PEDIATRIC Critical Care Review Pediatric Critical Care Review Pediatric Critical Care Review

PEDIATRIC Critical Care Review Pediatric Critical Care Review Pediatric Critical Care Review Edited by Rashed A. Hasan, md Boston Children s Hospital Department ofMedicine Harvard University Medical School Boston, MA Michael D. Pappas, md Children s Intensive Caring and Department ofPediatrics Medical University of Ohio Toledo, OH ^ Humana Press ^P Totowa, New Jersey © 2006 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256-8341, E-mail: [email protected]; or visit our Website: http:// humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. Cover design by Patricia F. Cleary Production Editor: Amy Thau This publication is printed on acid-free paper. (°5) ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $30 is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [1-58829-829-9/06 $30]. Printed in the United States of America. 10 987654321 elSBN: 1-59745-105-3 Library of Congress Cataloging-in-Publication Data Pediatric critical care review / edited by Rashed A. Hasan, Michael D. Pappas. p. ; cm. Includes bibliographical references. ISBN 1-58829-829-9 (alk. paper) 1. Pediatric intensive care—Examinations, questions, etc. [DNLM: 1. Critical Care—Examination Questions. 2. Child. WS 18.2 P36993 2006] I. Hasan, Rashed A. II. Pappas, Michael D. RJ370.P422 2006 618.92'0028076-dc22 2005034068 Dedication This book is dedicated to the happiness, health, and welfare of all children. Preface Thank you for selecting Pediatric Critical Care Review. This study guide is not intended to be a substitute for major textbooks or leading articles in pediatric critical care medicine, nor is it meant to replace bedside clinical medicine where knowledge is integrated with exciting and challenging realities. It is our hope that students and physicians in training will find the pathophysiological foundation of the case scenarios and questions a useful guide in their learning process. Additionally, we hope that these case scenarios and questions will be interesting and challenging enough for the experienced critical care clinician who would like to sharpen his or her clinical skills, case analyses, and decision-making abilities. In Pediatric Critical Care Review, you will find questions relevant to current clinical practices. We have also included in-depth, detailed explanations and points of reference in the answer section. We welcome your comments and criticisms regarding Pediatric Critical Care Review. RashedA. Hasan, md Michael D. Pappas, md Vll Acknowledgment We wish to recognize Ms. Julie Hall, who has been instrumental in the development and completion of this book. She has functioned as a transcriber, artist, diplomat, and coordinator, bringing this endeavor to completion. Julie is a true example of hard work and commitment. Thank you, Julie. IX Contents Dedication v Preface vii Acknowledgment ix Contributors xiii Companion CD xiv Chapter 1. Respiratory System 1 Answers 707 Chapter 2. Cardiovascular System 23 Answers 775 Chapter 3. Central Nervous System 33 Answers 779 Chapter 4. Infectious Diseases 43 Answers 123 Chapter 5. Hematology and Oncology 51 Answers 729 Chapter 6. Renal System 55 Answers 132 Chapter 7. Endocrine System 59 Answers 134 Chapter 8. Nutrition and the Gastrointestinal System 63 Answers 136 Chapter 9. Immunology 69 Answers 740 Chapter 10. Metabolic Disorders 73 Answers 144 Chapter 11. Pain Management 75 Answers 746 Chapter 12. Pharmacology and Toxicology 79 Answers 148 Chapter 13. Traumatology 89 Answers 755 Chapter 14. Statistics 97 Answers 767 Chapter 15. Ethics 99 Answers 762 Selected References 163 XI Contributors The following contributed to the gathering of information for this volume. Kimberly E. Fenton, md • Department of Critical Care Medicine, Children's National Medical Center; and The George Washington University School of Medicine, Washington, DC Vipul V. Patel, md • Medical Director, Pediatric Critical Care, Dayton Children's Hospital, Dayton, OH Anthony D. Slonim, md • Fellowship Director and Pediatric Intensivist, Children's National Medical Center; and the Departments of Internal Medicine and Pediatrics, The George Washington University School of Medicine, Washington, DC Mark Sorrentino, md • Director of Medical Sciences, Medlmmune Inc.; and Department of Pediatrics, The George Washington University School of Medicine, Washington, DC Glenn Stryjewski, md • Department of Critical Care Medicine, Children's National Medical Center; and the Department of Pediatrics, The George Washington University School of Medicine, Washington, DC Xlll Companion CD The Companion CD contains an interactive version of the test questions found in this volume. The Companion CD is compatible with both Mac and PC operating systems that run any web browser over 4.0. XIV . Respiratory System The following chapter will focus on the respiratory system. Pertinent questions, answers, and rationale will be reviewed. Answers for this chapter can be found beginning on page 101. Key Words: Lungs; airway; ventilator; oxygen; pulmonary. Which of the following is true regarding endotra- 5. Postextubation croup is most closely associated cheal intubation in infants and children? with which of the following? a. The presence of a Murphy eye side hole pro- a. Failure to lubricate the endotracheal tube prior vides absolute protection against obstruction of to insertion. the endotracheal tube. b. Failure to use analgesic sprays. b. Tube obstruction in infants is as high as 30%. c. Excess humidification. c. Incidence of obstruction with small tubes is d. History of upper respiratory infection prior to similar to the incidence with large tubes. intubation. d. The endotracheal tube insertion guide is the e. Surgery within the neck area. channel on the straight blade. e. Age is a more reliable determinant of endotra- 6. Which of the following is true of tracheostomy? cheal tube size than height. a. The highest complication rate occurs in infants. b. A mortality rate of up to 3% has been reported. The incidence of subglottic stenosis following intu- c. Complications are higher with emergency tra- bation in children is approximately: cheostomy compared with tracheostomy fol- a. 5%. c. 15%. lowing endotracheal intubation. b. 10%. d. 20%. d. Airway secretions are increased 24-48 hours following tracheostomy. 3. Predisposing risk factors for tracheal injury and e. All of the above. subglottic stenosis following tracheal intubation include: 7. Acute postoperative complications of tracheostomy a. General medical condition of the patient. include: b. Seizures. a. Subcutaneous emphysema. c. Head position. b. Pneumothorax. d. Endotracheal tube material. c. Pneumomediastinum. e. All of the above. d. Increased airway secretions. e. All of the above. 4. Which of the following is true of postextubation croup? 8. Immediate postoperative care of a child with a new a. Occurs in 50% of children. tracheostomy includes: b. Begins within 18 hours, peaks at 48 hours, and a. Evaluation of a chest radiograph for tube resolves by 5 days. position. c Less prevalent in patients with frequent

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