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WorksheetsPediatrics Exam II
Total questions: 54
Worksheet time: 27mins
What is incorrect about the maternal to fetal blood flow: Aorta - Uterine artery and ovarian artery - arcuate arteries - arcuate vessel -basal and spiral artery - intervillous space - chorionic villi - umbilical arteries - fetus - umbilical vein - mother
Arcuate arteries
Intervillous space
umbilical arteries
chorionic villi
To assist transportation of oxygenation for the fetus, which receptor is immature during fetal develop
2,3 Diphosphoglycerate
Hemoglobin
Iron acetate
4,6 Bisphosphoglyceric acid
Approximately how long can a fetus compensate in utero with hypoxia
5 minutes
20 minutes
45 minutes
15 minutes
Which of the following might decrease the fetal heart rate. select all that apply?
Post term pregnancy
Fetal heart block
Fetal asphyxia
Anesthesia
Maternal fever
What is the single most important characteristic of Fetal heart rate
Rate
Variability
Oxygenation status
Rhythm
Which deceleration on the fetal heart tone monitor is a type III pattern and is associated with cord compression
Early
Late
Variable
Prolonged
What is the normal Breaths per minute in a newborn healthy baby? When does breathing usually begin after delivery?
20- 30 BPM; 30 seconds
30-60 BPM; 90 seconds
30-40 BPM; 90 seconds
30-60 BPM; 30 seconds
Which answer choices are causes persistent pulmonary hypertension in the newborn.
hypoxia
acidosis
profound hypovolemia
hyperthermia
Which is Not a cause of Neonatal Depression
General Anesthesia given to Term mother
Intrauterine prolonged deceleration
Cold hospital room
Acceleration during labor
A baby boy is just 1 minute old his heart rate is 120; He is gasping for air; actively moving; Grimacing; and has a pink truck with cyanotic arms [acrocyanotic]. What is his apgar score?
7
6
8
9
What is the reason we place a pulse oximeter on the right upper extremity?
Pre-ductal blood flow
Convenience
Accurate measurement of portal vein flow
Allows accurate assessment of stronger right ventricle
What is the compression to ventilation ratio for neonates
20:1
3:1
6:1 if intubated
4:1
A baby girl is born with a heart rate of 96, Irregular shallow breaths, Some flexion, Cyanotic, and grimacing what is her Apgar score? What should you do
5; Start CPR
4; Provide fluids and support respiration
3; Start CPR
5; Provide fluids and support respiration
Meconium aspiration happens in 10% to 12% of births, what do you do as a CRNA if the meconium is said to be thick at birth
Amniotic-infusion
Bulb suction the meconium
Direct laryngoscopy with yankauer suction
Direct laryngoscopy intubate, and then suction
Which of the following is NOT a characteristic of Newborns
Non-compliant LV
Long Epiglottis
Anterior/ superior cephalad larynx
Low resistance to air flow
At what gestational age does surfactant production begin?
16-18 weeks
20-22 weeks
24-26 weeks
28-30 weeks
Which of the following statements is false regarding respiratory function of the newborn?
Lung volume is dis-proportionally large in relation to body size
O2 consumption per unit of body weight is twice as high than that of adults
Infants have lower concentration of type I diaphragm muscles
Infants chest walls move inward on inspiration
Neonates greatest loss of heat after birth is
Convection
Evaporation
Conduction
Radiation
What is the average range of normal circulating blood volume in a neonate
70 to 75 ml/kg
75 to 80 ml/kg
85 to 90 ml/kg
95 to 100 ml/kg
At what age does MAC values of volatile Anesthetic agents peak
3 months
6 months
1 Year
At birth
A 1 week newborn 34 week gestation is having difficulty ventilating, you as the SRNA turn up the FiO2 as a last resort. What are most concerned about with high FiO2
Retinopathy of prematurity
Oxy-hemoglobin acid shift
Partial pressure tension of oxygen
Drying out the airway
What is a cause of neonatal respiratory fatigue
Low content of type 1 muscle in the diaphragm
Chest wall stiffness
High content of cartilage making the chest wall floppy
Higher respiratory rate than adults
Pediatric patients depend on which of the following to maintain cardiac output
Heart Rate
Increased Blood Pressure
Increase SVR
Cardiac contractility
After having transfused blood to a 6 month old child what clinical implication must the SRNA be aware of?
Possible calcium replacement
Fluid Overload
Hyperkalemia
Hemolytic Toxic reaction
Which Apgar requires immediate resuscitation efforts by Anesthesia
3
6
8
7
What is a normal systolic blood pressure for a 0-3 month old child
90-120
65-85
85-100
55-65
An appropriate uncuffed ETT in a 4 year old would be what size [mm]? How far would you insert it [cm]?
4.0; 12
4.5; 10
5.0; 12
5.0; 14
Which medication can cause profound bradycardia within the neonate
Atropine
Succinylcholine
Fentanyl
Ketamine
Neonates have what type of rate increase in FA/FI compared to adults?
rapid
same
slower
it depends on the anesthetic
Babies that are large for gestation age are at an increased risk for all of the following except:
Hyperglycemia
Polycythemia
Birth trauma
Congenital malformation
Infants that weigh less than what value [in grams] are considered premature
3000
2720
1500
2500
According to Poiseuille's Law, the most important factor affecting air flow resistance through an ETT is which of the following?
The patients lung capacity
The change in the diameter of the tube
The length of the tube
The patients weight in kilograms
When meconium is noted in the amniotic fluid, the infant is delivered and is vigorous
Suction hypopharynx
Direct Tracheal suction to remove meconium from the airway
Bath the infant
Intubate the infant
Select the three Shunts that aid the fetus in circulating maternal blood?
Ductus Venosus
Foramen Ovale
Ductus Arteriosus
Ductus Splenosus
Oxygenated blood returns from the placenta via the umbilical vein > ductus arteriosus > inferior vena cava > RA > the saturated blood crosses the foramen ovale into the LA (cerebral circulation) > the remaining RV output crosses the ductus venosus. What does this describe?
Fetal circulation
PPHN
Pulmonary hypertension of the newborn
Nothing, because it is incorrect
You perform an ABG on a newborn using the umbilical artery. What ABG interpretation would be an ominous sign of fetal distress?
Metabolic Alkalosis
Metabolic Acidosis
Respiratory Alkalosis
Respiratory Acidosis
What is the APGAR score of a neonate that is pink, HR 90, actively coughing and sneezing, actively moving all extremities, and has irregular, shallow breathing?
4
9
3
8
Why would you avoid drugs that produce negative inotropic and chronotropic effects in infants?
PNS mature at birth, SNS immature until childhood
Low Compliance of Ventricles
Children are dependent on HR to maintain CO
Newborn rely of fetal circulation for blood flow
Blood pressure is the major element for newborn CO
Name three characteristics of the infant that would make ventilation and intubation different from that of an adult?
Infants have a smaller total lung capacity, FRC is decreased, and O2 consumption is increased
Infants have a greater surface area for gas exchange, less of a risk of desaturation, and airway resistance is increased in the central airways
The cartilage in the trachea is immature, chest wall moves outward on inspiration, and lung volume is disproportionately larger in relation to body size
High risk for desaturation, FRC is increased, High content of Type 1 muscle in the diaphragm
Infant has cyanosis and retractions after birth. The infant has more cyanosis at rest but color improves with crying. When you try to pass a suction catheter you are unable to pass it through the nose. This infant has
Choanal Atresia
Meconium Aspiration
Epiglottitis
Congenital Diaphragmatic hernia
When does the the liver P450 enzyme system become fully functional in a baby?
1 month
1 Week
1 day
2 weeks
Which resistant pressure forces blood to return to the placenta
Pulmonary vascular resistance
Right ventricle pressure
Left end diastolic pressure
Ductus Arteriosus
What causes the Foramen Ovale to functional close
Increase in blood flow to the newborn's heart
Increase in Left Ventricular end diastolic pressure
It does not close
Right Ventricular end diastolic pressure
Ductus arteriosus anatomically closes at?
1 to 2 months of life
1 to 3 days of life
1 to 3 weeks of life
it does not close
What causes the Newborn transitional circulation to revert to fetal circulation. Select all that apply
Hypoxia
Hypercarbia
Acidosis
Shock
Hypocarbia
You are the anesthesia provider for a two-month-old infant who has an upper respiratory infection and significant upper airway congestion. Your concern for the infant’s ability to protect her airway is mostly based on which of the following?
Infants are obligate nasal breathers so upper airway congestion prevents adequate air exchange
An upper respiratory infection reduces the risk of successful intubation
An upper respiratory infection reduces the view of the vocal chords
Air trapping from the nasal congestion leads to an increased FRC
A baby weighs 2 kg and is undergoing elap for NEC (Necrotizing Enterocolitis) what is the estimated 3rd space fluid loss resuscitation calculation
3-4 ml
10-12 ml
14-20 ml
6-8 ml
Excessive oral secretions; Regurgitation of feedings; Difficulties swallowing; Respiratory distress exacerbated by feedings; Oral catheter can not be passed into the stomach; Cyanosis and coughing during oral feeding; Life-threatening gastric distention might require one-lung ventilation until it is decompressed Describes what disease?
Tracheoesophageal Fistula
Respiratory Disease
Bronchopulmonar Dyplasia
Laryngeal obstruction
Walking into the pediatric ward you assess your next surgical case; the newborn has a scaphoid abdomen, barrel chest, with positive bowel sounds upon chest auscultation. What do you suspect as the diagnosis?
Congenital Diaphragmatic Hernia
Bronchopulmonary Dyplasia
Respiratory Distress Syndrome
Laryngeal obstruction
Where do want to keep the preductal saturation in congenital diaphragmatic hernia?
85 %
95%
75%
100%
Which pathological condition can you use N2O?
Omphacele
Gastrochisis
Congenital Diaphragmatic hernia
Choanal Atresia
Which diagnosis has signs and symptoms poor feedings, vomiting, malaborption of feedings, lethargy, and blood stools
Necrotizing Enterocolitis
Respiratory Distress
Congenital Diaphragmatic Hernia
Tracheoesophageal Fistula
Which disease that has a midline umbilical sac of gastric content and has a congenital factor associated with it?
Gastrochisis
Omphacele
Imperforate anus
Prune Belly Syndrome
Select all of the disease that are right to left shunt
Tetralogy of Fallot
Ebstein Anomaly
Atrial Septal Defect
Transposition of the great Arteries
Patent Foramen Ovale
