Principles of Pediatric Anesthesia and Care! Trivia Quiz

1. A healthy pediatric patient with no pre-existing congenital anomalies does not need any preop lab tests if the procedure is expected to have minimal blood loss.

True

False

In a healthy pediatric patient with no pre-existing congenital anomalies, preoperative lab tests are not necessary if the procedure is expected to have minimal blood loss. This is because the risk of complications or abnormalities is low in such cases, and the benefits of conducting lab tests may not outweigh the potential harm or discomfort to the patient. However, it is important to note that this answer assumes the patient is otherwise healthy and has no underlying medical conditions that may warrant further evaluation.

Explanation

In a healthy pediatric patient with no pre-existing congenital anomalies, preoperative lab tests are not necessary if the procedure is expected to have minimal blood loss. This is because the risk of complications or abnormalities is low in such cases, and the benefits of conducting lab tests may not outweigh the potential harm or discomfort to the patient. However, it is important to note that this answer assumes the patient is otherwise healthy and has no underlying medical conditions that may warrant further evaluation.

2. Halothane causes more myocardial depression than any of the other inhlational agents and increases risk of arrhythmia associated with epinephrine by 4 times.

True

False

Halothane is an inhalational anesthetic that is known to cause more depression of the heart muscle compared to other inhalational agents. This means that it can negatively affect the functioning of the heart. Additionally, halothane increases the risk of arrhythmias, or abnormal heart rhythms, when used in combination with epinephrine. The combination of halothane and epinephrine increases the risk of arrhythmias by four times compared to using epinephrine alone. Therefore, the statement that halothane causes more myocardial depression than other inhalational agents and increases the risk of arrhythmia associated with epinephrine is true.

Explanation

Halothane is an inhalational anesthetic that is known to cause more depression of the heart muscle compared to other inhalational agents. This means that it can negatively affect the functioning of the heart. Additionally, halothane increases the risk of arrhythmias, or abnormal heart rhythms, when used in combination with epinephrine. The combination of halothane and epinephrine increases the risk of arrhythmias by four times compared to using epinephrine alone. Therefore, the statement that halothane causes more myocardial depression than other inhalational agents and increases the risk of arrhythmia associated with epinephrine is true.

3. The majority of pediatric cardiac arrests occur when?

Induction

Maintenance

Emergence

Rates are equal during all 3 phases

Pediatric cardiac arrests mainly occur during the induction phase. This is the initial stage of anesthesia where the patient is being prepared for surgery and anesthesia is administered. During this phase, there are various factors that can contribute to cardiac arrest, such as the administration of medications, airway manipulation, and the stress response to surgery. The maintenance and emergence phases are relatively stable and less likely to result in cardiac arrest. Therefore, the majority of pediatric cardiac arrests occur during the induction phase.

Explanation

Pediatric cardiac arrests mainly occur during the induction phase. This is the initial stage of anesthesia where the patient is being prepared for surgery and anesthesia is administered. During this phase, there are various factors that can contribute to cardiac arrest, such as the administration of medications, airway manipulation, and the stress response to surgery. The maintenance and emergence phases are relatively stable and less likely to result in cardiac arrest. Therefore, the majority of pediatric cardiac arrests occur during the induction phase.

4. Which of the following disease states is associated with an increased risk of Malignant hyperthermia?

Cystic Fibrosis

Muscular Dystrophy

Sickle Cell Anemia

Latex Allergy

Muscular Dystrophy is associated with an increased risk of Malignant Hyperthermia. Muscular Dystrophy is a group of genetic disorders that cause progressive muscle weakness and degeneration. Malignant Hyperthermia is a potentially life-threatening reaction to certain medications used during general anesthesia, characterized by a rapid increase in body temperature and muscle rigidity. While individuals with any disease state may be at risk for Malignant Hyperthermia, Muscular Dystrophy patients are particularly susceptible due to their already compromised muscle function. Therefore, Muscular Dystrophy is the correct answer.

Explanation

Muscular Dystrophy is associated with an increased risk of Malignant Hyperthermia. Muscular Dystrophy is a group of genetic disorders that cause progressive muscle weakness and degeneration. Malignant Hyperthermia is a potentially life-threatening reaction to certain medications used during general anesthesia, characterized by a rapid increase in body temperature and muscle rigidity. While individuals with any disease state may be at risk for Malignant Hyperthermia, Muscular Dystrophy patients are particularly susceptible due to their already compromised muscle function. Therefore, Muscular Dystrophy is the correct answer.

5. The best way to administer an IV fluid bolus to an infant is through use of a pressure bag to administer fluid quickly.

True

False

Administering an IV fluid bolus to an infant through the use of a pressure bag is not the best way to do so. Infants have delicate veins that can easily be damaged by the high pressure from a pressure bag. The best way to administer an IV fluid bolus to an infant is by using a syringe pump or a gravity drip system, which allows for a slower and more controlled infusion of fluids.

Explanation

Administering an IV fluid bolus to an infant through the use of a pressure bag is not the best way to do so. Infants have delicate veins that can easily be damaged by the high pressure from a pressure bag. The best way to administer an IV fluid bolus to an infant is by using a syringe pump or a gravity drip system, which allows for a slower and more controlled infusion of fluids.

6. Which of the following properly describes the most common preceding events to a pediatric cardiac arrest?

Tachypnea, Tachycardia, Tachyphylaxis

Hypotension, Tachycardia, Muscle rigidity

Hypoxia, tachypnea, wheezing, tachycardia

Hypotension, Bradycardia, Low O2 sat

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Explanation

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7. Which of the following would not be an appropriate way to reduce intra-op heat loss in the pediatric patient?

Use of an overhead radiant heating unit

Use of a water mattress, with circulating warm water

Use cloths dipped in 40o C water and place onto child’s head during procedure

Use a Bair hugger placed on the child’s body

Using cloths dipped in 40o C water and placing them onto a child's head during a procedure would not be an appropriate way to reduce intra-op heat loss in a pediatric patient. This method could potentially cause hypothermia and increase the risk of complications. The other options mentioned, such as using an overhead radiant heating unit, a water mattress with circulating warm water, or a Bair hugger placed on the child's body, are all effective ways to reduce heat loss and maintain the patient's body temperature during surgery.

Explanation

Using cloths dipped in 40o C water and placing them onto a child's head during a procedure would not be an appropriate way to reduce intra-op heat loss in a pediatric patient. This method could potentially cause hypothermia and increase the risk of complications. The other options mentioned, such as using an overhead radiant heating unit, a water mattress with circulating warm water, or a Bair hugger placed on the child's body, are all effective ways to reduce heat loss and maintain the patient's body temperature during surgery.

8. When doing a pedi drug set up, it is recommended to draw up your drugs in ‘unit dose’ syringes.

True

False

Drawing up drugs in 'unit dose' syringes during a pedi drug set up is recommended because it ensures accurate dosing and reduces the risk of medication errors. Unit dose syringes contain a pre-measured amount of medication, which eliminates the need for manual calculations and reduces the chances of administering the wrong dose. This practice is particularly important when dealing with pediatric patients who require precise and individualized medication doses based on their weight and age. By using unit dose syringes, healthcare professionals can enhance patient safety and minimize the potential for dosing errors.

Explanation

Drawing up drugs in 'unit dose' syringes during a pedi drug set up is recommended because it ensures accurate dosing and reduces the risk of medication errors. Unit dose syringes contain a pre-measured amount of medication, which eliminates the need for manual calculations and reduces the chances of administering the wrong dose. This practice is particularly important when dealing with pediatric patients who require precise and individualized medication doses based on their weight and age. By using unit dose syringes, healthcare professionals can enhance patient safety and minimize the potential for dosing errors.

9. What side effect is commonly associated with fentanyl that we are concerned about during anesthesia?

Myocardial depression

Chest Wall Rigidity

Renal Toxicity

Cytochrome P450 induction

During anesthesia, fentanyl is commonly associated with a side effect called chest wall rigidity. This refers to the tightening or stiffness of the muscles in the chest wall, which can make it difficult for the patient to breathe. This side effect is concerning because it can lead to respiratory distress or even respiratory arrest if not promptly recognized and managed by the anesthesia team. Therefore, it is important for anesthesia providers to be aware of this potential side effect and be prepared to intervene if necessary.

Explanation

During anesthesia, fentanyl is commonly associated with a side effect called chest wall rigidity. This refers to the tightening or stiffness of the muscles in the chest wall, which can make it difficult for the patient to breathe. This side effect is concerning because it can lead to respiratory distress or even respiratory arrest if not promptly recognized and managed by the anesthesia team. Therefore, it is important for anesthesia providers to be aware of this potential side effect and be prepared to intervene if necessary.

10. COMIC RELIEF: 911 Fail

A warthog? Where the heck would you run across those

Ha ha ha!! Spelling is a wonderful thing

Sooo.... he picked up his injured wife and dragged a couple streets over?

All the above

The given answer "All the above" is correct because all of the statements mentioned in the question are examples of comic relief. The first statement mentions a warthog, which is unexpected and humorous. The second statement highlights a spelling mistake, which adds humor. The third statement presents a ridiculous scenario of someone dragging their injured wife a couple of streets over, which is also humorous. Therefore, all of the statements contribute to comic relief in the given context.

Explanation

The given answer "All the above" is correct because all of the statements mentioned in the question are examples of comic relief. The first statement mentions a warthog, which is unexpected and humorous. The second statement highlights a spelling mistake, which adds humor. The third statement presents a ridiculous scenario of someone dragging their injured wife a couple of streets over, which is also humorous. Therefore, all of the statements contribute to comic relief in the given context.

11. You are assessing 4 yr old Madelyn prior to her going in for enucleation of her left eye. When you see her in pre-op she appears to be a little under the weather. She is sneezing and has yellow mucus coming her nose. You listen to her lungs and hear a slight wheeze while her mom says she began to run a temperature late last night. She appears fine and is watching and giggling at a children’s show on a portable DVD player her mother brought to calm her. What do you do for this patient?

Give a dose of Tylenol and a respiratory treatement pre-op before continuing with procedure.

It is only an eye surgery, not thoracic so she will be fine.

Talk to the surgeon regarding possibly cancelling the surgery

That depends entirely upon whether Madelyn was a premature baby or has any other coexisting diseases.

Based on the given information, the patient, Madelyn, is showing symptoms of being sick, such as sneezing, yellow mucus, and a slight wheeze. Additionally, her mother mentions that she had a fever the previous night. These symptoms indicate that Madelyn may have an underlying respiratory infection, which can increase the risk of complications during surgery. Therefore, the appropriate action would be to talk to the surgeon about the possibility of cancelling the surgery to ensure Madelyn's safety and well-being.

Explanation

Based on the given information, the patient, Madelyn, is showing symptoms of being sick, such as sneezing, yellow mucus, and a slight wheeze. Additionally, her mother mentions that she had a fever the previous night. These symptoms indicate that Madelyn may have an underlying respiratory infection, which can increase the risk of complications during surgery. Therefore, the appropriate action would be to talk to the surgeon about the possibility of cancelling the surgery to ensure Madelyn's safety and well-being.

12. For a normal inhalational induction your N2O should be at ______ and your O2 should be at ________ to start out with.

70%, 30%

50%, 50%

40%, 60%

0 %, 100 %

For a normal inhalational induction, the correct ratio of N2O to O2 should be 70% N2O and 30% O2. This is because N2O acts as a potent analgesic and anxiolytic, helping to reduce pain and anxiety during the induction process. On the other hand, O2 is necessary to maintain adequate oxygenation and prevent hypoxia. Therefore, a higher concentration of N2O is required compared to O2 for a successful inhalational induction.

Explanation

For a normal inhalational induction, the correct ratio of N2O to O2 should be 70% N2O and 30% O2. This is because N2O acts as a potent analgesic and anxiolytic, helping to reduce pain and anxiety during the induction process. On the other hand, O2 is necessary to maintain adequate oxygenation and prevent hypoxia. Therefore, a higher concentration of N2O is required compared to O2 for a successful inhalational induction.

13. Which of the following will not trigger Malignant Hyperthermia?

Desflurane

Succinylcholine

Isoflurane

Vecuronium

Vecuronium is a non-depolarizing neuromuscular blocking agent that does not trigger Malignant Hyperthermia (MH). MH is a potentially fatal reaction to certain medications used during general anesthesia, characterized by a rapid increase in body temperature and muscle rigidity. The other options listed, Desflurane, Succinylcholine, and Isoflurane, are all known triggers of MH.

Explanation

Vecuronium is a non-depolarizing neuromuscular blocking agent that does not trigger Malignant Hyperthermia (MH). MH is a potentially fatal reaction to certain medications used during general anesthesia, characterized by a rapid increase in body temperature and muscle rigidity. The other options listed, Desflurane, Succinylcholine, and Isoflurane, are all known triggers of MH.

14. What is the most important componenent of the physical exam for down syndrome patients?

Airway examination and neck stability

Assessing degree of mental retardation

Obtaining history from parents regarding any heart conditions

Assessing for reflux and sings of URI

The most important component of the physical exam for Down syndrome patients is airway examination and neck stability. This is because individuals with Down syndrome often have anatomical abnormalities that can affect their airway and neck stability, such as a small or blocked airway, weak neck muscles, or a high risk of atlantoaxial instability. Therefore, assessing the airway and neck stability is crucial in order to ensure the safety and well-being of these patients.

Explanation

The most important component of the physical exam for Down syndrome patients is airway examination and neck stability. This is because individuals with Down syndrome often have anatomical abnormalities that can affect their airway and neck stability, such as a small or blocked airway, weak neck muscles, or a high risk of atlantoaxial instability. Therefore, assessing the airway and neck stability is crucial in order to ensure the safety and well-being of these patients.

15. Which of the following is not a sign of latex allergy?

Bradycardia and arrhythmias

Laryngeal Edema

Pruritis

Bronchospasm

Bradycardia and arrhythmias are not typically associated with latex allergy. Latex allergy is an immune response to latex proteins, which can cause symptoms such as skin itching (pruritis), swelling of the larynx (laryngeal edema), and constriction of the airways (bronchospasm). However, bradycardia and arrhythmias are not commonly observed as symptoms of latex allergy.

Explanation

Bradycardia and arrhythmias are not typically associated with latex allergy. Latex allergy is an immune response to latex proteins, which can cause symptoms such as skin itching (pruritis), swelling of the larynx (laryngeal edema), and constriction of the airways (bronchospasm). However, bradycardia and arrhythmias are not commonly observed as symptoms of latex allergy.

16. Which of the following is the most common reason for cancellation of pediatric procedures?

Asthma Exacerbation

Upper Respiratory Infections

Non-compliance with NPO requirements

Instability due to illness

Upper respiratory infections are the most common reason for cancellation of pediatric procedures. This is because these infections can cause symptoms such as coughing, sneezing, and congestion, which can make it difficult for the child to breathe and cooperate during the procedure. Additionally, there is an increased risk of complications and infection spread during the procedure if the child has an active respiratory infection. Therefore, it is common practice to cancel pediatric procedures when a child has an upper respiratory infection to ensure their safety and minimize the risk of complications.

Explanation

Upper respiratory infections are the most common reason for cancellation of pediatric procedures. This is because these infections can cause symptoms such as coughing, sneezing, and congestion, which can make it difficult for the child to breathe and cooperate during the procedure. Additionally, there is an increased risk of complications and infection spread during the procedure if the child has an active respiratory infection. Therefore, it is common practice to cancel pediatric procedures when a child has an upper respiratory infection to ensure their safety and minimize the risk of complications.

17. Why is it not safe to use an adult semi-closed system on an infant who weighs less than 10 kg?

Too much pressure, risk of barotrauma

Too large, circuit will not fit the pedi ETT properly

Too much dead space, and increased work of breathing

Absorber acts to remove almost all gases due to small tidal volume and pt will be undermedicated

Using an adult semi-closed system on an infant who weighs less than 10 kg is not safe because it would result in too much dead space and increased work of breathing. Dead space refers to the portion of the respiratory system that does not participate in gas exchange, and in this case, the system would be too large for the infant, leading to an inefficient exchange of gases. This would require the infant to exert more effort to breathe, potentially causing respiratory distress.

Explanation

Using an adult semi-closed system on an infant who weighs less than 10 kg is not safe because it would result in too much dead space and increased work of breathing. Dead space refers to the portion of the respiratory system that does not participate in gas exchange, and in this case, the system would be too large for the infant, leading to an inefficient exchange of gases. This would require the infant to exert more effort to breathe, potentially causing respiratory distress.

18. A 7 yr old child must not eat solid food for how many hours prior to procedure?

6 hours

8 hours

3 hours

4 hours

Prior to a medical procedure, it is generally recommended that a 7-year-old child refrains from consuming solid food for a period of 8 hours. This is important to ensure that the child's stomach is empty, reducing the risk of complications during the procedure such as aspiration or vomiting. By abstaining from solid food for 8 hours, the child's digestive system has sufficient time to process and empty any previously consumed food, resulting in a safer and more successful procedure.

Explanation

Prior to a medical procedure, it is generally recommended that a 7-year-old child refrains from consuming solid food for a period of 8 hours. This is important to ensure that the child's stomach is empty, reducing the risk of complications during the procedure such as aspiration or vomiting. By abstaining from solid food for 8 hours, the child's digestive system has sufficient time to process and empty any previously consumed food, resulting in a safer and more successful procedure.

19. Which of the following is not part of stage 2 PACU’s standard monitoring?

Heart Rate

Fluid Balance

O2 Sat

Blood pressure

Stage 2 PACU's standard monitoring includes heart rate, O2 sat, and blood pressure. Fluid balance is not part of stage 2 PACU's standard monitoring. This means that monitoring the patient's fluid balance, such as intake and output, is not a standard practice in this stage of post-anesthesia care.

Explanation

Stage 2 PACU's standard monitoring includes heart rate, O2 sat, and blood pressure. Fluid balance is not part of stage 2 PACU's standard monitoring. This means that monitoring the patient's fluid balance, such as intake and output, is not a standard practice in this stage of post-anesthesia care.

20. When placing a nerve stimulator on a child with cerebral palsy, which of the following is true?

Placing stimulator on spastic extremity will cause falsely low readings and may lead to underdosing of NMB

Placing stimulator on a spastic extremity may cause falsely high readings and may lead to overdosing of NMB’s

Children with CP do not need nerve stimulators due to their condition.

Placing a nerve stimulator on a spastic extremity in a child with cerebral palsy may cause falsely high readings and may lead to overdosing of neuromuscular blockers (NMBs). This is because the spastic extremity may already have increased muscle tone and resistance, which can result in an exaggerated response to the NMB. Therefore, placing the stimulator on a spastic extremity may not accurately reflect the child's true response to NMBs and may lead to administering higher doses than necessary, potentially causing adverse effects.

Explanation

Placing a nerve stimulator on a spastic extremity in a child with cerebral palsy may cause falsely high readings and may lead to overdosing of neuromuscular blockers (NMBs). This is because the spastic extremity may already have increased muscle tone and resistance, which can result in an exaggerated response to the NMB. Therefore, placing the stimulator on a spastic extremity may not accurately reflect the child's true response to NMBs and may lead to administering higher doses than necessary, potentially causing adverse effects.

21. What IM emergency drugs should you always have available for pediatric inhalation induction (assuming child has no IV access)? TWO ANSWERS

Sux 5 mg/kg

Ephedrine 750 mcg/kg

Lidocaine 1.5 mg/kg

Atropine 0.02 mg/kg

The correct answer is Sux 5 mg/kg and Atropine 0.02 mg/kg. These drugs are essential for pediatric inhalation induction when the child does not have IV access. Suxamethonium (Sux) is a neuromuscular blocking agent used to facilitate intubation. Atropine is a medication that increases heart rate and is used to counteract bradycardia, which can occur during induction. These drugs are crucial in ensuring a smooth and safe induction process for the pediatric patient.

Explanation

The correct answer is Sux 5 mg/kg and Atropine 0.02 mg/kg. These drugs are essential for pediatric inhalation induction when the child does not have IV access. Suxamethonium (Sux) is a neuromuscular blocking agent used to facilitate intubation. Atropine is a medication that increases heart rate and is used to counteract bradycardia, which can occur during induction. These drugs are crucial in ensuring a smooth and safe induction process for the pediatric patient.

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22. The preferred combination of narcotics and inhalational agents, commonly the “bread and butter” of many ped anesthetists is ______ & _________.

1-2 mcg/kg Fentanyl & O.5 MAC isoflurane

2-4 mcg/kg fentanyl & propfol gtt

0.25-0.5 mcg/kg Dilaudid and 0.3 MAC sevoflurane

1-2 mg/kg dialudid and .6 MAC desflurane

The preferred combination of narcotics and inhalational agents commonly used by pediatric anesthetists is 1-2 mcg/kg Fentanyl and O.5 MAC isoflurane. This combination provides effective pain relief and anesthesia during pediatric surgeries. Fentanyl is a potent opioid analgesic that helps manage pain, while isoflurane is an inhalational anesthetic that induces and maintains anesthesia. The dosage range specified ensures appropriate pain control and anesthesia without causing excessive sedation or respiratory depression in pediatric patients.

Explanation

The preferred combination of narcotics and inhalational agents commonly used by pediatric anesthetists is 1-2 mcg/kg Fentanyl and O.5 MAC isoflurane. This combination provides effective pain relief and anesthesia during pediatric surgeries. Fentanyl is a potent opioid analgesic that helps manage pain, while isoflurane is an inhalational anesthetic that induces and maintains anesthesia. The dosage range specified ensures appropriate pain control and anesthesia without causing excessive sedation or respiratory depression in pediatric patients.

23. Which of the following children would be at an increased risk Latex Allergy

Nika who is allergic to Egg yolk

Tyler, whose mom is a nurse

Charlie who has muscular dystrophy

Olivia who has spina bifida

Children with spina bifida are at an increased risk of developing latex allergy. This is because spina bifida is often associated with repeated exposure to latex during medical procedures and surgeries. Latex is commonly used in healthcare settings, such as hospitals, and individuals with spina bifida often require frequent medical interventions. Prolonged and repeated exposure to latex can sensitize the immune system, leading to the development of an allergic reaction to latex proteins. Therefore, Olivia, who has spina bifida, would be at an increased risk of latex allergy compared to the other children mentioned.

Explanation

Children with spina bifida are at an increased risk of developing latex allergy. This is because spina bifida is often associated with repeated exposure to latex during medical procedures and surgeries. Latex is commonly used in healthcare settings, such as hospitals, and individuals with spina bifida often require frequent medical interventions. Prolonged and repeated exposure to latex can sensitize the immune system, leading to the development of an allergic reaction to latex proteins. Therefore, Olivia, who has spina bifida, would be at an increased risk of latex allergy compared to the other children mentioned.

24. What would be an appropriate sized ETT for a 3 yr old child weighing 18 kg?

4.5

4

3.5

3

An appropriate sized ETT for a 3-year-old child weighing 18 kg would be 4.5. The size of the endotracheal tube (ETT) is determined based on the weight and age of the child. In this case, a 4.5 ETT would be suitable for a 3-year-old child weighing 18 kg.

Explanation

An appropriate sized ETT for a 3-year-old child weighing 18 kg would be 4.5. The size of the endotracheal tube (ETT) is determined based on the weight and age of the child. In this case, a 4.5 ETT would be suitable for a 3-year-old child weighing 18 kg.

25. How is the pediatric airway different from that of adults?

Airway has smaller tongue and very stiff epiglottis making visualization difficult

Airway is more superior and has a more acute angulation between plane of tongue and epiglottis

Narrowest portion of airway is the vocal cords, making passage of the ETT much more difficult

None of above

The pediatric airway is different from that of adults because it is more superior and has a more acute angulation between the plane of the tongue and the epiglottis. This anatomical difference can make visualization of the airway more challenging during procedures such as intubation.

Explanation

The pediatric airway is different from that of adults because it is more superior and has a more acute angulation between the plane of the tongue and the epiglottis. This anatomical difference can make visualization of the airway more challenging during procedures such as intubation.

26. Approximately what percentage of children with down syndrome will have associated cardiac anomalies?

5-15%

65-75%

40-60%

80-95%

Approximately 40-60% of children with Down syndrome will have associated cardiac anomalies. This means that a significant proportion of children with Down syndrome will have heart-related issues. These anomalies can range from mild to severe and may require medical intervention or surgery. It is important for healthcare professionals to be aware of this high prevalence and closely monitor the cardiac health of children with Down syndrome.

Explanation

Approximately 40-60% of children with Down syndrome will have associated cardiac anomalies. This means that a significant proportion of children with Down syndrome will have heart-related issues. These anomalies can range from mild to severe and may require medical intervention or surgery. It is important for healthcare professionals to be aware of this high prevalence and closely monitor the cardiac health of children with Down syndrome.

27. You are going to do a pre-op on a 6 yr old patient about to undergo a Left nephrectomy to remove a tumor.You walk into the room and find a very nervous little boy clutching a bear and hiding under the covers, the father also looks very upset and nervous. What should your approach be to do this pre-op?

Approach the parent and attempt to calm him first

Come back later when both are feeling a bit better

Approach the child, and attempt to calm him first.

Give the child some versed.

In this scenario, the best approach would be to first address the parent's concerns and attempt to calm them down. By doing so, it will create a more relaxed environment for both the child and the parent, which will ultimately help in calming the child as well. It is important to prioritize the emotional well-being of both the child and the parent before proceeding with the pre-op preparations.

Explanation

In this scenario, the best approach would be to first address the parent's concerns and attempt to calm them down. By doing so, it will create a more relaxed environment for both the child and the parent, which will ultimately help in calming the child as well. It is important to prioritize the emotional well-being of both the child and the parent before proceeding with the pre-op preparations.

28. What response will infants typically have to exogenously administered catecholamines such as ephedrine?

Exagerrated response and risk for subdural hemorrhage

Infants and kids respond in same manner as adults would

Blunted response due to lower catecholamine stores

More prone to allergic and anaphylactic responses

Infants typically have a blunted response to exogenously administered catecholamines such as ephedrine because they have lower catecholamine stores. Catecholamines are hormones that play a role in the body's response to stress and are involved in various physiological processes. In infants, the levels of catecholamines are lower compared to adults, which results in a diminished response to drugs that stimulate the release or mimic the actions of catecholamines. This blunted response can affect the effectiveness of the medication and may require different dosing strategies for infants compared to adults.

Explanation

Infants typically have a blunted response to exogenously administered catecholamines such as ephedrine because they have lower catecholamine stores. Catecholamines are hormones that play a role in the body's response to stress and are involved in various physiological processes. In infants, the levels of catecholamines are lower compared to adults, which results in a diminished response to drugs that stimulate the release or mimic the actions of catecholamines. This blunted response can affect the effectiveness of the medication and may require different dosing strategies for infants compared to adults.

29. Which of the following is not a risk factor associated with cardiac arrests in the pediatric patient?

Emergency Surgery

ASA 3-5

Congenital Airway Deformities

Children 1-4 yrs old

Children 1-4 years old are not a risk factor associated with cardiac arrests in pediatric patients. While emergency surgery, ASA 3-5 (American Society of Anesthesiologists physical status classification), and congenital airway deformities are all known risk factors, being in the age range of 1-4 years old does not increase the risk of cardiac arrests in pediatric patients.

Explanation

Children 1-4 years old are not a risk factor associated with cardiac arrests in pediatric patients. While emergency surgery, ASA 3-5 (American Society of Anesthesiologists physical status classification), and congenital airway deformities are all known risk factors, being in the age range of 1-4 years old does not increase the risk of cardiac arrests in pediatric patients.

30. During an inhalational induction, once your pediatric patient is tubed your first priority should be…

Inserting the precordial stethoscope

Applying nerve monitor to assess paralysis

Starting an IV

Turning up the sevo higher

Starting an IV is the first priority during an inhalational induction in a pediatric patient after intubation. This is because an IV provides access to administer medications, fluids, and emergency drugs if needed. It also allows for the administration of anesthesia and other necessary interventions during the procedure. Starting an IV early ensures that the patient has a secure and reliable route for medication administration and fluid management throughout the induction process.

Explanation

Starting an IV is the first priority during an inhalational induction in a pediatric patient after intubation. This is because an IV provides access to administer medications, fluids, and emergency drugs if needed. It also allows for the administration of anesthesia and other necessary interventions during the procedure. Starting an IV early ensures that the patient has a secure and reliable route for medication administration and fluid management throughout the induction process.

31. Inhalational induction should not be done on children with asthma due to increased risk of bronchospasm.

True

False

Inhalational induction should not be done on children with asthma due to the increased risk of bronchospasm. However, the given answer states "False," which implies that inhalational induction can be done on children with asthma. This contradicts the statement provided and is incorrect.

Explanation

Inhalational induction should not be done on children with asthma due to the increased risk of bronchospasm. However, the given answer states "False," which implies that inhalational induction can be done on children with asthma. This contradicts the statement provided and is incorrect.

32. At how much pressure should you observe an air leak in pediatric ETT’s?

No air leak should be observed

Air leak obersved at 5-10 cm H2O

Air leak observed at 15-20 cm H2O

Air leak observed at 25-30 cm H2O

An air leak should be observed at a pressure of 15-20 cm H2O in pediatric ETT's. This is because a small amount of air leak is necessary to ensure that the tube is properly sealed and to prevent excessive pressure buildup in the lungs. If there is no air leak, it may indicate that the tube is not properly sealed and could lead to complications such as inadequate ventilation or aspiration. On the other hand, if the air leak is too large (observed at higher pressures), it may indicate a loose or dislodged tube, which also requires immediate attention.

Explanation

An air leak should be observed at a pressure of 15-20 cm H2O in pediatric ETT's. This is because a small amount of air leak is necessary to ensure that the tube is properly sealed and to prevent excessive pressure buildup in the lungs. If there is no air leak, it may indicate that the tube is not properly sealed and could lead to complications such as inadequate ventilation or aspiration. On the other hand, if the air leak is too large (observed at higher pressures), it may indicate a loose or dislodged tube, which also requires immediate attention.

33. You are going to do a pre-op on 5 yr old Trevor who is going in today for a repair of an inguinal hernia. When you go to assess him pre-op you see he is sniffly. His mother says he has seasonal allergies and has a constant runny nose. You go to look at Trevor and indeed his little nose is red and he has clear mucus coming from his nose, but no fever or wheezes. He does not appear to be otherwise ill and in fact is playing with his stuffed dinosaur. Is it safe to proceed with the procedure?

Not enough information to decide at this time.

No, he is displaying signs of an upper respiratory infection.

Yeah, he’s fine. We can proceed!

Based on the given information, Trevor is only displaying symptoms of seasonal allergies such as a runny nose with clear mucus, but he does not have a fever or wheezes. He appears to be otherwise healthy and is even playing with his stuffed dinosaur. Therefore, it is safe to proceed with the procedure as his symptoms do not indicate an upper respiratory infection or any other serious illness.

Explanation

Based on the given information, Trevor is only displaying symptoms of seasonal allergies such as a runny nose with clear mucus, but he does not have a fever or wheezes. He appears to be otherwise healthy and is even playing with his stuffed dinosaur. Therefore, it is safe to proceed with the procedure as his symptoms do not indicate an upper respiratory infection or any other serious illness.

34. What is an appropriate hourly maintenance fluid rate for a child weighing 15 kg?

60 ml

50 ml

25 ml

15 ml

An appropriate hourly maintenance fluid rate for a child weighing 15 kg is 50 ml. This is because the maintenance fluid rate is typically calculated based on the child's weight, and a common formula used is 4-2-1. According to this formula, the first 10 kg of body weight requires 4 ml of fluid per kg per hour, the next 10 kg requires 2 ml per kg per hour, and any additional weight requires 1 ml per kg per hour. In this case, the child weighs 15 kg, so the calculation would be: (10 kg x 4 ml) + (5 kg x 2 ml) = 40 ml + 10 ml = 50 ml.

Explanation

An appropriate hourly maintenance fluid rate for a child weighing 15 kg is 50 ml. This is because the maintenance fluid rate is typically calculated based on the child's weight, and a common formula used is 4-2-1. According to this formula, the first 10 kg of body weight requires 4 ml of fluid per kg per hour, the next 10 kg requires 2 ml per kg per hour, and any additional weight requires 1 ml per kg per hour. In this case, the child weighs 15 kg, so the calculation would be: (10 kg x 4 ml) + (5 kg x 2 ml) = 40 ml + 10 ml = 50 ml.

35. Most pediatric arrests are due to ________ causes in children.

Cardiac

Respiratory

Congenital defects

Circulatory collapse

Most pediatric arrests are due to respiratory causes in children. This is because children have smaller airways compared to adults, making them more susceptible to respiratory issues such as asthma, bronchiolitis, and pneumonia. Additionally, children may not have fully developed respiratory muscles, making it harder for them to breathe during respiratory distress. Respiratory causes can lead to inadequate oxygenation and ventilation, resulting in cardiac arrest if not promptly addressed. Therefore, respiratory causes are the most common reason for pediatric arrests.

Explanation

Most pediatric arrests are due to respiratory causes in children. This is because children have smaller airways compared to adults, making them more susceptible to respiratory issues such as asthma, bronchiolitis, and pneumonia. Additionally, children may not have fully developed respiratory muscles, making it harder for them to breathe during respiratory distress. Respiratory causes can lead to inadequate oxygenation and ventilation, resulting in cardiac arrest if not promptly addressed. Therefore, respiratory causes are the most common reason for pediatric arrests.

36. You are the SRNA for a 2 week old child undergoing repair of a patent PDA. Which of the following is not true regarding proper monitor placement?

A precordial stethoscope should be used to evaluate heart tone, rate, and murmurs.

O2 sat probe should be placed on the left hand for the procedure

Twitch monitor should be placed along ulnar nerve at the wrist

The only change to ECG monitoring is the use of pediatric ECG leads and changing alarm limits.

The O2 sat probe should be placed on the right hand for the procedure, not the left hand. This is because the right hand is the standard site for pulse oximetry monitoring in pediatric patients.

Explanation

The O2 sat probe should be placed on the right hand for the procedure, not the left hand. This is because the right hand is the standard site for pulse oximetry monitoring in pediatric patients.

37. You are the SRNA for a 6 yr old child coming in from the ER for an emergent appendectomy. Which of the following is the best choice for induction?

Inhalational induction as patient Is not likely to cooperate with IV placement

IV must be placed prior to procedure for safe induction.

IM induction with ketamine

None of above are appropriate

The best choice for induction in this scenario is to place an IV prior to the procedure for safe induction. This is because an emergent appendectomy requires a reliable and immediate access to administer medications and fluids during the surgery. Inhalational induction may not be feasible as the patient is not likely to cooperate with IV placement, and IM induction with ketamine may not provide the necessary level of control and safety during the procedure. Therefore, the safest option is to ensure IV access before induction.

Explanation

The best choice for induction in this scenario is to place an IV prior to the procedure for safe induction. This is because an emergent appendectomy requires a reliable and immediate access to administer medications and fluids during the surgery. Inhalational induction may not be feasible as the patient is not likely to cooperate with IV placement, and IM induction with ketamine may not provide the necessary level of control and safety during the procedure. Therefore, the safest option is to ensure IV access before induction.

38. High dose opioid therapy during maintenance of anesthesia may be appropriate for which of the following?

Child with cardiac instability who requires surgical intervention

Pt who will be extubated after surgery and requires pain control

A healthy 2 yr old who is no longer at risk for post-op apnea

A child with respiratory insufficiency who may not have sufficient gas exchange for inhalational agents.

High dose opioid therapy during maintenance of anesthesia may be appropriate for a child with cardiac instability who requires surgical intervention. Opioids can provide effective analgesia and help stabilize hemodynamics in this patient population. The high dose may be necessary to adequately control pain and prevent further cardiovascular instability during the procedure. However, it is important to carefully monitor the patient's respiratory status and titrate the dose to avoid respiratory depression.

Explanation

High dose opioid therapy during maintenance of anesthesia may be appropriate for a child with cardiac instability who requires surgical intervention. Opioids can provide effective analgesia and help stabilize hemodynamics in this patient population. The high dose may be necessary to adequately control pain and prevent further cardiovascular instability during the procedure. However, it is important to carefully monitor the patient's respiratory status and titrate the dose to avoid respiratory depression.

39. You are the SRNa for 11 yr old Shaheem who has a PMH of asthma. Immediately after induction and intubation you hear wheezing develop. What should be your first action?

Deliver 100% FiO2

Administer hydrocortisone 5-7mg/kg IV to relieve wheezing

Turn off anesthetic and start propofol gtt to maintain anesthesia

Give B2 agonist such as albuterol 4-8 puffs through ETT

The correct answer is to give a B2 agonist such as albuterol 4-8 puffs through the endotracheal tube (ETT). Wheezing after induction and intubation in a patient with a history of asthma indicates bronchospasm. Administering a B2 agonist directly into the airway through the ETT helps to relieve the wheezing and bronchospasm quickly. This is the most appropriate first action to take in this situation.

Explanation

The correct answer is to give a B2 agonist such as albuterol 4-8 puffs through the endotracheal tube (ETT). Wheezing after induction and intubation in a patient with a history of asthma indicates bronchospasm. Administering a B2 agonist directly into the airway through the ETT helps to relieve the wheezing and bronchospasm quickly. This is the most appropriate first action to take in this situation.

40. What is the overall incidence of cardiac arrest in the pediatric population?

1.4 per 10,000

2.7 per 100,000

0.5 per 1,000

16 per 1,000,000

The overall incidence of cardiac arrest in the pediatric population is 1.4 per 10,000. This means that for every 10,000 children, 1.4 of them experience a cardiac arrest.

Explanation

The overall incidence of cardiac arrest in the pediatric population is 1.4 per 10,000. This means that for every 10,000 children, 1.4 of them experience a cardiac arrest.

41. In children, ETCO2 is particularly important to monitor because of which of the following reasons?

Will give you earliest indication of MH

Will detect hypoxia which is most common cause of pediatric arrest

Allows to asses adequacy of your ventilation

All the above

ETCO2 monitoring is particularly important in children because it provides multiple benefits. Firstly, it can give the earliest indication of malignant hyperthermia (MH), a potentially life-threatening condition. Secondly, it helps detect hypoxia, which is the most common cause of pediatric arrest. Lastly, monitoring ETCO2 allows healthcare providers to assess the adequacy of ventilation, ensuring that the child is receiving sufficient oxygen and that their respiratory function is optimal. Therefore, all of the given reasons are valid explanations for why ETCO2 monitoring is important in children.

Explanation

ETCO2 monitoring is particularly important in children because it provides multiple benefits. Firstly, it can give the earliest indication of malignant hyperthermia (MH), a potentially life-threatening condition. Secondly, it helps detect hypoxia, which is the most common cause of pediatric arrest. Lastly, monitoring ETCO2 allows healthcare providers to assess the adequacy of ventilation, ensuring that the child is receiving sufficient oxygen and that their respiratory function is optimal. Therefore, all of the given reasons are valid explanations for why ETCO2 monitoring is important in children.

42. What would be an appropriate dose of pre-op versed for a 6 yr old child weighing 24 kg?

24 mg IV

6 mg PO

12 mg PO

48 mg PO

An appropriate dose of pre-op versed for a 6-year-old child weighing 24 kg would be 12 mg PO (by mouth). This dosage is determined based on the weight of the child and the route of administration, which in this case is oral. It is important to consider the weight of the child when determining the appropriate dosage to ensure safety and effectiveness of the medication.

Explanation

An appropriate dose of pre-op versed for a 6-year-old child weighing 24 kg would be 12 mg PO (by mouth). This dosage is determined based on the weight of the child and the route of administration, which in this case is oral. It is important to consider the weight of the child when determining the appropriate dosage to ensure safety and effectiveness of the medication.

43. You are the SRNA for 15 yr old Valerie who has cerebral palsy. Due to the CP she has a past history lung infections and seizures. She currently takes dilantin to help control the seizures. Will this affect your case management?

I will not be able to use any succinylcholine due to dangerous drug interaction

I will need to use a much lower dose of ND-NMB’s due to enzyme inhibition

I will need to use a much higher dose of ND-NMB’s due to enzyme induction

Due to CP, I can not use any NMB’s so the dilantin doesn’t really matter anyway.

The correct answer suggests that the use of dilantin, which is an antiepileptic medication, will induce the enzymes responsible for metabolizing neuromuscular blocking agents (ND-NMB's). This means that the patient will require a higher dose of ND-NMB's in order to achieve the desired effect. Since the patient has a history of seizures and currently takes dilantin, it is important to consider this drug interaction when managing the case.

Explanation

The correct answer suggests that the use of dilantin, which is an antiepileptic medication, will induce the enzymes responsible for metabolizing neuromuscular blocking agents (ND-NMB's). This means that the patient will require a higher dose of ND-NMB's in order to achieve the desired effect. Since the patient has a history of seizures and currently takes dilantin, it is important to consider this drug interaction when managing the case.

44. Which of the following is not true regarding management of a patient with hemophilia?

Nasal intubations are contraindicated

Regional anesthesia is contraindicated

IM injection is preferred since IV sticks may cause bleeding

Transfusions should be done immediately preceding surgery

IM injection is not preferred over IV sticks because they may cause bleeding in patients with hemophilia. Patients with hemophilia have a deficiency in clotting factors, making them prone to excessive bleeding. Therefore, IV access is preferred over IM injection to minimize the risk of bleeding. Nasal intubations may be contraindicated due to the risk of bleeding, regional anesthesia may also be contraindicated depending on the specific case, and transfusions should be done prior to surgery to optimize clotting factors.

Explanation

IM injection is not preferred over IV sticks because they may cause bleeding in patients with hemophilia. Patients with hemophilia have a deficiency in clotting factors, making them prone to excessive bleeding. Therefore, IV access is preferred over IM injection to minimize the risk of bleeding. Nasal intubations may be contraindicated due to the risk of bleeding, regional anesthesia may also be contraindicated depending on the specific case, and transfusions should be done prior to surgery to optimize clotting factors.

45. What would be appropriate pre-op medication for a child with a latex allergy?

Benadryl 1mg/kg PO

Prednisone 1 mg/kg PO

Zantac 1-2mg/kg PO

All the above

All the above options would be appropriate pre-op medications for a child with a latex allergy. Benadryl is an antihistamine that can help reduce allergic symptoms such as itching and hives. Prednisone is a corticosteroid that can help reduce inflammation and allergic reactions. Zantac is an H2 blocker that can help reduce stomach acid production, which can be beneficial before surgery. Using all of these medications together can provide comprehensive relief for a child with a latex allergy before undergoing surgery.

Explanation

All the above options would be appropriate pre-op medications for a child with a latex allergy. Benadryl is an antihistamine that can help reduce allergic symptoms such as itching and hives. Prednisone is a corticosteroid that can help reduce inflammation and allergic reactions. Zantac is an H2 blocker that can help reduce stomach acid production, which can be beneficial before surgery. Using all of these medications together can provide comprehensive relief for a child with a latex allergy before undergoing surgery.

46. What would be an appropriate size ETT for a 9 yr old child weighing 33 kg?

5

6

4.5

7

An appropriate size endotracheal tube (ETT) for a 9-year-old child weighing 33 kg would be 6. This size is determined based on the weight and age of the child, as well as other factors such as the size of the child's airway and the intended use of the ETT. It is important to select the correct size ETT to ensure proper ventilation and oxygenation during medical procedures.

Explanation

An appropriate size endotracheal tube (ETT) for a 9-year-old child weighing 33 kg would be 6. This size is determined based on the weight and age of the child, as well as other factors such as the size of the child's airway and the intended use of the ETT. It is important to select the correct size ETT to ensure proper ventilation and oxygenation during medical procedures.

47. You are auscultating heart sounds on a 7 yr old child and hear a short, soft, systolic murmur. How would you classify this murmur?

Pathologic

Detrimental

Innocent

None of above

The given correct answer is "Innocent." In this scenario, the short, soft, systolic murmur heard in a 7-year-old child is likely to be innocent or benign. Innocent murmurs are common in children and are usually harmless. They are often soft, brief, and heard during systole. They are not associated with any structural heart abnormalities or symptoms. It is important to differentiate innocent murmurs from pathologic murmurs that may indicate underlying heart conditions. However, based on the given information, the murmur is most likely innocent.

Explanation

The given correct answer is "Innocent." In this scenario, the short, soft, systolic murmur heard in a 7-year-old child is likely to be innocent or benign. Innocent murmurs are common in children and are usually harmless. They are often soft, brief, and heard during systole. They are not associated with any structural heart abnormalities or symptoms. It is important to differentiate innocent murmurs from pathologic murmurs that may indicate underlying heart conditions. However, based on the given information, the murmur is most likely innocent.

48. When monitoring the pediatric patient, where should the precordial stethoscope be placed?

Left sternal border 2nd or 3rd intercostals space

Right sterna border 2nd or 3rd intercostals space

Left midclavicular line 5th intercostals space

Depends upon what you are trying to monitor

The correct answer is left sternal border 2nd or 3rd intercostals space. This is the ideal placement for the precordial stethoscope when monitoring a pediatric patient. This location allows for optimal auscultation of the heart sounds and allows the healthcare provider to assess any abnormalities or irregularities in the heart rhythm. Placing the stethoscope in this position ensures accurate and reliable monitoring of the pediatric patient's cardiac status.

Explanation

The correct answer is left sternal border 2nd or 3rd intercostals space. This is the ideal placement for the precordial stethoscope when monitoring a pediatric patient. This location allows for optimal auscultation of the heart sounds and allows the healthcare provider to assess any abnormalities or irregularities in the heart rhythm. Placing the stethoscope in this position ensures accurate and reliable monitoring of the pediatric patient's cardiac status.

49. You are nearing the end of surgery for 13 yr old Kami who started wheezing part way through her surgery. You gave albuterol and started her on steroid therapy but she is still wheezing. Her O2 sats are good and she is breathing adequate tidal volumes. What should you do?

Do not extubate, take her to PACU and they can extubate when wheezing goes away

Extubate deep to help prevent laryngospasm

Deliver another albuterol treatment and extubate fully awake

Give Fentanyl 1-2mcg/kg IV to help smooth out extubation

not-available-via-ai

Explanation

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50. In the pediatric population, the greatest amount of heat loss during surgery comes from…

Conduction

Radiation

Convection

All above are equal contributors to heat loss.

Radiation is the process by which heat is transferred through electromagnetic waves. In the pediatric population, the greatest amount of heat loss during surgery comes from radiation. This is because children have a larger surface area to body mass ratio compared to adults, making them more susceptible to heat loss through radiation. Conduction and convection also contribute to heat loss, but radiation is the primary mechanism in this population.

Explanation

Radiation is the process by which heat is transferred through electromagnetic waves. In the pediatric population, the greatest amount of heat loss during surgery comes from radiation. This is because children have a larger surface area to body mass ratio compared to adults, making them more susceptible to heat loss through radiation. Conduction and convection also contribute to heat loss, but radiation is the primary mechanism in this population.

51. Which of the following reasons explains why opioids appear to be more potent in neonates?

Easier entry across blood brain barrier

Decreased metabolic capabilities

Increased sensitivity of respiratory centers

All the above

Opioids appear to be more potent in neonates due to a combination of factors. Firstly, neonates have an easier entry across the blood-brain barrier, allowing opioids to reach the brain more readily. Secondly, neonates have decreased metabolic capabilities, leading to slower breakdown and elimination of opioids from the body. Lastly, neonates have an increased sensitivity of respiratory centers, making them more susceptible to the respiratory depressant effects of opioids. These factors combined make opioids more potent in neonates.

Explanation

Opioids appear to be more potent in neonates due to a combination of factors. Firstly, neonates have an easier entry across the blood-brain barrier, allowing opioids to reach the brain more readily. Secondly, neonates have decreased metabolic capabilities, leading to slower breakdown and elimination of opioids from the body. Lastly, neonates have an increased sensitivity of respiratory centers, making them more susceptible to the respiratory depressant effects of opioids. These factors combined make opioids more potent in neonates.

52. You are the SRNA for 10 yr old Jacob who is coming in for an emergent appendectomy. Due to the surgery being emergent, he is being induced with IV rapid sequence induction. Almost immediately folloring administration of Succinycholine Jacob develops a severe arrhythmia and then goes into cardiac arrest. What caused this and what do you do?

Begin immediate treatment for MH as you run code

Run standard code and administer 100% O2 as you ventilate

Give fluid boluses and volume to treat hypovolemia as you run code

Immediately begin treatment for hyperkalemia as you run code

The correct answer is to immediately begin treatment for hyperkalemia as you run the code. Succinylcholine, a depolarizing neuromuscular blocking agent, can cause a release of potassium from skeletal muscle cells, leading to hyperkalemia. This can result in severe arrhythmias and cardiac arrest. Therefore, the priority is to treat the hyperkalemia by administering calcium gluconate to stabilize the cardiac membrane, followed by other measures to lower serum potassium levels, such as administering sodium bicarbonate, insulin with glucose, and albuterol. Running the code and providing supportive measures, such as ventilation and oxygenation, are also important, but addressing the underlying hyperkalemia is crucial in this scenario.

Explanation

The correct answer is to immediately begin treatment for hyperkalemia as you run the code. Succinylcholine, a depolarizing neuromuscular blocking agent, can cause a release of potassium from skeletal muscle cells, leading to hyperkalemia. This can result in severe arrhythmias and cardiac arrest. Therefore, the priority is to treat the hyperkalemia by administering calcium gluconate to stabilize the cardiac membrane, followed by other measures to lower serum potassium levels, such as administering sodium bicarbonate, insulin with glucose, and albuterol. Running the code and providing supportive measures, such as ventilation and oxygenation, are also important, but addressing the underlying hyperkalemia is crucial in this scenario.

53. You are the nurse for a premature child who was born at full term. The child is now 10 weeks old and doing very well. The child is having a minor procedure and was maintained with fentanyl 2mcg/kg and 0.5 MAC Isoflurane. The childs mother wants to know when the child can come home. What do you tell her?

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

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

We will keep her for 48-72 hours just to monitor her for safety.

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

The correct answer is "We will most likely keep her overnight on a pulse oximeter just to watch her." This answer is the most appropriate because it ensures the safety and well-being of the premature child after the minor procedure. Monitoring the child overnight on a pulse oximeter allows for continuous monitoring of oxygen levels, which is important for premature infants who may be more susceptible to respiratory issues. This precautionary measure helps to ensure that any potential complications can be identified and addressed promptly before allowing the child to go home.

Explanation

The correct answer is "We will most likely keep her overnight on a pulse oximeter just to watch her." This answer is the most appropriate because it ensures the safety and well-being of the premature child after the minor procedure. Monitoring the child overnight on a pulse oximeter allows for continuous monitoring of oxygen levels, which is important for premature infants who may be more susceptible to respiratory issues. This precautionary measure helps to ensure that any potential complications can be identified and addressed promptly before allowing the child to go home.

54. Which of the following is not an advantage associated with IV induction?

Helps to avoid cardiac depressant effects of VAA

Less pain and anxiety for children with IV starts then with inhalational induction

Helps to avoid airway problems associated with inhalational induction

Allows for safer induction for emergent procedures

IV induction does not provide the advantage of less pain and anxiety for children compared to inhalational induction.

Explanation

IV induction does not provide the advantage of less pain and anxiety for children compared to inhalational induction.

55. Malignant Hyperthermia is a severe reaction which results in ryanodine receptor activation leading to…

Intracellular Hyperkalemia

Intracellular Hypernatremia

Intracellular Hypercalcemia

Intracellular Hyperglycemia

Malignant Hyperthermia is a severe reaction that occurs due to the activation of ryanodine receptors. These receptors are responsible for regulating calcium release from the sarcoplasmic reticulum in muscle cells. In the case of Malignant Hyperthermia, there is an abnormal increase in calcium release, leading to an excessive amount of calcium within the muscle cells. This condition is known as Intracellular Hypercalcemia.

Explanation

Malignant Hyperthermia is a severe reaction that occurs due to the activation of ryanodine receptors. These receptors are responsible for regulating calcium release from the sarcoplasmic reticulum in muscle cells. In the case of Malignant Hyperthermia, there is an abnormal increase in calcium release, leading to an excessive amount of calcium within the muscle cells. This condition is known as Intracellular Hypercalcemia.

56. What would be an appropriate starting dose of dantrolene to give to a 3 yr old child weighing 14 kg?

14 mg

140 mg

35 mg

280 mg

The appropriate starting dose of dantrolene for a 3-year-old child weighing 14 kg would be 35 mg. This dose is determined based on the weight of the child and the recommended dosage guidelines for dantrolene. It is important to consider the child's weight when determining the appropriate dose to ensure safety and effectiveness of the medication.

Explanation

The appropriate starting dose of dantrolene for a 3-year-old child weighing 14 kg would be 35 mg. This dose is determined based on the weight of the child and the recommended dosage guidelines for dantrolene. It is important to consider the child's weight when determining the appropriate dose to ensure safety and effectiveness of the medication.

57. What would be an appropriate size LMA for a child weighing 27 kg?

3

1.5

4

2.5

An appropriate size LMA for a child weighing 27 kg would be 2.5. The size of the LMA is chosen based on the weight of the child, and in this case, a child weighing 27 kg would require a size 2.5 LMA.

Explanation

An appropriate size LMA for a child weighing 27 kg would be 2.5. The size of the LMA is chosen based on the weight of the child, and in this case, a child weighing 27 kg would require a size 2.5 LMA.

58. How much Ketamine (in dart form) should be given for pre-op sedation of a child weighing 15 kg?

10 mg

5 mg

60 mg

30 mg

The correct answer is 30 mg. Ketamine is a medication used for pre-op sedation in children. The dosage is typically based on the child's weight, with a recommended dose of 1-2 mg/kg. Since the child in this question weighs 15 kg, the appropriate dose would be 15-30 mg. Therefore, the correct answer is 30 mg.

Explanation

The correct answer is 30 mg. Ketamine is a medication used for pre-op sedation in children. The dosage is typically based on the child's weight, with a recommended dose of 1-2 mg/kg. Since the child in this question weighs 15 kg, the appropriate dose would be 15-30 mg. Therefore, the correct answer is 30 mg.

59. The MAC for all anesthetic agents are highest at what age?

6-12 months

4-6 yrs

1-4 yrs

0-6 months

The correct answer is 6-12 months. During this age range, the MAC (minimum alveolar concentration) for anesthetic agents is highest. MAC refers to the concentration of anesthetic required to prevent movement in response to a painful stimulus in 50% of patients. This suggests that infants between 6-12 months require a higher concentration of anesthetic agents to achieve the desired effect compared to other age groups.

Explanation

The correct answer is 6-12 months. During this age range, the MAC (minimum alveolar concentration) for anesthetic agents is highest. MAC refers to the concentration of anesthetic required to prevent movement in response to a painful stimulus in 50% of patients. This suggests that infants between 6-12 months require a higher concentration of anesthetic agents to achieve the desired effect compared to other age groups.

60. Which of the following is not true regarding management of a patient with sickle cell disease?

After inserting an IV, you should consider giving a 10-15 ml/kg fluid bolus

Narcotics should be avoided due to respiratory depression and the need to avoid hypoxemia in these patients

Sickled cells cause vaso-occlusion in microvasculature which ultimately results in ned-organ damage

Sickle cell children may be given clear liquids up to 2 hours before surgery to help maintain hydration

Narcotics should be avoided in patients with sickle cell disease due to the risk of respiratory depression and the need to avoid hypoxemia. This is because narcotics can further depress the respiratory drive and worsen hypoxemia in these patients. It is important to manage pain in patients with sickle cell disease using alternative methods such as nonsteroidal anti-inflammatory drugs (NSAIDs) or non-opioid analgesics.

Explanation

Narcotics should be avoided in patients with sickle cell disease due to the risk of respiratory depression and the need to avoid hypoxemia. This is because narcotics can further depress the respiratory drive and worsen hypoxemia in these patients. It is important to manage pain in patients with sickle cell disease using alternative methods such as nonsteroidal anti-inflammatory drugs (NSAIDs) or non-opioid analgesics.

61. A 2 yr old child may drink milk up to how many hours prior to procedure?

6 hours

4 hours

3 hours

8 hours

A 2-year-old child should not drink milk up to 6 hours prior to a medical procedure. This is because milk can take longer to digest compared to other fluids and may increase the risk of complications during the procedure, such as vomiting or aspiration. It is important to follow these guidelines to ensure the child's safety and to obtain accurate test results.

Explanation

A 2-year-old child should not drink milk up to 6 hours prior to a medical procedure. This is because milk can take longer to digest compared to other fluids and may increase the risk of complications during the procedure, such as vomiting or aspiration. It is important to follow these guidelines to ensure the child's safety and to obtain accurate test results.

62. Which of the following children would likely experience the greatest amount of separation anxiety?

A 4 month old child

An 11 month old child

A 5 yr old child

A 13 yr old child

An 11-month-old child would likely experience the greatest amount of separation anxiety because this stage is known as the "stranger anxiety" phase. During this time, infants become more aware of their primary caregivers and may become distressed when separated from them. This is a normal part of their development as they begin to form attachments and understand the concept of object permanence. The other age groups mentioned (4 months, 5 years, and 13 years) are less likely to experience significant separation anxiety compared to an 11-month-old child.

Explanation

An 11-month-old child would likely experience the greatest amount of separation anxiety because this stage is known as the "stranger anxiety" phase. During this time, infants become more aware of their primary caregivers and may become distressed when separated from them. This is a normal part of their development as they begin to form attachments and understand the concept of object permanence. The other age groups mentioned (4 months, 5 years, and 13 years) are less likely to experience significant separation anxiety compared to an 11-month-old child.

63. What would be the ideal position for induction of a 4 yr old child who is frightened and refuses to lie flat on the OR table?

Use a couple nurses to make the child lie down and then induce

Use reason, tell the child if they do not lie down you will have to give them a shot instead.

The ideal position for induction of a frightened 4-year-old child who refuses to lie flat on the OR table would be to have the child sit in the center of the OR table while the healthcare provider sits nearby and wraps their arm around the child. This position allows for close proximity and physical contact, which can provide comfort and reassurance to the child. Inducing via mask inhalation also allows for a non-invasive method of administration, which may be less intimidating for the child compared to other options such as receiving a shot.

Explanation

The ideal position for induction of a frightened 4-year-old child who refuses to lie flat on the OR table would be to have the child sit in the center of the OR table while the healthcare provider sits nearby and wraps their arm around the child. This position allows for close proximity and physical contact, which can provide comfort and reassurance to the child. Inducing via mask inhalation also allows for a non-invasive method of administration, which may be less intimidating for the child compared to other options such as receiving a shot.

64. What size IV catheter would be best to use on a 3 yr old child?

24

22

20

18

A 22-gauge IV catheter would be best to use on a 3-year-old child. IV catheters are measured by their gauge size, with a smaller gauge indicating a larger diameter. A 22-gauge catheter is smaller in diameter compared to a 24-gauge catheter, making it more suitable for a young child. It allows for a more comfortable insertion and reduces the risk of complications such as infiltration or phlebitis. A larger gauge catheter, such as 20 or 18, may cause unnecessary discomfort and potential complications for a child of this age.

Explanation

A 22-gauge IV catheter would be best to use on a 3-year-old child. IV catheters are measured by their gauge size, with a smaller gauge indicating a larger diameter. A 22-gauge catheter is smaller in diameter compared to a 24-gauge catheter, making it more suitable for a young child. It allows for a more comfortable insertion and reduces the risk of complications such as infiltration or phlebitis. A larger gauge catheter, such as 20 or 18, may cause unnecessary discomfort and potential complications for a child of this age.

65. You are the SRNA for 8 yr old Camryn who is in today to have a Tympanoplasty. She has a PMH of asthma, and she had her adenoids removed at age 3. You listen to her lungs and hear wheezing. You ask her mom about the wheezing and her mother says that Camryn has a constant wheeze that does not clear, this is normal for her. What do you now?

Administer an albuterol treatment prior to surgery to help stabilize her and then proceed.

Cancel the surgery.

Obtain medical clearance from her pulmonologist prior to proceeding with surgery.

Administer hydrocortisone prior to procedure and give albuterol treatment once induced.

Given the patient's history of asthma and the presence of wheezing, it is important to obtain medical clearance from her pulmonologist prior to proceeding with surgery. This is necessary to ensure that her asthma is well-controlled and that there are no underlying respiratory issues that could complicate the surgery. Administering albuterol treatment or hydrocortisone without obtaining medical clearance may not be appropriate as it does not address the need for a comprehensive evaluation by a pulmonologist. Canceling the surgery without further evaluation would also not be the best course of action without first consulting with the pulmonologist.

Explanation

Given the patient's history of asthma and the presence of wheezing, it is important to obtain medical clearance from her pulmonologist prior to proceeding with surgery. This is necessary to ensure that her asthma is well-controlled and that there are no underlying respiratory issues that could complicate the surgery. Administering albuterol treatment or hydrocortisone without obtaining medical clearance may not be appropriate as it does not address the need for a comprehensive evaluation by a pulmonologist. Canceling the surgery without further evaluation would also not be the best course of action without first consulting with the pulmonologist.

66. What is the incidence of Malignant Hyperthermia in children?

1: 50,000

1: 100,000

1: 15,000

1: 250,000

The incidence of Malignant Hyperthermia in children is 1 in 15,000. This means that out of every 15,000 children, one will develop Malignant Hyperthermia.

Explanation

The incidence of Malignant Hyperthermia in children is 1 in 15,000. This means that out of every 15,000 children, one will develop Malignant Hyperthermia.

67. Which of the following would be the best choice for induction of a pediatric patient coming in for emergent surgery following an MVA? The child is currently wheezing and according to his father, the child has a history of sever asthma.

Propofol

Ketamine

Inhalational induction with Sevoflurane

Fentanyl & Versed

Ketamine would be the best choice for induction of a pediatric patient in this scenario. The child is currently wheezing and has a history of severe asthma, which indicates potential airway reactivity. Ketamine is a dissociative anesthetic that provides bronchodilation and minimal respiratory depression, making it a suitable choice for patients with reactive airways. Propofol and inhalational induction with sevoflurane can potentially cause bronchospasm and worsen wheezing in asthmatic patients. Fentanyl and Versed are opioids and sedatives, respectively, and may not be the ideal choice for induction in this case.

Explanation

Ketamine would be the best choice for induction of a pediatric patient in this scenario. The child is currently wheezing and has a history of severe asthma, which indicates potential airway reactivity. Ketamine is a dissociative anesthetic that provides bronchodilation and minimal respiratory depression, making it a suitable choice for patients with reactive airways. Propofol and inhalational induction with sevoflurane can potentially cause bronchospasm and worsen wheezing in asthmatic patients. Fentanyl and Versed are opioids and sedatives, respectively, and may not be the ideal choice for induction in this case.

68. A child with a recent URI would be at an increased risk for all of the following except:

Laryngospasm

Pneumonia

Atelectasis

Wheezing

A child with a recent URI (upper respiratory infection) is at an increased risk for complications such as laryngospasm, atelectasis, and wheezing. This is because the inflammation and mucus production in the upper airways can lead to narrowing or blockage of the air passages, causing these symptoms. However, pneumonia is a lower respiratory tract infection that affects the lungs, and while a URI can sometimes progress to pneumonia, it is not directly associated with a recent URI. Therefore, pneumonia would not be considered an increased risk for a child with a recent URI.

Explanation

A child with a recent URI (upper respiratory infection) is at an increased risk for complications such as laryngospasm, atelectasis, and wheezing. This is because the inflammation and mucus production in the upper airways can lead to narrowing or blockage of the air passages, causing these symptoms. However, pneumonia is a lower respiratory tract infection that affects the lungs, and while a URI can sometimes progress to pneumonia, it is not directly associated with a recent URI. Therefore, pneumonia would not be considered an increased risk for a child with a recent URI.

69. What should be your first action when preparing to do a pre-op assessment on a 3 yr old child?

Review the chart

Introduce yourself to the child’s parents and obtain a thorough history

Introduce yourself to child, and attempt to play a game or comfort them

Get your blow gun ready, and load it with a ketamine dart.

When preparing to do a pre-op assessment on a 3-year-old child, the first action should be to review the chart. This is important because it allows the healthcare provider to familiarize themselves with the child's medical history, any previous surgeries, allergies, and other relevant information. Reviewing the chart helps in planning and tailoring the assessment according to the child's specific needs and medical condition, ensuring a safe and effective pre-op assessment process.

Explanation

When preparing to do a pre-op assessment on a 3-year-old child, the first action should be to review the chart. This is important because it allows the healthcare provider to familiarize themselves with the child's medical history, any previous surgeries, allergies, and other relevant information. Reviewing the chart helps in planning and tailoring the assessment according to the child's specific needs and medical condition, ensuring a safe and effective pre-op assessment process.

70. What size laryngoscope blade would you choose to intubate an 8 yr old child?

1.5 mil

3 mac

2.5 mil

2 mac

The correct answer is 2 mac. The size of the laryngoscope blade for intubating an 8-year-old child would typically be chosen based on the child's age and size. The "mac" measurement refers to the size of the blade, with larger numbers indicating larger blades. In this case, 2 mac would be the appropriate size for intubating the child.

Explanation

The correct answer is 2 mac. The size of the laryngoscope blade for intubating an 8-year-old child would typically be chosen based on the child's age and size. The "mac" measurement refers to the size of the blade, with larger numbers indicating larger blades. In this case, 2 mac would be the appropriate size for intubating the child.

71. In order to work well EMLA cream must be applied at least how many minutes prior to IV start?

45 minutes

2 hours

30 minutes

15 minutes

EMLA cream is a topical anesthetic that needs time to take effect before it can numb the skin for an IV start. Applying it at least 45 minutes prior allows the cream to penetrate the skin and desensitize the area, ensuring that the patient feels minimal pain during the procedure. Applying it for a shorter duration may not provide sufficient numbing effect, while applying it for longer than 45 minutes may not provide any additional benefit and may unnecessarily prolong the waiting time for the patient.

Explanation

EMLA cream is a topical anesthetic that needs time to take effect before it can numb the skin for an IV start. Applying it at least 45 minutes prior allows the cream to penetrate the skin and desensitize the area, ensuring that the patient feels minimal pain during the procedure. Applying it for a shorter duration may not provide sufficient numbing effect, while applying it for longer than 45 minutes may not provide any additional benefit and may unnecessarily prolong the waiting time for the patient.

72. What would be an appropriate size LMA for an infant weighing 9 kg?

0.5

1

1.5

2.5

An appropriate size LMA for an infant weighing 9 kg would be 1.5. This is because the size of the LMA is typically chosen based on the weight of the patient. In this case, the infant weighs 9 kg, and the appropriate size LMA for this weight range is 1.5.

Explanation

An appropriate size LMA for an infant weighing 9 kg would be 1.5. This is because the size of the LMA is typically chosen based on the weight of the patient. In this case, the infant weighs 9 kg, and the appropriate size LMA for this weight range is 1.5.

73. What type of breathing circuit would you choose for a child weighing less than 10 kg?

Small semi-closed Circuit

Mapleson A

Standard adult semi closed system

Jackson-Rees Circuit

The Jackson-Rees Circuit would be the most suitable choice for a child weighing less than 10 kg. This circuit is specifically designed for pediatric patients and provides controlled ventilation. It is a modification of the Mapleson A circuit, which is not as suitable for small children. The Standard adult semi-closed system is designed for adult patients and may not provide the appropriate ventilation for a child of this size. Therefore, the Jackson-Rees Circuit is the best option for ensuring safe and effective ventilation in a child weighing less than 10 kg.

Explanation

The Jackson-Rees Circuit would be the most suitable choice for a child weighing less than 10 kg. This circuit is specifically designed for pediatric patients and provides controlled ventilation. It is a modification of the Mapleson A circuit, which is not as suitable for small children. The Standard adult semi-closed system is designed for adult patients and may not provide the appropriate ventilation for a child of this size. Therefore, the Jackson-Rees Circuit is the best option for ensuring safe and effective ventilation in a child weighing less than 10 kg.

74. What type of circuit would you choose for a pediatric patient weighing more than 10 kg?

Small semi-closed Circuit

Mapleson A

Standard adult semi closed system

Jackson-Rees Circuit

A small semi-closed circuit would be the most suitable choice for a pediatric patient weighing more than 10 kg. This type of circuit is specifically designed for smaller patients and provides a more controlled and precise delivery of anesthesia gases. It allows for efficient removal of carbon dioxide and minimizes the risk of rebreathing. Additionally, the smaller circuit size ensures that the patient receives the appropriate amount of anesthesia gases based on their weight and size.

Explanation

A small semi-closed circuit would be the most suitable choice for a pediatric patient weighing more than 10 kg. This type of circuit is specifically designed for smaller patients and provides a more controlled and precise delivery of anesthesia gases. It allows for efficient removal of carbon dioxide and minimizes the risk of rebreathing. Additionally, the smaller circuit size ensures that the patient receives the appropriate amount of anesthesia gases based on their weight and size.

75. What would be an appropriate IM stun dose ketamine for a 14 yr old boy weighing 40 kg?

320 mg

200 mg

160 mg

80 mg

An appropriate IM stun dose of ketamine for a 14-year-old boy weighing 40 kg would be 80 mg. This dose is determined based on the weight of the individual and is considered suitable for achieving the desired effect.

Explanation

An appropriate IM stun dose of ketamine for a 14-year-old boy weighing 40 kg would be 80 mg. This dose is determined based on the weight of the individual and is considered suitable for achieving the desired effect.

76. Which of the inhalational agents had the highest incidence of emergence delirum?

Sevoflurane

Isoflurane

Desflurane

Halothane

Desflurane has the highest incidence of emergence delirium among the given inhalational agents. Emergence delirium is a common side effect of anesthesia, characterized by confusion, agitation, and disorientation upon awakening from anesthesia. Desflurane is known to have a faster onset and offset of action compared to other inhalational agents, which may contribute to a higher incidence of emergence delirium. Additionally, Desflurane has a pungent odor and irritates the airway, which can further increase the risk of delirium.

Explanation

Desflurane has the highest incidence of emergence delirium among the given inhalational agents. Emergence delirium is a common side effect of anesthesia, characterized by confusion, agitation, and disorientation upon awakening from anesthesia. Desflurane is known to have a faster onset and offset of action compared to other inhalational agents, which may contribute to a higher incidence of emergence delirium. Additionally, Desflurane has a pungent odor and irritates the airway, which can further increase the risk of delirium.

77. Which of the following properly describes the Sundown Sign?

When toddlers become confused at night and start climbing out of bed.

Contraction of the inferior rectus muscle of the eye causing the eyeball to look downward toward the toes.

The Sundown Sign refers to the contraction of the inferior rectus muscle of the eye, which causes the eyeball to look downward toward the toes. This term is used to describe this specific eye movement.

Explanation

The Sundown Sign refers to the contraction of the inferior rectus muscle of the eye, which causes the eyeball to look downward toward the toes. This term is used to describe this specific eye movement.

78. What pre-op medication would you choose for a 3 week old child, who weighs 4 kg, undergoing surgery to correct a pyloric stenosis?

Ketamine 8 mg IM

Versed 0.4 mg IM

Fentanyl lollipop 40 mcg PO

Atropine 0.08 mg IM

Atropine is the correct pre-op medication choice for a 3 week old child undergoing surgery to correct pyloric stenosis. Atropine is commonly used to reduce secretions and prevent bradycardia during anesthesia induction. It is administered intramuscularly (IM) and the dosage of 0.08 mg is appropriate for a child of this age and weight. Ketamine and Versed are not typically used in infants of this age, and Fentanyl lollipop is not the preferred route of administration for pre-op medication in this case.

Explanation

Atropine is the correct pre-op medication choice for a 3 week old child undergoing surgery to correct pyloric stenosis. Atropine is commonly used to reduce secretions and prevent bradycardia during anesthesia induction. It is administered intramuscularly (IM) and the dosage of 0.08 mg is appropriate for a child of this age and weight. Ketamine and Versed are not typically used in infants of this age, and Fentanyl lollipop is not the preferred route of administration for pre-op medication in this case.

79. A normal healthy child may be transported to PACU without any supplemental oxygen.

True

False

A normal healthy child may be transported to the PACU (Post-Anesthesia Care Unit) without any supplemental oxygen because their oxygen levels are stable and within the normal range. Supplemental oxygen is typically used for patients who have difficulty breathing or have low oxygen levels. Since the child is healthy, there is no need for additional oxygen during transportation to the PACU.

Explanation

A normal healthy child may be transported to the PACU (Post-Anesthesia Care Unit) without any supplemental oxygen because their oxygen levels are stable and within the normal range. Supplemental oxygen is typically used for patients who have difficulty breathing or have low oxygen levels. Since the child is healthy, there is no need for additional oxygen during transportation to the PACU.

80. Which of the following is not true regarding children with cystic fibrosis?

No routine lab test are indicated unless there is significant organ system involvement

You will almost always hear rhonchi and wheezes with these patient

N2O should be avoided with these patients

The correct answer is "ETT placement may increase airway swelling and thus these patients are much better to have LMA’s and spontaneous ventilations if at all possible." This statement is not true because ETT (endotracheal tube) placement does not increase airway swelling in children with cystic fibrosis.

Explanation

The correct answer is "ETT placement may increase airway swelling and thus these patients are much better to have LMA’s and spontaneous ventilations if at all possible." This statement is not true because ETT (endotracheal tube) placement does not increase airway swelling in children with cystic fibrosis.

81. You are the SRNA for 16 month old Arturo, who is about to be extubated. As he is waking up from anesthesia you deliver 100% FiO2, but then Arturo begins to cough. He becomes cyanotic as you suction your tube to rule out any kind of obstruction. Your FiO2 is100% and the pt is ventilating but still blue. What do you do?

Just wait, it will go away in a moment once he stops coughing

Administer sux to break laryngospasm

Give albuterol 4 puffs via ETT

Call code and begin PALS protocol

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Explanation

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82. You are the SRNA for 22 month old Collin who is about to be extubated. During emergence he starts to vigorously cough and then becomes cyanotic. You have 100% O2, and make sure he is not hypoventilating. You suction his airway to check form any obstruction and find there is no obstruction, yet little Collin still remains blue. What is wrong?

Laryngospasm

Bronchospasm

Pulmonary Hypertension

PPFO

not-available-via-ai

Explanation

not-available-via-ai

83. Why are patients with muscular dystrophy more prone to cardiac arrhythmias?

Due to conduction node abnormalities which are common genetic issues associated with MD

Due to chest wall rigidity and propensity toward effusions, predisposing pts to tamponade

Due to hyperkalemia and upregulation of pts, making pts more prone to electrolyte abnormalities

Due to lack of dystrophin which is essential for proper cardiac function

Patients with muscular dystrophy are more prone to cardiac arrhythmias due to the lack of dystrophin, which is essential for proper cardiac function. Dystrophin is a protein that helps stabilize and protect muscle fibers, including those in the heart. Without dystrophin, the heart muscles become weak and are unable to contract and relax properly, leading to abnormalities in the electrical signals that regulate the heart's rhythm. This increases the risk of developing cardiac arrhythmias in patients with muscular dystrophy.

Explanation

Patients with muscular dystrophy are more prone to cardiac arrhythmias due to the lack of dystrophin, which is essential for proper cardiac function. Dystrophin is a protein that helps stabilize and protect muscle fibers, including those in the heart. Without dystrophin, the heart muscles become weak and are unable to contract and relax properly, leading to abnormalities in the electrical signals that regulate the heart's rhythm. This increases the risk of developing cardiac arrhythmias in patients with muscular dystrophy.

84. Which of the following inhalational anesthetic agents may cause bradycardia, vasodilation and myocardial depression in infants?

Desflurane

Isoflurane

Sevoflurane

Opioids

Isoflurane is known to cause bradycardia, vasodilation, and myocardial depression in infants. This is because it has a direct negative inotropic effect on the heart, causing a decrease in cardiac contractility. Additionally, it can cause vasodilation, leading to a decrease in systemic vascular resistance and blood pressure. These effects are more pronounced in infants compared to adults, making isoflurane a potential risk for cardiovascular depression in this population.

Explanation

Isoflurane is known to cause bradycardia, vasodilation, and myocardial depression in infants. This is because it has a direct negative inotropic effect on the heart, causing a decrease in cardiac contractility. Additionally, it can cause vasodilation, leading to a decrease in systemic vascular resistance and blood pressure. These effects are more pronounced in infants compared to adults, making isoflurane a potential risk for cardiovascular depression in this population.

85. What is the most important factor when examining a patient with cystic fibrosis?

Asking parent about age of onset and severity of illness.

The physical exam, and checking for signs of chronic hypoxia

The CXR, to check for lung scarring, and the PFT

Check labs and ECG results

The most important factor when examining a patient with cystic fibrosis is conducting a physical exam and checking for signs of chronic hypoxia. This is because cystic fibrosis primarily affects the lungs, leading to chronic respiratory problems and a decreased ability to absorb oxygen. By conducting a physical exam and checking for signs of chronic hypoxia, such as cyanosis (bluish discoloration of the skin), clubbing of the fingers, and shortness of breath, healthcare professionals can assess the severity of the respiratory symptoms and determine the appropriate treatment plan for the patient.

Explanation

The most important factor when examining a patient with cystic fibrosis is conducting a physical exam and checking for signs of chronic hypoxia. This is because cystic fibrosis primarily affects the lungs, leading to chronic respiratory problems and a decreased ability to absorb oxygen. By conducting a physical exam and checking for signs of chronic hypoxia, such as cyanosis (bluish discoloration of the skin), clubbing of the fingers, and shortness of breath, healthcare professionals can assess the severity of the respiratory symptoms and determine the appropriate treatment plan for the patient.

86. Which of the following is not helpful in preventing laryngospasm?

Suction secretions immediately after extubation

Extubate deep

Extubate totally awake

Immediately after extubation, stretch the larynx

Suctioning secretions immediately after extubation is not helpful in preventing laryngospasm. Laryngospasm is a condition where the vocal cords spasm and close off the airway, leading to difficulty in breathing. Suctioning secretions may irritate the larynx and trigger laryngospasm. The other options, such as extubating deep, extubating totally awake, and stretching the larynx immediately after extubation, are helpful in preventing laryngospasm as they promote a smooth and safe extubation process.

Explanation

Suctioning secretions immediately after extubation is not helpful in preventing laryngospasm. Laryngospasm is a condition where the vocal cords spasm and close off the airway, leading to difficulty in breathing. Suctioning secretions may irritate the larynx and trigger laryngospasm. The other options, such as extubating deep, extubating totally awake, and stretching the larynx immediately after extubation, are helpful in preventing laryngospasm as they promote a smooth and safe extubation process.

87. Which of the following children is the best candidate for a deep extubation?

An 18 month old child who just had a minor procedure, no past HX and spontaneous ventilation for whole case.

An 5 yr old healthy child with no medical history, needed paralysis during procedure but has now been fully reversed.

A 7 yr old child who came for emergent appendectomy

The 9-year-old healthy child with asthma is the best candidate for a deep extubation because they have not had any asthma attacks in one year and do not currently have wheezes. This indicates that their asthma is well-controlled and stable. Additionally, the child is undergoing a minor elective procedure and has maintained spontaneous ventilation throughout the procedure, suggesting that they have good respiratory function. These factors make them a suitable candidate for a deep extubation, where the endotracheal tube is removed while the patient is still anesthetized.

Explanation

The 9-year-old healthy child with asthma is the best candidate for a deep extubation because they have not had any asthma attacks in one year and do not currently have wheezes. This indicates that their asthma is well-controlled and stable. Additionally, the child is undergoing a minor elective procedure and has maintained spontaneous ventilation throughout the procedure, suggesting that they have good respiratory function. These factors make them a suitable candidate for a deep extubation, where the endotracheal tube is removed while the patient is still anesthetized.

88. You are the SRNA for 14 yr old Nathan who has a PMH of cerebral palsy. The mother of states he has reflux and takes medication at home to help control this. He currently has a PEG tube due to difficulty swallowing. When you examine the pt you notice copious amounts of drool coming from his mouth. What sort of induction would be best for this patient?

Inhalational induction

Awake intubation

Give atropine pre-op and then do IM induction

Rapid sequence induction with succinylcholine

The copious amounts of drool coming from the patient's mouth suggest that he may have difficulty managing his secretions, which can increase the risk of aspiration during anesthesia induction. Rapid sequence induction with succinylcholine is the most appropriate choice in this case because it allows for rapid intubation while minimizing the risk of aspiration. Atropine pre-op and IM induction may not adequately protect against aspiration, and an awake intubation may not be feasible or well-tolerated in this patient with cerebral palsy. Inhalational induction may also increase the risk of aspiration due to the excessive drooling.

Explanation

The copious amounts of drool coming from the patient's mouth suggest that he may have difficulty managing his secretions, which can increase the risk of aspiration during anesthesia induction. Rapid sequence induction with succinylcholine is the most appropriate choice in this case because it allows for rapid intubation while minimizing the risk of aspiration. Atropine pre-op and IM induction may not adequately protect against aspiration, and an awake intubation may not be feasible or well-tolerated in this patient with cerebral palsy. Inhalational induction may also increase the risk of aspiration due to the excessive drooling.

89. You are SRNA for 17 yr old Sarah who has a past history of down syndrome. Her mother tells you that during previous procedures it had been told to her that Sarah has a very difficult airway and an unstable neck. You look at the airway and it does indeed look to be very difficult. How will you choose to intubate sarah?

Via retrograde intubation

Awake intubation, with airway numbed

Use LMA fasttrach to place ETT

Fiberoptic nasal intubation

Given the information that Sarah has a difficult airway and an unstable neck, fiberoptic nasal intubation would be the most appropriate choice. This method allows for a more controlled and precise intubation, as the fiberoptic scope can navigate through the airway and visualize the vocal cords without excessive manipulation. It also avoids the need for direct visualization, which may be challenging in a difficult airway. Additionally, nasal intubation can be a more comfortable option for the patient compared to other methods.

Explanation

Given the information that Sarah has a difficult airway and an unstable neck, fiberoptic nasal intubation would be the most appropriate choice. This method allows for a more controlled and precise intubation, as the fiberoptic scope can navigate through the airway and visualize the vocal cords without excessive manipulation. It also avoids the need for direct visualization, which may be challenging in a difficult airway. Additionally, nasal intubation can be a more comfortable option for the patient compared to other methods.

90. What should be your first action for a suspected anaphylactic response during anesthesia?

Switch to 100% O2

Discontinue anesthetics and any antibiotic or blood infusions

Give epi 0.5-5mcg/kg IV

Give benedryl 0.5-1 mg/kg IV

In a suspected anaphylactic response during anesthesia, the first action should be to switch to 100% O2. This is because anaphylaxis can cause severe respiratory distress, and providing the patient with a high concentration of oxygen can help alleviate the symptoms and ensure adequate oxygenation. Switching to 100% O2 should be done immediately to prioritize the patient's respiratory needs.

Explanation

In a suspected anaphylactic response during anesthesia, the first action should be to switch to 100% O2. This is because anaphylaxis can cause severe respiratory distress, and providing the patient with a high concentration of oxygen can help alleviate the symptoms and ensure adequate oxygenation. Switching to 100% O2 should be done immediately to prioritize the patient's respiratory needs.

91. You are the SRNA for 10 yr old Jovan who has down syndrome. He has a past hx of mild joint instability, is relatively high functioning, but has multiple cardiac anomalies. He was born with tetrology of fallot and has had multiple cardiac surgies in the past. He still has significant cardiac issues and is in today to correct strabismus in his eyes. Knowing his history, what agents is preferred for imaintenance?

Propofol gtt for maintenance

Inhalational induction and standard anesthetic management

Ketamine IV for maintenance

Versed and Fentanyl for maintenance

Given Jovan's history of multiple cardiac anomalies and significant cardiac issues, Ketamine IV for maintenance is the preferred agent. Ketamine is known for its cardiovascular stability, making it a suitable choice for patients with cardiac conditions. Additionally, Ketamine provides analgesia and sedation, which is beneficial for maintaining anesthesia during the procedure. Propofol gtt for maintenance may not be ideal due to its potential for cardiovascular depression. Inhalational induction and standard anesthetic management may not be preferred as it may not provide adequate cardiovascular stability. Versed and Fentanyl for maintenance may not be the best choice as they do not offer the same level of cardiovascular stability as Ketamine.

Explanation

Given Jovan's history of multiple cardiac anomalies and significant cardiac issues, Ketamine IV for maintenance is the preferred agent. Ketamine is known for its cardiovascular stability, making it a suitable choice for patients with cardiac conditions. Additionally, Ketamine provides analgesia and sedation, which is beneficial for maintaining anesthesia during the procedure. Propofol gtt for maintenance may not be ideal due to its potential for cardiovascular depression. Inhalational induction and standard anesthetic management may not be preferred as it may not provide adequate cardiovascular stability. Versed and Fentanyl for maintenance may not be the best choice as they do not offer the same level of cardiovascular stability as Ketamine.

92. Which of the following is not true regarding muscular dystrophy patients?

Succinylcholine should be avoided, but VAA are still considered safe for most patients unless past history indicates otherwise

Cardiomyopathy is a constant feature of the diease and these children may be prone to dysrhythmias.

Dose of ND-NMB’s should be cut by 1/3 to ½ due to decreased muscle mass.

Atropine or robinul should be given to patients who have trouble managing their own secretions.

Muscular dystrophy patients should avoid succinylcholine because it can cause a life-threatening reaction called malignant hyperthermia. However, volatile anesthetic agents (VAA) are generally considered safe for most patients with muscular dystrophy, unless there is a past history of adverse reactions. VAA can be used for anesthesia without significant risks.

Explanation

Muscular dystrophy patients should avoid succinylcholine because it can cause a life-threatening reaction called malignant hyperthermia. However, volatile anesthetic agents (VAA) are generally considered safe for most patients with muscular dystrophy, unless there is a past history of adverse reactions. VAA can be used for anesthesia without significant risks.

93. At what level is the larynx located in infants?

C4

C5

C2

C3

The larynx is located at the level of C4 in infants. The larynx, also known as the voice box, is a structure in the throat that houses the vocal cords and is responsible for producing sound. In infants, the larynx is positioned higher in the neck compared to adults. This is because the larynx gradually descends as a child grows and develops. Therefore, at the infant stage, the larynx is located at the level of C4.

Explanation

The larynx is located at the level of C4 in infants. The larynx, also known as the voice box, is a structure in the throat that houses the vocal cords and is responsible for producing sound. In infants, the larynx is positioned higher in the neck compared to adults. This is because the larynx gradually descends as a child grows and develops. Therefore, at the infant stage, the larynx is located at the level of C4.

94. Which of the following is not commonly associated with Trisomy 21?

Endocardial Cushion Defects

Hirschsprungs disease

Frequent upper respiratory infections

Stiff joints and neck resulting in limited mobility

Trisomy 21, also known as Down syndrome, is a genetic disorder caused by the presence of an extra copy of chromosome 21. It is commonly associated with various medical conditions. Endocardial Cushion Defects and Hirschsprung's disease are both congenital abnormalities that can occur in individuals with Trisomy 21. Additionally, individuals with Trisomy 21 often have a weakened immune system, leading to frequent upper respiratory infections. However, stiff joints and neck resulting in limited mobility are not commonly associated with Trisomy 21. This symptom is more commonly seen in other conditions such as arthritis or musculoskeletal disorders.

Explanation

Trisomy 21, also known as Down syndrome, is a genetic disorder caused by the presence of an extra copy of chromosome 21. It is commonly associated with various medical conditions. Endocardial Cushion Defects and Hirschsprung's disease are both congenital abnormalities that can occur in individuals with Trisomy 21. Additionally, individuals with Trisomy 21 often have a weakened immune system, leading to frequent upper respiratory infections. However, stiff joints and neck resulting in limited mobility are not commonly associated with Trisomy 21. This symptom is more commonly seen in other conditions such as arthritis or musculoskeletal disorders.

95. Which of the following is incorrect regarding maintenance of survival position?

The jaw and chin should be rotated downward to further open the airway

Using tips of your fingers, jaw thrust should be applied bilaterally

Fingers should be placed on bony prominence of face

Downward pressure should not be applies to mask, instead lift jaw up to form tight seal

The correct answer is "Downward pressure should not be applied to the mask, instead lift the jaw up to form a tight seal." This is incorrect because when performing maintenance of the survival position, downward pressure should be applied to the mask to ensure a tight seal. This helps in maintaining an open airway and ensuring effective respiration.

Explanation

The correct answer is "Downward pressure should not be applied to the mask, instead lift the jaw up to form a tight seal." This is incorrect because when performing maintenance of the survival position, downward pressure should be applied to the mask to ensure a tight seal. This helps in maintaining an open airway and ensuring effective respiration.

96. Which of the following is not true regarding pre-op treatment of a patient with down syndrome?

Atropine PO should be given as soon as possible to these patients.

Neck X-rays should be obtained for all down syndrome patients

Patients with heart disease should receive antibiotic prophylaxis against SBE

All the above are true

The statement "Neck X-rays should be obtained for all down syndrome patients" is not true regarding the pre-op treatment of a patient with Down syndrome. There is no specific indication or recommendation for obtaining neck X-rays in all Down syndrome patients as a part of their pre-operative treatment.

Explanation

The statement "Neck X-rays should be obtained for all down syndrome patients" is not true regarding the pre-op treatment of a patient with Down syndrome. There is no specific indication or recommendation for obtaining neck X-rays in all Down syndrome patients as a part of their pre-operative treatment.

97. Due to decreased FRC, infants are more prone to all of the following except:

Atelectasis

Laryngospasm

Hypoxemia and rapid desaturation

All the above

Infants have a decreased functional residual capacity (FRC), which refers to the amount of air remaining in the lungs after a normal exhalation. This decreased FRC can lead to various respiratory complications. Atelectasis, which is the collapse of lung tissue, and hypoxemia with rapid desaturation, which is a low level of oxygen in the blood, are more likely to occur in infants due to their decreased FRC. However, laryngospasm, which is a sudden spasm of the vocal cords that can cause difficulty breathing, is not directly related to FRC and is therefore less likely to occur in infants.

Explanation

Infants have a decreased functional residual capacity (FRC), which refers to the amount of air remaining in the lungs after a normal exhalation. This decreased FRC can lead to various respiratory complications. Atelectasis, which is the collapse of lung tissue, and hypoxemia with rapid desaturation, which is a low level of oxygen in the blood, are more likely to occur in infants due to their decreased FRC. However, laryngospasm, which is a sudden spasm of the vocal cords that can cause difficulty breathing, is not directly related to FRC and is therefore less likely to occur in infants.

98. What is the most common cause of respiratory arrest in pediatric patients?

Airway Obstruction

Difficult intubation

Laryngospasm

Bronchospasm

Laryngospasm is the most common cause of respiratory arrest in pediatric patients. Laryngospasm refers to the sudden closure of the vocal cords, which can obstruct the airway and lead to respiratory distress or arrest. It can be triggered by various factors such as irritation, infection, or aspiration. Prompt recognition and intervention are crucial in managing laryngospasm to prevent further complications and ensure adequate oxygenation.

Explanation

Laryngospasm is the most common cause of respiratory arrest in pediatric patients. Laryngospasm refers to the sudden closure of the vocal cords, which can obstruct the airway and lead to respiratory distress or arrest. It can be triggered by various factors such as irritation, infection, or aspiration. Prompt recognition and intervention are crucial in managing laryngospasm to prevent further complications and ensure adequate oxygenation.

99. The first step in the pediatric RSI sequence is….

Preoxygenation with spontaneous ventilation

Application of cricoids pressure

Pretreatment with atropine

Delivery of induction agent

Pretreatment with atropine is the first step in the pediatric RSI sequence. Atropine is administered to children to prevent bradycardia, which can occur during intubation due to stimulation of the vagus nerve. By administering atropine before the induction agent, the risk of bradycardia is minimized, ensuring a safer intubation procedure. Preoxygenation with spontaneous ventilation, application of cricoids pressure, and delivery of the induction agent are important steps in the RSI sequence, but they occur after pretreatment with atropine.

Explanation

Pretreatment with atropine is the first step in the pediatric RSI sequence. Atropine is administered to children to prevent bradycardia, which can occur during intubation due to stimulation of the vagus nerve. By administering atropine before the induction agent, the risk of bradycardia is minimized, ensuring a safer intubation procedure. Preoxygenation with spontaneous ventilation, application of cricoids pressure, and delivery of the induction agent are important steps in the RSI sequence, but they occur after pretreatment with atropine.

100. Neonates and infants have less effective ventilation due to all of the following except what?

Larger tongue and head

Weak intercostals and diaphragmatic musculature

More pliable and horizontal ribs

Protuberant abdomen

Neonates and infants have less effective ventilation due to weak intercostals and diaphragmatic musculature, more pliable and horizontal ribs, and a protuberant abdomen. However, a larger tongue and head does not contribute to their less effective ventilation.

Explanation

Neonates and infants have less effective ventilation due to weak intercostals and diaphragmatic musculature, more pliable and horizontal ribs, and a protuberant abdomen. However, a larger tongue and head does not contribute to their less effective ventilation.

101. When setting an adult vent for pediatric use in pressure controlled mode, which of the following would be inappropriate?

Set I:E ratio 1:2

Pop off limit to vent to 30 cm H2O

VT to minimum of 200 ml/kg/min

All the above are correct

Setting the pop off limit to vent to 30 cm H2O would be inappropriate when setting an adult vent for pediatric use in pressure controlled mode. This is because the pop off limit should be set to a lower value in order to prevent excessive pressure buildup in the pediatric patient's lungs. A higher pop off limit could lead to barotrauma or lung injury. Therefore, the correct answer is to set the pop off limit to a lower value, not 30 cm H2O.

Explanation

Setting the pop off limit to vent to 30 cm H2O would be inappropriate when setting an adult vent for pediatric use in pressure controlled mode. This is because the pop off limit should be set to a lower value in order to prevent excessive pressure buildup in the pediatric patient's lungs. A higher pop off limit could lead to barotrauma or lung injury. Therefore, the correct answer is to set the pop off limit to a lower value, not 30 cm H2O.

102. You are doing an inhalation induction on 6 yr old Tessie when she begins to cough and goes into laryngospasm. She begins to desaturate, how do you treat her?

Apply jaw thrust and positive pressure with 100% O2.

Administer sux 4-6 mg/kg IM

Administer rocuronium 0.6 mg/kg IV

Administer atropine 0.02 mg/kg IM

Laryngospasm is a sudden closure of the vocal cords, which can lead to airway obstruction and desaturation. The most appropriate treatment for laryngospasm is to administer suxamethonium (sux) intramuscularly (IM) at a dose of 4-6 mg/kg. Suxamethonium is a depolarizing neuromuscular blocker that rapidly relaxes the vocal cords and allows for proper ventilation. Applying jaw thrust and positive pressure with 100% oxygen may help maintain oxygenation, but it does not address the underlying laryngospasm. Administering rocuronium or atropine is not indicated in the treatment of laryngospasm.

Explanation

Laryngospasm is a sudden closure of the vocal cords, which can lead to airway obstruction and desaturation. The most appropriate treatment for laryngospasm is to administer suxamethonium (sux) intramuscularly (IM) at a dose of 4-6 mg/kg. Suxamethonium is a depolarizing neuromuscular blocker that rapidly relaxes the vocal cords and allows for proper ventilation. Applying jaw thrust and positive pressure with 100% oxygen may help maintain oxygenation, but it does not address the underlying laryngospasm. Administering rocuronium or atropine is not indicated in the treatment of laryngospasm.

Principles Of Pediatric Anesthesia And care! Trivia Quiz