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Pediatrics Exam II

Total questions: 54

Worksheet time: 27mins

Name
Class
Date
1.

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

a)

Arcuate arteries

b)

Intervillous space

c)

umbilical arteries

d)

chorionic villi

2.

To assist transportation of oxygenation for the fetus, which receptor is immature during fetal develop

a)

2,3 Diphosphoglycerate

b)

Hemoglobin

c)

Iron acetate

d)

4,6 Bisphosphoglyceric acid

3.

Approximately how long can a fetus compensate in utero with hypoxia

a)

5 minutes

b)

20 minutes

c)

45 minutes

d)

15 minutes

4.

Which of the following might decrease the fetal heart rate. select all that apply?

a)

Post term pregnancy

b)

Fetal heart block

c)

Fetal asphyxia

d)

Anesthesia

e)

Maternal fever

5.

What is the single most important characteristic of Fetal heart rate

a)

Rate

b)

Variability

c)

Oxygenation status

d)

Rhythm

6.

Which deceleration on the fetal heart tone monitor is a type III pattern and is associated with cord compression

a)

Early

b)

Late

c)

Variable

d)

Prolonged

7.

What is the normal Breaths per minute in a newborn healthy baby? When does breathing usually begin after delivery?

a)

20- 30 BPM; 30 seconds

b)

30-60 BPM; 90 seconds

c)

30-40 BPM; 90 seconds

d)

30-60 BPM; 30 seconds

8.

Which answer choices are causes persistent pulmonary hypertension in the newborn.

a)

hypoxia

b)

acidosis

c)

profound hypovolemia

d)

hyperthermia

9.

Which is Not a cause of Neonatal Depression

a)

General Anesthesia given to Term mother

b)

Intrauterine prolonged deceleration

c)

Cold hospital room

d)

Acceleration during labor

10.

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?

a)

7

b)

6

c)

8

d)

9

11.

What is the reason we place a pulse oximeter on the right upper extremity?

a)

Pre-ductal blood flow

b)

Convenience

c)

Accurate measurement of portal vein flow

d)

Allows accurate assessment of stronger right ventricle

12.

What is the compression to ventilation ratio for neonates

a)

20:1

b)

3:1

c)

6:1 if intubated

d)

4:1

13.

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

a)

5; Start CPR

b)

4; Provide fluids and support respiration

c)

3; Start CPR

d)

5; Provide fluids and support respiration

14.

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

a)

Amniotic-infusion

b)

Bulb suction the meconium

c)

Direct laryngoscopy with yankauer suction

d)

Direct laryngoscopy intubate, and then suction

15.

Which of the following is NOT a characteristic of Newborns

a)

Non-compliant LV

b)

Long Epiglottis

c)

Anterior/ superior cephalad larynx

d)

Low resistance to air flow

16.

At what gestational age does surfactant production begin?

a)

16-18 weeks

b)

20-22 weeks

c)

24-26 weeks

d)

28-30 weeks

17.

Which of the following statements is false regarding respiratory function of the newborn?

a)

Lung volume is dis-proportionally large in relation to body size

b)

O2 consumption per unit of body weight is twice as high than that of adults

c)

Infants have lower concentration of type I diaphragm muscles

d)

Infants chest walls move inward on inspiration

18.

Neonates greatest loss of heat after birth is

a)

Convection

b)

Evaporation

c)

Conduction

d)

Radiation

19.

What is the average range of normal circulating blood volume in a neonate

a)

70 to 75 ml/kg

b)

75 to 80 ml/kg

c)

85 to 90 ml/kg

d)

95 to 100 ml/kg

20.

At what age does MAC values of volatile Anesthetic agents peak

a)

3 months

b)

6 months

c)

1 Year

d)

At birth

21.

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

a)

Retinopathy of prematurity

b)

Oxy-hemoglobin acid shift

c)

Partial pressure tension of oxygen

d)

Drying out the airway

22.

What is a cause of neonatal respiratory fatigue

a)

Low content of type 1 muscle in the diaphragm

b)

Chest wall stiffness

c)

High content of cartilage making the chest wall floppy

d)

Higher respiratory rate than adults

23.

Pediatric patients depend on which of the following to maintain cardiac output

a)

Heart Rate

b)

Increased Blood Pressure

c)

Increase SVR

d)

Cardiac contractility

24.

After having transfused blood to a 6 month old child what clinical implication must the SRNA be aware of?

a)

Possible calcium replacement

b)

Fluid Overload

c)

Hyperkalemia

d)

Hemolytic Toxic reaction

25.

Which Apgar requires immediate resuscitation efforts by Anesthesia

a)

3

b)

6

c)

8

d)

7

26.

What is a normal systolic blood pressure for a 0-3 month old child

a)

90-120

b)

65-85

c)

85-100

d)

55-65

27.

An appropriate uncuffed ETT in a 4 year old would be what size [mm]? How far would you insert it [cm]?

a)

4.0; 12

b)

4.5; 10

c)

5.0; 12

d)

5.0; 14

28.

Which medication can cause profound bradycardia within the neonate

a)

Atropine

b)

Succinylcholine

c)

Fentanyl

d)

Ketamine

29.

Neonates have what type of rate increase in FA/FI compared to adults?

a)

rapid

b)

same

c)

slower

d)

it depends on the anesthetic

30.

Babies that are large for gestation age are at an increased risk for all of the following except:

a)

Hyperglycemia

b)

Polycythemia

c)

Birth trauma

d)

Congenital malformation

31.

Infants that weigh less than what value [in grams] are considered premature

a)

3000

b)

2720

c)

1500

d)

2500

32.

According to Poiseuille's Law, the most important factor affecting air flow resistance through an ETT is which of the following?

a)

The patients lung capacity

b)

The change in the diameter of the tube

c)

The length of the tube

d)

The patients weight in kilograms

33.

When meconium is noted in the amniotic fluid, the infant is delivered and is vigorous

a)

Suction hypopharynx

b)

Direct Tracheal suction to remove meconium from the airway

c)

Bath the infant

d)

Intubate the infant

34.

Select the three Shunts that aid the fetus in circulating maternal blood?

a)

Ductus Venosus

b)

Foramen Ovale

c)

Ductus Arteriosus

d)

Ductus Splenosus

35.

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?

a)

Fetal circulation

b)

PPHN

c)

Pulmonary hypertension of the newborn

d)

Nothing, because it is incorrect

36.

You perform an ABG on a newborn using the umbilical artery. What ABG interpretation would be an ominous sign of fetal distress?

a)

Metabolic Alkalosis

b)

Metabolic Acidosis

c)

Respiratory Alkalosis

d)

Respiratory Acidosis

37.

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?

a)

4

b)

9

c)

3

d)

8

38.

Why would you avoid drugs that produce negative inotropic and chronotropic effects in infants?

a)

PNS mature at birth, SNS immature until childhood

b)

Low Compliance of Ventricles

c)

Children are dependent on HR to maintain CO

d)

Newborn rely of fetal circulation for blood flow

e)

Blood pressure is the major element for newborn CO

39.

Name three characteristics of the infant that would make ventilation and intubation different from that of an adult?

a)

Infants have a smaller total lung capacity, FRC is decreased, and O2 consumption is increased

b)

Infants have a greater surface area for gas exchange, less of a risk of desaturation, and airway resistance is increased in the central airways

c)

The cartilage in the trachea is immature, chest wall moves outward on inspiration, and lung volume is disproportionately larger in relation to body size

d)

High risk for desaturation, FRC is increased, High content of Type 1 muscle in the diaphragm

40.

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

a)

Choanal Atresia

b)

Meconium Aspiration

c)

Epiglottitis

d)

Congenital Diaphragmatic hernia

41.

When does the the liver P450 enzyme system become fully functional in a baby?

a)

1 month

b)

1 Week

c)

1 day

d)

2 weeks

42.

Which resistant pressure forces blood to return to the placenta

a)

Pulmonary vascular resistance

b)

Right ventricle pressure

c)

Left end diastolic pressure

d)

Ductus Arteriosus

43.

What causes the Foramen Ovale to functional close

a)

Increase in blood flow to the newborn's heart

b)

Increase in Left Ventricular end diastolic pressure

c)

It does not close

d)

Right Ventricular end diastolic pressure

44.

Ductus arteriosus anatomically closes at?

a)

1 to 2 months of life

b)

1 to 3 days of life

c)

1 to 3 weeks of life

d)

it does not close

45.

What causes the Newborn transitional circulation to revert to fetal circulation. Select all that apply

a)

Hypoxia

b)

Hypercarbia

c)

Acidosis

d)

Shock

e)

Hypocarbia

46.

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?

a)

Infants are obligate nasal breathers so upper airway congestion prevents adequate air exchange

b)

An upper respiratory infection reduces the risk of successful intubation

c)

An upper respiratory infection reduces the view of the vocal chords

d)

Air trapping from the nasal congestion leads to an increased FRC

47.

A baby weighs 2 kg and is undergoing elap for NEC (Necrotizing Enterocolitis) what is the estimated 3rd space fluid loss resuscitation calculation

a)

3-4 ml

b)

10-12 ml

c)

14-20 ml

d)

6-8 ml

48.

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?

a)

Tracheoesophageal Fistula

b)

Respiratory Disease

c)

Bronchopulmonar Dyplasia

d)

Laryngeal obstruction

49.

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?

a)

Congenital Diaphragmatic Hernia

b)

Bronchopulmonary Dyplasia

c)

Respiratory Distress Syndrome

d)

Laryngeal obstruction

50.

Where do want to keep the preductal saturation in congenital diaphragmatic hernia?

a)

85 %

b)

95%

c)

75%

d)

100%

51.

Which pathological condition can you use N2O?

a)

Omphacele

b)

Gastrochisis

c)

Congenital Diaphragmatic hernia

d)

Choanal Atresia

52.

Which diagnosis has signs and symptoms poor feedings, vomiting, malaborption of feedings, lethargy, and blood stools

a)

Necrotizing Enterocolitis

b)

Respiratory Distress

c)

Congenital Diaphragmatic Hernia

d)

Tracheoesophageal Fistula

53.

Which disease that has a midline umbilical sac of gastric content and has a congenital factor associated with it?

a)

Gastrochisis

b)

Omphacele

c)

Imperforate anus

d)

Prune Belly Syndrome

54.

Select all of the disease that are right to left shunt

a)

Tetralogy of Fallot

b)

Ebstein Anomaly

c)

Atrial Septal Defect

d)

Transposition of the great Arteries

e)

Patent Foramen Ovale