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Block 4 - Peds > A+P: Peds I > Flashcards

A+P: Peds I Flashcards

1
Q

The heart is derived from what neural tissue?

A

mesoderm

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2
Q

What does the heart initially form from?

A

2 simple endothelial tubes

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3
Q

What do the simple endothelial tubes of the heart develop into?

A

4 slightly bulged areas representing early heart chambers

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4
Q

What gestational age does blood usually start pumping?

A

day 22

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5
Q

What gestational age does the heart tube contort into a structurally developed heart?

A

2nd month

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6
Q

What happens at day 22 of gestation?

A

blood is pumping in the heart

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7
Q

What is happening by the 2nd month of gestation?

A

the heart tube contorts into structurally developed heart

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8
Q

List the primitive chamber of the heart.

A
  • Sinus venous
  • Atrium
  • Ventricle
  • Bulbus cordis
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9
Q

Describe the sinus venosus:

A

Receives venous blood of embryo; becomes smooth wall of RA & coronary sinus. gives rise to SA node (early control & setting of heart rate as embryo)

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10
Q

What gives rise to the SA node & what does the SA node do?

A
  • sinus venosus
  • early control and setting of heart rate as embryo
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11
Q

What is the strongest pumping chamber of early heart?

A

the ventricle

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12
Q

What does the bulbus cordis include?

A

truncus arteriosus

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13
Q

What does the bulbus cordis give rise to?

A

pulm truck (1st part of aorta) and most of RV

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14
Q

Is fetal circulation high or low resistance circuit?

A

low-resistance circuit

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15
Q

Which side of the heart has a greater pressure?

A

right side > left side

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16
Q

What is the point of fetal heart structures?

A

help bypass pulmonary circulation in utero b/c lungs aren’t mature

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16
Q

List fetal heart structures.

A
  • ductus venosus
  • foramen ovale
  • ductus arteriosus
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17
Q

Explain what the left umbilical vein does.

A
  • send O2 blood to liver via portal vein
  • deO2 blood levels the liver via hepatic vein to IVC
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18
Q

Primary function of ductus venosus?

A

to carry O2 blood from umbilical vein to the IVC then to RA bypassing the liver

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19
Q

What plays a key role in maintaining fetal circulation pattern?

A

ductus venosus

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20
Q

How does the ductus venosus close and when?

A
  • secondary to incr cardiac pressures & decreased circulating PGs postpartum
  • closes postpartum
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21
Q

Describe the foramen ovale.

A

patent structure during fetal circulation that connects the 2 atria

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22
Q

Functions (2) of the foramen ovale

A
  1. allows O2 rich blood to go from RA to LA & LV or aorta
  2. allows most O2 blood to go to the brain
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23
Q

Describe the foramen ovale.

A

Connecting structure that shunts blood from pulm artery to aorta

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24
Q

Function of the ductus arteriosus.

A

sends O2 poor blood (mixed blood) from RV for systemic circulation & lungs

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25
Q

Fetal systemic circulation includes:

A
  • right/left common iliac arteries to internal/external iliac arteries & back to umbilical arteries to return deO2 blood to placenta
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26
Q

What happens to pressure in fetal circulation postpartum?

A

Pulm circulatory pressure decr & systemic circulation incr

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27
Q

Why does the ductus arteriosus close?

A

b/c decr blood flow related to pressure changes (due to back pressure)

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28
Q

How long does it take for the ductus arteriosus to close?

A

12-24 hrs after birth

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29
Q

The ductus arteriosus forms that structure postpartum?

A

ligamentum arteriosum

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30
Q

Why does the foramen ovale close?

A

related to falling pressure from the right side of the heart

31
Q

The foramen ovale forms that structure postpartum?

A

fossa ovalis

32
Q

Umbilical vein becomes what structure postpartum

A

round ligament of liver

33
Q

Ductus venosus becomes what structure postpartum

A

ligament venosum of liver

34
Q

Umbilical arteries become what structure postpartum

A

superior vesical arteries

35
Q

Which EKG find is not uncommon is peds pts? why?

A

Sinus arrhythmia related to changing HR w/ respiration

36
Q

What is coarctation of the aorta?

A

Portion of aorta is narrowed increasing the workload (pressure) of the LV

37
Q

Results of coarctation of the aorta.

A

The LV must work harder to try to move blood through the narrowing in the aorta.

38
Q

What do children have HA w/ coarctation or the aorta?

A

too much pressure in the vessels in the head, or cramps in the legs or abdomen from too little blood flow in that region.
B/C poor perfusions

39
Q

Congenital heart defects are generally related to:

A
  • prenatal infxs (ex. Rubella)
  • environmental exposures
  • industrial solvents
  • drug use (both Rx & illicit)
40
Q

What other birth defects are related to congenital heart defects?

A

cleft palate or Down syndrome

41
Q

Assoc. Sx of congenital heart defects. (6)

A
  • Abdo or periorbital edema
  • Cyanosis
  • Dyspnea
  • Fatigue
  • Poor feeding or eating habits
  • Tachycardia
42
Q

What complications should be looked out for in coarctation of the aorta?

A
  • walls of the ascending aorta, aortic arch or any of the arteries in the head/arms may become weakened by high pressure.
  • Spontaneous tears in any of these arteries can occur–> can cause a stroke or uncontrollable bleeding.
43
Q

What defects are seen in Tetralogy of Fallot?

A
  • narrow pulm trunk & pulm valve is stenosed
  • RVH
  • VSD
  • Aorta receives blood from both ventricles
44
Q

Causes of Tetralogy of Fallot

A
  • alcoholism
  • DM
  • Adv maternal age
  • viral illness
45
Q

Describe a “tet” spell.

A

bluish skin during episodes of crying or feeding

46
Q

General cause of innocent heart murmur:

A

normal flow of blood through the heart

47
Q

Why are innocent heart murmurs usually heard?

A

b/c thin heart walls

48
Q

Describe a holosystolic murmur.

A

Grade 3, harsh, prolonged

49
Q

What does a diastolic murmur usually indicate?

A

structural heart dz

50
Q

The 7 S’s: key features of innocent murmurs

A
  1. Sensitive (changes in position/resp)
  2. Short duration (not holosystolic)
  3. Single (no assoc. clicks or gallops)
  4. Small (murmur limited to small area and non-radiating)
  5. ** Soft** (low amp)
  6. Sweet (no harsh sound)
  7. Systolic (only during systole)
51
Q

What part of the resp tract developed first?

A

upper respiratory

52
Q

What is the epithelium of the lower resp organs develop from?

A

out pocket of endoderm foregut to become pharyngeal mucosa (laryngotracheal bud)

53
Q

By what week does the lower resp tract develop?

A

5th week of development

54
Q

What happens at 20wks gestation as far as the resp system?

A

reflexive breathing movements begin to “practice” using lungs, although amniotic fluid is ingested & eliminated through urination
“gulping”

55
Q

What happens at (24) 28wks gestation as far as the resp system?

A

resp system is developed enough to handle premature birth, however, may experience infant resp distress from inadequate surfactant

56
Q

What is the role of surfactant?

A

decr surface tension to keep lungs inflated

57
Q

What can be given to help immature fetal lungs development?

A

steroids

58
Q

When is surfactant PRO A (SP-A) produced?

A

weeks before delivery

59
Q

What does surfactant PRO A trigger?

A

inflammatory response in cervix, causing it to soften in preparation of labor

60
Q

How is the first breath initiated?

A

CO2 levels rise in the fetal blood b/c placenta is no longer doing it causing central acidosis

61
Q

What happens to pulm circulatory pressure postpartum?

A

O2 diffuses into BVs surrounding alveoli + pulm arterioles relax + pulm resistance falls to promote blood flow into lungs

62
Q

How long does it take before lungs fully inflate postpartum?

A

up to 2 weeks

63
Q

Is respiration higher or lower in newborns?

A

higher

64
Q

What is the average RR in newborns?

A

40-80 breath/min

65
Q

At birth, how much of the alveoli are present?

A

1/6

66
Q

Anatomically explain the rib cage in a newborn.

A

nearly horizontal & must use descent of diaphragm to incr thoracic volume for inspiration (may incr risk for infxs)

67
Q

Babies are natural nose-breathers until what age?

A

2 yo

68
Q

By 5yo, what does the RR drop to?

A

25 breaths/min

69
Q

Describe the ribs by age 2.

A

ribs more oblique & adult form of breathing established

70
Q

Describe RR by teenage years.

A

rate usually mirrors adulthood (12-20 breaths/min)

71
Q

NOTE

A

lungs mature & form alveoli into young adulthood

72
Q

What does smoking do in teen to the resp system?

A

stunt/block alveoli maturity (+/- permanent damage)

73
Q

Unique Differences of Pediatric Respiratory System (6)

A
  1. smaller diameter & shorter length–> incr risk of choking
    –> also have larger adenoids & tonsils
  2. large tongue–> occlude airway
  3. Larynx located more superior & anterior
  4. large head–> neck flexion–> ?air obstruction
  5. long, floppy, narrow epiglottis
  6. <10yo narrow below glottis at level of cricoid cartilage
74
Q

What is the most common cause of noisy breathing in infancy?

A

laryngomalacia

75
Q

What is laryngomalacia?

A

congenital softening of the tissues of the larynx above vocal cords

76
Q

Describe pathophys of laryngomalacia.

A

structure is malformed & floppy, causing the tissues to fall over the airway opening & partially block it.

Block 4 - Peds (10 decks)

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