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cardioped Flashcards

1
Q

receives the largest amount of combined ventricular output(55%) and has the lowest resistance in the fetal circulation

A

placenta

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2
Q

why is the fetal heart unable to increase stroke volume when the HR falls

A

it has a low compliance

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3
Q

why does is there functional closure of the foramen ovale

A

due to increased pressure in the left atrium

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4
Q

why does the ductus venosus closes

A

it is the result of lack of blood flow leading to faill in pulmonary artery pressure

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5
Q

trigger for closure of PDA(within 10-15hrs)

A

increased arterial Oxygen saturation

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6
Q

why is the ductus arteriosus more likely to remain open in preterms

A

because the preterm’s ductal smooth muscle does not have a fully developed constrictor response to oxygen

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7
Q

congenital acyanotic heart dses

A

ASD VSD PDA

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8
Q

most common type of ASD

A

ostium secundum (at the site of fossa ovalis)

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9
Q

chamber enlargement in ASD

A

right sided of the heart (RA RV PA)

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10
Q

murmur in ASD

A

systolic ejection murmur at the 2nd left ICS due to relative stenosis of pulmonary valve; wide-split S2 resulting from RBBB which delays both electrical depolarization of the RV and the ventricular contraction resulting in DELAYED closure of PV

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11
Q

most common congenital heart diease

A

VSD

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12
Q

irreversible changes occur in the pulmonary arterioles leading to pulmonary vascular obstructive dse (from L-R shunt to R-L shunt)

A

Eisenmenger syndrome

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13
Q

pertinent PE findings in VSD

A

Gr 2-5/6 systolic regurgitant murmur at the LLSB; loud S2; P2 intensity is increased in large shunt

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14
Q

site of enlargement in VSD

A

LA LA main PA

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15
Q

site of enlargement in PDA

A

LA LV Aorta

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16
Q

auscultatory finding in PDA

A

continuous machinery-like murmur

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17
Q

manifestations in PDA

A

tachycardia; exertional dyspnea due to volume overload; hyperactive precordium; bounding peripheral pulses with widened pulse pressure

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18
Q

complications of PDA

A

CHF; recurrent pneumonia

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19
Q

contraindication to surgical of PDA

A

PVOD

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20
Q

most common cause of cyanotic congenital heart disease in the newbords

A

TOGA

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21
Q

egg-shaped cardiac silhouette with a narrow superior mediastinum

A

TOGA

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22
Q

balloon atrial septostomy (creating interatrial communication in TOGA)

A

Rashkind procedure

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23
Q

atrial septostomy (creating interatrial communication in TOGA)

A

Blalock-Hanlon procedure

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24
Q

Definitive repair of TOGA

A

switch right and left-sided blood at 3 levels atrial(SENNING or MUSTARD); ventricular(RASTELLI); great artery level(JATENE)

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25
manifestations of TOF
cyanosis; tachypnea; clubbing; RV tap on the left sternal border; Gr 3-5/6 systolic ejection murmur at the mid and ULSB(PS) with radiation to the back; single S2(esp with pulmonary HTN)
26
small heart size; decreased pulmonary markings; concave main PA with an unruptured apex
Boot-shaped heart seen in CXR of those with TOF
27
natural history of TOF
polycythemia develops; growth retardation if cyanosis is severe; brain abscess and CVA rarely occur; coagulopathy is a late complication
28
paroxysm of hyperpnea; irritability; prolonged crying; increasing cyanosis; decreasing intensity of murmur
hypoxic spell
29
management of hypoxic spell
put the child in knee-chest position to decrease systemic venous return; morphine to suppress the respiratory center and hyperpnea; O2 to improve O2sat; Phenylephrin to raise SVR; Propranolol may stabilize vascular reactivity of the systemic arteries preventing decrease in SVR; Ketamine to increase SVR
30
pathogenesis of truncus arteriosus(both ventricles eject blood to a common vessel; VSD always present)
caused by a failure of development of SPIRAL septum
31
mechanism of TAPVR
all 4 pulmonary veins drain to the RA causing RV volume overload
32
snowman sign on xray
TAPVR
33
what chromosomal abnormality is associated with coarctation of the aorta
Turner syndrome
34
how does coarctation of the aorta seen in xray of children around 7yo
rib notching
35
manifestations of coarctation of the aorta
asymptomatic but can have CHF if severe; weak or delayed femoral pulses; BP higher in arms than legs; LVH in CXR or ECG
36
which part of the aorta is typically affected in coarctation of the aorta
descending aorta distal to the origin of the left subclavian artery
37
what obstructive condition is associated with congenital Rubella; Noonan and William syndrome
Pulmonic stenosis
38
auscultatory finding in pulmonic stenosis
systolic ejection murmur at the LUSB with radiation to the back; soft P2
39
ECG finding in pulmonic stenosis
right axis deviation; RBBB if mild; RVH (pure R and upright T in V1)
40
surgical tx for Pulmonic stenosis
valvotomy(Brock's procedure)
41
auscultatory finding in aortic stenosis
harsh systolic ejection murmur at the RUSB; systolic thrill (suprasternal notch)
42
surgical tx for aortic stenosis that remove patient's own pulmonary valve and using it to replace the abnormal aortic valve and a homograft is placed in the pulmonary position
Ross procedure
43
inflammatory lesions with swelling fragmentation of the collagen fibers with altered staining characteristics of connective tissue found in the atrial myocardium seen in Rheumatic fever
Aschoff bodies
44
Jones Criteria
Arthritis; Carditis; Erythema marginatum; subcutaneous nodules; Sydenham's chorea(associated with increased antineuronal antibodies); ACESS; minor:arthralgia(not considered if arthritis is present); fever(at least 38.8); elveated ESR/CRP; prolonged PR interval in ECG
45
most reliable lab evidence in Rheumatif fever
ASO (titers usually become elevated 2 weeks after strep infection; peaks at 4-6wks; and decreases after another 2wks; a 4-fold rise in titer in samples taken 10days apart)
46
Diagnosis of rheumatic fever
highly probable when either 2 major + ASO positive OR 1major and 2 minor +ASO
47
Antibiotics to eradicate Strep in Rheumatic fever
Penicillin VK 200-500mg QID x10days; Benzathine PCN 0.6 to 1.2MU IM; Eryhromycin 250mgTID x10days
48
anti-inflammatory tx for Rheumatic Fever
ASA 100mkd and prednisone 2mkd for 6-8wks
49
secondary prophylaxis (prevent recurrences of RF and RHD)
Pen VK 250mg BID; or Benzathine Penicillin 0.6-1.2MU q21days IM Duration: Arthritis: at least 5 years; Carditis: at least 10years
50
most common valvular involvement in adults
mitral stenosis
51
auscultatory finding in mitral stenosis
OPENING snap followed by mitral diastolic rumble
52
CXR finding in mitral stenosis
LA and RV enlargement; prominent MPA
53
why does hemoptysis develop in mitral stenosis
due to rupture of small vessels in the bronchi as a result of long-standing pulmonary venous hypertension
54
most common valvular involvement in children with RHD
mitral regurgitation
55
hallmark auscultatory finding in mitral regurgitation
systolic regurgitant murmur Gr2-4/6 at the apex with transmission to the left axilla
56
semilunar cusps are deformed and shortened; dilated valve ring so that the cusps fail to appose lightly
aortic regurgitation
57
manifestations in aortic regurgitation
widened pulse pressure; bounding WATER-HAMMER pulse in severe cases; high-pitched diastolic murmur at the 3rd-4th LICS (hallmark and more easily audible when sitting and leaning forward)
58
CXR finding in aortic regurgitation
Left ventricular enlargement; dilated ascending aorta and prominent aortic knob
59
most common valvular heart disease
MVP
60
most common complaint of patients with MVP
palpitations
61
major complications of MVP
infective endocarditis; sudden cardiac death; severe MV regurgitation; cerebrovascular ischemic events
62
auscultatory finding in MVP
MIDSYSTOLIC CLICK due to tensing of the MV as the leaflets prolapses into the LA during systole
63
subacute infective endorcarditis in SLE px
Libman-Sacks endocarditis or sterile endocarditis
64
etiology of infective endocarditis
Strep viridans and Staph aureus
65
manifestations in IE
prolonged fever; new murmur or a changing heart murmur; fatigue; myalgia; arthralgia; splenomegaly; petechiae; meningismus
66
tender pea sized intradermal nodules in pads of fingers and toes in IE
Osler nodes
67
painless small erythematous or hemorrhagic lesions on the palms and soles in px with IE
Janeway lesions
68
linear lesions beneath the nails in px with IE
splinter hemorrhages
69
duke major criteria in IE
(+) 2 blood cultures; evidence of endocarditis in echocradiography a.intracardiac mass on valve or other site; b.regurgitant flow near a prosthesis; c.abscess; d.partial dehiscence of prosthetic valves; e.new valve regurgitant flow
70
Tx of IE caused by Staph
Oxacillin with optional addition of Gentamicin; if resistant:Vancomycin
71
Tx of IE caused by Strep
Pen G Na or Ceftriaxone plus Gentamicin
72
Tx of prosthetic valve endocarditis due to Staph
Oxacillin + Rifampicin + Gentamicin
73
when to repeat 2d-echo in Kawasaki dse after performing 2d echo at diagnosis
repeat after 2-3wks of illness

pediatrics (16 decks)

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