Cardio, Pulmonary, Endocrine & Renal

Question 1

___% of kids have a benign murmur

Answer 1

30

Question 2

Two types of benign murmurs

Answer 2

stills murmur and venous hum

Question 3

Stills murmur

Answer 3

SYSTOLIC,

Question 4

Venous hum

Answer 4

best heard in anterior neck, disappears when jugular vein is compressed

Question 5

Murmurs that are NEVER normal; tx

Answer 5

DIASTOLIC, anything >II/VI; get an echo

Question 6

Dx–Newborn is cyanotic @

birth, O2 does not improve; most common in ____; [NO MURMUR]

Answer 6

transposition of great arteries; infants of diabetic mothers

Question 7

Transposition of great arteries–tx

Answer 7

PGE1 to keep PDA patent

Question 8

Dx–2y/o child who gets cyanotic and hyperpnea while playing, squats down; tx

Answer 8

TOF [pulm stenosis, RA hypertrophy, overriding aorta, VSD]; O2 and knees to chest, sx

Question 9

TOF–murmur type

Answer 9

harsh SEM + single S2

Question 10

Dx–Bipolar woman gives birth to a child w/ holosystolic murmur worse on inspiration

Answer 10

Ebstein anomaly

Question 11

Ebstein anomaly

Answer 11

Tricuspid insuficciency 2/2 TV displacement into RV

Question 12

Ebstein anomaly–arrhythmia

Answer 12

Wolff-Parkinson-White

Question 13

Dx–Cyanosis @ birth with holosystolic murmur, depends on VSD or ASD for life. EKG shows LVH

Answer 13

Tricuspid atresia

Question 14

Tricuspid atresia–tx

Answer 14

PGE1 until sx

Question 15

Dx–Heart defect associated with DiGeorge syndrome. CXR shows ↑pulm blood flow and bi-ventricular hypertrophy

Answer 15

Truncus arteriosis

Question 16

In truncus arteriosis, _____ develops early. Tx w/ sx in first few weeks of life

Answer 16

Eisenmenger

Question 17

Describe Eisenmenger syndrome

Answer 17

increased blood flow to lungs instead of body causing extreme pulm HTN–>instead blood goes through shunt from RV to LV and gives O2-poor blood to body

Question 18

MC congenital heart murmur; describe murmur

Answer 18

VSD; harsh holosystolic over LL sternal border, loud P2

Question 19

If harsh holosystolic over LL sternal border at II/VI in 2mo w/ no sxs, next step

Answer 19

continue to monitor [VSD must close by 1-2yrs]

Question 20

Gold standard test for murmurs

Answer 20

echo

Question 21

VSD–surgery is indicated if____

Answer 21

FTT, 6-12mo w/ pHTN, >2yr w/ Qp/Qs >2:1

Question 22

VSD–is louder murmurs better or worse? why?

Answer 22

Better. It means the defect is small. Most often membranous. More likely to spontaneously
close

Question 23

Dx–Loud S1 w/ fixed and split S2. Older child w/ exercise intolerance

Answer 23

ASD

Question 24

Dx–Most common defect in Down Syndrome baby

Answer 24

Endocardial cushion defect

Question 25

Endocardial cushion defect--describe murmur

Answer 25

Fixed & split S2 + SEM w/ diastolic rumble

Question 26

Endocardial cushion defect----tx

Answer 26

sx before pHTN at 6-12mo [at risk for early Eisenmengers]

Question 27

Dx--Continuous machine-like murmur w/ bounding pulses and wide pulse pressure

Answer 27

PDA

Question 28

PDA--associated pathologies

Answer 28

prematurity, congenital rubella syndrome

Question 29

PDA--tx

Answer 29

if not closed by 1wk, give indomethacin or sx

Question 30

Dx--Most common defect in Turner’s baby

Answer 30

Coarctation of aorta

Question 31

Dx--Decreased femoral pulses, “reverse 3 sign”, “notching” @ inf rib border 2/2 incr collateral

Answer 31

Coarctation of aorta

Question 32

Dx--15yo athlete w/ occasional palpations, angina, dizziness. Last week, fainted during baseball game

Answer 32

Hypertrophic CM

Question 33

Hypertrophic CM--murmur type; better with ____ preload, ___ w/ valsalva/standing/exercise

Answer 33

SEM; increased; louder

Question 34

Hypertrophic CM--tx

Answer 34

ß-blockers or CCB, alcohol ablation or surgical myotomy

Question 35

Hypertrophic CM--restrictions

Answer 35

no sports/heavy exercise!

Question 36

Why can't you use diuretics or digitalis in Hypertrophic CM?

Answer 36

Dig--glycosides contraindicated except in pts a/ uncontrolled afib; Diuretics--potential adverse effect on the LV outflow gradient and ventricular volume

Question 37

Dx--7yo w/ vague chest pain, pain in different joints over the past few days, and a rash. ESR is elevated. EKG shows prolongation of the PR interval

Answer 37

Acute rheumatic fever

Question 38

Acute rheumatic fever--Tx

Answer 38

oral PCN (or erythromycin) for 10 days then prophylactically until 20yo

Question 39

Acute rheumatic fever--cardiac complications

Answer 39

mitral stenosis (M > aorta > tricuspid)

Question 40

CF--signs at birth; dx and tx

Answer 40

meconium ileus (dilated loops), "ground glass", +/- rectal prolapse from chronic diarrhea; gastrograffin enema

Question 41

Early childhood, expect CF when see ____

Answer 41

FTT (

Question 42

CF--genetics and inheritance

Answer 42

AR, mut chr7, CFTR protein

Question 43

CF--dx

Answer 43

sweat test [>60mEq/L chloride]

Question 44

CF--tx (A) thick resp secretions (B) pneumonia (C) pancreatic insuff (D) electrolyte loss thru skin

Answer 44

(A) DNAse (mucolytic), albuterol/saline nebs (B) piperacillin + tobramycin or ceftazidime (C) enz replace w/ meals + ADEK supplement (D) fluid replacement

Question 45

CF--MC type pneumonia

Answer 45

pseudomonas or b. cepacia

Question 46

Asthma tx--pt has sxs twice a week and PFTs are normal

Answer 46

albuterol only

Question 47

Asthma tx--pt has sxs 4x a week, night cough 2x a month and | PFTs are normal

Answer 47

albuterol + inhaled CS

Question 48

Asthma tx--pt has sxs daily, night cough 2x a week and FEV1 is 60-80%

Answer 48

albuterol + inhaled CS + long-acting ß-ag (salmeterol)

Question 49

Asthma tx--pt has sxs daily, night cough 4x a week and FEV1 is

Answer 49

Albuterol + inhaled CS + salmeterol + montelukast and oral steroids

Question 50

Asthma exacerbation--tx w/ _____.

Answer 50

albuterol and PO/IV steroids

Question 51

Asthma exacerbation--watch __ and ___. PCO2 should be ____

Answer 51

peak flow rates; blood gas; low [if normalizing PCO2, means impending resp failure--must INTUBATE]

Question 52

Asthma can cause severe complications during this case _____

Answer 52

allergic bronchopulmonary aspergillus [hyper-reactivity of immune system]

Question 53

Type 1 DM--sxs when present to ER in DKA; labs--__ Na/Cl, ___HCO3, __ glucose

Answer 53

emesis, wt loss, polyphagia, polydipsia, polyuria; low; low/nl; high

Question 54

Child w/ DKA--next best steps

Answer 54

Start insulin drip + IVF, monitor BGL and anion gap, start K, bridge w/ glargine once tolerating PO

Question 55

Type 1 DM--pathophys

Answer 55

T-cell destruction of islet cells in pancreas, insulin autoAb, glutamic acid decarboxylase autoAb

Question 56

Diagnostic criteria for DM?

Answer 56

fasting glc >125 (x2) OR 2hr OGTT (75g) >200, random glc >200 + sxs

Question 57

Kid peeing blood--best first test

Answer 57

UA

Question 58

Kid peeing blood--dysmorphic RBCs or RBC casts

Answer 58

glomerular source

Question 59

Kid peeing blood--1-2 days after runny nose, sore throat and cough

Answer 59

Berger's Dz (IgA nephropathy) = MCC

Question 60

Nephritic syndrome

Answer 60

proteinuria (

Question 61

Kid peeing blood--1-2 wks after sore throat of skin infx

Answer 61

Post-strep GN

Question 62

Post-strep glomerulonephritis characteristics

Answer 62

smoky/cola urine, best 1st test is ASO titer. Subepithelial IgG humps

Question 63

Hematuria + hemoptysis

Answer 63

Goodpasture syndrome (Abs to collagen IV)

Question 64

Hematuria + deafness

Answer 64

Alport syndrome (XLR mut in collagen IV)

Question 65

Dx--Flank pain radiating to groin + hematuria

Answer 65

kidney stone

Question 66

Kidney stone--best test

Answer 66

CT

Question 67

Kidney stone--MC type; tx

Answer 67

calcium oxalate; HCTZ

Question 68

Kidney stone--kid w/ family hx stones--MC type

Answer 68

cysteine (can't resorb certain AA)

Question 69

Kidney stone--chronic indwelling foley and alkaline pee--MC type

Answer 69

struvite = Mg/Al/PO4

Question 70

What pathogens cause struvite kidney stones?

Answer 70

proteus, staph, pseudomonas, klebsiella

Question 71

Kidney stone--leukemia being tx w/ chemo--MC type

Answer 71

uric acid [tx by alkalinizing urine + hydration]

Question 72

Kidney stone--s/p bowel resection for volvulus--MC type

Answer 72

pure oxylate stone (CA not reabsorbed by gut and so pooped out)

Question 73

Kidney stone--tx of stones

Answer 73

will pass, hydrate

Question 74

Kidney stone--tx of stones >2cm

Answer 74

open or endoscopic sx

Question 75

Kidney stone--tx stones 5mm-2cm

Answer 75

extracorporal shock wave lithotropsy

Question 76

Kid peeing protein--best first test

Answer 76

repeat in 2 wks then quantify w/ 24hr urine

Question 77

Kid peeing protein--MC

Answer 77

minimal change disease (fusion foot processes)

Question 78

Minimal change disease--tx; MC complication

Answer 78

prednisone 4-6wks; infection (make sure immunized for pneumo and varicella)

Question 79

Nephrotic syndrome

Answer 79

>3.5g protein/24hrs, hypoalbuminemia, edema, hyperlipidemia (fatty/waxy casts)

Question 80

Kid peeing protein--random cause

Answer 80

orthostatic =MC in school-aged kids; normal while supine

Question 81

Dx--nephrotic pt suddenly w/ flank pain

Answer 81

renal vein thrombosis (EMERGENCY), 2/2 peeing out ATIII, protein C/S; do CT/US!!