3-25 Pediatric Clinical Pathology - Dow Flashcards

Question

What is a closing ductus murmur? Where is it located, and what ages get them?

Answer 1

Common benign murmurs in children **Low pitched (non-turbulent, not high velocity)** Newborn Transient, soft, ejection Location: upper left sternal border

Answer 2

Newborn to 1 year Soft, slightly ejectile, systolic Location: to the left of upper left sternal border & in lung fields & axillae upper left sternal border. High pitched - best heard with the diaphragm Also seen in adolescents or in children with pectus excavatum. Prominent in high-flow situations, such as when a child has a fever or is anemic

Answer 3

Older child **Still’s**: low-pitched sounds heard at the **lower left sternal area, “musical.”** These most commonly occur between age 3 and adolescence. Low pitched - best heard with the bell of the stethoscope. Can change with alteration of position and then can decrease or disappear with the Valsalva maneuver. No clicks are present

Answer 4

Low pitched (non-turbulent, not high velocity) Venous hum: low-pitched continuous murmurs made by blood returning from the great veins to the heart - bell

Answer 5

Failure of closure of ductus arteriosus within a few days after birth Girls\>boys More common in premature infants, neonatal respiratory distress, infants w/ genetic d/o (such as Down syndrome) & those w/ congenital heart lesions Premature infants closure up to 2 years Full term infants closure rarely after first week of life w/o intervention

Answer 6

Small PDAs usu. asymptomatic **Large PDAs:** **◦Bounding pulse, murmur** **◦Tachypnea** **◦Poor feeding habits** **◦Shortness of breath** **◦Sweating while feeding** **◦Tiring very easily** **◦Poor growth** Tx: Indomethacin or surgery

Answer 7

Changes in pulm vascular resistance Obstructive lesions Pressure gradient differences Changes associated with growht

Answer 8

Changes in pulmonary vascular resistance ◦VSD or PDA ◦Audible 7-10 days after birth

Answer 9

Obstructive lesions ◦Pulmonic & aortic stenosis ◦Coarctation of the aorta ◦Audible at birth

Answer 10

Pressure gradient differences ◦Atrioventricular valve regurgitation Audible at birth

Answer 11

Changes associated with growth Due to alterations in normal blood flow & occur or change w/ growth Aortic stenosis (obstructive) but not often seen until considerable growth has occurred Pulmonary flow murmur of ASD

Answer 12

Often not seen until adulthood; despite congenital cause

Answer 13

Pulmonary flow murmur of ASD Right ventricular compliance gradually increases & shunt becomes larger Resulting in too much blood flow across normal pulmonary valve May not be heard for a year or more

Answer 14

Asymmetrical thickening of left ventricle ◦Causing increase work on heart to pump Inherited Younger people are likely to have a more severe form

Answer 15

◦Chest pain ◦Dizziness ◦Fainting, especially during exercise ◦Heart failure (in some patients) ◦High blood pressure ◦Light-headedness, especially with or after activity or exercise ◦Palpitations ◦Shortness of breath Sudden collapse/death occurs due to arrhythmia or blockage of blood flow

Answer 16

5 T’s: ◦Tetralogy of Fallot 1. VSD 2. Overriding aorta 3. RV outflow obstruction 4. RV hypertrophy

Answer 17

Cyanotic Congenital Heart Disease 5 T’s: **◦Tetralogy of Fallot** **◦Transposition of the Great Arteries** **◦TAPVR** **◦Truncus arteriosus** **◦Tricuspid Atresia**

Answer 18

Sx: (seen within minutes to a few hours after birth) ◦Cyanosis ◦Apnea ◦Decreased urine output ◦Grunting, nasal flaring ◦Puffy or swollen arms or legs ◦Rapid breathing &/or shortness of breath

Answer 19

Most common complication seen in premature infants that affects breathing Due to lack of surfactant Most cases seen in premies \<28 weeks

Answer 20

Increased risks of RDS: A brother or sister who had RDS Diabetes in the mother Cesarean delivery Delivery complications that lead to acidosis in the newborn at birth Multiple pregnancy (twins or more) Rapid labor

Answer 21

CXR: ground glass appearance Tx: surfactant, intubation or CPAP

Answer 22

Children younger than six years have an average of **six to eight colds per year** (up to one per month, September through April), with a typical symptom duration of **14 days** Young children in **daycare** appear to have more colds than children cared for at home. However, when they enter primary school, children who attended daycare are less vulnerable to colds than those who did not. Older children and adults have an average of two to four colds per year, with a typical symptom duration of five to seven days Acute, self-limiting viral syndrome of the upper respiratory tract

Answer 23

Symptoms: rhinorrhea, congestion, sneezing, and may include **fever**

Answer 24

Fever, otalgia, cough, rhinorrhea May be a complication of URI Pathogens: Viral Bacterial: ***Strep pneumoniae*, *Moraxella catarrhalis*, *H. flu* nontypables**

Answer 25

First line: **amoxicillin (high dose = 80-90 mg/kg/day)** Second line: amoxicillin-clavulinic acid (Augmentin) or second generation cephalosporin

Answer 26

Diagnosis is based on: 1. **Persistence of nasal discharge**: if the child has a very congested and/or runny nose for 10 days without improvement, especially when it is associated with a daytime cough (may also have a night cough) 2. **Severe symptoms**: if the child has a high fever (over 39 C, which is 102.2 F) for 72 hours or has a high fever and is not eating or drinking and is difficult to calm 3. **Worsening symptoms**: A child's cold got better and then in a day or two the child is suddenly much more ill with a fever and/or pus-filled nasal discharge

Answer 27

Aka laryngotracheobronchitis **Steeple sign ◦ Subglottic narrowing of trachea** Most common cause of **inspiratory stridor** in peds Viral in origin

Answer 28

Sx: ◦Coryza 1-2d prior to **croupy cough, hoarseness, & stridor** Tx: if severe, inhaled epinephrine & oral steroids

Answer 29

Invasive exudative bacterial infection of the soft tissues of the trachea “Acute bacterial laryngotracheobronchitis” – with similarities to croup but worse

Answer 30

◦Bacterial: *Staphylococcus aureus*, *Streptococcus pneumoniae*, gram-negative enteric bacteria, *Pseudomonas aeruginosa* ◦Predisposing viral infections with: **influenza A**, influenza B, respiratory syncytial virus (RSV), parainfluenza virus, measles, and enterovirus

Answer 31

◦CMV, adenoviruses, HSV, influenza viruses, and enterovirus, EBV

Answer 32

◦EBV Monospot testing is not accurate under 4-5 years of age or before 2nd week of illness remember it has a really long incubation period Exudative pharyngitis is accompanied by fever, generalized adenopathy, hepatosplenomegaly, heterophile antibodies Sometimes treated with steroids

Answer 33

Group A beta hemolytic streptococcus ◦**15 to 30 percent** of all cases of pharyngitis in children between the **ages of 5 and 15 years** ◦Peaks during the winter and early spring ◦Rapid strep in office, back up culture Other bacterial pathogens ◦Group C and group G strep: acute rheumatic fever is not a complication of infection due to these organisms ◦*Arcanobacterium hemolyticum* *◦Corynebacterium diphtheriae* ◦Tularemia

Answer 34

History: ◦Typically has an abrupt onset of symptoms ◦Typically the school aged child ◦**Sore throat** **◦Fever** **◦Headache** ◦**GI symptoms**: abdominal pain, nausea, and vomiting ◦Poor oral intake ◦**NO cough or rhinorrhea**!! Aka, no viral symptoms ( coryza, conjunctivitis, hoarseness, anterior stomatitis, discrete ulcerative lesions or vesicles).

Answer 35

Physical: ◦**Exudative pharyngitis** or erythema of posterior orophayngeal mucosa ◦Enlarged tender **anterior cervical lymph nodes** ◦Palatal **petechiae** ◦Inflamed uvula ◦**Scarlatiniform rash** **◦Pastia’s lines**

Answer 36

**Work Up:** **Rapid strep with back up culture if negative** - How can you possibly get a sample?? - Use two swabs at once; double tongue depressor for stronger kids, have smaller child pant like a puppy dog - Wear a mask because you’ll probably get coughed on

Answer 37

◦Peritonsillar abscess **Most common deep neck infection in children and adolescents**, accounting for at least 50 percent of cases – can be a complication of strep pharyngitis

Answer 38

Symptoms: Severe sore throat (usually unilateral) Fever “Hot potato" or muffled voice Pooling of saliva or drooling may be present Trismus neck swelling and pain

Answer 39

needle aspiration: antimicrobial therapy (amoxicillin/clavulinic, cephalosporins, and clindamycin), and supportive care (hydration, analgesia)

Answer 40

◦Retropharyngeal abscess Most commonly in **young children** between the ages of two and four years

Answer 41

Difficulty swallowing (dysphagia) pain with swallowing (odynophagia) drooling with decreased oral intake Unwillingness to move the neck secondary to pain (torticollis), particularly unwillingness to extend the neck "hot potato" quality [dysphonia] Gurgling sound, or stertor (snoring sound) Respiratory distress (stridor, tachypnea, or both); stridor develops as disease progresses Neck swelling, mass, or lymphadenopathy Trismus (in approximately 20 percent

Answer 42

Respiratory virus affecting nasal passages and lungs Almost all children will be infected by 2 years of age Recovery within 1-2 weeks of infection May be severe in premature or very young infants

Answer 43

young age preterm birth (specific guidelines for immunization with Synagis = palivizumab) low birth weight chronic pulmonary disease cyanotic or complicated cardiac disease neurologic disease immunodeficiency or immunosuppression congenital defects of the airway

Answer 44

**RSV is the most common cause of bronchiolitis** ◦Inflammation of small airways of lung ◦Other causes of bronchiolitis include: **rhinovirus, parainfluenza, influenza, human metapneumovirus, and adenovirus** ◦Seen most often in fall, winter & early spring

Answer 45

Foreign Body Important cause of chronic cough in toddler ◦Nasal Unilateral purulent drainage Foul smelling ◦Lower respiratory tract DDx: recurrent viral infections and asthma PE and CXR may be unrevealing

Answer 46

Often begins in infancy Sx: ◦Vomiting ◦Poor weight gain ◦Substernal CP ◦Abd pain ◦Dysphagia ◦Esophagitis

Answer 47

Dx often based on clinic sx only Tests: ◦Upper GI (r/o other abn.) ◦24 hr esophageal pH probe Tx: ◦Dec. feedings, positioning ◦Acid suppressive meds ◦OMT

Answer 48

Rotavirus causes viral gastroenteritis ◦Most common cause of diarrhea in young children throughout the world ◦Normally self-limiting but can cause severe dehydration ◦Sx: fever, vomiting, diarrhea ◦Highly contagious, lasting 3-9 days

Answer 49

Usually, it's a sisyphean effort However: Rotavirus vaccination in early infancy ◦Rotateq 3 dose series ◦Rotarix 2 dose series

Answer 50

aspiration or ingestion

Answer 51

Tracheal or esophageal – how can you tell? Urgent or emergent intervention: When the object is sharp, long, or consists of magnets When the object is a disk battery in the esophagus If airway compromise, such as tracheal compression, is present If there is evidence of esophageal obstruction (eg, the patient is unable to swallow secretions) If there are signs or symptoms suggesting inflammation or intestinal obstruction (fever, abdominal pain, or vomiting) If the object is in the esophagus and the suspected ingestion occurred 24 or more hours prior to the evaluation, or if the time of ingestion is unknown

Answer 52

Neonates Result of thick suprapubic fat Resolve as infant grows

Answer 53

1:250 male births Infants should not be circumcised ◦Dorsal preputial skin may be need repair Repair usu. at 6 months of age

Answer 54

Common in prepubertal age group Fusion of labia minora inflammation of thin labial mucosa that adheres in midline Severe fusion may result in dysuria& urinary problems including UTIs

Answer 55

## Footnote **Tx: mechanical separation then petroleum ointment to diminish irritation** **◦estrogen creams (Premarin)**

Answer 56

Congenital Normal valve mechanics of uretervesicular jxn is impaired Reflux from bladder to ureter or kidney

Answer 57

Grades I to III high rate of spontaneous resolution, grades go up to 5 Suppressive Abx

Answer 58

Girls\>boys Don’t trust a culture from a bag urine sample!! Catheterized sample only in infants Clean catch if potty trained