Peds 3, Physiology & Anesthesia

Front 1

617....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. Administer verapamil
...B. Administer esmolol
...C. Administer labetalol
...D. Administer atropine
...E. Administer phentolamine

Back 1

617. (E)

Front 2

618....A 6-kg, 3-month-old male infant undergoes a left inguinal herniorrhaphy with a spinal anesthetic. How long would 0.5 mL of a 0.5% bupivacaine solution be expected to last?
...A. Less than 30 minutes
...B. 30 to 60 minutes
...C. 60 to 90 minutes
...D. 90 minutes to 2 hours
...E. Cannot be predicted

Back 2

618. (C)

Front 3

619....In addition to inspiratory stridor, which sign or symptom is consistent with epiglottitis?
...A. Rapid onset in less than 24 hours
...B. Mild temperature elevation (<39° C)
...C. Age younger than 2 years
...D. Rhinorrhea
...E. Lymphocytosis

Back 3

619. (A)

Front 4

620....Which technique for resuscitation of a 6-month-old by a lay single rescuer is correct
...A. Mouth-to-mouth or mouth-to-nose ventilation at a rate of 12 to 20 breaths/min with good chest expansion
...B. Chest compressions with two fingers on the upper half of the sternum just above the intermammary line
...C. Sternal compression depth of no more than ½ cm
...D. Lay rescuer should check the carotid pulse every minute
...E. Compression to ventilation ratio of 5:1

Back 4

620. (A)

Front 5

621....All of the following are true statements concerning physiology of newborns compared with that in adults EXCEPT
...A. Newborns have a greater percentage of total body water compared with adults
...B. Newborns have a prolonged effect with thiopental
...C. Newborns have a higher glomerular filtration rate than adults
...D. Newborn hearts are relatively non-compliant compared with adults
...E. Newborn diaphragms have a lower proportion of type I muscle fibers (i.e., fatigue resistant, highly oxidative fibers)

Back 5

621. (C)

Front 6

622....Which of the following statements concerning the anatomy of the infant airway compared with the adult airway is true?
...A. The larynx is at the C5-C6 level in infants and C6-C7 in adults
...B. The epiglottis is relatively small in infants compared with adults
...C. The glottic opening is more anterior in infants than in adults
...D. The vocal cords are in a more horizontal position within the larynx in infants than in adults
...E. The vocal cords are the narrowest part of the larynx in infants, whereas the cricoid cartilage is the narrowest part of the larynx in adults

Back 6

622. (C)

Front 7

623....Which of the following operations would be associated with the LEAST incidence of postoperative nausea and vomiting (PONV) in a 5-year-old boy?
...A. Tonsillectomy
...B. Strabismus surgery
...C. Myringotomy tube placement
...D. Orchiopexy
...E. Inguinal herniorrhaphy

Back 7

623. (C)

Front 8

624....Anomalies and features associated with Down syndrome include
...A. Smaller tracheas
...B. Atlanto-occipital instability
...C. Thyroid hypofunction
...D. Endocardial cushion defect
...E. All of the above are correct

Back 8

624. (E)

Front 9

625....Congenital syndromes frequently associated with cardiac abnormalities include all of the following EXCEPT
...A. Tracheoesophageal fistula
...B. Meningomyelocele
...C. Omphalocele
...D. Gastroschisis
...E. Congenital diaphragmatic hernia

Back 9

625. (D)

Front 10

626....Appropriate management of a neonate born with congenital diaphragmatic hernia (CDH) should include
...A. Ventilation of the lungs with a bag and mask to keep saturation greater than 95%
...B. Insertion of an orogastric tube
...C. Expansion of the hypoplastic lung with positive-pressure ventilation
...D. Hyperventilation to keep the PaCO2 below 40 and pH greater than 7.40
...E. Rapid transport to the operating room for surgical correction

Back 10

626. (B)

Front 11

627....Factors associated with an increased incidence of laryngospasm include all of the following EXCEPT
...A. Younger age (<5 years of age)
...B. Presence of an airway anomaly
...C. Presence of an active upper respiratory infection (URI)
...D. Use of a laryngeal mask airway
...E. All are correct

Back 11

627. (E)

Front 12

628....Which of the following statements regarding perioperative cardiac arrest in children is NOT CORRECT?
...A. Cardiac arrest is more common in neonates than infants or older children
...B. “Equipment related” causes occur in more than 25% of cardiac arrests
...C. Resuscitation is more often successful if the cause is anesthesia-related rather than non-anesthesia related
...D. Many cases of cardiac arrest occur in children with concomitant congenital heart disease
...E. Emergency surgery is associated with greater than 5 times the chance of a cardiac arrest

Back 12

628. (B)

Front 13

629....Klippel-Feil syndrome is associated with
...A. Kyphoscoliosis
...B. Renal anomalies
...C. Congenital heart abnormalities
...D. Cervical spine instability
...E. All are correct

Back 13

629. (E)

Front 14

630....Which of the following statements regarding the Mapleson D breathing circuit is FALSE?
...A. It is an semi-open breathing system
...B. It has a proximal fresh gas inflow and a distal overflow valve
...C. With an inspiratory to expiratory (I:E) breathing ratio of 1:2, rebreathing is eliminated with spontaneous ventilation when the fresh gas flow is 3 times the minute ventilation
...D. To eliminate rebreathing, higher fresh gas flows are needed with controlled ventilation than with spontaneous ventilation
...E. The Mapleson D circuit is the most widely used of the Mapleson circuits for pediatric anesthesia

Back 14

630. (D)

Front 15

631....Which of the following is LEAST likely to reduce the incidence of postoperative apnea in preterm infants undergoing surgery for inguinal hernia repair?
...A. Delaying operation until 60 weeks post conception
...B. Preoperative correction of anemia
...C. Caffeine administration
...D. Ketamine administration
...E. Spinal anesthetic without sedation

Back 15

631. (D)

Front 16

632....Air should not be used to identify the epidural space in children because of the risk of
...A. Venous air embolism
...B. Infection
...C. Epidural hematoma
...D. Subcutaneous emphysema
...E. Neurologic complications

Back 16

632. (A)

Front 17

633....Induction of general anesthesia for an elective operation should be delayed how many hours after breast feeding?
...A. 2 hours
...B. 4 hours
...C. 6 hours
...D. 8 hours
...E. No fasting needed because breast milk is OK

Back 17

633. (B) MINIMUM FASTING PERIODS

Front 18

634....In the infant, hypothermia can be manifested as
...A. Metabolic acidosis
...B. Prolonged duration of action of nondepolarizing muscle relaxants
...C. Hypoglycemia
...D. Respiratory depression
...E. All are correct

Back 18

634. (E)

Front 19

635....Necrotizing enterocolitis has all of the following characteristics EXCEPT
...A. Most have thrombocytopenia (<75,000/mm3)
...B. A potential complication of umbilical artery catheterization
...C. Commonly associated with decreased cardiac output in the presence of fetal asphyxia or postnatal respiratory complications
...D. Umbilical artery catheters are useful to assess acid base status
...E. Occurs in 10% to 20% of newborns weighing less than 1500 g

Back 19

635. (D)

Front 20

636....The LEAST useful analgesic for prevention/treatment of tonsillar pain
...A. Acetaminophen
... B. Ropivacaine infiltration
... C. Dexmedetomidine
... D. Codeine
... E. Ketorolac

Back 20

636. (C)

Front 21

637....Which of the following statements concerning sudden infant death syndrome (SIDS) is true
...A. SIDS most frequently occurs from 1 to 3 years of age
...B. Risk of SIDS is the same with lower birth weight infants as with normal birth weight infants
...C. Maternal smoking is associated with a higher incidence of SIDS
...D. The risk of SIDS is increased with a recent general anesthetic
...E. Sleeping in the prone position has a lower frequency of SIDS than sleeping in the supine position

Back 21

637. (C)

Front 22

638....A 5-year-old girl with hemolytic-uremic syndrome is brought to the OR for placement of a dialysis catheter. Medical issues typical for this disease include
...A. Anemia
...B. Thrombocytopenia
...C. Increased intracranial pressure
...D. Pancreatitis
...E. All are correct

Back 22

638. (E)

Front 23

639....A 3-year-old child status postresection 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 all of the following EXCEPT
...A. Thrombocytopenia
...B. Inhibition of plasma cholinesterase
...C. Cardiac depression
...D. Pulmonary fibrosis
...E. Hypertension

Back 23

639. (D)

Front 24

640....Preoperatively, hypotension (i.e., decompensated shock) is characterized by a systolic blood pressure (SBP)
...A. Less than 60 mm Hg for the term neonate (0 to 28 days old)
...B. Less than 70 mm Hg for infants 1 to 12 months old
...C. Less than 70 mm Hg + (2 × age in years) for children 1 to 10 years old
...D. Less than 90 mm Hg for children 10 years or older
...E. All of the above are correct

Back 24

640. (E)

Front 25

641....During peanut retrieval from the left mainstem bronchus, the foreign body becomes lodged in the trachea and is pushed back, but goes now into right mainstem bronchus. Air movement is impossible with bag and mask and the patient’s heart rate falls to 30 beats per minute. The most appropriate next step would be to
...A. Intubate the left mainstem
...B. Intubate the right mainstem
...C. Attempt the Heimlich maneuver
...D. Institute cardiopulmonary bypass
...E. Perform an emergent tracheostomy

Back 25

641. (A)

Front 26

642....Each of the following results in a reduction of the incidence of nausea and vomiting in children undergoing strabismus surgery EXCEPT
...A. Withholding oral intake
...B. Premedication with clonidine 4 mg/kg orally
...C. Dexamethasone 0.15-1 mg/kg IV
...D. Ondansetron 50-200 μg/kg IV
...E. Gastric content evacuation before emergence from anesthesia

Back 26

642. (E)