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PEDS UWORLD > Chest problems > Flashcards

Chest problems Flashcards

1
Q

Kids with Respiratory distress, prenatal polyhydramnios, 70/40, 176bpm, 70RR, pulse ox,82%, absent breaths on left and fair aeration of right lung, right heart sounds, abd appears scaphoid;
DX?

A

Congenital diaphragmatic hernia (CDH)

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2
Q

CDH causes

A

abdomincal viscera to herniate into chest:

pulmonary hypoplasia and pulmonary HTN

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3
Q

Why is there polyhydramnios in CDH?

A

esophageal compression

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4
Q

Stat protocol in CDH?

C/I maneuvers?

A
  1. endotracheal intubation
  2. bag-mask ventilation can pump air into GI and exacerbate problem
    After airway secure: NG tube and suction
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5
Q

1 day old Kid with respiratory problems, 80% sat, mask with 100% air doesnt help, Machine like murmur heard; administer what?

A

PGE1
Many congenital heart defects can be associated with a PDA and need to be ruled out first
PDA usually closes by day 3

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6
Q

1 month old kid, harsh III/VI holosystolic murmur over LL sternal border, everything else normal, Dx?

A

VSD
Do echo
mcc of congenital heart disease

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7
Q

Electrolyte derangements of QT prolongation?

A

Hypocalcemia
Hypokalemia
Hypomagnesemia

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8
Q

Med induce long QT syndrome

A 
Macrolide
Flouroquinolone
Antipsychotics
TCA
SSRI
Methadone
Oxycodone
Ondansetrone/gransetron
Class 1a: Quinidine, procainamide
Flecainide
Class 3: except amiodarone
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9
Q

Inherited long qt syndrome

A

Jervel and lange nielsen sydnrome (AR)

Romano- Ward syndrome (AD)

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10
Q

Rx long QT syndrome

A

Class II antiarrhythims
B-Blockers: Propranolol
possibly pacemaker placement

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11
Q

Hypertrophic Cardiomyopathy EKG findings

A

LVH: Tall R wase in aVL + Deep S wave in V3

Repolarization change in anterolaterl leads (I, aVL, V4-V6)

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12
Q

Trisomy 21 Cardiac problems

A

ECD: complete ACSD
VSD
PDA,ASD
MVP

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13
Q

Trisomy 18 and 13 cardiac issues

A

VSD > ASD, PDA

cyanotic lesions

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14
Q

Williams syndrome cardiac porblems

A

Supravalvular AS

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15
Q

Turner syndrome cardiac issue

A

Bicuspid AV
Coarctaion of aorta
AS,MVP,
HTN common

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16
Q

Neonatal lupus cardiac problem

A

congenital heart block

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17
Q

Marfan syndrome cardiac problem

A

Ascending aortic dilation->dissecting aorts

2ndry AR or MVP

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18
Q

Ehler Danlos syndrome cardiac problems

A

MVP, TVP
Aortic dilation-> dissecting aneurysm
ASD

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19
Q

Fetal alcohol syndrome cardiac issue

A

VSD>ASD

TOF

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20
Q

Rubella assoc cardiac problem

A

PDA

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21
Q

Kawasaki disease cardiac issue

A

Coronary artery aneursyms

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22
Q

Transient tachypnea of newborn xray findings

A

increased pulmonary vascular markings or fluid in the fissures
(bilateral perihilar linear streaking)

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23
Q

Rheumatic fever rx:

A

penicillin G IM every 4 wks

24
Q

RF w/out carditis duration of antibiotic

A

5 yrs or until 21

whichever longer

25
Q

RF with carditis but no residual hear or valvular disease; AB rx duration

A

10 yrs or until 21

whichever longer

26
Q

RF w/ carditis and persistent heart or valvular disease;

AB Rx duration

A

10 yrs or until 40 years olf

whichever longer

27
Q

MS symptomatic rx

A

preload reduction: diuretics or nitrates

28
Q

Auscultation and xray of Transposition of great vessels

A

Cyanosis w/in 24 hrs of life
Exam: Single S2; +/- VSD
Xray: egg on string

29
Q

Auscultation and xray of TOF

A

Exam: Harsh PS murmur or single S2, VSD
Xray: Boot shaped heart

30
Q

Auscultation and xray of Tricuspid atresis

A

Exam: Single S2, VSD murmur
Xray: minimal pulm BF

31
Q

Auscultation and xray of Truncus arteriosus

A

Exam: SIngle S2, systolic ejection murmur (increased flow through truncal valve)
Xray: increase pulmonary BF, Edema

32
Q

Auscultation and xray of TAPVR with obstruction

A

Exam: severe cyanosis, respiratory distress
Xray: pulmonary edema, snowman sign (enlarged supracardiac veins & SVC)

33
Q

Pediatric viral myocarditis etiology

A

Coxsackie B virus

Adenovirus

34
Q

Myocarditis Clinical presentation

A

Viral prodrome

HF: dyspnea, syncope, tachycardia, N/V, hepatomegaly

35
Q

Xray of myocarditis

A

Cardiomegaly

Pulmonary edema

36
Q

ECG and ECHO of mycarditis

A

EKG: sinus tachy
ECHO: decreased EF
Diffuse hypokinesis

37
Q

auscultaion of myocarditis

A

holosystolic murmur may be identified secondary to dilated cardiomyopathy and the resulting functional MR

38
Q

Rx of myocarditis

A

diuretics and inotrope

Rx in ICU due to risk of shock and fatal arrhythmias

39
Q

Fredrich ataxia cardiac problems

A

assoc w/ necrosis and degeneration of cardia muscle fibers leading to myocarditis, myocardial fibrosis and cardiomyopathy
EKG: T Wave inversion due to myocarditis

40
Q

VSD auscultation and if uncorrected

A

holosystolic murmur at left lower sternal border,

uncorrected apical diastolic rumble( increased BF across MV)

41
Q

VSD is not corrected what happens

A

L-R shunt produces permanant pulmonary htn and RVH leading to Eisenmenger syndrome which causes R-L shunting

42
Q

In a TOF what are the 4 defects

A

RV outflow tract obstruction (PS or atresia)
RVH
Overriding aorta
VSD

43
Q

Patient with a RVOT obstruction develope profound cyanosis and hypoxemia why?

A

they develop a infundibular spasm precipitated by agitation or exertion (feeding, crying, hyperventilation)
results in complete occlusion
shunts blood R->L via VSD

44
Q

Respiratory distress syndrome x-ray

A

diffuse reticulogranular (ground glass) appearance, air bronchograms, low lung volumes

45
Q

High pulmonary vascular resistance results in R->L shunting and hypoxia; causes what?

A

Persistent pulmonary HTN

Tachypnea and severe cyanosis

46
Q

Chest xray in Pulmonary htn

A

clear lungs w/ decreased pulmonary vascularity

47
Q

inadequate alveolar fluid clearance at birth results in mild pulm edema; Dx?

A

Transient tachypnea of newborn

48
Q

Croup: laryngotracheobronchitis C/f..

A

MC 6-6 yrs old
assoc w/ barky cough,
fever,
rhinorrhea and Congestion

49
Q

Laryngomalacia c/f

A

Stridor most severe at 4-8 months

persistent stridor that worsens in supine positions + improve in prone position

50
Q

Vascular Ring C/F

A

Present before age 1
Persistent stridor that improves w/ neck extension
Assoc. w/ cardiac abnormalities

51
Q

Dx/Rx laryngomalacia

A

Dx: Flexible laryngoscopy
Rx: reassurance (fixes by 18 months)
Supraglottopasty is severe symptoms

52
Q

Tricuspid Valve atresia EKG/xray

A

Left axis deviation
Tall peaked P waves
LVH
Xray: decreased pulmonary BF

53
Q

Ebsteins anomaly EKG

A

TR + R atrial enlargement=
Tall P waves
Right axis deviation

54
Q

Respiratory Distress Syndrome R/F

A

Maternal DM
Male sex
perinatal asphyxia
C-section w/out labor

55
Q

How Maternal DM cause RDS

A

Maternal hyperglycemia leads to fetal hyperglycemia which trigger fetal hyperinsulinism
High insulin antagonize cortisol and block maturation of sphingomyelin

56
Q

Decrease risk of RDS in newborn

A

Intrauterine stress stimulates early fetal lung maturity:
IUGR
Maternal HTN
PROM

57
Q

Postpericardiotomy syndrome

A

pleuropericardial disease that occurs days or months after cardiac surgery or injury

PEDS UWORLD (9 decks)

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