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VACTER syndrome - presence of 3 or more physical congenital anomalies
- V - vertebral defect
- A - anal malformation
- C - cardiac anomaly
- T - transesophageal fistula
- E - esophageal atresia
- R - renal anomaly
- L - limb defect
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CHARGE syndrome
- C - coloboma (split iris) defect in the eye
- H - hearing impairment
- A - atresia choanae
- R - retardation
- G - genitourinary defects
- E - esophageal defects
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most common surgically corrected childhood disease
appendicitis
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frequency of malignant tumors in infants and children
minimal frequency when compared with occurrence rates for adults
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leading cause of death in children
accidental injury
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chronologic category - not compatible with life
embryo
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chronologic category - in utero after 3 months' gestation
fetus
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chronologic category - gestational age more than 24 weeks, birthweight >500 g, capable of sustaining life outside uterus
potentially viable
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chronologic category - gestational age less than 37 weeks, birthweight 2500 g or less
true preterm
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chronologic category - gestational age less than 38 weeks, birthweight more than 2500 g
large preterm
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chronologic category - gestational age 38-40 weeks, birthweight >2500 g
term neonate
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chronologic category - gestational age extended by more than 8 weeks
postterm
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chronologic category - first 28 days of extrauterine life
neonatal
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chronologic category - 28 days to 18 months
infant
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chronologic category - 18-30 months
toddler
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chronologic category - 2-1/2 to 5 years
preschool age
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chronologic category - 6-12 years
school age
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chronologic category - 13-18 years
adolescent
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when is hypotension apparent in an infant?
not until 50% of circulating volume is lost
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blood volume of neonate
75-80
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blood volume of age 6 weeks-2 years
75
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blood volume of age 2 years-puberty
72
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newborn heart rate
- awake - 100-180
- asleep - 80-160
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infant heart rate
- awake - 110-150
- asleep - 70-120
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toddler heart rate
- awake - 110-130
- asleep - 70-100
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preschool heart rate
- awake - 80-120
- asleep - 60-90
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school age heart rate
- awake - 70-115
- asleep - 60-90
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adolescent heart rate
- awake - 60-100
- asleep - 60-90
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critical factors in selection of instrumentation, sutures, needles and equipment for peds surgery
size and weight
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instruments used on delicate tissues of children
small instruments
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in peds surgery, what should hemostats have?
fine points
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in peds surgery, what does mosquito hemostat clamp?
superficial vessel, but not major artery
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in peds surgery, what are noncrushing vascular clamps used for?
occlusion of major vessels as well as can be placed across intestine
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in peds surgery, where should instruments not being used be placed?
- return to Mayo stand or instrument table immediately after use
- never on patient, especially not on chest
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what are frequently used in peds surgery to retract blood vessels and small structures to give greater visibility
umbilical tape or vessel loops
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types of instruments used on adolescents
adult-size instruments
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acute congenital anomaly characterized by esophageal obstruction, accumulation of secretions, gastric reflux, and respiratory complications
esophageal atresia
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what is the goal of esophageal atresia?
to obtain end-to-end esophageal anastomosis
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why is gastrostomy performed for esophageal atresia?
to establish conduit for feeding newborn less than 1200 g
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what type of tube is placed during gastrostomy
PEG tube
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when does anorectal malformation generally occur?
during 4th to 12th week of fetal development
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how is imperforate anus classified?
as high or low in relation to levator muscles
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single opening for urethra, rectum, and vagina
cloaca
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most common cause for abdominal surgical procedure in child aged 5-10 years
appendicitis
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how can appendectomy be performed?
laparoscopy or open laparotomy
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how is questionable diagnosis of appendicitis confirmed or ruled out?
laparoscopy
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undescended testicles
cryptorchidism
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with what condition is cryptorchidism associated?
hypospadius
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operation performed for cryptorchidism
two-stage Torek operation
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when is cryptorchidism usually repaired?
at age 5 or 6 years
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treatment for congenital dislocated hip if diagnosed early in infancy
closed reduction with immobilization
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treatment for congenital dislocated hip if diagnosed after child has begun to walk
open reduction with osteotomy to stabilize the joint
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otherwise known as clubfoot
talipes varus
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treatment for talipes varus during infancy
casting
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treatment for talipes varus in older, weightbearing child
wedge cast with turnbuckles
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most common chronic condition of childhood
secretory otitis media
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incision in tympanic membrane for drainage
myringotomy
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what is commonly performed bilaterally in association with myringotomy?
tympanostomy
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cleft lip rules of 10
- 10 weeks of age
- 10 g hemoglobin
- 10 lbs body weight
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fusion of two or more fingers or toes
syndactyly
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most common congenital hand deformity
webbing between fingers
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what does separation of webbed digits almost always necessitate?
skin grafts
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occurs when passages between ventricles are blocked and dilated by accumulated CSF
hydrocephalus
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how is hydrocephalus treated in utero?
cephalocentesis with insertion of ventriculoamniotic shunt to drain ventricles
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how is hydrocephalus treated after birth?
implantation of shunt for transporting excess fluid from ventricles
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funnel-shaped concave depression over lower end of sternum
pectus excavatum
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what can result from extreme pectus excavatum during pubertal growth period?
cardiopulmonary impairment
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procedures for pectus excavatum
- Nuss procedure - minimally invasive
- Ravitch repair - open
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when is pulmonary ventilation established?
- during first breath at birth
- this causes increased left atrial force, which closes foramen ovale
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when does ductus arteriosus close after birth?
- after 15 hours
- some neonates have delay of 1-3 weeks for complete closure
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opening in septum between right and left atria, allowing oxygenated blood to shunt from left to right and return to lungs
atrial septal defect
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2 ways atrial septal defect can be repaired
- closed with sutures
- if cannot be closed with sutures, patch graft is inserted
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opening in membranous portion of septum between right and left ventricles
ventricular septal defect
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repair of ventricular septal defect
- patients with small defects may not necessitate repair - 1/3 small defects close spontaneously by age 2
- patch graft is used to repair large defects
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4 defects of tetralogy of Fallot
- large VSD
- stenosis or atresia of pulmonary valve
- hypertrophy of right ventricle
- displacement of aorta to the right
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"blue babies"
infants with tetralogy of Fallot
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procedure in which aorta and pulmonary arteries are anatomically switched
Jantene procedure
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why is Jantene procedure done?
infants with VSD or large PDA
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absence of tricuspid valve between right atrium and ventricle, preventing normal blood flow through chambers of the heart
tricuspid atresia
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treatment for tricuspid atresia
Fontan procedure - performed at 3 or 4 years of age - direct anastomosis of pulmonary artery to right atrium
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Rashkind procedure
a balloon catheter is advancd into the right atrium, through foramen ovale and into left atrium, balloon inflated and pulled back, enlarging foramen ovale
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most common cause of cardiac death in first week of life
hypoplastic left heart syndrome
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what happens with hypoplastic left heart syndrome?
- left ventricle is severely underdeveloped and right ventricle is overloaded
- patient is in complete heart failure within 28 hours of life
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treatment for hypoplastic left heart syndrome
immediate cardiac transplant
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in postop peds care, how often is the patient's recovery evaluated?
at 5-min to 15-min intervals as patient emerges from anesthesia
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who is responsible for the postop pediatric patient in PACU and for release criteria?
anesthesia provider
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theories of aging
- wear-and-tear theory - body loses ability to keep pace
- genetic mutation theory - various agents damage DNA code
- viral theory - viruses use genetic materials to fool immune system
- environmental theory - environmental elements accelerate aging process
- physical factor theory - free radicals may cause premature aging
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in physical factor theory, hormonal activities affecting organ systems
- decrease in estrogen production = increased risk for osteoporosis and heart disease
- decrease in thyroid activity decreases basal metabolic rate and increases weight gain
- decrease in efficiency of insulin production decreases efficiency of glucose metabolism
- decrease in testosterone production = decreased libido in men
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how many geriatric patients have than one medical diagnosis capable of causing death?
more than 73%
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aging myths
- older adults are senile
- older adults do not engage in sexual behavior
- older adults always decline in health after surgical procedure
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hearing defect of an older adult could be mistaken for?
cognitive impairment
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where should hearing aids be during surgical procedure
if possible, patient should be allowed to wear it to the OR and possibly throughout the procedure
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how many geriatric patients experience depression and alteration in self-image?
- between 10% and 65%
- physical decline may be rapid if psychological well-being is threatened
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assessment of integumentary system
skin, fingernails and toenails, and all hair patterns of body, face and scalp
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normal skin changes
- skin is often wrinkled as result of changes in connective tissue
- pigmentation and skin tags can be normal lesions in aging process
- hair patterns may be thinning or loss
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chronic inflammatory disease characterized by fixation or fusion of vertebral joint
ankylosing spondylosis
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increased forward thoracic curvature
kyphosis
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when assessing geriatric cardiopulmonary status, what is assessed?
- BP in sitting and lying positions
- respiratory efforts
- temperature
- hemoglobin and hematocrit levels
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multiple vaginal births can cause what?
uterine and bladder prolapse
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at what temp are geriatric patients at risk for hypothermia?
when temp falls below 96.8 F (36 C)
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why is anesthesia induction sometimes prolonged?
- because of COPD such as emphysema
- surgical procedures tend to be major and take longer
- increase in body fat is accompanied with aging process and most anesthetics are fat-soluble
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