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Pediatric Board Review- ID > Cards > Flashcards

Cards Flashcards

1
Q

wide splitting of 2nd heart sound (persistently)

A

Can be due to delayed right ventricular emptying and may indicate ASD, RBBB or severe pulmonic stenosis

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2
Q

Paradoxical splitting of S2

A

(normally see split with inspiration)

  • But if you hear split with expiration then this is sue to a delay in left ventricular emptying with the aortic closure sound coming after the pulmonic.
  • I.E. in severe aortic stenosis of LBBB
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3
Q

Third heart sound

A

in early diastole

  • “stiff” ventricle
  • Can be normal in children and in pregnant women
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4
Q

Fourth heart sound

A

in late diastole

  • never normal
  • Aortic stenosis, mitral regard, HOCM and LV hypertroph
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5
Q

Innocent systolic murmurs

A

-Should get louder when child is supine, (sometimes with exercise, anxiety, anemia or fever)

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6
Q

Stills murmur

A

systolic ejection murmur
vibratory quality
best in the lower precordium
very common

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7
Q

Physiologic peripheral pulmonic stenosis

A
  • soft, harsh systolic ejection murmur best hear in axillae and both the right and left hemithoraces
  • Usually disappears by 12 months
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8
Q

Venous hum

A
  • due to blood draining down the collapsed jugular veins in to the dilated intrathoracic veins
  • low pitched murmur
  • Generally absent when supine
  • Valsalva, turning of the head or compression of the jugular vein also makes it go away
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9
Q

QRS duration

A

usually < 100 ms

  • May be longer in:
  • BBB, PVC, WPW, electrolyte problems
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10
Q

QTc

A

Normalls 340-440 ms

-Prolonged: tendency to develop torsaddes

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11
Q

Causes of prolonged QTc

A
  • Tricyclic OD
  • Hypocalcemia
  • Hypomagnesemia
  • Hypokalemia
  • CNS insult
  • Azithromycin
  • Liquid protein diet
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12
Q

Long QT + sensorineural deafness

A

Jervell and Lange-Nielsen syndrome

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13
Q

Normal P wave

A

positive in II and negative in aVR

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14
Q

Peaked T wave

A

Hyperkalemia

Intracerebral hemorrhage

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15
Q

Diffuse ST segment changes

A

most often pericarditis

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16
Q

1st degree AV block

A

prolongs the PR interval by more than 200 ms for age

17
Q

2nd degree AV block- type 1

A

Mobitz 1

  • progressive prolongation of the PR interval until there is a drop in QRS
  • Occasional follow-up recommended
  • No treatment usually required
18
Q

2nd degree AV block- type 2

A

Mobitz 2

  • Normal PR intervals but occasional drop in QRS
  • Often requires a pacemaker
19
Q

3rd degree AV block

A

Complete heart block

-complete AV dissociation

20
Q

Left to right shunts

A

systemic circulation is shunted to pulmonary circulation

  • determined based on:
  • Size of the shunt
  • Pressure difference between the 2 vessels
  • Total outflow (vascular bed) resistances
21
Q

PDA- normal closure

A

10-15 hours after birth, but may take up to 3 weeks

22
Q

PDA- murmur

A

Continuous murmur, “machinery” like murmur

best below left clavicle

23
Q

Large PDA

A

May increase LV output, increases stroke volume

  • May see a bounding pule (b/c flow continues during diastole so you get a low diastolic pressure)
  • EKG may show evidence of LV hypertrophy
  • CXR will show increased pulmonary markings which may eventionally lead to irreversible pulmonary hypertension (Eisenmenger syndrome)
24
Q

VSD

A
  • Most common congenital heart defect in the first few years of life
  • In <1 year: typically muscular septum and will close spontaneously
  • In > 1 year: typically membranous septum, just below the aortic valve
25
Q

VSD- murmur

A

Harsh/high-pitched murmur

  • Holosystolic as it increases in size
  • Generally best at LLSB, radiates through precordium
26
Q

ASD-murmur

A

Systolic ejection murmur that is crescendo-decrescendo and heard best at ULSB

27
Q

Most common heart defect in Down Syndrome

A

Complete AV Canal defect (AV septal defect, Endocardial Cushion Defect)

28
Q

Aortic regurgitation- murmur

A

High pitched early diastolic murmur

29
Q

Mitral regurgitation

A

Apical, high pitched blowing systolic murmur

  • Can radiate to the left axilla and the back
  • Most common cause, world-wide, is rheumatic fever
30
Q

Mitral valve prolapse- murmur

A

late-systolic crescendo murmur at apex, almost always preceded by 1 or more clicks

  • With sitting/standing (decreased LV volume) the murmur will get longer and the click moves earlier
  • With laying or squatting (increased LV volume) the murmur gets shorter and the click moves later
31
Q

Pulmonary regurgitation- murmur

A

Low-pitched, decrescendo diastolic murmur

32
Q

Pulmonic stenosis- murmur

A

Systolic ejection click (that varies with respiration) along the left sternal border, followed by a crescendo-decrescendo murmur

Pediatric Board Review- ID (3 decks)

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