Peds 2, Physiology & Anesthesia

Front 1

592....A 4-kg, 3-hour-old newborn with macrosomia and large fontanelles is scheduled for surgical repair of an omphalocele. Physical examination reveals macroglossia but no other anomalies are found. Which of the following is likely to occur in this patient?
...A. Hypokalemia
...B. Hyperkalemia
...C. Metabolic acidosis
...D. Hypoxemia
...E. Hypoglycemia

Back 1

592. (E)

Front 2

593....Which of the following is the LEAST appropriate technique for induction of general anesthesia in a newborn for surgical repair of TEF?
...A. Awake tracheal intubation
...B. Inhalation induction with spontaneous ventilation and tracheal intubation
...C. Inhalation induction using positive-pressure bag and mask ventilation and tracheal intubation
...D. Rapid IV induction and tracheal intubation
...E. Intramuscular induction with high-dose ketamine and tracheal intubation

Back 2

593. (C)

Front 3

594....Each of the following statements concerning side effects of succinylcholine when used to paralyze neonates is true EXCEPT
...A. It seldom causes muscle fasciculation
...B. It can cause bradycardia
...C. Dysrhythmias frequently occur following intramuscular injections
...D. It can cause myoglobinuria
...E. It can cause hyperkalemia

Back 3

594. (C)

Front 4

595....The predicted blood volume in a 4-kg neonate is
...A. 240 mL
...B. 280 mL
...C. 340 mL
...D. 400 mL
...E. 440 mL

Back 4

595. (C)

Front 5

596....The pulmonary vascular resistance in newborns decreases to that of adults by age
...A. 1 day
...B. 1 week
...C. 2 months
...D. 2 years
...E. 5 years

Back 5

596. (C)

Front 6

597....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 following are effective and reasonable means of preventing hypothermia in this patient EXCEPT
...A. Placement of an infrared heater over the operating table and prewarming the OR
...B. Covering the OR table with a heating blanket
...C. Wrapping the extremities with sheet wadding and covering the head with a cloth cap
...D. Ventilating the patient with a Mapleson D circuit at low gas flows (e.g., 50 mL/kg/min)
...E. Warming and humidifying the inspired anesthetic gases

Back 6

597. (D)

Front 7

598....Central postoperative depression of ventilation in a full-term neonate is most likely to occur after surgery for which of the following?
...A. Gastroschisis
...B. Omphalocele
...C. Tracheoesophageal fistula
...D. Diaphragmatic hernia
...E. Pyloric stenosis

Back 7

598. (E)

Front 8

599....A premature male neonate born at 32 weeks of gestation is scheduled to undergo emergency repair of a left-sided diaphragmatic hernia. Which of the following vessels could be cannulated for preductal arterial blood sampling?
...A. Femoral artery
...B. Umbilical artery
...C. Dorsalis pedis artery
...D. Right radial artery
...E. Left radial artery

Back 8

599. (D)

Front 9

600....In which of the following patients would the minimum alveolar concentration (MAC) for halothane or isoflurane be the greatest?
...A. A premature infant 30 weeks postconceptual age
...B. Full-term neonate
...C. 3-month-old infant
...D. 19-year-old male bodybuilder
...E. 35-year-old woman with hyperthyroidism

Back 9

600. (C)

Front 10

601....A 40-kg, 10-year-old child sustains a thermal injury to his legs, buttocks, and back. The estimated area involved is 50%. How much fluid should be administered during the first 24 hours?
...A. 2.5 L
...B. 4.0 L
...C. 5.5 L
...D. 8.0 L
...E. 10.0 L

Back 10

601. (D)

Front 11

602....An otherwise healthy 3-month-old black female infant with a hemoglobin of 19 mg/dL at birth presents for elective repair of an inguinal hernia. Her preoperative hemoglobin is 10 mg/dL. Her father has a history of polycystic kidney disease. The most likely explanation for this patient’s anemia is
...A. Sickle cell trait
...B. Sickle-cell anemia
...C. Iron deficiency
...D. Undiagnosed polycystic kidney disease
...E. It is a normal finding

Back 11

602. (E)

Front 12

603....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 states 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. Aerosolized racemic epinephrine
...B. Awake tracheal intubation in the emergency room
...C. Transfer to the OR and awake tracheal intubation
...D. Transfer to the OR, inhalation induction, and tracheal intubation
...E. Transfer to the OR, IV induction, paralysis with succinylcholine, and tracheal intubation

Back 12

603. (D)

Front 13

604....A 2-year-old child with cerebral palsy and known severe gastroesophageal reflux (with frequent nightly aspiration) is scheduled to undergo iliopsoas release under general anesthesia. Which of the following would be the most appropriate technique for inducing general anesthesia in this patient?
...A. Inhalation induction with sevoflurane followed by mask anesthesia with cricoid pressure
...B. Inhalation induction with sevoflurane followed by tracheal intubation
...C. IV induction with propofol followed by laryngeal mask airway
...D. IV induction with propofol followed by tracheal intubation
...E. Rapid-sequence induction with thiopental and succinylcholine followed by tracheal intubation

Back 13

604. (E)

Front 14

605....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 mEq/L, chloride 85 mEq/L, glucose 85 mg/dL, and potassium 2.0 mEq/L. Respiratory rate is 20 breaths/min, and according to the patient’s mother, urine output has been 0 for the last 4 hours. The most appropriate fluid for resuscitation of this patient would be
...A. D5W
...B. D5W with 0.45 sodium chloride and 20 mEq/L potassium chloride
...C. 0.45% sodium chloride
...D. 0.9% sodium chloride with 30 mEq/L potassium chloride
...E. 0.9% sodium chloride

Back 14

605. (E)

Front 15

606....An 8-hour-old, 1600-g neonate, 30 weeks postgestational age, is noted in the ICU to begin making twitching movements. Blood pressure is 45 mm Hg systolic, blood glucose 50 mg/dL, and urine output 10 mL/hr. The O2 saturation on pulse oximeter is 88%. The most appropriate course of action to take at this point would be
...A. Administer calcium gluconate 250 mg (2.5 mL of 10% solution)
...B. Glucose 10 mg IV over 5 minutes (2 mL of D5W)
...C. Hyperventilate with 100% O2
...D. Administer a 20-mL bolus of 5% albumin
...E. Begin a dopamine infusion

Back 15

606. (A)

Front 16

607....An Eutectic Mixture of the Local Anesthetics (EMLA) cream is a mixture of which local anesthetics?
...A. Lidocaine and prilocaine
...B. Lidocaine and benzocaine
...C. Prilocaine and benzocaine
...D. Mepivacaine and lidocaine
...E. Prilocaine, benzocaine, and lidocaine

Back 16

607. (A)

Front 17

608....Advantages of catheterization of the umbilical artery versus the umbilical vein in a newborn include all of the following EXCEPT
...A. It allows assessment of oxygenation
...B. Hepatic damage from hypertonic infusion is avoided
...C. It permits assessment of systemic blood pressure
...D. It is easier to cannulate
...E. There are two vessels to choose from

Back 17

608. (D)

Front 18

609....The true statement concerning thermoregulation in neonates is which of the following?
...A. A significant proportion of their heat loss can be accounted for by their small surface area-to-weight ratio
...B. They compensate for hypothermia by shivering
...C. The principal method of heat production is metabolism of brown fat
...D. Heat loss through conduction can be reduced by humidification of inspired gases
...E. Heat loss by convection is reduced with the use of a warming blanket

Back 18

609. (C)

Front 19

610....Normal values for a healthy 6-month-old, 7-kg infant include
...A. Hemoglobin 17 g/dL
...B. Heart rate 90 beats/min
...C. Respiratory rate 20 breaths/min
...D. O2 consumption at rest 35 mL/min
...E. Systolic blood pressure of 70

Back 19

610. (D)

Front 20

611....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 therapy is appropriate for treating this arrhythmia?
...A. Tell the surgeon to stop pulling on the eye muscle
...B. Tell the surgeon to do a retrobulbar block
...C. Change from halothane to sevoflurane
...D. Decrease the depth of the volatile anesthetic
...E. Administer atropine

Back 20

611. (A)

Front 21

612....Which of the following respiratory indices is increased in neonates compared with adults?
...A. Tidal volume (Vt) (mL/kg)
...B. pH
...C. Alveolar ventilation (mL/kg/min)
...D. Functional residual capacity (mL/kg)
...E. Paco2

Back 21

612. (C) PHYSIOLOGIC VARIABLES

Front 22

613....A 14-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
...A. Presence of a pheochromocytoma
...B. Upper airway obstruction from a laryngeal neurofibroma
...C. Intracranial hypertension
...D. Increased risk for malignant hyperthermia
...E. Abnormal response to neuromuscular blocking agents

Back 22

613. (D)

Front 23

614....Retinopathy of prematurity
...A. Occurs only after exposure to high concentrations of O2 for 12 or more hours
...B. Cannot occur in patients who have never received supplemental O2
...C. Is caused by obliteration of immature retinal arteries
...D. Is most commonly seen in newborns younger than 44 weeks postconceptual age
...E. Is more common in newborns when anesthesia is administered for non-ophthalmologic procedures

Back 23

614. (D)

Front 24

615....The most reliable method of determining mild dehydration in a child is by the observation of
...A. Dryness of mucous membrane
...B. Skin turgor
...C. Urine output
...D. Fontanelles
...E. Blood pressure

Back 24

615. (C)

Front 25

616....Postoperative bleeding following tonsillectomy occurs most commonly
...A. By the first 6 hours
...B. 6-24 hours postop
...C. On third postoperative day
...D. On seventh postoperative day
...E. On tenth postoperative day

Back 25

616. (A)