do these pts need aggressive treatment for pain once the surgery is over?

Answer 28

1. RSI, endotracheal tube | 2. no

Question 29

Wilms tumor: 1. arise from persistent immature what renal tissue? (P) 2. 80% of the children present in what age range? 3. what are the 2 words to describe the anticipated blood loss for the tumor removal? (M, R) 4. is adequate blood warming capability mandatory? 5. pts with this tumor can have issues with what making an epidural block not an option?

Answer 29

1. parenchymal 2. 1-5 years 3. massive, rapid 4. yes 5. coagulation

Question 30

peniles procedures: 1. what type of block are great for these procedures? 2. what is hypospadias? 3. for outpatient procedures, what 2 blocks can the children receive? 4. more extensive hypospadias that require longer surgeries require what 2 types of airways?

Answer 30

1. caudal 2. malpositioned urethral meatus 3. penile, caudal 4. LMA, ETT

Question 31

block in general: 1. laparoscopies require what type of block technique? 2. open procedures require what type of block technique?

Answer 31

1. single shot | 2. catheter

Question 32

caudal block for penile procedures: 1. for procedures longer than 4 hours, what concentration of LA at beginning and end? 2. for procedures that are 3-4 hours, what concentration of LA at beginning and end? 3. what is the mL/kg of LA?

Answer 32

1. 0.2% ropivacaine with epi 2. 0.1% ropivacaine with epi 3. 1 mL/kg

Question 33

will she do a caudal on an 8 or 9 year old who is very slender at 20-30 kg for genital procedures?

Answer 33

yes

Question 34

what LA provides a motor blockade?

Answer 34

0.375% ropivacaine with epi

Question 35

what 2 LAs block sensory without significantly blocking motor?

Answer 35

bupivacaine 0.125% with epi, ropivacaine 0.2% with or without epi

Question 36

testicular torsion: 1. majority of testes saved if surgery within how many hours? 2. are these considered a full stomach? 3. are neonates still considered a full stomach? 4. a caudal can be performed for this, but what is the limiting factor for doing a one? (T) 5. after the torsion is relieved, do these pts need a much narcotics?

Answer 36

1. 6 hours 2. yes, RSI 3. yes 4. time 5. no

Question 37

what 2 pts require RSI? (SH, TT)

Answer 37

1. strangulated hernia | 2. testicular torsion

Question 38

cloacal anomaly: 1. definition: collection of defects during what development? (F) 2. more common in boys or girls? 3. girls present with what 3 things converged together called a "cloaca"? (U,V,R) 4. the most severe/complicated cloacal anomaly involves what? (BE)

Answer 38

1. fetal 2. girls 3. urethra, vagina, rectum 4. bladder exstrophy

Question 39

bladder exstrophy: 1. therapy is aimed at surgical reconstruction of what and preservation of what function? (B, R) 2. surgical goal is to close what 3 things? (B, PU, AW) 3. what type of osteotomy facilitates surgical closure and decreases stress on the midline incisions? (BIO) 4. are these peds at risk for multiple procedures?

Answer 39

1. bladder, renal 2. bladder, posterior urethra, abd wall 3. bilateral iliac osteotomy 4. yes

Question 40

bladder exstrophy: 1. bilateral iliac osteotomy may be done in conjunction with what other service? 2. parents and child who come multiple times for these procedures like the same what each time? (R) 3. by having really good pain control with these peds, what are you trying to prevent? 4. as the child becomes a toddler, what should you discuss with the parents?

Answer 40

1. orthopedics 2. routine 3. fear of coming to the hospital 4. pre-med

Question 41

Anesthesia for bladder exstrophy and cloacal repairs: 1. assess what 2 things with genetic anomalies? (C, A) 2. can have S/S of what 2 things? (RI, ED) 3. considered a hi risk for fluid loss d/t exposed what? (V) 4. talk with surgical team regarding fluid resuscitation with what 3 products? (BSS, C, BP)

Answer 41

1. cardiac, airway 2. renal insufficiency, electrolyte disturbances 3. viscera 4. balanced salt solution, colloid, blood products

Question 42

Anesthesia for bladder exstrophy and cloacal repairs: 1. should IV access be above or below surgical site? 2. at risk for what? (H) 3. what should be considered for post-op pain? 4. what 3 IV accesses do you want?

Answer 42

1. above 2. hypothermia 3. epidural catheter 4. 1 large bore IV, art line, and another PIV or central line

Question 43

Anesthesia for bladder exstrophy and cloacal repairs: 1. what is anesthesia plan? 2. how many hours do you run epidural for? 3. what is bupivacaine epidural mg/kg/hr? 4. what is lidocaine epidural mg/kg/hr?

Answer 43

1. GETA with narcotics and/or regional 2. 48 hours 3. 0.2 mg/kg/hr 4. 0.8 mg/kg/hr

Question 44

are peds at increased or decreased risk for LAST?

Answer 44

increased

Question 45

Anesthesia for bladder exstrophy and cloacal repairs: 1. what type of induction is preferred? 2. is RSI needed? 3. is there time to resuscitate the pt before doing these surgeries? 4. what are 3 reasons these surgeries put pt at risk for hypothermia? (LP, PL, PC)

Answer 45

1. IV 2. no 3. yes 4. lithotomy position, procedure length, position changes

Question 46

What do these procedures allow for: 1. mitrofanoff appendicovesicostomy 2. malone antegrade continence enema

Answer 46

1. abdominal self catheterization for urine | 2. abdominal self enema administration to facilitate bowel continence