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pediatrics > cardioped > Flashcards

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
Q

manifestations of TOF

A

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)

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26
Q

small heart size; decreased pulmonary markings; concave main PA with an unruptured apex

A

Boot-shaped heart seen in CXR of those with TOF

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27
Q

natural history of TOF

A

polycythemia develops; growth retardation if cyanosis is severe; brain abscess and CVA rarely occur; coagulopathy is a late complication

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28
Q

paroxysm of hyperpnea; irritability; prolonged crying; increasing cyanosis; decreasing intensity of murmur

A

hypoxic spell

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29
Q

management of hypoxic spell

A

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

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30
Q

pathogenesis of truncus arteriosus(both ventricles eject blood to a common vessel; VSD always present)

A

caused by a failure of development of SPIRAL septum

31
Q

mechanism of TAPVR

A

all 4 pulmonary veins drain to the RA causing RV volume overload

32
Q

snowman sign on xray

A

TAPVR

33
Q

what chromosomal abnormality is associated with coarctation of the aorta

A

Turner syndrome

34
Q

how does coarctation of the aorta seen in xray of children around 7yo

A

rib notching

35
Q

manifestations of coarctation of the aorta

A

asymptomatic but can have CHF if severe; weak or delayed femoral pulses; BP higher in arms than legs; LVH in CXR or ECG

36
Q

which part of the aorta is typically affected in coarctation of the aorta

A

descending aorta distal to the origin of the left subclavian artery

37
Q

what obstructive condition is associated with congenital Rubella; Noonan and William syndrome

A

Pulmonic stenosis

38
Q

auscultatory finding in pulmonic stenosis

A

systolic ejection murmur at the LUSB with radiation to the back; soft P2

39
Q

ECG finding in pulmonic stenosis

A

right axis deviation; RBBB if mild; RVH (pure R and upright T in V1)

40
Q

surgical tx for Pulmonic stenosis

A

valvotomy(Brock’s procedure)

41
Q

auscultatory finding in aortic stenosis

A

harsh systolic ejection murmur at the RUSB; systolic thrill (suprasternal notch)

42
Q

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

A

Ross procedure

43
Q

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

A

Aschoff bodies

44
Q

Jones Criteria

A

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
Q

most reliable lab evidence in Rheumatif fever

A

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
Q

Diagnosis of rheumatic fever

A

highly probable when either 2 major + ASO positive OR 1major and 2 minor +ASO

47
Q

Antibiotics to eradicate Strep in Rheumatic fever

A

Penicillin VK 200-500mg QID x10days; Benzathine PCN 0.6 to 1.2MU IM; Eryhromycin 250mgTID x10days

48
Q

anti-inflammatory tx for Rheumatic Fever

A

ASA 100mkd and prednisone 2mkd for 6-8wks

49
Q

secondary prophylaxis (prevent recurrences of RF and RHD)

A

Pen VK 250mg BID; or Benzathine Penicillin 0.6-1.2MU q21days IM Duration: Arthritis: at least 5 years; Carditis: at least 10years

50
Q

most common valvular involvement in adults

A

mitral stenosis

51
Q

auscultatory finding in mitral stenosis

A

OPENING snap followed by mitral diastolic rumble

52
Q

CXR finding in mitral stenosis

A

LA and RV enlargement; prominent MPA

53
Q

why does hemoptysis develop in mitral stenosis

A

due to rupture of small vessels in the bronchi as a result of long-standing pulmonary venous hypertension

54
Q

most common valvular involvement in children with RHD

A

mitral regurgitation

55
Q

hallmark auscultatory finding in mitral regurgitation

A

systolic regurgitant murmur Gr2-4/6 at the apex with transmission to the left axilla

56
Q

semilunar cusps are deformed and shortened; dilated valve ring so that the cusps fail to appose lightly

A

aortic regurgitation

57
Q

manifestations in aortic regurgitation

A

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
Q

CXR finding in aortic regurgitation

A

Left ventricular enlargement; dilated ascending aorta and prominent aortic knob

59
Q

most common valvular heart disease

A

MVP

60
Q

most common complaint of patients with MVP

A

palpitations

61
Q

major complications of MVP

A

infective endocarditis; sudden cardiac death; severe MV regurgitation; cerebrovascular ischemic events

62
Q

auscultatory finding in MVP

A

MIDSYSTOLIC CLICK due to tensing of the MV as the leaflets prolapses into the LA during systole

63
Q

subacute infective endorcarditis in SLE px

A

Libman-Sacks endocarditis or sterile endocarditis

64
Q

etiology of infective endocarditis

A

Strep viridans and Staph aureus

65
Q

manifestations in IE

A

prolonged fever; new murmur or a changing heart murmur; fatigue; myalgia; arthralgia; splenomegaly; petechiae; meningismus

66
Q

tender pea sized intradermal nodules in pads of fingers and toes in IE

A

Osler nodes

67
Q

painless small erythematous or hemorrhagic lesions on the palms and soles in px with IE

A

Janeway lesions

68
Q

linear lesions beneath the nails in px with IE

A

splinter hemorrhages

69
Q

duke major criteria in IE

A

(+) 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
Q

Tx of IE caused by Staph

A

Oxacillin with optional addition of Gentamicin; if resistant:Vancomycin

71
Q

Tx of IE caused by Strep

A

Pen G Na or Ceftriaxone plus Gentamicin

72
Q

Tx of prosthetic valve endocarditis due to Staph

A

Oxacillin + Rifampicin + Gentamicin

73
Q

when to repeat 2d-echo in Kawasaki dse after performing 2d echo at diagnosis

A

repeat after 2-3wks of illness

pediatrics (16 decks)

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