MetroHealthAnesthesiaPediatric Anesthesiology

Congenital Heart Disease - QUIZ

DIRECTIONS FOR QUESTION NUMBERS 1-4: Each question below is followed by four suggested answers or completions. Select the one that is best in each case and click on the button containing the corresponding letter.

1. When examining an infant, the best place to look for the cyanosis of a physiologic R->L intracardiac shunt is the

(A) nail beds.
(B) lips.
(C) tongue.
(D) skin.
(E) conjunctiva.

2. In a preoperative patient with tetralogy of Fallot, the best indicator of the magnitude of the average, chronic R->L shunt is the

(A) color of the tongue.
(B) arterial pO2.
(C) pulmonary blood flow at catheterization.
(D) hematocrit.
(E) loudness and length of the systolic murmur.

3. In the late-gestation fetal circulation, all of the following are true EXCEPT

(A) The pulmonar vascular resistance is greater than the systemic vascular resistance.
(B) The RV ejects about twice as much blood as the LV.
(C) The brain receives blood of higher oxygen saturation than that perfusing the kidneys.
(D) Umbilical venous pO2 is in the range 25-35 mmHg.
(E) The ascending aorta is the largest blood vessel.

4. In pediatric postop cardiac patients, ketamine

(A) predictably causes an increase in pulmonary vascular resistance (PVR).
(B) increases PVR only in patients with pulmonary vascular disease.
(C) usually leads to a decrease in PVR.
(D) appears not to elevate PVR if airway and ventilation are adequately maintained.
(E) increases PVR only in patients without pulmonary vascular disease.

DIRECTIONS FOR QUESTION NUMBERS 5-10: For each of the following questions or incomplete statements, ONE or MORE of the answers or completions given is correct. Click below on button
A if only 1, 2, and 3 are correct,
B if only 1 and 3 are correct,
C if only 2 and 4 are correct,
D if only 4 is correct,
E if all are correct.

5. Ketamine is relatively contraindicated for induction of anesthesia in an infant with
  1. anomalous left coronary artery.
  2. critical aortic stenosis.
  3. hypoplastic left heart syndrome.
  4. tetralogy of Fallot.

6. Inhalational induction and maintenance with early postop extubation in the OR may be a satisfactory technic for
  1. pulmonary valvotomy for simple pulmonic stenosis in a 7-year-old.
  2. closure of an ASD in a child.
  3. repair of an isolated coarctation of the aorta.
  4. ligation of a PDA in a 4-year-old.

7. In simple transposition of the great arteries there is a large
  1. anatomic L->R shunt
  2. physiologic L->R shunt
  3. anatomic R->L shunt
  4. physiologic R->L shunt

8. The newborn ductus arteriosus is likely to be constricted by
  1. oxygen
  2. acetycholine
  3. indomethacin
  4. PGE1

9. The magnitude of shunting across a simple nonrestrictive VSD depends on
  1. location of the VSD
  2. left ventricle to right ventricle pressure gradient
  3. size of the VSD
  4. pulmonary and systemic vascular resistances

10. During induction of anesthesia in infants and children with cyanotic congenital heart disease, which agent(s) is(are) associated with an increase in systemic arterial oxygen saturation?
  1. thiopental
  2. fentanyl
  3. halothane
  4. ketamine

Greg Gordon MD