Principles II- Quiz 1

1. Which of the following allows oxygenated blood coming from the umbilical vein to go directly into the inferior vena cava, bypassing the liver?

Ductus Arteriosis

Ductus Venosus

Foramen Ovale

Iliac Arteries

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Explanation

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2. You are caring for a child who is two weeks old. What would this kid be classified as?

Neonate

Infant

Child

Newborn

A child who is two weeks old would be classified as a neonate. The term "neonate" refers to a newborn baby who is within the first 28 days of life. This stage is characterized by the child's adaptation to life outside the womb and their vulnerability to various health risks. Therefore, "neonate" is the correct classification for a two-week-old child.

Explanation

A child who is two weeks old would be classified as a neonate. The term "neonate" refers to a newborn baby who is within the first 28 days of life. This stage is characterized by the child's adaptation to life outside the womb and their vulnerability to various health risks. Therefore, "neonate" is the correct classification for a two-week-old child.

3. You are caring for Baby Hannah today in the NICU. She came to the NICU shortly after birth. Her primary symptoms are that feeding causes her to choke, cough, and become cyanotic. These are hallmark symptoms of what congenital anamoly?

Congenital Diaphraghmatic Hernia

Intestinal Obstruction

Gastroschisis

Tracheoesophageal Fistula

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Explanation

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4. For the Neonate, Cardiac output is primarily dependent upon….

Stroke Volume

Systolic Blood Pressure

Pulmonary Vascular Resistance

Heart Rate

In neonates, cardiac output is primarily dependent upon heart rate. This is because the heart rate determines the number of times the heart contracts and pumps blood per minute. As neonates have a relatively small stroke volume (the amount of blood pumped out of the heart with each contraction), their cardiac output is mainly regulated by heart rate. Additionally, factors such as systolic blood pressure and pulmonary vascular resistance may also influence cardiac output, but they are not the primary determinants in neonates.

Explanation

In neonates, cardiac output is primarily dependent upon heart rate. This is because the heart rate determines the number of times the heart contracts and pumps blood per minute. As neonates have a relatively small stroke volume (the amount of blood pumped out of the heart with each contraction), their cardiac output is mainly regulated by heart rate. Additionally, factors such as systolic blood pressure and pulmonary vascular resistance may also influence cardiac output, but they are not the primary determinants in neonates.

5. Which of the following allows oxygenated blood from the right side of the heart to pass into the left side circulation via a shunt located between the right and left atria?

Ductus Arteriosus

Ductus Venosus

Foramen Ovale

Pulmonary Artery

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Explanation

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6. General anesthesia inhibits nonshivering thermogenesis in infants.

True

False

General anesthesia refers to the administration of drugs that induce a reversible loss of consciousness and sensation. Nonshivering thermogenesis is the process by which infants generate heat to maintain their body temperature. This process is inhibited by general anesthesia, meaning that infants under general anesthesia are unable to generate heat through nonshivering thermogenesis. Therefore, the statement "General anesthesia inhibits nonshivering thermogenesis in infants" is true.

Explanation

General anesthesia refers to the administration of drugs that induce a reversible loss of consciousness and sensation. Nonshivering thermogenesis is the process by which infants generate heat to maintain their body temperature. This process is inhibited by general anesthesia, meaning that infants under general anesthesia are unable to generate heat through nonshivering thermogenesis. Therefore, the statement "General anesthesia inhibits nonshivering thermogenesis in infants" is true.

7. You have just extubated a 3 week old child and are on your way to PACU when you notice the childs respirations become very shallow. The child is wearing an O2 face mask already so what should be your first action?

Stimulate the angle of the jaw

Pick up the child and shake them

Call for a crash cart and begin chest compressions

Reintubate the child and take them to PACU to be extubated later.

Stimulating the angle of the jaw can help to stimulate the child's respiratory drive and increase their respirations. This action can be performed by gently tapping or rubbing the angle of the jaw, which can help to stimulate the nerves and muscles involved in breathing. It is a non-invasive intervention that can be quickly performed in order to address the shallow respirations and potentially prevent further complications.

Explanation

Stimulating the angle of the jaw can help to stimulate the child's respiratory drive and increase their respirations. This action can be performed by gently tapping or rubbing the angle of the jaw, which can help to stimulate the nerves and muscles involved in breathing. It is a non-invasive intervention that can be quickly performed in order to address the shallow respirations and potentially prevent further complications.

8. You are in the delivery room with Mrs. Nypa when her new son is born. Upon his birth it becomes obvious something is wrong. The baby becomes hypoxic shortly after birth, and his abdomen has a strange inward curve to it. You auscultate the babies lungs and hear what sound like bowel sounds. What do you think is wrong with this infant?

Tracheoesophageal fistula

Gastroschisis

Pyloric Stenosis

Congenital diaphragmatic Hernia

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Explanation

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9. Which of the following is not true regarding physiological differences of the neonate?

Lower Lung Compliance

Cardiac output dependent on Heart rate

Increased FRC at birth

Higher total body water content

Increased FRC at birth is not true regarding physiological differences of the neonate. FRC (Functional Residual Capacity) refers to the volume of air present in the lungs at the end of passive expiration. In neonates, FRC is actually lower at birth compared to adults due to their smaller lung size and higher lung compliance. As the lungs develop and mature, FRC gradually increases. Therefore, the statement that there is an increased FRC at birth is incorrect.

Explanation

Increased FRC at birth is not true regarding physiological differences of the neonate. FRC (Functional Residual Capacity) refers to the volume of air present in the lungs at the end of passive expiration. In neonates, FRC is actually lower at birth compared to adults due to their smaller lung size and higher lung compliance. As the lungs develop and mature, FRC gradually increases. Therefore, the statement that there is an increased FRC at birth is incorrect.

10. You are the nurse for a premature child who was born at 30 weeks gestation. The child is now 5 months old and doing very well. They have come in today for a minor elective procedure and the childs mother asks you when the child will go home. What do you tell her?

As soon as I wheel her out of the OR you can take her!

We will most likely keep her overnight on a pulse oximeter just to watch her.

We will watch her in the PACU for 2-3 hours after the procedure and then she may go home.

NEVER!! She isn’t really expected to survive this. You may want to call Goodwill to take the crib now.

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Explanation

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11. In infants with CDH, what associated congenital anomaly contributes most to increased morbidity and mortality?

CNS disorders

GI Disorders

Cardiac Defects

GU disorders

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Explanation

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12. In fetal circulation, which side of the heart ejects more of the cardiac output?

Left Atria

Both are equal

Left Ventricle

Right Ventricle

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Explanation

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13. Rapid sequence intubation is recommended for patients with pyloric stenosis.

True

False

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Explanation

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14. Which of the following is not one of the three major concerns during CVP placement?

Airway management

Electrolyte Imbalances

Pneumothorax

Bleeding

During CVP placement, the three major concerns are airway management, pneumothorax, and bleeding. Electrolyte imbalances are not directly related to the placement of a central venous catheter.

Explanation

During CVP placement, the three major concerns are airway management, pneumothorax, and bleeding. Electrolyte imbalances are not directly related to the placement of a central venous catheter.

15. You are caring for a 5 week old today. How would you classify this kid?

Neonate

Infant

Child

Newborn

The correct answer is "Infant" because at 5 weeks old, the child is no longer considered a newborn. The term "neonate" refers to a baby within the first 4 weeks of life, so it does not apply in this case. The term "child" is typically used for older children, so it is not appropriate for a 5-week-old. Therefore, "infant" is the most accurate classification for this age group.

Explanation

The correct answer is "Infant" because at 5 weeks old, the child is no longer considered a newborn. The term "neonate" refers to a baby within the first 4 weeks of life, so it does not apply in this case. The term "child" is typically used for older children, so it is not appropriate for a 5-week-old. Therefore, "infant" is the most accurate classification for this age group.

16. What would be appropriate vital signs for 3 month old child in your care?

RR 62 HR 145 BP 76/40

RR 10 HR 62 BP 58/30

RR 22 HR 120 BP 135/ 82

RR 28 HR 130 BP 72/40

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Explanation

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17. Which of the following describes an appropriate time to extubate a 2 month old child?

When the child is still drowsy, but maintaining an adequate RR and Todal Volume.

When the child can lift their head off the bead for 5 seconds and grasp your finger.

When the child begins to move, regardless of eye opening (babies just aren’t cooperative here)

When the child is attempting to cry, grab tube and their eyes are open

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Explanation

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18. Why would you not administer 100% oxygen to a premature infant?

Because of their immature respiratory control center which will cause apnea if arterial O2 tension becomes too high

Because of the risk of retinopathy of prematurity

Because of the risk of causing the Ductus Arteriosis & Forman Ovale to reopen

Because you don’t feel like it.

Administering 100% oxygen to a premature infant can increase the risk of retinopathy of prematurity. This condition is characterized by abnormal blood vessel growth in the retina, which can lead to vision problems or even blindness. High levels of oxygen can contribute to the development or worsening of retinopathy of prematurity. Therefore, it is important to carefully monitor and control the oxygen levels given to premature infants to prevent this complication.

Explanation

Administering 100% oxygen to a premature infant can increase the risk of retinopathy of prematurity. This condition is characterized by abnormal blood vessel growth in the retina, which can lead to vision problems or even blindness. High levels of oxygen can contribute to the development or worsening of retinopathy of prematurity. Therefore, it is important to carefully monitor and control the oxygen levels given to premature infants to prevent this complication.

19. You are the SRNA for an infant having a correction of coarctation of the aorta. The child is very ill with questionable volume status, as the BP has been dropping. Which drug should you choose as your main anesthetic to induce this patient?

Desflurane

Propofol

Ketamine

Pancuronium

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Explanation

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20. Comic Reflief:

Yeeaaahh! Dinosaurs!!!

Eewweeeee

All the above.

The answer "All the above" is correct because the given text includes the phrases "Yeeaaahh! Dinosaurs!!!" and "Eewweeeee," indicating excitement and disgust respectively. Since the question asks for an explanation for the correct answer, it can be inferred that the answer encompasses both emotions expressed in the text.

Explanation

The answer "All the above" is correct because the given text includes the phrases "Yeeaaahh! Dinosaurs!!!" and "Eewweeeee," indicating excitement and disgust respectively. Since the question asks for an explanation for the correct answer, it can be inferred that the answer encompasses both emotions expressed in the text.

21. You are caring for 3 day old Zach. During delivery he aspirated meconium into his trachea. He has needed respiratory support due to hypoxia. Little Zach is currently in resp distress and about to be intubated. When you auscultate his chest you hear a pansystolic murmur, indicating a patent ductus arteriosis. What is the most likely diagnosis for little Zach?

Transient Tachypnea of the newborn

Persistant Pulmonary Hypertension

Hyperbilirubinemia

Pneumonitis of infancy

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Explanation

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22. When intubating the neonate, you should do all of the following except?

Place a pillow at the occiput to achieve a sniffing position

Place a roll at their neck/shoulder

Use an uncuffed ETT

Use cricoid pressure to displace anterior anatomy

Placing a pillow at the occiput to achieve a sniffing position is not a step that should be done when intubating a neonate. The sniffing position is a technique used to align the airway axis and improve visualization during intubation. It involves extending the head and flexing the neck. Placing a pillow at the occiput would counteract this positioning and hinder the intubation process. Therefore, it should not be done.

Explanation

Placing a pillow at the occiput to achieve a sniffing position is not a step that should be done when intubating a neonate. The sniffing position is a technique used to align the airway axis and improve visualization during intubation. It involves extending the head and flexing the neck. Placing a pillow at the occiput would counteract this positioning and hinder the intubation process. Therefore, it should not be done.

23. Which of the following is a herniation of the abdominal contents outside of the abdominal cavity that is not covered by a sac and is not associated with any other congenital anomalies?

Omphalocele

Congenital Diaphragmatic Hernia

Gastroschisis

Tracheoesophageal Fistula

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Explanation

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24. You are the SRNA for a 3 day old child having surgery for intestinal obstruction. This patient is hypovolemic and you are worried this child may not tolerate anesthesia well. What is your agent of choice for this patient?

Sevoflurane

Etomidate

Ketamine

Propofol

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Explanation

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25. In fetal circulation, Right Ventricular blood is pumped into the Pulmonary artery. Because of high PVR, 95% of blood ejected from RV (60% O2 sat) is shunted across the __________ into the descending Aorta and back to the placenta & lower body.

Aortic Coarctation

Ductus Venosus

Foramen Ovale

Ductus Arteriosus

In fetal circulation, the right ventricle pumps blood into the pulmonary artery. However, due to the high pulmonary vascular resistance (PVR), a significant amount of the blood (95%) that is ejected from the right ventricle is shunted across the ductus arteriosus into the descending aorta. This allows the blood to bypass the lungs and flow back to the placenta and lower body for oxygenation. Therefore, the correct answer is Ductus Arteriosus.

Explanation

In fetal circulation, the right ventricle pumps blood into the pulmonary artery. However, due to the high pulmonary vascular resistance (PVR), a significant amount of the blood (95%) that is ejected from the right ventricle is shunted across the ductus arteriosus into the descending aorta. This allows the blood to bypass the lungs and flow back to the placenta and lower body for oxygenation. Therefore, the correct answer is Ductus Arteriosus.

26. You are SRNA for 2 month old Giovanni, you go to visit him in pre-op and see he has no IV currently. He is an otherwise healthy baby who is coming in to repair an umbilical hernia. When should you insert an IV on this infant?

Immediately so you can give pre-op meds

This child does need an IV for a minor procedure

Give Midazolam PO and then start the IV before induction

After induction when the patient is asleep, hunt for an IV

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Explanation

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27. In fetal circulation the ____ is relatively high while the ____ is relatively low, though this changes upon birth of the child.

PVR, SVR

SVR, PVR

HCT, HgB

HgB, HCT

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Explanation

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28. What would be an appropriate pre-medication dose of atropine for a 5 month old child weighing 7 kg?

14 mg

0.14 mg

0.07 mg

0.7 mg

Atropine is a medication commonly used to treat certain medical conditions. The appropriate dose of atropine for a 5-month-old child weighing 7 kg would be 0.14 mg. This dosage is based on the weight of the child and is calculated to ensure the medication is safe and effective for their size. It is important to carefully calculate and administer the correct dose of medication to avoid any potential harm or adverse effects.

Explanation

Atropine is a medication commonly used to treat certain medical conditions. The appropriate dose of atropine for a 5-month-old child weighing 7 kg would be 0.14 mg. This dosage is based on the weight of the child and is calculated to ensure the medication is safe and effective for their size. It is important to carefully calculate and administer the correct dose of medication to avoid any potential harm or adverse effects.

29. You are the SRNA for baby Martha who is having a VP shunt placement for hydrocephalus. During your pre-op evaluation your find her to be awake and alert, pupils are normal size, and a regular respiratory rate and SBP. Her vital signs appear stable at the time. She has been NPO for 8 hours prior to procedure. Would it be safe to do an inhalational induction on baby Martha?

Dude… seriously…. I have no clue.

No, Rapid sequence must be done for hydrocephalus patients

No, She should be induced with ketamine & vecuronium.

Yes, this can be done.

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Explanation

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30. Which of the following is true regarding anesthetic management of children with hydrocephalus?

Patients with elevated ICP should be hyperventilated to an ETCO2 of 28-33.

Patients with elevated ICP should be positioned supine during the procedure.

Opioids are recommended to help control ventilations,since spontaneous ventilations are encouraged.

Anesthesia should be maintained with Propofol and Rocuronium.

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31. How do neonates control their temperature?

By increasing SVR and HR to constrict peripheral vessels and direct blood to their core

Through metabolism of brown fat.

Through Shivering to generate heat and energy within tissues.

All The Above.

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Explanation

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32. You are having a bad day and you are about to do a small procedure on a neonate. You decide to make your life easier you will use some short-acting Sux to facilitate your intubation. Which of the following statements is correct?

Sux has the ability to cause severe bradycardia in peds and should be avoided unless an emergency

Ok to use, make sure to increase your dose from 1-1.5 mg/kg to 2-3 mg/kg IV

Do not use, Sux is contraindicated in neonates

Ok to use the IM dose of 4-5 mg/kg because redistribution is quicker

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33. You are caring for 1 month old Audrey today who is having repair of pyloric stenosis. She weighs 5 kg currently. What would be an appropriate IV intubating dose of sux for Audrey?

10 mg

7.5 mg

5 mg

20 mg

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34. Which drug would you give to a 5kg infant to blunt the physiologic response to awake intubation?

Sux 10mg IV

Glyco 0.05mg IV

Lidocaine 7.5 mg IV

Nitrous oxide 70%

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Explanation

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35. Which of the following is not true regarding pharmacologic differences in neonates?

Neonates have decreased Volume of Distribution for H2O soluble drugs.

Neonates have Immature Hepatic Biotransformation

Neonates have decreased protein binding of drugs

Neonates have immature renal function

Neonates have a larger volume of distribution for water-soluble drugs compared to adults. This is because neonates have a higher proportion of total body water compared to adults. Due to their higher water content, water-soluble drugs distribute more widely in neonates, resulting in a larger volume of distribution. This is in contrast to lipid-soluble drugs, which have a smaller volume of distribution in neonates due to their lower proportion of fat compared to adults. Therefore, the statement that neonates have decreased volume of distribution for water-soluble drugs is not true.

Explanation

Neonates have a larger volume of distribution for water-soluble drugs compared to adults. This is because neonates have a higher proportion of total body water compared to adults. Due to their higher water content, water-soluble drugs distribute more widely in neonates, resulting in a larger volume of distribution. This is in contrast to lipid-soluble drugs, which have a smaller volume of distribution in neonates due to their lower proportion of fat compared to adults. Therefore, the statement that neonates have decreased volume of distribution for water-soluble drugs is not true.

36. Which of the following problems would not be a pre-op problem associated with Necrotizing Enterocolitis?

Peritonitis

Acute Abdomen

Pulmonary Hypoplasia

Metabolic Acidosis

Pulmonary hypoplasia refers to underdevelopment of the lungs, which is not directly associated with necrotizing enterocolitis (NEC). NEC is a condition characterized by inflammation and tissue death in the intestines, commonly seen in premature infants. Pre-op problems associated with NEC typically include peritonitis, acute abdomen, and metabolic acidosis, which are all related to the gastrointestinal system. Pulmonary hypoplasia, on the other hand, is a separate condition that affects lung development and is not directly linked to NEC.

Explanation

Pulmonary hypoplasia refers to underdevelopment of the lungs, which is not directly associated with necrotizing enterocolitis (NEC). NEC is a condition characterized by inflammation and tissue death in the intestines, commonly seen in premature infants. Pre-op problems associated with NEC typically include peritonitis, acute abdomen, and metabolic acidosis, which are all related to the gastrointestinal system. Pulmonary hypoplasia, on the other hand, is a separate condition that affects lung development and is not directly linked to NEC.

37. When caring for infants having large abdominal surgeries(omphalocele, malrotation) one the MOST important considerations during surgery is the need for…

Positive pressure ventilation

Antibiotic therapy to treat sepsis

The need for deep sedation with VAA’s and adequate paralysis.

The need for early and aggressive fluid therapy.

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Explanation

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38. Why is Fetal Ion Trapping a concern for us?

When CO2 becomes trapped in less compliant neonatal lungs, this can lead to acidosis

When fetal blood breaks down, ion trapping will lead to a physiologic anemia

Pregnant women may have severe electrolyte abnormalities due to the fetus ‘trapping’ vital nutrients within its circulation to sustain life.

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Explanation

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39. Neonates are prone to hypothermia because:

VAA inhibit thermoregulation of brown fat

Layered, chubby skin has an increase BSA

Increase TBW and ECF

Convection and Conduction heat loss through cold OR’s

Neonates are prone to hypothermia because volatile anesthetic agents (VAA) inhibit the thermoregulation of brown fat. Brown fat is responsible for generating heat in the body, and when its thermoregulation is inhibited, the neonate's ability to maintain body temperature is compromised. This can lead to hypothermia, as the body is unable to generate enough heat to keep warm.

Explanation

Neonates are prone to hypothermia because volatile anesthetic agents (VAA) inhibit the thermoregulation of brown fat. Brown fat is responsible for generating heat in the body, and when its thermoregulation is inhibited, the neonate's ability to maintain body temperature is compromised. This can lead to hypothermia, as the body is unable to generate enough heat to keep warm.

40. A full-term infant delivered via a scheduled cesarean section may be at an increased risk for what?

Transient Tachypnea

Persistant Pulmonary Hypertension

Meconium Aspiration

Cesarean Infants are not at an increased for any complications.

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Explanation

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41. You are performing a caudal block for a patient going in for repair of pyloric stenosis. What do you choose as an appropriate dose of local anesthetic for this?

Chloroprocaine 1% 0.75 ml/kg

Bupivacaine 0.25% 1.25 ml/kg

Lidocaine 2% 0.25 ml/kg

Mepivacaine 1% 0.5 ml/kg

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42. You caring for baby Noah in the NICU today. When you examine him you find that he is tachypnic, has bounding pulses, a continuous murmur, and you are able to palpate hepatomegally in his abdomen. This is consistent with his current diagnosis of…

Necrotizing Enterocolitis

Hydrocephalus

Patent Ductus Arteriosus

Bacterial Pneumonia

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Explanation

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43. What size ETT would you choose for a newborn full term baby?

3-3.5

2-2.5

4-4.5

None of above

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Explanation

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44. After closure of a PDA, the patient suddenly becomes hypotensive. What is your immediate response to this?

Make the surgeon aware and ask him to remove retractors until patient BP returns to acceptable levels.

Administer fluid bolus of 10-15 ml/kg of NS or LR to augment volume

Give ephedrine 0.15 mg/kg to raise BP

Place the patient into trendelenburg position to increase venous return.

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Explanation

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45. You are the SRNA for an 11 month old child today. They were a fullterm baby and now weigh 10kg. The child has been NPO for 6 hours and is having an atraumatic surgical procedure. How much fluid would you give to this child TOTAL during the SECOND hour of the procedure? (fluid total just for 2^nd hour, not for entirety of procedure)

160

180

120

40

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46. You are the SRNA for a full term neonate who is going in today for repair of an omphalocele. The child weighs 4 kg, with a current HCT 55%. The doctor says to transfuse the baby if the HCT drops to 40%. What is the allowable blood loss for the full term neonate?

90 ml

110 ml

50 ml

185 ml

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47. How would you treat laryngospasm in a 6 week old child?

Administer Sux 2mg/kg IV

Give racemic epinephrine treatment

Give 100% Oxygen via facemask and apply jaw thrust

Flick bottom of childs feet to stimulate vagal nerve.

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Explanation

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48. Which of the following may be an indication for an awake intubation?

A child with pyloric stenosis who has been persistently vomitting

1 day old child born to a diabetic mother, weighing 13 lbs.

A child born with hydrocephalus going in for emergent Shunt placement

A newborn with Meningomyelocele going in for repair, NPO for 6 hours.

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49. Which of the following is true regarding anesthetic management of a child with CDH?

Due to abnormal gastric anatomy, NG tubes should NOT be placed prior to surgery.

N2O is contraindicated in these cases, due to ability to expand the bowel in the chest.

High levels of positive pressure are necessary to maintain oxygenation in hypoplastic lungs.

The patient may easily be extubated immediately post-op when the pressure within the chest is relieved.

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50. You are caring for baby Niko who has hydrocephalus and is going in for a shunt placement today. Upon assessment of the child you find that this baby has been vomiting through the night, is lethargic, and has an increased systolic BP with slight bradycardia. The child has been NPO for 10 hours prior to schedules procedure. With this knowledge what sort of induction would you choose for this child?

Standard Inhalational Induction

Cancel procedure until child is more stable

Rapid Sequence induction

Induce with vecuronium and fentanyl

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Explanation

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51. Upon autopsy, what percentage of adults are found to have a PFO?

10%

50%

25%

15%

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Explanation

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52. Pulmonary hypoplasia is associated with what congenital anomaly?

Persistant pulmonary hypertension

Congenital diaphragmatic hernia

Omphalocele

Pyloric Stenosis

Pulmonary hypoplasia is a condition characterized by underdevelopment of the lungs. It is commonly associated with congenital diaphragmatic hernia, which is a defect in the diaphragm that allows abdominal organs to move into the chest cavity. This displacement of organs can compress the developing lungs, leading to pulmonary hypoplasia. Persistent pulmonary hypertension, omphalocele, and pyloric stenosis are not typically associated with pulmonary hypoplasia.

Explanation

Pulmonary hypoplasia is a condition characterized by underdevelopment of the lungs. It is commonly associated with congenital diaphragmatic hernia, which is a defect in the diaphragm that allows abdominal organs to move into the chest cavity. This displacement of organs can compress the developing lungs, leading to pulmonary hypoplasia. Persistent pulmonary hypertension, omphalocele, and pyloric stenosis are not typically associated with pulmonary hypoplasia.

53. Pyloric Stenosis is commonly associated with what fluid and electrolyte abnormalities?

Hypovolemia and Metabolic Acidosis

Hypernatremia and Respiratory Acidosis

Hyperkalemia and Respiratory Alkalosis

Hypochloremia and Metabolic Alkalosis

Pyloric stenosis is a condition characterized by the narrowing of the pylorus, the opening between the stomach and the small intestine. This narrowing can lead to obstruction and vomiting. The excessive vomiting can cause a loss of stomach acid, leading to hypochloremia (low chloride levels) and metabolic alkalosis (increased pH in the blood). Hypochloremia occurs because chloride is lost along with the excessive vomiting, while metabolic alkalosis occurs due to the loss of stomach acid. Therefore, hypochloremia and metabolic alkalosis are commonly associated with pyloric stenosis.

Explanation

Pyloric stenosis is a condition characterized by the narrowing of the pylorus, the opening between the stomach and the small intestine. This narrowing can lead to obstruction and vomiting. The excessive vomiting can cause a loss of stomach acid, leading to hypochloremia (low chloride levels) and metabolic alkalosis (increased pH in the blood). Hypochloremia occurs because chloride is lost along with the excessive vomiting, while metabolic alkalosis occurs due to the loss of stomach acid. Therefore, hypochloremia and metabolic alkalosis are commonly associated with pyloric stenosis.

54. What is an appropriate ABG for an infant that is one hour old?

PO2 50 PCO2 48 pH 7.2

PO2 70 PCO2 35 pH 7.35

PO2 85 PCO2 25 pH 7.5

PO2 60 PCO2 50 pH 7.4

The appropriate ABG for an infant that is one hour old would have a slightly higher PO2 level compared to the other options, as newborns typically have higher oxygen levels immediately after birth. The PCO2 level should be within a normal range, and the pH should be slightly alkaline but still within a normal range. The given answer of PO2 70, PCO2 35, and pH 7.35 meets these criteria and is therefore the most appropriate ABG for a one-hour-old infant.

Explanation

The appropriate ABG for an infant that is one hour old would have a slightly higher PO2 level compared to the other options, as newborns typically have higher oxygen levels immediately after birth. The PCO2 level should be within a normal range, and the pH should be slightly alkaline but still within a normal range. The given answer of PO2 70, PCO2 35, and pH 7.35 meets these criteria and is therefore the most appropriate ABG for a one-hour-old infant.

55. Which of the following is not true regarding anatomic differences between neonates and adults?

Anterior and Cephalad Larynx

Long Epiglottis

Narrow Nasal Passages

Decreased Right Ventricular Compliance

Neonates have a higher right ventricular compliance compared to adults. This means that the right ventricle in neonates is more elastic and can expand more easily to accommodate blood flow. In contrast, adults have a lower right ventricular compliance, indicating that their right ventricle is less elastic and has a reduced ability to stretch. Therefore, the statement "Decreased Right Ventricular Compliance" is not true regarding the anatomic differences between neonates and adults.

Explanation

Neonates have a higher right ventricular compliance compared to adults. This means that the right ventricle in neonates is more elastic and can expand more easily to accommodate blood flow. In contrast, adults have a lower right ventricular compliance, indicating that their right ventricle is less elastic and has a reduced ability to stretch. Therefore, the statement "Decreased Right Ventricular Compliance" is not true regarding the anatomic differences between neonates and adults.

56. Which form of TEF is most common?

A

B

C

D

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Explanation

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57. Which of the following is not true about anesthetic considerations for a child with a menigomyelocele?

No muscle relaxants should be used during surgery.

No nitrous oxide should be used during surgery.

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Explanation

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58. Which of the following physiological changes occurs in neonates?

Increase Vd, Decrease ECF; therefore require higher loading dose

Decrease LV compliance; therefore SV dependent

Under developed NMJ with lower pseudocholinterase activity

Developed sympathetic nervous system only without full baroreceptor functionality

Neonates have underdeveloped neuromuscular junctions (NMJ) with lower pseudocholinesterase activity. This means that their NMJs are not fully matured, and they have lower levels of the enzyme pseudocholinesterase, which is responsible for breaking down acetylcholine. Acetylcholine is a neurotransmitter that plays a crucial role in muscle contraction. Therefore, neonates may have slower muscle response and require special considerations when administering medications that affect the neuromuscular system.

Explanation

Neonates have underdeveloped neuromuscular junctions (NMJ) with lower pseudocholinesterase activity. This means that their NMJs are not fully matured, and they have lower levels of the enzyme pseudocholinesterase, which is responsible for breaking down acetylcholine. Acetylcholine is a neurotransmitter that plays a crucial role in muscle contraction. Therefore, neonates may have slower muscle response and require special considerations when administering medications that affect the neuromuscular system.

59. Is your MAC higher or lower in a neonate as compared to a 6 yr old child?

Higher

Lower

Roughly Equal

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Explanation

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60. One of the first signs of hypovolemia in a neonate is tachycardia.

True

False

Tachycardia refers to an abnormally fast heart rate, which is not typically seen as one of the first signs of hypovolemia in a neonate. Instead, common signs of hypovolemia in neonates include poor perfusion, decreased urine output, and lethargy. Therefore, the correct answer is False.

Explanation

Tachycardia refers to an abnormally fast heart rate, which is not typically seen as one of the first signs of hypovolemia in a neonate. Instead, common signs of hypovolemia in neonates include poor perfusion, decreased urine output, and lethargy. Therefore, the correct answer is False.

61. What is the total body water content of a premature baby?

90%

70%

80%

60%

Premature babies have a higher water content compared to full-term babies due to their underdeveloped organs and higher surface area to body weight ratio. This is because water is lost through the skin more easily in premature babies. Therefore, the total body water content of a premature baby is 80%.

Explanation

Premature babies have a higher water content compared to full-term babies due to their underdeveloped organs and higher surface area to body weight ratio. This is because water is lost through the skin more easily in premature babies. Therefore, the total body water content of a premature baby is 80%.

62. Why is an awake intubation generally not recommended for premature neonates?

Can lead the reopening of the Forman Ovale

Due to hyperactive vagal activity it will cause the premature infant to become bradycardic

Due to size of the airway we are more likely to cause severe damage to the esoaphagus and vocal cords.

May lead to HTN and rupture of intracerebral vessels.

An awake intubation is generally not recommended for premature neonates because it may lead to hypertension (HTN) and rupture of intracerebral vessels. Premature neonates have fragile blood vessels and their cerebral vasculature is not fully developed, making them more susceptible to complications such as HTN and vessel rupture. Therefore, it is safer to avoid awake intubation in this population to minimize the risk of these potentially serious complications.

Explanation

An awake intubation is generally not recommended for premature neonates because it may lead to hypertension (HTN) and rupture of intracerebral vessels. Premature neonates have fragile blood vessels and their cerebral vasculature is not fully developed, making them more susceptible to complications such as HTN and vessel rupture. Therefore, it is safer to avoid awake intubation in this population to minimize the risk of these potentially serious complications.

63. You are the SRNA for a 3 week old baby today. In order to decrease hypothermia, which of the following actions would be appropriate?

Keep the OR at 20 degrees celcius

Place a cloth blanket under the infant during the procedure

Use a fluid warmer to deliver IV fluids

All the above

Using a fluid warmer to deliver IV fluids is appropriate in order to decrease hypothermia in a 3 week old baby. Infants are more susceptible to hypothermia due to their limited ability to regulate body temperature. By using a fluid warmer, the IV fluids can be warmed to a temperature that is closer to the baby's body temperature, preventing further heat loss. This helps to maintain the baby's body temperature and reduce the risk of hypothermia. Keeping the operating room at 20 degrees Celsius and placing a cloth blanket under the infant may also help in maintaining the baby's body temperature, but using a fluid warmer specifically addresses the issue of delivering IV fluids at an appropriate temperature.

Explanation

Using a fluid warmer to deliver IV fluids is appropriate in order to decrease hypothermia in a 3 week old baby. Infants are more susceptible to hypothermia due to their limited ability to regulate body temperature. By using a fluid warmer, the IV fluids can be warmed to a temperature that is closer to the baby's body temperature, preventing further heat loss. This helps to maintain the baby's body temperature and reduce the risk of hypothermia. Keeping the operating room at 20 degrees Celsius and placing a cloth blanket under the infant may also help in maintaining the baby's body temperature, but using a fluid warmer specifically addresses the issue of delivering IV fluids at an appropriate temperature.

64. Which of the following surgical procedures is not commonly performed in the first week of life?

TE Fistula repair

Shunt procedure for hydrocephalus

Intestinal Obstruction Repair

Omphalocele repair

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Explanation

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65. Due to shunting, the fetal pulmonary circulation receives _____ of cardiac output.

20-25%

5-10%

30-40%

80-85%

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Explanation

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66. Which of the following is an anatomical difference that is present in neonates?

Omega shaped tongue

Long Epiglottis

Anterior esophagus and pharynx

Long submental distance

Neonates have a long epiglottis, which is an anatomical difference present in newborns. The epiglottis is a flap of cartilage located at the base of the tongue that prevents food and liquid from entering the trachea during swallowing. In neonates, the epiglottis is longer compared to adults, which helps protect the airway and ensures that food and liquid are directed towards the esophagus. This anatomical difference gradually changes as the neonate grows and develops into an adult.

Explanation

Neonates have a long epiglottis, which is an anatomical difference present in newborns. The epiglottis is a flap of cartilage located at the base of the tongue that prevents food and liquid from entering the trachea during swallowing. In neonates, the epiglottis is longer compared to adults, which helps protect the airway and ensures that food and liquid are directed towards the esophagus. This anatomical difference gradually changes as the neonate grows and develops into an adult.

67. Which drug is considered the muscle relaxant drug of choice for a normal, healthy neonate undergoing a minor cosmetic procedure to separate webbed toes. The child weighs 8 kg.

Sux 32 mg IM

Rocuronium 8mg IV

Pavulon 0.8 mg IV

Cisatracurium 4mg IV

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Explanation

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68. Which of the following is not true regarding anesthetic considerations for children with TEF?

An NG tube should be inserted to decompress the stomach and decrease risk of aspiration

The ETT should be placed between the fistula and the carina

Surgical retraction commonly causes a main stem bronchi to collapse, and the surgeon should redraw retractors.

Post-op ventilation is considered the norm as patients are still at risk for complications.

ppt slides 38 & 41, diagnosis can be made by the inablity to pass an NG tube... it can't get past the pouch.

A gastrostomy tube MAY be inserted but not an NG tube.

Explanation

ppt slides 38 & 41, diagnosis can be made by the inablity to pass an NG tube... it can't get past the pouch.

A gastrostomy tube MAY be inserted but not an NG tube.

69. A neonate born to a diabetic mother is having surgery today and mom tells you that she was afraid of the baby becoming hypoglycemic and that she gave the baby some a couple sips of formula 2 hours ago. What anesthetic plan will you employ?

General or Regional

Awake intubation

RSI

Either b or c

The correct answer is "Either b or c". When a neonate is born to a diabetic mother, they are at risk of developing hypoglycemia due to high insulin levels. Giving the baby some sips of formula before surgery helps maintain blood sugar levels. Anesthesia can further lower blood sugar levels, so an awake intubation or rapid sequence induction (RSI) may be employed to minimize the risk of hypoglycemia. Both options ensure the baby is breathing adequately and can receive glucose if needed during the procedure.

Explanation

The correct answer is "Either b or c". When a neonate is born to a diabetic mother, they are at risk of developing hypoglycemia due to high insulin levels. Giving the baby some sips of formula before surgery helps maintain blood sugar levels. Anesthesia can further lower blood sugar levels, so an awake intubation or rapid sequence induction (RSI) may be employed to minimize the risk of hypoglycemia. Both options ensure the baby is breathing adequately and can receive glucose if needed during the procedure.

70. Retinopathy of Prematurity:

Is a Fibrovascular proliferation over the retina causing permanent blindless

Is due to vasoconstricting effects of O2

Is related to hyperoxygenation

Is prevented by underoxygenating the neonate

Retinopathy of Prematurity is related to hyperoxygenation. This means that an excessive supply of oxygen to the premature infant can lead to the development of retinopathy. This condition occurs when the blood vessels in the retina grow abnormally, causing damage and potentially leading to permanent blindness. Hyperoxygenation, or an excess of oxygen, can cause vasoconstriction and disrupt the normal development of blood vessels in the retina, contributing to the development of retinopathy of prematurity.

Explanation

Retinopathy of Prematurity is related to hyperoxygenation. This means that an excessive supply of oxygen to the premature infant can lead to the development of retinopathy. This condition occurs when the blood vessels in the retina grow abnormally, causing damage and potentially leading to permanent blindness. Hyperoxygenation, or an excess of oxygen, can cause vasoconstriction and disrupt the normal development of blood vessels in the retina, contributing to the development of retinopathy of prematurity.

71. Reversal of agents should ALWAYS be given to neonates due to their tendency toward post-op apnea.

True

False

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Explanation

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72. You are the SRNA for a CVP placement on a 3 week old infant. The surgeon is taking the subclavian approach during this procedure. During the procedure you first observe sudden hypotension, yet maintain a normal O2 sat. You immediately inform the surgeon you suspect…

Pneumothorax

Patent PDA

Hemothorax

All the above!! It is an unholy %^*& storm!!

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Explanation

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73. An infant with an upper respiratory infection has a higher probability of….

Vomitting

Malnutrition

Diarrhea

SIDS

An infant with an upper respiratory infection has a higher probability of vomiting because the infection can cause mucus to build up in the throat and nasal passages, leading to increased swallowing of mucus. This can irritate the stomach and trigger vomiting as a protective mechanism to remove the excess mucus. Additionally, the infection can cause inflammation in the respiratory system, leading to coughing fits that can also induce vomiting.

Explanation

An infant with an upper respiratory infection has a higher probability of vomiting because the infection can cause mucus to build up in the throat and nasal passages, leading to increased swallowing of mucus. This can irritate the stomach and trigger vomiting as a protective mechanism to remove the excess mucus. Additionally, the infection can cause inflammation in the respiratory system, leading to coughing fits that can also induce vomiting.

74. At what point will there be functional closure of the Ductus Arteriosus?

As soon as the infant is born and SVR increases

At 2-4 weeks of age

At 1-2 months of age

At 1-8 days of age

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Explanation

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75. Which of the following conditions recommends use of a caudal block?

Meningomyelocele

CVP placement

Pyloric Stenosis

Necrotizing Enterocolitis

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Explanation

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76. For baby born today at 32 weeks gestation, hypoglycemia would be any glucose reading that is below what?

45

35

25

60

Hypoglycemia refers to low blood sugar levels. For a baby born at 32 weeks gestation, a glucose reading below 25 would be considered hypoglycemia.

Explanation

Hypoglycemia refers to low blood sugar levels. For a baby born at 32 weeks gestation, a glucose reading below 25 would be considered hypoglycemia.

77. Which other anomalies are commonly associated with Omphalocele? (check all that apply)

Necrotizing Enterocolitis

Trisomy 21

CDH

TEF

Cardiac Malformations

Omphalocele is a birth defect where the infant's abdominal organs protrude through the belly button. Trisomy 21, also known as Down syndrome, is commonly associated with Omphalocele. CDH, which stands for Congenital Diaphragmatic Hernia, is another anomaly commonly associated with Omphalocele. CDH occurs when there is a hole in the diaphragm, allowing abdominal organs to move into the chest cavity. Cardiac malformations, or heart defects, are also commonly seen in infants with Omphalocele. Therefore, the correct answers for the question are Trisomy 21, CDH, and Cardiac Malformations.

Explanation

Omphalocele is a birth defect where the infant's abdominal organs protrude through the belly button. Trisomy 21, also known as Down syndrome, is commonly associated with Omphalocele. CDH, which stands for Congenital Diaphragmatic Hernia, is another anomaly commonly associated with Omphalocele. CDH occurs when there is a hole in the diaphragm, allowing abdominal organs to move into the chest cavity. Cardiac malformations, or heart defects, are also commonly seen in infants with Omphalocele. Therefore, the correct answers for the question are Trisomy 21, CDH, and Cardiac Malformations.

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78. How does the position of the larynx differ in full term Neonates, when compared to that of adults? (Check all that apply)

More Anterior and Cephalad

Located at level of C4

Located at level of C3

Floppy epiglottis

From in class review, larynx at C3 in preemies and C4 in full term neonates, C5 in adults

Explanation

From in class review, larynx at C3 in preemies and C4 in full term neonates, C5 in adults

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