In the premature newborn, the glottis is at which level relative to the cervical spine?

A 5‑month‑old infant is scheduled for an elective operative reduction of a right inguinal hernia. Spinal anesthesia is performed. The first sign of a high spinal block in this patient would be

What percentage of a term newborn’s total body weight consists of water?

Which of the following patients is LEAST likely to develop retinopathy of prematurity (ROP)?

A 4‑week‑old male infant is brought to the emergency room with projectile vomiting. At the time of admission, the patient is lethargic, with a respiratory rate of 16 breaths/min and has had no urine output in the preceding 3 hours. A diagnosis of pyloric stenosis is made, and the infant is brought emergently to the operating room (OR) for pyloromyotomy. The MOST appropriate anesthetic management would be

Which figure of esophageal atresia (EA) or tracheoesophageal fistula (TEF) is the MOST common?

The predicted blood volume in a 3‑kg term newborn is

An 11‑month‑old infant is to undergo a craniosynostosis repair. The surgeon and anesthesiologist agreed to start transfusing blood when the hemoglobin fell to 8 g/dL (hematocrit [Hct] of 24%). Using the transfusion threshold of a hemoglobin of 8, what is the maximum allowable blood loss (MABL) for this 10‑kg infant whose initial Hct is 32 and the minimal acceptable Hct is 24?

What volume of packed red blood cells (PRBCs) with an Hct of 60 is needed to raise the Hct from 18 to 24 in a 10‑kg 11‑month‑old?

Reasons for selecting a cuffed endotracheal tube (ETT) over an uncuffed ETT include all of the following EXCEPT

An otherwise healthy 4-year-old male patient is undergoing elective tonsillectomy. Before induction of general anesthesia, the patient is breathing at a rate of 20 breaths/min. An inhalation induction is begun with 8% sevoflurane, 50% nitrous oxide, and oxygen. Sixty seconds later, the patient is noted to breathe at a rate of 40 breaths/min, and the heart rate is 160. This rapid respiratory rate with tachycardia most likely represents

A healthy 3‑kg, 1‑month‑old neonate is anesthetized for an inguinal hernia repair. An inhalation induction with sevoflurane is carried out, and the patient is intubated. Before the surgical incision, the systolic blood pressure is noted to be 65 mm Hg and the heart rate is 150 beats/min. The most appropriate intervention for this patient’s blood pressure would be

A 5‑year‑old boy is anesthetized for elective repair of an umbilical hernia. General anesthesia is induced and maintained with sevoflurane, nitrous oxide, and oxygen via an anesthesia mask. At the conclusion of the operation, the patient is taken to the recovery room and subsequently discharged to the outpatient ward. Before discharge, the patient’s mother notes that the urine appears dark brown (cola‑colored). The most appropriate action at this time would be

At what maximum inspiratory pressure should a cuffed ETT leak be present in a child (leak test)?

A premature newborn delivered at 32 weeks of gestation is brought to the OR 5 days after delivery for repair of a left‑sided congenital diaphragmatic hernia (CDH). The newborn has a nasogastric tube in place, is intubated, and is stable with mechanical ventilation at peak airway pressures < 25 cm H2O. Thirty minutes after induction of general anesthesia, the anesthesiologist notes significant difficulty with adequate ventilation. The SaO2 subsequently falls to 65%, and the heart rate decreases to 50 beats/min. What would be the most appropriate step to take at this time?

An 8‑year‑old boy, who weighs 30 kg, was found at the site of a motor vehicle accident (MVA). He has arrived in the OR for exploratory laparotomy. He has not received any sedation or pain medication because he appeared “confused and lethargic.” He has a normal blood pressure, is tachycardic with thready distal pulses, and has cold extremities. In spite of a 20 mL/kg fluid bolus, the patient has produced only 5 mL of urine. What is the approximate percentage of blood volume loss in this patient?

In a 6‑year‑old child, the distance an oral ETT should be placed (from the gums to the midtrachea) most often is

Which of the following is the most suitable intraoperative replacement fluid for a 3‑year‑old, 14‑kg child who has been NPO for 10 hours and will be undergoing repair of clubfeet?

An otherwise healthy 14‑day‑old neonate is transported to the OR well hydrated for surgery for a bowel obstruction. A rapid‑sequence induction is planned. Compared with the adult dose, the intravenous (IV) dose of succinylcholine administered to this patient should be

You receive a call from the preoperative nurse stating that the child you will be caring for with type 1 diabetes mellitus has a preoperative blood glucose value of 300 mg/dL. He has been NPO for the morning and has not had any rapid‑onset or short‑acting insulin. The child typically uses a total of 30 units of insulin a day. How much rapid‑onset or short‑acting insulin should you give the child to reduce the blood sugar to 150 mg/dL?

A 10‑week‑old infant born at 31 weeks’ gestation is anesthetized for repair of an inguinal hernia. General anesthesia is induced by mask with sevoflurane, an ETT is placed, and anesthesia is maintained with sevoflurane and oxygen. What is the best postoperative pain management for this patient?

A 6‑year‑old, 20‑kg girl develops pulseless ventricular tachycardia (pVT) after induction of general anesthesia for a tonsillectomy. The anesthesiologist intubates the child, administers 100% oxygen, and starts chest compressions. When the biphasic defibrillator quickly arrives in the OR and is attached to the child, the defibrillator should be charged to what energy level for the initial shock?

The spinal cord of newborns extends to the

The most common initial symptom of esophageal atresia (EA) or tracheoesophageal fistula (TEF) is

A 4.5‑kg, 3‑hour‑old newborn with Beckwith‑Wiedemann syndrome is scheduled for surgical repair of an omphalocele. Which of the following is NOT part of this syndrome?

Which of the following is the LEAST appropriate technique for induction of general anesthesia in a newborn for surgical repair of a TEF?

A 3‑year‑old with cough, sore throat, and temperature of 102° F, is scheduled for hydrocele repair. Physical examination reveals wheezing and rhonchi. Chest x‑ray reveals small left lower lobe (LLL) infiltrate. The best course of action would be

Which of the following statements regarding teeth is INCORRECT?

The pulmonary vascular resistance (PVR) in newborns decreases to that of adults by age

A 10‑month‑old infant is undergoing elective repair of a left testicular hydrocele under general anesthesia with isoflurane, nitrous oxide, oxygen, and fentanyl. All of the following are effective and reasonable means of preventing hypothermia in this patient EXCEPT

Postoperative mechanical ventilation is common after repair of the following lesions. Which of the following is MOST likely to result in central postoperative depression of spontaneous ventilation in a term newborn?

A premature male neonate born at 36 weeks of gestation is scheduled to undergo repair of a left‑sided diaphragmatic hernia. Which of the following vessels could be cannulated for preductal arterial blood sampling?

In which of the following patients would the minimum alveolar concentration (MAC) for isoflurane be the greatest?

A 40‑kg, 10‑year‑old child sustains a thermal injury to his legs, buttocks, and back. The estimated area involved is 50%. Using only crystalloid fluids, how much fluid should be administered during the first 24 hours after the burn?

An otherwise healthy 3-month-old black female infant who had a hemoglobin value of $$19\ \mathrm{mg/dL}$$ at birth presents for elective repair of an inguinal hernia. Her preoperative hemoglobin is $$10\ \mathrm{mg/dL}$$ . Her father has a history of polycystic kidney disease. The most likely explanation for this patient’s anemia is

The anesthesiologist is called to the emergency room by the pediatrician to help manage a 3-year-old boy with a high fever and upper airway obstruction. His mother stated that earlier that afternoon, he complained of a sore throat and hoarseness. The patient is sitting erect and leaning forward; has inspiratory stridor, tachypnea, and sternal retractions; and is drooling. Which of the following is the MOST appropriate management of airway obstruction in this patient?

A 2-year-old child with cerebral palsy (CP) and known severe gastroesophageal reflux (with frequent nightly aspiration) and a seizure disorder is scheduled to undergo iliopsoas release under general anesthesia. Which of the following would be the preferred technique for inducing general anesthesia in this patient?

A 7-week-old male infant is admitted to the pediatric intensive care unit (ICU) with a bowel obstruction. His laboratory values are sodium $$120\ \mathrm{mEq/L}$$ , chloride $$85\ \mathrm{mEq/L}$$ , glucose $$85\ \mathrm{mg/dL}$$ , and potassium $$2.0\ \mathrm{mEq/L}$$ . Respiratory rate is 40 breaths/min, heart rate is 220 beats/minute, and blood pressure is 50/32. According to the patient’s mother, urine output has been zero for the last 4 hours. The most appropriate initial fluid for resuscitation of this patient would be

A 24-hour-old, 1200-g neonate, 30 weeks’ estimated gestational age (EGA), is noted in the ICU to begin making twitching movements. Blood pressure is 45/30, heart rate is 160, oxygen saturation is 88%, blood glucose is $$50\ \mathrm{mg/dL}$$ , total calcium level is $$4\ \mathrm{mg/dL}$$ , and urine output is $$5\ \mathrm{mL/hr}$$ . The MOST appropriate course of action to take at this point would be

A Eutectic Mixture of Local Anesthetics (EMLA) cream is a mixture of which local anesthetics?

Advantages of catheterization of the umbilical artery versus the umbilical vein in a newborn include all of the following EXCEPT

The TRUE statement concerning thermoregulation in neonates is which of the following?

A 10-year-old child was climbing a tree and fell, sustaining a lower cervical neck injury. He is unable to move his legs but can move his arms somewhat and is scheduled for an MRI scan. All of the following are signs of neurogenic shock EXCEPT

A 5-year-old child undergoing strabismus surgery under general anesthesia suddenly develops sinus bradycardia and intermittent ventricular escape beats but is hemodynamically stable. Which initial therapy is appropriate for treating this arrhythmia?

Which of the following respiratory indices is increased in healthy neonates compared with healthy adults?

A 16-year-old girl with neurofibromatosis is anesthetized for resection of an acoustic neuroma. Each of the following may potentially complicate the anesthetic management of this patient EXCEPT

With which of the following congenital anomalies is right-to-left intracardiac shunting of blood from pulmonary hypertension MOST likely and difficult to treat?

Which of the following is NOT CONSISTENT with an infant who suffers from severe dehydration?

Postoperative bleeding following tonsillectomy occurs most commonly

A 9-year-old undergoing sinus surgery is treated with an unmeasured amount of 0.5% phenylephrine by the surgeon, and the patient develops a blood pressure of 250/150. The most appropriate treatment for this would be

A 5-kg, 3-month-old male infant undergoes a left inguinal herniorrhaphy with a spinal anesthetic. Typically, how long would 1 mL of a 0.5% bupivacaine (5 mg) isobaric solution last?

Which of the following combination of drug and dose used alone is INCORRECT for preoperative sedation for an anxious child?

Which of the following statements regarding resuscitation of the infant by health care providers is NOT correct?

All of the following are true statements concerning the physiology of newborns compared with that of adults EXCEPT

Which of the following statements concerning the anatomy of the infant and the adult airway is INCORRECT?

Which of the following operations would be associated with the LEAST incidence of postoperative nausea and vomiting (PONV) in a 5-year-old boy?

Anomalies and features associated with Down syndrome include which of the following?

Congenital syndromes frequently associated with cardiac abnormalities include all of the following EXCEPT

Appropriate management of a neonate born with congenital diaphragmatic hernia (CDH) should include

Select the TRUE statement regarding complex regional pain syndrome (CRPS) in children

Which of the following statements regarding perioperative cardiac arrest in children is NOT correct?

Which of the following represents the greatest risk for postoperative apnea in an infant?

Which of the following statements regarding the Mapleson D breathing circuit is FALSE?

Which of the following is LEAST likely to reduce the incidence of postoperative apnea in preterm infants undergoing surgery for inguinal hernia repair?

A 32-week-EGA, 2-kg newborn born a few hours ago is to undergo a repair of his gastroschisis under general anesthesia. Which of the following sizes of uncuffed ETTs should you use, and how far should it be positioned to most likely be properly placed in the trachea (gums to midtrachea distance)?

Induction of general anesthesia for an elective operation should be delayed how many hours after breastfeeding?

In the infant, hypothermia would LEAST likely manifest as

Necrotizing enterocolitis (NEC) has all of the following characteristics EXCEPT

Which of the following statements concerning codeine is INCORRECT?

Which of the following drugs is LEAST likely to be used for a 4-year-old receiving proton beam radiation treatment for his medulloblastoma?

A 5-year-old girl with hemolytic-uremic syndrome (HUS) is brought to the OR for placement of a dialysis catheter. Medical issues typical for this disease include

A 3-year-old child status post resection of Wilms tumor at age 2 years is receiving doxorubicin (Adriamycin) and cyclophosphamide for metastatic disease. The patient is scheduled for placement of a Hickman catheter for continued chemotherapy. Anesthetic concerns related to this patient’s chemotherapeutic treatment include each of the following EXCEPT

Hypotension in children is characterized by a systolic blood pressure

What percent of the adult’s glomerular filtration rate, or GFR, does a 1-year-old old possess?

Each of the following results in a reduction of the incidence of postoperative vomiting (POV) in children undergoing strabismus surgery EXCEPT

According to the “1500 rule” for insulin correction, if a child’s total daily insulin dose is 30 units, approximately how much will 1 unit of regular insulin lower the blood glucose level?

Postoperative apnea risk in former premature infants is inversely related to postconceptual age. For an infant born at 31 weeks’ gestation who is now 10 weeks old (41 weeks’ postconceptual age) after general anesthesia, what is the most appropriate disposition?

For a 20‑kg child with documented ventricular fibrillation, what initial defibrillation energy is recommended when using a manual defibrillator?

In neonates, which spinal interspace is commonly selected for spinal puncture to minimize the risk of cord injury?

In a newborn with suspected esophageal atresia with tracheoesophageal fistula shortly after birth, what immediate management is recommended to reduce aspiration risk while awaiting definitive care?

Which statement about omphalocele is most accurate?

During anesthetic management for repair of tracheoesophageal fistula in a vigorous newborn, which airway strategy is preferred before the endotracheal tube is properly positioned?

A child with an acute lower respiratory infection (pneumonia with a left lower lobe infiltrate) is scheduled for elective surgery. What is the recommended timing for postponement?

Which statement about primary (deciduous) teeth is correct?