Cardiology-Table 1 Flashcards
Most common endocrine/metabolic disorder of childhood
Type 1 DM
(adenoma/destructive lesions) are the more common cause of hypopituitarism
Destructive Lesions of the hypothalamus
Polyuria, polydipsia, and polyphagia are common S&S of
Type 1 DM
Acanthosis Nigricans is a S&S of
Type 2 DM
____have been shown to reverse/delay kidney damage when detected early
ACE inhibitors
___ is a complication of DKA that results from an osmolar shift of fluid into cells
Cerebral edema
Diagnostic tests for DKA
Blood gasses, CBC, BMP, A1C, UA, Ucx
DKA treatments include:
Restore fluid volume
Insulin
Replace body salts
Correction of acidosis
Emergency management of hypoglycemia includes
IV glucose
Bolus D10W
Then Constant Infusion
The most common presenting complaint in pediatric endocrinologist
Growth disturbances (GH deficiency)
Workup for a GH deficiency includes:
X ray electrolytes
CBC karyotype
ESR thyroid fxn
Urinalysis, BUN/Cr
____ is the most common neonatal metabolic disorder
Congenital hypothyroidism
____ is the most common cause of goiter and thyroiditis in childhood
Hashimoto’s Thyroiditis
Hypothyroidism has increased incidence in these 2 chromosomal disorders
Trisomy 21
Turner’s syndrome
Your patient presents with mental sluggishness, pale skin, non-pitting edema, hoarse voice, and dry skin. You suspect:
Hypothyroidism
The most common cause of excess thyroid hormone
Graves disease
Treatment for hyperthyroidism includes
B blockers
PTU, methimazole
CNS tumors and familial factors are causes of ____ precocious puberty.
Central
Treatment of central precocious puberty includes
Leuprolide (GnRH analog)
Most common cause of delayed puberty in boys
Kleinfelter syndrome
What is the most common cause of female pseudohermaphrodite
CAH (Congenital adrenal hyperplasia)
___ is the most frequent cause of ambiguous genitalia in the newborn
CAH
What is the most common cause of CAH?
Deficiency of 21-hydroxylase
____ help maintain BP by supporting vascular tone and promoting Na and H2O retention
Glucocorticoids
Most common cause of cushing’s in children
Prolonged administration of exogenous glucocorticoids
Poor feeding w/ lethargy in an infant could be a sign of
Cardiac disease or Infection
Chest X-rays are good for visualizing these heart characteristics:
Cardiomegaly
Pulmonary circulation
Heart shape
The size, shape, flow within, and pressures within the heart can be visualized with ____
ECHO
Later stage Heart failure can present with _____ on abdominal exam
Hepatomegaly
____ in the fingers is a response to hypoxia
Clubbing
Differential pulses could be a sign of ____
Coarctation of the Aorta
Bounding pulses could be due to L PDA shunt , or ___
Aortic Insufficiency
___ is the heart sound associated with the closing of aortic and pulmonic valves
S2
___ is the heart sound associated with closing of mitral and tricuspid valves
S1
S1 is best heard at
LLSB or apex
___ is heard in diastole & is related to rapid ventricular filling (splash)
S3
____ is never normal. Comes just before S1. Pathognomonic with heart failure and decreased ventricular compliance.
S4
Aortic or pulmonary stenosis present with this heart sound:
Ejection click
Mid-systolic clicks are usually due to
Mitral valve prolapse
Loud S2 can be due to
Pulmonary HTN
A fixed, split S2 could be due to pulmonary stenosis or ____
ASD
Truncus is associated with which heart valves?
Semilunar (only 1)
Murmurs are described based on:
Location/radiation
Relationship to cardiac cycle
Intensity
Quality
6 most common functional murmurs
Newborn Peripheral pulmonary arterial stenosis (PPS) Still murmur Pulmonary Ejection Murmur Venous Hum Innominate or carotid Bruit
Most common murmur of early childhood
Still murmur
Most common innocent murmur in older children
Pulmonary ejection murmur
Most common CHD presenting in the first week of life
Transposition of Great Arteries
Most common CHD presenting beyond infancy
Most common cyanotic lesion in childhood
Tetralogy of Fallot
How do you know if a murmur is benign?
If they have other sx not benign
Kid OK? benign
Which murmur is best heard sitting at the R infraclavicular area?
Venous hum
Most causes of syncope in kids is due to this type of cause
Vasovagal or
Neurocardiogenic
Cardiac causes of syncope in kids includes:
Arrhythmia or Congenital Heart Disease
____ are a benign rhythm disturbance where there is a compensatory pause before the next beat
PAC
Premature Atrial Contract.
PVC’s have a wide________ and NO compensatory pause
Wide QRS
3 PVCs in a row is considered ______
V-tach
Re-entrant tachycardia is characteristic of this syndrome caused by supraventricular tachycardia
Wolff-Parkinson-White syndrome
Acute treatment for SVT includes IV _____
Adenosine
In babies, Ice on the face causes vagal stimulation for treatment of _______
SVT
Maternal lupus can lead to ____
Congenital heart block
Most common heart block in peds
3rd degree
Heart disease in peds is primarily due to _______ abnormalities
Structural
____ is the most common CHD presenting in the 1st week of life
Transposition of Great Arteries
3 shunts necessary for survival in baby:
Ductous venosus
Foramen ovale
Ductus arteriosus
Cyanotic shunts are ___ _____ and the blood bypasses the lungs
R L
Most common L R shunt
VSD
ASD, VSD, PDA, and blood flow obstructions all cause _____-_____ shunts
L R
ASD can cause _____heart enlargement
Right
Which heart condition is Pathognomonic with fixed split S2
ASD
Most common type of VSD
Peri-membranous
Over time, the _____ becomes enlarged in a VSD
Left Ventricle
_____ have a harsh holosystolic murmur
VSD
______ is an endocardial cushion defect
AVSD
AVSD is associated with this genetic condition
Trisomy 21
PDA murmurs are holosystolic and ________-like
Machine like
_____ is generally not progressive, and may result in decreased blood flow to the lungs depending on size
Pulmonary Stenosis
____ is an obstruction of LV output and may occur above or below the valve
Aortic Stenosis
___ is usually the first sign of aortic stenosis
Heart murmur
ejection click, basilar ejection murmur, precordial thrill
In older kids, Dizziness and fainting at a low threshold may suggest:
AS (aortic stenosis)
CoA (coarctation of the aorta) is commonly associated with this other structural abnormality:
Bicuspid aortic valve
CoA presents with a _______ systolic murmur heard best at the ____ axilla
“blowing” Left
___ presents with HTN, weak femoral pulses, leg cramps, HA, epistaxis
CoA in older children
In a __ ___ shunt, blue blood bypasses the lungs
R L
_____ can result in extreme pulmonary overcirculation
Truncus Arteriosis
4 components of Tetralogy of Fallot
Pulmonary Stenosis
Displaced aorta
VSD
RV hypertrophy
Your 1 week old pt presents with cyanosis, a systolic ejection murmur heard at the LSB, and hypoxemic spells. You suspect:
Tetralogy of Fallot
_________ are the hallmark of severe tetralogy, where the child exhibits blue skin during episodes of crying or feeding
Hypoxemic spells
A child with Tet of Fallot might do this when they feel a tet spell coming on
Squat
Your patient presents with varying degrees of cyanosis, no murmur, tachypnea, and a normal ECG. What do you suspect?
Transposition of the Great Arteries (TGA)
___ is an embryologic problem where the LV and aora/arch are misformed
Hypoplastic Left Heart
Which type of cardiomyopathy is associated with a prolonged QT interval
Hypertrophic
Most common type of cardiomyopathy in kids
Dilated
___ is best test for diagnosing pericarditis
ECHO
Polyarthritis, Sydenham’s chorea, and erythema marginatum are all systemic findings in _____
Rheumatic Fever
This is now the #1 cause of acquired heart disease in kids
Kawasaki disease
Treatment for Kawasaki disease includes
IVIG
High dose aspirin
Cardiomyopathies are more common in
Boys
Intestines formed outside the abdominal cavity is called
Gastroschesis
Gastroschesis is an _____ problem
Organic
An LFT consists of
ALT, AST, Alk Phos
Which lab tests are better indicators of liver function?
Coags: PT/PTT/ Fibrinogen
Most common abdominal imaging study
Xray
Microcolon is best visualized with ____
Barium swallow
The pylorus, GB, and appendix are best seen with ____
Ultrasound
Chronic abdominal pain in kids is usually ______
Functional
In young kids, acute abdominal pain is usually due to
Malrotation
Intussusception
Incarcerated hernia
Congenital abnormalities
In older kids, acute abdominal pain us usually due to
Appendicitis
Most common cause of vomiting in childhood
Viral gastroenteritis
Recurrent Abdominal Pain Syndrome of Childhood is also known as…
IBS
Your pt presents with projectile vomiting. Your first suspicion is:
Pyloric stenosis
Obstruction is more common, and of much greater concern, in ___
Neonates
In older kids, most vomiting is due to ____ illness
Viral
Your pt presents with bloody emesis. You should suspect:
Mallory Weiss tear
gastritis, peptic ulcer
Management for acute diarrhea in kids is usually:
Management
Fluids – oral rehydration
What is the effect of starvation on diarrhea in most kids?
Prolongs diarrhea
Most common viral cause of diarrhea
Rotavirus
Rotavirus immunizations are recommended at __, __, and __ mo
2,4,6
Your patient has a high fever accompanying their diarrhea. You suspect it is caused by ______
Bacteria Campylobacter Salmonella Shigella E. coli C diff
Chronic constipation is defined as 2 or more of the following for 2 months: (6 criteria)
Could be a “which of the following is NOT…” type of questions…
- 1 episode encoperesis per week
- impaction of rectum with stool
- stool that plugs toilet
- retentive posturing and fecal withholding
- pain with defecation
Most causes of childhood constipation are ____ in nature
Functional
Your patient presents with wt loss, growth failure, and is looking ILL with chronic diarrhea. You suspect an_____ cause
Organic
How to treat c. diff in peds
Flagyl
Metronidazole
Vanco ($$)
Hypothyroid and Hirschsprung disease are both ___ causes of constipation
Organic
___ are most common cause of minor bleeding in kiddos
Anal fissures
other causes: Mallory-weiss, swallowed nasopharyngeal blood
Rectal bleeding in infants is usually due to _____, anal fissures, or a milk protein allergy (or NEC in preemies)
Colitis
Rectal bleeding in older kids is usually due to Meckel’s diverticulum or ___
IBD
____ is an example of an intraluminal obstruction in a kid with CF
Meconium plug
Escalating pain is commonly associated with ____
Ischemia
Your newborn pt hasn’t passed a stool in the 1st 24 hours of life. You suspect:
Hirschsprung
Where to start a workup for a baby with possible obstruction
X-ray
____ is the best position for visualization of free air
LL decubitus Xray
Inflammation of the _____ presents as a warm, erythematous belly.
Peritoneum
____ in neonates presents as dusky blue/gray belly.
Gut perforation
Periumbilical blue discoloration in neonates is known ____ sign
Cullen’s sign
Blue discolorations on flank, groin, and scrotum is known as____
Gray-Turners sign
What is the key for evaluating acidosis?
Bicarb
____ is characterized by effortless non-projectile vomiting
Reflux
Reflux is usually due to a ____ problem in babies
Neuromuscular
T/F a negative barium swallow study can rule out GER
False. Cannot fully R/o
Metoclopramide (reglan) can lead to
Tardive Dyskinesia
Sx of _____ include copious oral secretions, choking, and aspiration
Esophageal atresia
Test for suspected TEF
Cannot pass NG tube
TEFs are associated with other ___________ anomalies
VACTERL
____ anomalies are the most common association with TEF
Vertebral
More (girls/boys) typically have umbilical hernias
Girls
More (girls/boys) typically have Inguinal hernias
Boys
You have a 4 wk old pt with cc of vomiting after feeding. Active bowel sounds w/ projectile vomiting. Afebrile w/ normal vitals. You suspect:
Pyloric stenosis
Test for suspected pyloric stenosis
Ultrasound
______ in a neonatal period has been associated with pyloric stenosis
Erythromycin
Palpable “olive” in epigastric region is a sign of:
Pyloric Stenosis
US of pyloric stenosis shows muscle thickening of ______
> 4mm
___ is the most common site of atresia and stenosis
Jejunum
PUD is more common in _____
boys
____ is most definitive test for PUD
UGI
H. pylori is (more/less) common in kiddos
LESS
_____ obstruction presents sooner with distension and possible emesis
Complete
The ____ is the most common site of atresia & stenosis
Jejunum
Duodenal atresia is seen on x-ray by the ______ sign
Double bubble
Bilious emesis, polyhydramnios, and abdominal distension are sx of ___
Duodenal Atresia
Kids with this chromosomal disorder often have duodenal atresia
Down Syndrome
Your pt presents looking SICK with a hard, distended belly and bilious vomiting. You suspect:
Malrotation
Study of choice for malrotation
Barium study
Gastroschisis, omphalocele, and CDH are all _______GI anomalies
Congenital
_____ is a herniation through the umbilical cord
Omphalocele
Your patient presents with an omphalocele. Your next step should include:
Evaluate for cardiac anomalies
80% of patients with congenital diaphragmatic hernias occur on the _____
Left
Your patient presents with painless GI bleeding (melena). You suspect
Meckel Diverticulum
A patient with meckel diverticulum is at risk for ____ or _____ as well
Intussusception & volvulus
Most infants with Hirschsprung’s fail to pass meconium within ____
First 24 hrs of life
Lack of gut innervation (ganglion cells) leads to this condition
Hirschsprung
Describe stool found in Hirschsprung dz
Foul smelling, ribbon like
_____ can result from untreated congenital megacolon
E. coli sepsis
Treatment for Hirschsprung disease includes
Diverting colostomy
Your 2 yo patient presents with colicky abdominal pain with intermittent fits of crying. Pt draws up legs as if they are bearing down. Pt is afebrile and lethargic. You suspect?
Intussusception
Common stool finding of intussusception
Currant jelly stool
Treatment for intussusception includes
Contrast enema
Pelviectasis may progress to
Hydronephrosis
Most common cause of vomiting/diarrhea in kids
Rotavirus
Most common cause of acute renal failure in kids
ATN dehydration
Most common abdominal mass on newborn exam
Enlarged kidney
Your peds patient presents with HTN and edema. What do you suspect?
Renal disease
You suspect renal disease in your patient. What other physical findings might increase your suspicion?
Ear deformities
What is the most reliable indicator of glomerular function?
SrCr
___ is the most common identifiable cause of hematuria in kids
UTI
___ is defined as the ratio of urine Cr compared to serum Cr
Creatinine clearance
Cr should be less than _____ in most kiddos
____ and ____ are most common imaging studies for kidneys
US, VCUG
Which commonly used imaging technique DOES have inherent radiation exposure?
VCUG
If your pt has hematuria AND dysuria, think:
Infection
If your pt has hematuria AND associated back pain, think:
pyelonephritis
If your pt has hematuria AND proteinuria, think:
Nephropathy
____ is the most common form of glomerulonephritis in childhood
APSG
acute post-streptococcal glomerulonephrnitis
___ is the most common CHRONIC form of GN in children and is typically treated using steroids
Membranoproliferative GN
The abnormal immune response of membranoproliferative GN includes these 3 findings:
Proteinuria
Hematuria
Hypocomplementemia
Treatment of chronic GN includes
Steroids
