Principles Of Pediatric Anesthesia And care! Trivia Quiz

102 Questions | Total Attempts: 124

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Infant Quizzes & Trivia

Review of material for Principles II quiz 2 on pediatric anesthesia.


Questions and Answers
  • 1. 
    What should be your first action when preparing to do a pre-op assessment on a 3 yr old child?
    • A. 

      Review the chart

    • B. 

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

    • C. 

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

    • D. 

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

  • 2. 
    Which of the following is the most common reason for cancellation of pediatric procedures?
    • A. 

      Asthma Exacerbation

    • B. 

      Upper Respiratory Infections

    • C. 

      Non-compliance with NPO requirements

    • D. 

      Instability due to illness

  • 3. 
    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?
    • A. 

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

    • B. 

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

    • C. 

      Talk to the surgeon regarding possibly cancelling the surgery

    • D. 

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

  • 4. 
    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?
    • A. 

      Not enough information to decide at this time.

    • B. 

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

    • C. 

      Only safe to proceed if pt is given a respiratory treatment and an arterial line inserted to closely monitor hemodynamic stability.

    • D. 

      Yeah, he’s fine. We can proceed!

  • 5. 
    A 2 yr old child may drink milk up to how many hours prior to procedure?
    • A. 

      6 hours

    • B. 

      4 hours

    • C. 

      3 hours

    • D. 

      8 hours

  • 6. 
    A 7 yr old child must not eat solid food for how many hours prior to procedure?
    • A. 

      6 hours

    • B. 

      8 hours

    • C. 

      3 hours

    • D. 

      4 hours

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

      Use of an overhead radiant heating unit

    • B. 

      Use of a water mattress, with circulating warm water

    • C. 

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

    • D. 

      Use a Bair hugger placed on the child’s body

  • 8. 
    What type of breathing circuit would you choose for a child weighing less than 10 kg?
    • A. 

      Small semi-closed Circuit

    • B. 

      Mapleson A

    • C. 

      Standard adult semi closed system

    • D. 

      Jackson-Rees Circuit

  • 9. 
    What type of circuit would you choose for a pediatric patient weighing more than 10 kg?
    • A. 

      Small semi-closed Circuit

    • B. 

      Mapleson A

    • C. 

      Standard adult semi closed system

    • D. 

      Jackson-Rees Circuit

  • 10. 
    When setting an adult vent for pediatric use in pressure controlled mode, which of the following would be inappropriate?
    • A. 

      Set I:E ratio 1:2

    • B. 

      Pop off limit to vent to 30 cm H2O

    • C. 

      VT to minimum of 200 ml/kg/min

    • D. 

      All the above are correct

  • 11. 
    What would be an appropriate size LMA for an infant weighing 9 kg?
    • A. 

      0.5

    • B. 

      1

    • C. 

      1.5

    • D. 

      2.5

  • 12. 
    What would be an appropriate size LMA for a child weighing 27 kg?
    • A. 

      3

    • B. 

      1.5

    • C. 

      4

    • D. 

      2.5

  • 13. 
    What would be an appropriate sized ETT for a 3 yr old child weighing 18 kg?
    • A. 

      4.5

    • B. 

      4

    • C. 

      3.5

    • D. 

      3

  • 14. 
    What would be an appropriate size ETT for a 9 yr old child weighing  33 kg?
    • A. 

      5

    • B. 

      6

    • C. 

      4.5

    • D. 

      7

  • 15. 
    What size laryngoscope blade would you choose to intubate an 8  yr old child?
    • A. 

      1.5 mil

    • B. 

      3 mac

    • C. 

      2.5 mil

    • D. 

      2 mac

  • 16. 
    In order to work well EMLA cream must be applied at least how many minutes prior to IV start?
    • A. 

      45 minutes

    • B. 

      2 hours

    • C. 

      30 minutes

    • D. 

      15 minutes

  • 17. 
    What is an appropriate hourly maintenance fluid rate for a child weighing 15 kg?
    • A. 

      60 ml

    • B. 

      50 ml

    • C. 

      25 ml

    • D. 

      15 ml

  • 18. 
    When doing a pedi drug set up, it is recommended to draw up your drugs in ‘unit dose’ syringes.
    • A. 

      True

    • B. 

      False

  • 19. 
    What would be an appropriate dose of pre-op versed for a 6 yr old child weighing 24 kg?
    • A. 

      24 mg IV

    • B. 

      6 mg PO

    • C. 

      12 mg PO

    • D. 

      48 mg PO

  • 20. 
    How much Ketamine (in dart form) should be given for pre-op sedation of a child weighing 15 kg?
    • A. 

      10 mg

    • B. 

      5 mg

    • C. 

      60 mg

    • D. 

      30 mg

  • 21. 
    The majority of pediatric cardiac arrests occur when?
    • A. 

      Induction

    • B. 

      Maintenance

    • C. 

      Emergence

    • D. 

      Rates are equal during all 3 phases

  • 22. 
    Most pediatric arrests are due to ________ causes in children.
    • A. 

      Cardiac

    • B. 

      Respiratory

    • C. 

      Congenital defects

    • D. 

      Circulatory collapse

  • 23. 
    What is the most common cause of respiratory arrest in pediatric patients?
    • A. 

      Airway Obstruction

    • B. 

      Difficult intubation

    • C. 

      Laryngospasm

    • D. 

      Bronchospasm

  • 24. 
    Which of the following is not a risk factor associated with cardiac arrests in the pediatric patient?
    • A. 

      Emergency Surgery

    • B. 

      ASA 3-5

    • C. 

      Congenital Airway Deformities

    • D. 

      Children 1-4 yrs old

  • 25. 
    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?
    • A. 

      Approach the parent and attempt to calm him first

    • B. 

      Come back later when both are feeling a bit better

    • C. 

      Approach the child, and attempt to calm him first.

    • D. 

      Give the child some versed.

  • 26. 
    A child with a recent URI would be at an increased risk for all of the following except:
    • A. 

      Laryngospasm

    • B. 

      Pneumonia

    • C. 

      Atelectasis

    • D. 

      Wheezing

  • 27. 
    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.
    • A. 

      True

    • B. 

      False

  • 28. 
    You are auscultating heart sounds on a 7 yr old child and hear a short, soft, systolic murmur.  How would you classify this murmur?
    • A. 

      Pathologic

    • B. 

      Detrimental

    • C. 

      Innocent

    • D. 

      None of above

  • 29. 
    What pre-op medication would you choose for a 3 week old child, who weighs 4 kg, undergoing  surgery to  correct a pyloric stenosis?
    • A. 

      Ketamine 8 mg IM

    • B. 

      Versed 0.4 mg IM

    • C. 

      Fentanyl lollipop 40 mcg PO

    • D. 

      Atropine 0.08 mg IM

  • 30. 
    When monitoring the pediatric patient, where should the precordial stethoscope be placed?
    • A. 

      Left sternal border 2nd or 3rd intercostals space

    • B. 

      Right sterna border 2nd or 3rd intercostals space

    • C. 

      Left midclavicular line 5th intercostals space

    • D. 

      Depends upon what you are trying to monitor

  • 31. 
    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. 

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

    • B. 

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

    • C. 

      Twitch monitor should be placed along ulnar nerve at the wrist

    • D. 

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

  • 32. 
    The best way to administer an IV fluid bolus to an infant is through use of a pressure bag to administer fluid quickly.
    • A. 

      True

    • B. 

      False

  • 33. 
    Which of the following children would likely experience the greatest amount of separation anxiety?
    • A. 

      A 4 month old child

    • B. 

      An 11 month old child

    • C. 

      A 5 yr old child

    • D. 

      A 13 yr old child

  • 34. 
    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?
    • A. 

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

    • B. 

      Stand next to the child, as they sit on the side of the OR table and then apply the mask to induce.

    • C. 

      Have the child sit in center of OR table while you sit nearby and wrap your arm around child to induce via mask inhalation.

    • D. 

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

  • 35. 
    For a normal inhalational induction your N2O should be at ______ and your O2 should be at ________ to start out with.
    • A. 

      70%, 30%

    • B. 

      50%, 50%

    • C. 

      40%, 60%

    • D. 

      0 %, 100 %

  • 36. 
    What size IV catheter would be best to use on a 3 yr old child?
    • A. 

      24

    • B. 

      22

    • C. 

      20

    • D. 

      18

  • 37. 
    During an inhalational induction, once your pediatric patient is tubed your first priority should be…
    • A. 

      Inserting the precordial stethoscope

    • B. 

      Applying nerve monitor to assess paralysis

    • C. 

      Starting an IV

    • D. 

      Turning up the sevo higher

  • 38. 
    Which of the following is incorrect regarding maintenance of survival position?
    • A. 

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

    • B. 

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

    • C. 

      Fingers should be placed on bony prominence of face

    • D. 

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

  • 39. 
    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?  
    • A. 

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

    • B. 

      IV must be placed prior to procedure for safe induction.

    • C. 

      IM induction with ketamine

    • D. 

      None of above are appropriate

  • 40. 
    The first step in the pediatric RSI sequence is….
    • A. 

      Preoxygenation with spontaneous ventilation

    • B. 

      Application of cricoids pressure

    • C. 

      Pretreatment with atropine

    • D. 

      Delivery of induction agent

  • 41. 
    What would be an appropriate IM stun dose ketamine for a 14 yr old boy weighing 40 kg?
    • A. 

      320 mg

    • B. 

      200 mg

    • C. 

      160 mg

    • D. 

      80 mg

  • 42. 
    The MAC for all anesthetic agents are highest at what age?
    • A. 

      6-12 months

    • B. 

      4-6 yrs

    • C. 

      1-4 yrs

    • D. 

      0-6 months

  • 43. 
    Which of the following inhalational anesthetic agents may cause bradycardia, vasodilation and myocardial depression in infants?
    • A. 

      Desflurane

    • B. 

      Isoflurane

    • C. 

      Sevoflurane

    • D. 

      Opioids

  • 44. 
    Which of the inhalational agents had the highest incidence of  emergence delirum?
    • A. 

      Sevoflurane

    • B. 

      Isoflurane

    • C. 

      Desflurane

    • D. 

      Halothane

  • 45. 
    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?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 46. 
    High dose opioid therapy during maintenance of anesthesia may be appropriate for which of the following?
    • A. 

      Child with cardiac instability who requires surgical intervention

    • B. 

      Pt who will be extubated after surgery and requires pain control

    • C. 

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

    • D. 

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

  • 47. 
    Which of the following children is the best candidate for a deep extubation?
    • A. 

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

    • B. 

      A 9 yr old healthy child with asthma (no attacks in one year and no wheezes) having a minor elective procedure, spontaneous ventilation maintained throughout procedure

    • C. 

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

    • D. 

      A 7 yr old child who came for emergent appendectomy

  • 48. 
    Which of the following properly describes the Sundown Sign?
    • A. 

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

    • B. 

      A sign commonly seen in pts with a PPFO where the pt will turn blue (sundown) while coughing or bucking and creating a temporary shunt.

    • C. 

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

    • D. 

      Just before waking up when the child begins to move and both feet point down as their back arches upward due to stimulation from ETT.

  • 49. 
    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?
    • A. 

      Laryngospasm

    • B. 

      Bronchospasm

    • C. 

      Pulmonary Hypertension

    • D. 

      PPFO

  • 50. 
    Which of the following is not helpful in preventing laryngospasm?
    • A. 

      Suction secretions immediately after extubation

    • B. 

      Extubate deep

    • C. 

      Extubate totally awake

    • D. 

      Immediately after extubation, stretch the larynx

  • 51. 
    A normal healthy child may be transported to PACU without any supplemental oxygen.
    • A. 

      True

    • B. 

      False

  • 52. 
    Which of the following is not part of stage 2 PACU’s standard monitoring?
    • A. 

      Heart Rate

    • B. 

      Fluid Balance

    • C. 

      O2 Sat

    • D. 

      Blood pressure

  • 53. 
    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?
    • A. 

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

    • B. 

      Cancel the surgery.

    • C. 

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

    • D. 

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

  • 54. 
    Inhalational induction should not be done on children with asthma due to increased risk of bronchospasm. 
    • A. 

      True

    • B. 

      False

  • 55. 
    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?
    • A. 

      Deliver 100% FiO2

    • B. 

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

    • C. 

      Turn off anesthetic and start propofol gtt to maintain anesthesia

    • D. 

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

  • 56. 
    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?
    • A. 

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

    • B. 

      Extubate deep to help prevent laryngospasm

    • C. 

      Deliver another albuterol treatment and extubate fully awake

    • D. 

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

  • 57. 
    What is the most important factor when examining a patient with cystic fibrosis?
    • A. 

      Asking parent about age of onset and severity of illness.

    • B. 

      The physical exam, and checking for signs of chronic hypoxia

    • C. 

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

    • D. 

      Check labs and ECG results

  • 58. 
    Which of the following is not true regarding children with cystic fibrosis?
    • A. 

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

    • B. 

      You will almost always hear rhonchi and wheezes with these patient

    • C. 

      ETT placement may increase airway swelling and thus these patients are much better to have LMA’s and spontaneous ventilations if at all possible

    • D. 

      N2O should be avoided with these patients

  • 59. 
    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?
    • A. 

      Inhalational induction

    • B. 

      Awake intubation

    • C. 

      Give atropine pre-op and then do IM induction

    • D. 

      Rapid sequence induction with succinylcholine

  • 60. 
    When placing a nerve stimulator on a child with cerebral palsy, which of the following is true?
    • A. 

      The nerve stimulator should be placed on a spastic extremity as these are best indicators of childs TRUE response to NMB

    • B. 

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

    • C. 

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

    • D. 

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

  • 61. 
    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?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 62. 
    Which of the following is not commonly associated with Trisomy 21?
    • A. 

      Endocardial Cushion Defects

    • B. 

      Hirschsprungs disease

    • C. 

      Frequent upper respiratory infections

    • D. 

      Stiff joints and neck resulting in limited mobility

  • 63. 
    What is the most important componenent of the physical exam for down syndrome patients?
    • A. 

      Airway examination and neck stability

    • B. 

      Assessing degree of mental retardation

    • C. 

      Obtaining history from parents regarding any heart conditions

    • D. 

      Assessing for reflux and sings of URI

  • 64. 
    Which of the following is not true regarding pre-op treatment of a patient with down syndrome?
    • A. 

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

    • B. 

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

    • C. 

      Patients with heart disease should receive antibiotic prophylaxis against SBE

    • D. 

      All the above are true

  • 65. 
    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?
    • A. 

      Propofol gtt for maintenance

    • B. 

      Inhalational induction and standard anesthetic management

    • C. 

      Ketamine IV for maintenance

    • D. 

      Versed and Fentanyl for maintenance

  • 66. 
    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?
    • A. 

      Via retrograde intubation

    • B. 

      Awake intubation, with airway numbed

    • C. 

      Use LMA fasttrach to place ETT

    • D. 

      Fiberoptic nasal intubation

  • 67. 
    Which of the following is not true regarding muscular dystrophy patients?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 68. 
    Which of the following is not true regarding management of a patient with sickle cell disease?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 69. 
    Which of the following is not true regarding management of a patient with hemophilia?
    • A. 

      Nasal intubations are contraindicated

    • B. 

      Regional anesthesia is contraindicated

    • C. 

      IM injection is preferred since IV sticks may cause bleeding

    • D. 

      Transfusions should be done immediately preceding surgery

  • 70. 
    Which of the following children would be at an increased risk Latex Allergy
    • A. 

      Nika who is allergic to Egg yolk

    • B. 

      Tyler, whose mom is a nurse

    • C. 

      Charlie who has muscular dystrophy

    • D. 

      Olivia who has spina bifida

  • 71. 
    What would be appropriate pre-op medication for a child with a latex allergy?
    • A. 

      Benadryl 1mg/kg PO

    • B. 

      Prednisone 1 mg/kg PO

    • C. 

      Zantac 1-2mg/kg PO

    • D. 

      All the above

  • 72. 
    What should be your first action for a suspected anaphylactic response during anesthesia?
    • A. 

      Switch to 100% O2

    • B. 

      Discontinue anesthetics and any antibiotic or blood infusions

    • C. 

      Give epi 0.5-5mcg/kg IV

    • D. 

      Give benedryl 0.5-1 mg/kg IV

  • 73. 
    In the pediatric population, the greatest amount of heat loss during surgery comes from…
    • A. 

      Conduction

    • B. 

      Radiation

    • C. 

      Convection

    • D. 

      All above are equal contributors to heat loss.

  • 74. 
    Why is it not safe to use an adult semi-closed system on an infant who weighs less than 10 kg?
    • A. 

      Too much pressure, risk of barotrauma

    • B. 

      Too large, circuit will not fit the pedi ETT properly

    • C. 

      Too much dead space, and increased work of breathing

    • D. 

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

  • 75. 
    How is the pediatric airway different from that of adults?
    • A. 

      Airway has smaller tongue and very stiff epiglottis making visualization difficult

    • B. 

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

    • C. 

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

    • D. 

      None of above

  • 76. 
    At how much pressure should you observe an air leak in pediatric ETT’s?
    • A. 

      No air leak should be observed

    • B. 

      Air leak obersved at 5-10 cm H2O

    • C. 

      Air leak observed at 15-20 cm H2O

    • D. 

      Air leak observed at 25-30 cm H2O

  • 77. 
    What IM emergency drugs should you always have available for pediatric inhalation induction (assuming child has no IV access)? TWO ANSWERS
    • A. 

      Sux 5 mg/kg

    • B. 

      Ephedrine 750 mcg/kg

    • C. 

      Lidocaine 1.5 mg/kg

    • D. 

      Atropine 0.02 mg/kg

  • 78. 
    At what level is the larynx located in infants?
    • A. 

      C4

    • B. 

      C5

    • C. 

      C2

    • D. 

      C3

  • 79. 
    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?
    • A. 

      Apply jaw thrust and positive pressure with 100% O2.

    • B. 

      Administer sux 4-6 mg/kg IM

    • C. 

      Administer rocuronium 0.6 mg/kg IV

    • D. 

      Administer atropine 0.02 mg/kg IM

  • 80. 
    Which of the following properly describes the most common preceding events to a pediatric cardiac arrest?
    • A. 

      Tachypnea, Tachycardia, Tachyphylaxis

    • B. 

      Hypotension, Tachycardia, Muscle rigidity

    • C. 

      Hypoxia, tachypnea, wheezing, tachycardia

    • D. 

      Hypotension, Bradycardia, Low O2 sat

  • 81. 
    Neonates and infants have less effective ventilation due to all of the following except what?
    • A. 

      Larger tongue and head

    • B. 

      Weak intercostals and diaphragmatic musculature

    • C. 

      More pliable and horizontal ribs

    • D. 

      Protuberant abdomen

  • 82. 
    Due to decreased FRC, infants are more prone to all of the following except:
    • A. 

      Atelectasis

    • B. 

      Laryngospasm

    • C. 

      Hypoxemia and rapid desaturation

    • D. 

      All the above

  • 83. 
    What response will infants typically have to exogenously administered catecholamines such as ephedrine?
    • A. 

      Exagerrated response and risk for subdural hemorrhage

    • B. 

      Infants and kids respond in same manner as adults would

    • C. 

      Blunted response due to lower catecholamine stores

    • D. 

      More prone to allergic and anaphylactic responses

  • 84. 
    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?
    • A. 

      Begin immediate treatment for MH as you run code

    • B. 

      Run standard code and administer 100% O2 as you ventilate

    • C. 

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

    • D. 

      Immediately begin treatment for hyperkalemia as you run code

  • 85. 
    What is the overall incidence of cardiac arrest in the pediatric population?
    • A. 

      1.4 per 10,000

    • B. 

      2.7 per 100,000

    • C. 

      0.5 per 1,000

    • D. 

      16 per 1,000,000

  • 86. 
    In children, ETCO2 is particularly important to monitor because of which of the following reasons?
    • A. 

      Will give you earliest indication of MH

    • B. 

      Will detect hypoxia which is most common cause of pediatric arrest

    • C. 

      Allows to asses adequacy of your ventilation

    • D. 

      All the above

  • 87. 
    Which of the following is not an advantage associated with IV induction?
    • A. 

      Helps to avoid cardiac depressant effects of VAA

    • B. 

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

    • C. 

      Helps to avoid airway problems associated with inhalational induction

    • D. 

      Allows for safer induction for emergent procedures

  • 88. 
    Halothane causes more myocardial depression than any of the other inhlational agents and increases risk of arrhythmia associated with epinephrine by 4 times.
    • A. 

      True

    • B. 

      False

  • 89. 
    The preferred combination of narcotics and inhalational agents, commonly the “bread and butter” of many ped anesthetists is ______  & _________.
    • A. 

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

    • B. 

      2-4 mcg/kg fentanyl & propfol gtt

    • C. 

      0.25-0.5 mcg/kg Dilaudid and 0.3 MAC sevoflurane

    • D. 

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

  • 90. 
    What side effect is commonly associated with fentanyl that we are concerned about during anesthesia?
    • A. 

      Myocardial depression

    • B. 

      Chest Wall Rigidity

    • C. 

      Renal Toxicity

    • D. 

      Cytochrome P450 induction

  • 91. 
    What is the incidence of Malignant Hyperthermia in children?
    • A. 

      1: 50,000

    • B. 

      1: 100,000

    • C. 

      1: 15,000

    • D. 

      1: 250,000

  • 92. 
    Malignant Hyperthermia is a severe reaction which results in ryanodine receptor activation leading to…
    • A. 

      Intracellular Hyperkalemia

    • B. 

      Intracellular Hypernatremia

    • C. 

      Intracellular Hypercalcemia

    • D. 

      Intracellular Hyperglycemia

  • 93. 
    Which of the following will not trigger Malignant Hyperthermia?
    • A. 

      Desflurane

    • B. 

      Succinylcholine

    • C. 

      Isoflurane

    • D. 

      Vecuronium

  • 94. 
    Which of the following disease states is associated with an increased risk of Malignant hyperthermia?
    • A. 

      Cystic Fibrosis

    • B. 

      Muscular Dystrophy

    • C. 

      Sickle Cell Anemia

    • D. 

      Latex Allergy

  • 95. 
    What would be an appropriate starting dose of dantrolene to give to a 3 yr old child weighing 14 kg?
    • A. 

      14 mg

    • B. 

      140 mg

    • C. 

      35 mg

    • D. 

      280 mg

  • 96. 
    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?
    • A. 

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

    • B. 

      Administer sux to break laryngospasm

    • C. 

      Give albuterol 4 puffs via ETT

    • D. 

      Call code and begin PALS protocol

  • 97. 
    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.
    • A. 

      Propofol

    • B. 

      Ketamine

    • C. 

      Inhalational induction with Sevoflurane

    • D. 

      Fentanyl & Versed

  • 98. 
    Approximately what percentage of children with down syndrome will have associated cardiac anomalies?
    • A. 

      5-15%

    • B. 

      65-75%

    • C. 

      40-60%

    • D. 

      80-95%

  • 99. 
    Why are patients with muscular dystrophy more prone to cardiac arrhythmias?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 100. 
    Which of the following is not a sign of latex allergy?
    • A. 

      Bradycardia and arrhythmias

    • B. 

      Laryngeal Edema

    • C. 

      Pruritis

    • D. 

      Bronchospasm

  • 101. 
    Which of the following reasons explains why opioids appear to be more potent in neonates?
    • A. 

      Easier entry across blood brain barrier

    • B. 

      Decreased metabolic capabilities

    • C. 

      Increased sensitivity of respiratory centers

    • D. 

      All the above

  • 102. 
    COMIC RELIEF: 911 Fail
    • A. 

      A warthog? Where the heck would you run across those

    • B. 

      Ha ha ha!! Spelling is a wonderful thing

    • C. 

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

    • D. 

      All the above