6 Flashcards
When do you consider failure to thrive?
< 5th for weight OR weight for length
crossing more than 2 major lines
Organic causes of failure to thrive
Congenital heart defects Cystic fibrosis Gastroesophageal reflux Neurologic disorders Metabolic disease
Typical feeding pattern of a young infant
10-30 minutes every 1-2 hours; bottle-fed may be less frequent because takes more with each feed
What is a critical portion of the pediatric cardiac exam?
PULSES- brachial vs femoral pulses = rule out coarctation of the aorta
What grade murmur has a thrill?
4
What is the number one cyanotic congenital heart defect?
Tetrology of fallot
Why do we see hepatomegaly in congestive heart failure?
Decreased renal blood flow leads to fluid retention via RAAS = systemic venous congestion, and hepatomegaly.
On an abdominal exam of a newborn you appreciate the liver edge 3 cm below rib border. Is that normal? What is ddx for hepatomegaly?
Not normal - < 1 cm = normal
If > 1cm ddx = Congestive heart failure Congenital infections Inborn errors of metabolism Anemias, and (less commonly) Tumors
You hear a systolic ejection murmur with widely split, fixed S2. What is this murmur and how old is the patient?
ASD, 3-5 most common age
How does coarctation fo the aorta present?
- murmur
- HTN in upper extremities
- discrepancy between the upper and lower extremity pulses and BP
You are examining an infant in the nursery and detect a holosystolic murmur beginning with S1 with a blowing quality. What is it?
VSD
Describe physical exam of aortic stenosis
Systolic ejection murmur, radiating to the neck (and occasionally a thrill in the jugular notch), with an early systolic click
Continuous ‘machine-like’ murmur and bounding pulses (from a widened pulse pressure)
patent ductus arteriosus murmur
Why does tetralogy of fallot result in systolic ejection murmur?
RVOT obstruction
Why does ASD result in systolic murmur?
increased flow across a normal pulmonic valve
How does an innocent murmur sound?
Vibratory, low-pitched, louder when supine
Heard best at the left lower sternal border
Which heart murmurs present with signs of CHF in infancy?
VSD
Severe aortic stenosis
Coarctation of the aorta
Large patent ductus arteriosus
What are the three embryological components of the ventricular septum?
endocardial cushion
embryologic conotruncus
embryologic trabecular septum
What determines the magnitude of left to right shunt in VSD?
size of the defect and pulmonary vascular resistance
A child is diagnosed with VSD murmur. Why was it not detected in the nursery?
elevated pulmonary vascular resistance in a newborn
3 medications for CHF
Enalapril, furosemide, digoxin
What is a potential bleak outcome of untreated VSD?
Pulmonary vascular obstructive disease (Eisenmenger’s syndrome)
What is an akinetic/atonic seizure?
Involves loss of motor tone
Things a 16 month old should be able to do
Uses 4-6 words consistently
Uses a spoon and cup, spills some
Follows simple commands
Stoops and recovers
Are febrile seizures hereditary?
YES
vaccinations against which two bugs has contributed to bacteremia as a rare event?
Haemophilus influenzae type b and Streptococcus pneumoniae
What is fever without a source?
no localizing symptoms or signs on physical exam
What are some SBI to keep in mind?
bacteremia, meningitis, pyelonephritis, osteomyelitis, appendicitis, pneumonia, bacterial gastroenteritis, septic arthritis
When is an EEG indicated?
in children who have focal, recurrent, or complex seizures
EEG spike 3-Hz spike-and-wave pattern
Absence seizure
What is a complex febrile seizure?
More than once in 24-hour period, > 15 minutes
If a child has his first febrile seizure before age 12 months, the recurrence risk for a second febrile seizure is about ___
50%
What are 6 types of seizure medications?
Diazepam Valproic acid Phenobarbitol Phenytoin Primidone Carbamazepine
red lips, a strawberry tongue, and a light-red sandpaper rash
Scarlet fever
A high fever (38.5 to 40.5 C) for 3-5 days in a typically fairly well-appearing child, followed by abrupt resolution of fever and development of a maculopapular rash
Roseola
Primary HHV-6 infection is associated with approximately 20% to 30% of first _______
febrile seizure
What questions can you ask to evaluate if organ perfusion is being maintained in sickness (evaluate severity of sickness)?
Brain (alert vs. lethargic)
Skin (well-perfused, flushed, cool/clammy?)
Kidneys (urine output)
Lungs (RR, work of breathing, cyanosis)
What are some emergency conditions that cause AMS?
Hypoxia, shock, and hypoglycemia
What are some CNS causes of AMS?
Infection (sepsis, meningitis, or encephalitis) Poisoning/Toxic ingestion Increased ICP (CNS tumor, hemorrhage) Trauma Metabolic disturbance (DKA)
Why the tachypnea in a child with shock?
Blow off CO2 to compensate for metabolic acidosis from decreased oxygen perfusion of the tissues and cells.
Is hypotension a late sign on shock in children?
YES; can usually compensate with RR and HR
What are the types of shock?
Distributive
Hypovolemic
Cardiogenic
Septic
Patients with septic shock may intitially present in “warm” shock. What are the sx of warm shock?
Warm extremities Bounding pulses Tachycardia Tachypnea Adequate urination Mild metabolic acidosis
A child presents in shock. What is an appropriate fluid resuscitation?
repeated boluses of isotonic fluids (20 ml/kg at a time, total of 60 mL/kg)
if still not adequately responding, start inotropic rx
How do fluids administered through IO enter the blood stream?
Tibia blood flow = popliteal vein
Femur = femoral vein
What are some PEx findings with meningitis?
AMS, fever, neck stiffness, kernig’s or brudzinski’s sign
When does meningococcal disease happen?
Peak incidence occurs in children < 12 months of age, with another peak at age 16 through 21 years.
What are risk factors for meningococcal disease?
Close accommodations (dormitories, military) Complement deficiency Anatomic or functional asplenia
Fever and petechiae - what do you need to rule out?
bacterial sepsis, meningococcal disease
Does ceftriaxone treat disease and eliminate carrier state of n. meningidities?
YES
Should IV abx be ordered on hourly terms?
YES
What meds are given as n. meningitis ppx?
Adults = Cipro Children = Rifampin
What vaccines protect against n. meningococcal disease?
MCV4 (first at 11-12, 2nd at 16)
MenB (first at 16, booster 6 mo following)
