Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Cardiopulmonary > Flashcards

Cardiopulmonary Flashcards

1
Q

Kawasaki disease

A

Asian children < 4 yo

Acute (1-2 wks):
- Fever

Subacute (2-4 wks):

  • desquamation
  • thrombocytosis
  • coronary aneurysms
  • highest risk of death

Convalescent (6-8 wks)

  • clinical signs gone
  • ESR nl

Other sx:

  • Cervical lymphadenitis (usually unilateral)
  • Conjunctival injection
  • Strawberry tongue
  • Hand-foot erythema
  • Desquamating rash

Complications:
Coronary aneurysms –> MI (2nd-3rd wk)

Tx:

  • IV Ig
  • ASA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Churg Strauss syndrome

A

Vasculitis

Asthma
Sinusitis
Palpable purpura
Peripheral neuropathy

+ pANCA
increased IgE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Henoch-Schonlein purpura

A

Most common childhood systemic vasculitis

Often follows URI

Peak age 4-8yo

Vasculitis 2/2 IgA complex deposition in small vessels

Classic triad:

  • Skin –> palpable purpura (butt + legs)
  • Arthralgias
  • GI –> pain, melena
  • *GI pain can be 2/2 GI bleed or Intussusception

Most lab tests normal
Coag studies normal

Tx:

  • supportive (self limited)
  • steroids for GI and CNS complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cystic hygroma

A

Cavernous lymphangioma of neck

Assoc w/ Turner syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sturge Weber disease

A

Congenital vascular d/o affecting capillary sized blood vessels

  • Port wine stain on face
  • ipsilateral leptomeningeal angiomatosis (intracerebral AVM)
  • seizures
  • early onset glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Choanal atresia

A

Septum between nose and pharynx

High association with CHARGE syndrome

  • Coloboma
  • Heart dz
  • Atresia choanae
  • Retarded growth
  • GEnital anomalies (hypogonadism)
  • Ear anomalies (deafness)

Presentation

  • cyanosis w/ crying
  • newborns are basically nose breathehrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Epistaxis

A

1 cause = picking nose

Nosebleed, usually from anterior septum

Also consider juvenile nasopharyngeal angiofibroma in pubertal boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common sites for foreign body

A

< 1 yo = larynx

> 1 yo = trachea and bronchi (esp R main stem bronchus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Asthma

A

Reversible obstructive airway disease affecting small and large airways

3 components to attack:

  • bronchospasm
  • mucous production
  • airway edema

Dx:

  • eosinophilia in blood and sputum
  • allergy skin testing to ID environmental allergens
  • PFTs
  • increased lung markings on CXR; also hyperinflation and atelectasis

You start as respiratory alkalosis first and then turn into respiratory acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tx asthma

A

Short acting beta agonist (not regularly though)

Long acting beta agonist (daily controller)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mild intermittent asthma

A

Sx =< 2x / wk

Night sx =< 2x / month

Daily meds not needed

Tx flares with inhaled or systemic steroids if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mild persistent asthma

A

Sx > 2x / wk

Night sx > 2x / month

Need daily:

  • low dose steroid vs cromolyn
  • Short acting beta agonist prn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Moderate persistent asthma

A

Daily sx

Asthma exacerbation >= 2s / wk

Need daily:
- Low dose inhaled steroids (vs lekotriene receptor antagonist) + LABA
OR
- medium dose inhaled steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Severe persistent asthma

A

Continual sx

Frequent exacerbation

Need daily:
- high dose ICS + LABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx exercise induced asthma

A

Prevent by B2-agonist immediately before exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ddx wheezing

A 
Asthma
CF
Postinfectious
Infectious
CHD
Ciliary dyskinesia
Chronic aspiration
FOreign body
Immunodeficiency
Congenital airway anomaly
Extrinsic airway compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tx apnea

A

Adenotonsillectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

3 types of apnea

A

Central - lack of respiratory effort

Obstructive - total airway obstruct

Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Types of mixed apnea

A

Apnea of prematurity

  • preemies < 30 wks old
  • bradycardia
  • Tx: theophylline or caffeine or intubation

Cyanotic breath holding

  • < 3 yo
  • hold breath because of anger
  • tx = reassurance

Pallid breath holding

  • happens after painful stimulus
  • turn pale and have asystole and seizure
  • Tx = atropine

Obesity hypoventilation

  • 2/2 airway obstruction
  • obesity
  • somnolence
  • polycythemia
  • cor pulmonale
  • Tx: weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Sudden infant death syndrome

A 
#1 cause of death in infants 1-12 mo of age
Peak at 2-3 mo age

Prevention:

  • sleep on back
  • electronic monitoring of HR, respiratory pattern, oxygenation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

An innocent murmur is never…

A

Diastolic

> 2/6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Acyanotic heart disease

A

L —> R shunting

VSD
ASD
PDA
Endocardial cushion defects
Coartctation of aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Harsh holosystolic murmur at left lower sternal border

A

VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

EKG changes seen in large VSD

A

BIventricular hypertrophy

NOtched peaked P waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tx VSD

A

Usually small defects close

Abx to ppx endocarditis

Surgery for large defects w/ pulm HTN that has not yet become severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ASD - most common type

A

Ostium secundum most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Systolic ejection murmur in left mid and upper sternal border

Wide fixed split S2

A

ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Complications of ASD

A

Sx usually appear in 30s

Endocarditis rare - ppx not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Wide pulse pressure
Bounding arterial pulses

Machinery continuous murmur

A

PDA

wide PP and bounding arterial pulses happen in large PDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Associations of PDA

A

Maternal rubella

Prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

CXR PDA

A

Prominent pulm A

INcreased pulm vascular markings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tx PDA

A

Indomethacin

Spontaneous closure
- but rare to close after infancy so need surgery

Risk of endocarditis and CHF if don’t close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is an endocardial cushion defect?

A

ASD and VSD occur and are continuous

AV valves also abnormal

Higher risk with trisomy 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Complications of large AV defects

A

Heart failure early in infancy

Eisenmenger

LAD

Death 2/2 heart failure

Heart block 2/2 surgery

ALWAYS DO SURGERY ON THESE!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Most coarctations of aora occur

A

Just below origin of L subclavian A

More common in boys

Increased incidence in Turner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

CXR of coarctation of aorta

A

Cardiac enlargement
pulm vascular markins

Rib notching in older kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Should coarctation be corrected?

A

Yes, as soon as pt is stable

Keep PDA open w/ prostaglandin E1

38
Q

Cyanotic Heart disease

A 
Tetralogy of Fallot
Transposition
Pulmonary atresia
Tricuspid atresia
Total anomalous pulmonary venous return
Truncus arteriosus
Hypoplastic left heart
39
Q

Tetralogy of fallot features

A

Pulmonary stenosis
VSD
Overriding aorta
RVH

Most common cyanotic heart dz

40
Q

Murmur of ToF

A

Loud
Harsh
Systolic ejection murmur @ LUSB

S2 is single or soft b/c of pulm stenosis

41
Q

CXR ToF

A

Boot shaped heart

Lung fields clear

42
Q

Sx of ToF depend on….

A

Size of VSD
Degree of RV outflow tract obstruction

Increase in pulm vascular resistance causes shunting of deoxygenated blood from RV –> aorta –> CYANOSIS!
- therefore want to increase systemic vascular resistance to reduce degree of R to L shunting

43
Q

Transposition of great arteries association

A

1 congenital hear disease to present with cyanosis in first 24 h of life

More common in infants of diabetic mothers and in boys

44
Q

CXR Transposition

A

Egg on a string appearance - caused by change in relationship of great vessels as exit heart

45
Q

Tx transposition and Tof

A

Med management
- PGE1 to maintain DA

Surgery

46
Q

Pulmonary atresia

A

Right ventricular blood backs up to RA and shunted across foramen ovale

Cyanosis happens 2-3 days when ductus closes

can hear 1 2nd heart sound

EKG - spiked P waves of RA enlargment + LVH

47
Q

Cyanosis at birth

Pansystolic murmur along LSB

Underdevelopment of pulm valve and/or artery —> decreased pulmonary markings on CXR

EKG - LAD + LVH

A

Tricuspid atresia

Causes RV outflow tract obstruction - blood shunts across FO

48
Q

Total anomalous pulmonary venous return

A

Pulm V drain back into systemic venous circulation!

Mixed blood reaches LA through ASD or foramen ovale

49
Q

CXR of TAPVR

A

“snowman” pattern (aortic knob and hear look like snowmen blobs)

50
Q

Truncus arteriosus

A

VSD always present

No cyanosis initially b/c of high pulm vascular resistance at birth causing normal pulm blood flow

Systolic ejection murmur with thrill at LSB

51
Q

Hypoplastic L heart

A

Cyanosis
Dyspnea
Hepatomegaly

RVH

Surgery!

52
Q

Myocarditis causes

A

Viral most common

  • adenovirus
  • coxsackie

Other:

  • diptheria
  • rickettsia
  • toxins
  • CT and granulomatous dz
53
Q

Most common presentation of myocarditis

A

Heart failure

  • dyspnea
  • syncope
  • tachy
  • hepatomegaly
54
Q

CXR myocarditis

A

Large heart

Pulm edema

55
Q

How do you confirm dx of myocarditis?

A

Endomyocardial biopsy = inflammatory infiltrate of myocardium w/ myocyte necrosis

56
Q

Tx myocarditis

A

Manage heart failure and arrhythmias

steroids maybe?

Heart transplant

Mortality mostly in newborns that are infected

57
Q

Endocardial fibroelastosis

A

Thickened, white, fibroelastic endocardium

Primary EFE

  • no predisposing valvular lesion or congenital anomaly
  • dilated LV

Secondary EFF

  • severe left-sided obstructive heart disease
  • contracted ventricular cavity

Presentation:
- CHF

Tx:
- transplant if fail med management of CHF

58
Q

What should all children with seconday HTN have?

A

Renal eval

59
Q

Heart defects presenting with murmur and signs of CHF in infancy

A

VSD
Severe aortic stenosis
Coarctation of aorta
large PDA

60
Q

What has been shown to improve sx in infants with CHF 2/2 VSD?

A

DIgoxin

Diuretics (Furosemide)

61
Q

Contraindicated tx in Kawasaki disease

A

Glucocorticoids - due to higher rate of coronary aneurysms

62
Q

Pulmonary sequestration - intralobar sequestration

A

a medical condition wherein a piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary arterial blood supply

Venous drainage is usually to the left atrium via pulmonary veins establishing a left to right shunt.

63
Q

Pulmonary sequestration - extralobar sequestration

A

a medical condition wherein a piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary arterial blood supply

the arterial supply of ELS comes from an aberrant vessel arising from the thoracic aorta.
- It usually drains via the systemic venous system to the right atrium, vena cava, or azygous systems

64
Q

1 cause of bacterial PNA in CF person

  • kid
  • adult
A

Kid ( give vanco

Adult (> 20) - Pseudomonas

65
Q

Pathologic cardiac murmurs in children - associated signs adn sx

A

Infants

  • diaphoresis or tiring w/ feeds
  • poor wt gain

Kids

  • CP
  • dizziness
  • syncope
  • SOB
  • fatigue
66
Q

Pathologic cardiac murmurs in children - PE findings

A

Harsh or holosystolic

Diastolic

Grade 3/4 intensity or higher

Increases w/ standing or valsalva

Assoc w/

  • abnormal S2 (loud, fixed split, or single)
  • decreased or absence femoral pulses
67
Q

Pathologic cardiac murmurs in children - workup

A

CXR for cardiomegaly

EKG for hypertrophy

Echo for structure

Cards referral

68
Q

What is unique of intussusception in kids in HSP?

A

Most intussusception is ileo-colic

HSP insussusception is small bowel or ileo-ileal.

  • there can’t be seen on contrast enema
  • dx via target sign on US
  • tx w/ area or contrast enema but those that don’t reduce spontaneously often need surgery
69
Q

Beck’s triad

A

Distant heart sounds

Distended jugular veins

Hypotension

In tamponade!

PUlsus paradoxus can be present

70
Q

Sx CHF in infant

A

Poor feeding
Tachycardia
Pulm edema / SOB

71
Q

1 cause of polycythemia in term infants

A

Delayed clamping of umbilical cord –> excess transfer of placental blood

If get sx from polycythemia…:

  • lethargy
  • irritability
  • respiratory distress
  • poor feeding
  • hypoglycemia
  • hypocalcemia
  • neuro manifestations

Tx:

  • hydration
  • partial exchange transfusion
72
Q

RSV infection in child may cause increased risk for

A

Asthma

73
Q

Laryngomalacia

A

Increased laxity of supraglottic structures

Sx:

  • inspiratory stridor worse when supine, crying or feeding. better in prone position
  • peaks at age 4-8 mo, resolves by 12-18 mo

Dx:
- flex laryngoscopy –> collapse of supraglottic structure w/ inspiration

Management:

  • reassurance
  • supraglottoplasty for severe sx
74
Q

Congenital heart associations

  • ASD + endocardial cushion defects
  • Supravalvular aortic stenosis
  • congenital heart block
  • PDA
  • pulmonary valvular stenosis
A

ASD - Trisomy 21

Supravalvular aortic stenosis - williams

Congenital heart block - neonatal lupus

PDA - congenital rubella

Pulmonary valvular stenosis - Noonan’s syndrome

75
Q

Order of events for tx croup

A

ALWAYS give trial of epi

then intubation if epi doesn’t work

76
Q

Stridor in infants and children - ddx

A

Croup
Laryngomalacia
Foreign body aspiration
Vascular ring

77
Q

Croup vs laryngo malacia vs foreign body aspiration vs vascular ring - how do you tell the difference?

A

> 6 mo –> usually croup
< 6 mo stridor –> vascular ring

Croup
- barky cough + fever + rhinorrhea + congestion

Laryngomalacia
- worsen in supine position, better in prone

Foreign body aspiration

  • acute onset
  • mod-severe resp distress

Vascular ring

  • improves with neck extension
  • assoc w/ cardiac abnormalities
78
Q

Most common cardiac finding in Downs syndrome

A

Complete atrioventricular septal defect

  • endocardial cushions of common AV canal merge and form AV septum and mitral and tricuspid
  • result in Downs is ASD + VSD + abnl mitral and tricuspid valves

Can result in heart failure ~ 6 weeks old

Auscultation:

  • Loud S2 2/2 pulm HTN
  • systolic ejection murmur from increased flow across pulm valve from L–> R across ASD
  • holosystolic murmur of VSD
79
Q

Ddx of T wave inversion

A

MI

Myocarditis

Old pericarditis

Myocardial contusion

Dig toxicity

80
Q

Infant p/w cyanosis aggravated by feeding and relieved by crying…what do you suspect?

A

Choanal atresia

Confirm dx w/ CT scan w/ contrast

81
Q

Tet spell vs choanal atresia

A

Cyanosis in choanal atresia NOT triggered by stress but by anything that will keep infant’s mouth closed long enough (eg feeds)

ToF will have systolic ejection murmur of pulm stenosis + continuous VSD mumur

82
Q

Increase risk of RDS in infants with

A 
prematurity
male sex
csection without labor
perinatal asphyxia
maternal diabetes
83
Q

Decrease risk of RDS in infants with

A

prolonged rupture of membranes
IUGR
Maternal HTN
Antenatal corticosteroids

84
Q

When start eval of kids with 1st or 2nd degree relative with early onset CHD for coronary heart dz

A

> 2 yo

85
Q

Conditions other than CF that may manifest an elevated sweat chloride

A 
Adrenal insufficiency
Ecotdermal dysplasia
nephrogenic diabetes insipidus
hypothyroidism
malnutrition
86
Q

How long does it take after exposure before hypersensitivity to tuberculin develops on TB test?

A

3-8 weeks

TB tests usually negative in infants, even if active TB

87
Q

Are small children with TB contagious to others?

A

No

They are not capable of coughing up and producing sputum
- sputum when produced is promply swallowed

88
Q

Idiopathic pulmonary hemosiderosis

A

Recurrent PNA + rapid clearing of radiologic findings

Hemoptysis

Digital clubbing

Microcytic and hypochromic anemia
Low serum Fe levels
occult blood in stool from swallowed pulm secretions

BAL will reveal hemosiderin laden macrophages

89
Q

Pneumatization order of sinuses

A

Infancy

  • maxillary
  • ethmoid

3-5 yo
- Sphenoid

6-10 yo
- frontal

90
Q

Pus in middle meatus of nose suggests

A

Maxillary
frontal
or anterior ehmoid sinusitis

91
Q

Pus in superior meatus indicates

A

sphenoid

or posterior ethmoid sinuses

Pediatrics (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions