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Cpr exam 3 > Cardiac, Pulmonary and Renal Pediatric Pearls > Flashcards

Cardiac, Pulmonary and Renal Pediatric Pearls Flashcards

1
Q

What is the most common cyanotic congenital heart disease?

A

Tetrology of Fallot

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2
Q

Cardiac arrest in kids- most likely from__________t that begins with a variable period of systemic ______, ______, and ______ and progresses to _______ and ______–>cardiac arrest

A

Cardiac arrest in kids- most likely from asphyxial arrest that begins with a variable period of systemic hypoxemia, hypercapnea, and acidosis and progresses to bradycardia and hypotension–>cardiac arrest

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3
Q

Well controlled asthma looks like ______ asthma in the table above

Poorly-controlled asthma looks like _____ asthma in the table above

A

intermittant

severe

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4
Q

List the mainstays of treating a patient suffering an acute asthma exacerbation

A

SABA (albuterol)

O2

Steroids (systemic); prednisone, prednisolon, methylprenisolone

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5
Q

Diagnose acute post-streptococcal glomerulonephritis

A

Recent strep throat followed by:

  1. Gross hematuria consistent with glomerular involvement
  2. HTN: mainly due to Na+ and water retention
  3. Swelling/edema: due to Na+ and water retention
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6
Q

What labs will you see in a patient in with post-strep GN?

A
  • UA: hematuria and proteinuria of varying degrees
  • ↑ ASO titer
  • ↓ serum complement C3
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7
Q

How is post-strep glomerulonephritis treated?

A

Supportive care, usually kids are fine

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8
Q

What is the mechanism of post-strep glomerulonephritis?

A

Deposition of immune complexes in the glomeruli.

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9
Q

Henoch-Schonlein purpura is also called __________.

A

Immunoglobin A vasculitis

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10
Q

Name the prognostic indicator of long-term renal damage in children with Henoch-Schonlein Purpura.

A

Development of PROTEINURIA, along with hematuria

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11
Q

Henoch-Schonlein Purpura is ______ to diagnose

How long do children with Henoch-Schonlein Purpura feel shitty for

A
  • hard
  • kid feels really bad for a long time
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12
Q

In HSP, follow up with regard to _____________ is important–> follow until clear.

A

Follow up with regard to UA’s for RBC’s and protein is important–> follow until clear

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13
Q

List the signs and symptoms of urinary tract infections (UTIs) in children

A
  1. Fever (with no identifiable cause on PE)
  2. ↓ intake
  3. Dark, strong smelling urine
  4. Stomach pain
  5. ↑ frequency and urgency
  6. Dysuria
  7. Loss of control
  8. Sometimes emesis, sometimes diarrhea
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14
Q

When can a clean-catch urine be obtained?

A
  • If the child can void on command
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15
Q

If the child cannot void on command, what are other methods of urine collection when sending a urine sample for culture and sensitivity?

A
  1. Catheterization
  2. Suprapubic aspiration (usually done in NICU)
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16
Q

_________ are only helpful if NEGATIVE and are NOT appropriate for culture.

A

Bag urine samples

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17
Q

If a child is acutely ill, febrile and empiric ABX are going to be given, how and when should a urine sample be obtained?

A
  • Via catheterization or suprapubic aspiration
  • BEFORE meds are given
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18
Q

Describe the criteria for the diagnosis of a UTI in a child if the urine is obtained via

  1. - clean catch
  2. - catheterization
  3. - by SPA
A
  • Clean catch: prescence of both:
    • pyuria
    • at least 50,000 colonies/mL of a single uropathogenic organism in an appropriately collected specimen of urine (child has to be potty trained)
  • Catheter:
    • ​pyuria &
    • colony count of 50,000 CPM or 10,000-50,000 CPM confirmed by repeat meets criteria
  • SPA:
    • ​pyuria and ANY growth on culture
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19
Q

What is leukocyte esterase and what is it used for?

A
  • Enzyme present in most WBC and if in urine, indicative of a bacterial infection.
    • (-) test when few WBC in urine in NL
    • (+) test when number of WBC ↑ significantly.
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20
Q

↑ WBC count in urine (leukocyturia) =

A

Inflammation/infection in the kidney or UT

  • bacterial infection-
21
Q

What can contaiminate a leukocyte esterase test?

A

Vaginal secretions

22
Q

Urine nitrate testing screens for what _______.

A

prescence of UTI;

bacteria that convert nitrate => nitrite,** which can cause a **UTI

23
Q

Most common cause of UTI in pediatrics (57-67%)?

A

Escherichia coli (E. coli)

24
Q

What are the other most common urinary pathogens in children?

A

Gram (-) pathogens:

  1. Klebsiella
  2. Proteus
  3. Enterococcus
  4. Pseudomonas

Gram (+) pathogens:

  1. Staph saprophyticus
  2. Enterococcus (esp of indwelling cather or post-intstrumentation
  3. Stap aureus (rare)
25
Q

If you are going to treat pediatric patients empirically for a UTI, what should you choose?

A
  • Not acutely ill & tolerating (po);ORAL ABX.
    • Cephalosporins (cefixime or cefdinir)
    • Resistance to amoxicillin-clav and TMP/SMX is ↑
  • Acutely ill & not tolerating PO; Parenteral
    • 3rd generation cephalosporin (cefriaxone)
26
Q

How long should you treat a UTI in pediatrics?

A

Depends on if fever is present with UTI.

  • No fever + UTI: 3-4 days
  • Fever + UTI: 10 14 days
27
Q

When treating UTI in pediatrics, you should see improvement in __________.

Always modify ABX choice depending on _________.

A

28-48 hours

results of culture

28
Q

When do you image a childs Urinary tract?

A
  • Boys: after first UTI
  • Girls: after 2nd (sometimes 3rd)
29
Q

How do we image a child UT?

A
  • 1. Renal and bladder US
    • Anatomic abnormalities
    • Obstruction with secondary dilation
    • Duplication of collecting system/ureters
    1. Conduct a VCUG if
      * Abnormal RBUS
      * Temp > 39C + pathogen other than E.coli
      * Pt has poor growth & HTN
30
Q

After a 2nd UTI, what is done to image childs UT and why?

A
  • VCUG
    • to look for eviedence of VUR
    • Grade 1-5
    • Notorious for causing renal scarring
31
Q

What is renal scarring?

A

Loss of renal parenchyma between calyces and capsule.

32
Q

Long term complications of renal scarring is ?

A

1. HTN

2. Decreased renal function

3. Proteinuria

4. ESRD

33
Q

Explain the significance of the different grades of VUR in pediatric pts

A
  • Grade I- kidneys not affected
  • Grade II- renal pelvis affected
  • Grade III-dilatation of calyces and ureter
  • Grade IV- worse dilatation of all structures
  • Grave V- extreme dilatation

Grade 3 or less usually goes away on its own

Notorious for causing renal scarring

34
Q

List the most common causes of obstructive uropathy children

  1. Anatomic:
  2. Neurologic
  3. Functional
A
  1. Anatomic
    1. UPJ obstruction
    2. Posterior urethral valves (PUV); only in boys
    3. Duplex kidney; 2 ureters come out of 1 kidney
  2. Neurologic
    1. Myelomeningocele with neurogenic bladder
  3. Functional
    1. Bladder or bowel obstruction
35
Q

When do suspect that a child has urinary obstruction?

A
  1. When a patient has problems voiding
  2. Family hx of urinary problems,
  3. GU exam revels abnormalities ****
  4. Sx dont respond to therapy
36
Q

When does a PCP refer to a specialist, in a child with a UTI? (6)

A
    1. Grades 3-5 of VUR
    1. Obstructive uropathy is preesnt
    1. Renal abnormlaities
    1. Impairment of kidney fx
    1. Pt is HTN
    1. Bowerl and bladder dysfunction is cannot be managed by PCP
37
Q

Develop a DDx for a newborn w/ tachypnea

A

Most indicative of a cardiac abnormality**** but can also be ARDS.

38
Q

What are the ONLY acyanotic congenital heart defects, meaning that all others are cyanotic?

A
  1. ASD
  2. VSD
  3. PDA
  4. Coarctation of the aorta (CoA)
39
Q
  1. Truncus arteriosus
  2. Transposition of great vessels
  3. Tricuspid atresia
  4. Tetralogy of Fallot
  5. VSD
  6. Total anomalous pulmonary vascular return
  7. Hypoplastic left heart syndrome
  8. ASD
  9. Double outlet R ventricle
  10. Ebstein’s anomaly
  11. PDA
  12. Coartication of the aorta
  13. Pulmonary atresia
  14. Single ventricle
  15. Total anomalous pulmonary return
A
  1. Truncus arteriosus: C
  2. Transposition of great vessels: C
  3. Tricuspid atresia: C
  4. Tetralogy of Fallot: C
  5. VSD: A
  6. Total anomalous pulmonary vascular return: C
  7. Hypoplastic left heart syndrome: C
  8. ASD: A
  9. Double outlet R ventricle: C
  10. Ebstein’s anomaly: C
  11. PDA: A
  12. Coarctation of the aorta: A
  13. Pulmonary atresia: C
  14. Single ventricle: C
  15. Total anomalous pulmonary return: C
40
Q
  1. List the criteria for referring a pt with a heart murmur to a cardiologist
A
  1. Grade 4 murmur or above
  2. Diastolic murmur
  3. Increased intensity when pt stands
  4. Anytime a murmur is symptomatic
  5. Heart sounds are obscured
  6. Femoral pulses are weak
  7. Clicks
  8. Hyperactive precordium
  9. History of sudden death at a young age in family
  10. Abnormal or extra heart sounds (except S3 in children or young adults)
  11. Conditions (congenital or prenatal) predisposing pt to congenital heart lesions
  12. If you get “that feeling”
41
Q

If you hear S3 in children or young adults, do you refer them do a cardiologst?

A

No, refer to cardiologist for abnormal or extra heart sounds, EXCEPT S3

42
Q

What test is done to detect critical congenital HD in newborms before discharge from nursey

A

Pulse ox screening test

43
Q

5T’s and 1-5 mneumonic

A

Tells us which CHD are cyanotic.

1. Truncus arterious

2. Transpotiion of great vessels

3. Tricuspid atresia

4. Tet of Fallot

6. Total anomalous pulmonary vascular return

44
Q

What happens if a baby fails screening test for Critical CHD?

A

ITS JUST A SCREEN!

if it fails, a more thorough assessment is needed to find out the cause of ↓ O2 sat.

45
Q

When do we conduct pulse ox screening in newborns to look for critical CHD?

A
  1. BB is in nursey 24 or more hours old
  2. Right before discharge, if bb is less than 24 hours old
46
Q

Screen baby.

What inidicates if the baby fails screen, needs to repeat in 1 hour or passes?

A
  • Fails: Pulse Ox is <90% in right hand or foot
  • Repeat: 90-95% in right hand and foot or if there is a >3% difference between right hand and foot
    • repeat up to 2x
  • Pass: 95% or greater in right hand or foot and 3% or less differance between right hand and foot.
47
Q

Study of choice of CHD is _________, ____ is helful in initial work up.

A

Echo

CXR

48
Q

BP cuff that is too small => artificially _____ BP

BP cuff that is too large => artificially _____ BP

A
  • Small => high BP
  • Large => low BP
49
Q
  1. Locate electronically and be able to use the following
  • A. Clinical practice guidelines for screening and management of High blood pressure in children and adolescents, pediatrics. 2017;140(3)
  • B. Fourth report (January 2004);
    • Diagnosis, Evaluation and Tx of HBP
A

refer to them for scpeicifc guidelines and numbers

Cpr exam 3 (13 decks)

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