Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CV II Exam 3 > CV Pediatric Session #1 > Flashcards

CV Pediatric Session #1 Flashcards

1
Q

A female infant born at 36 weeks gestation presented to the ED with feeding difficulties, intermittent cyanosis and apneic spells.

First Impressions?

A

Sepsis until proven otherwise!

Congenital heart disease
Inborn error of metabolism (IEM)
TORCH infections
Hypoxic ischemic encephalopathy
Intracranial bleed
Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What kind of questions do you ask?

A 
Did mom have group B strep screen?
Fever during delivery?
Is there FH of congenital disease?
Ultrasound during pregnancy that might have shown something?
Previous kids with problems?
Relationship between parents - cousins?
Vaccinations?
What was the delivery like - aspiration, cord problems?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Normal pregnancy and delivery
Normal at discharge day 3

8 days later:
Ill, respiratory distress, subcostal retractions and a dusky blue color of the lips and nail beds that was intermittent. Episodic apneic spells were observed that responded to administration of O2 and stimulation. Tachycardia and tachypnea were present. Lungs revealed crackles but no regions of consolidation. No murmurs. No masses or organomegaly.

A

Still thinking sepsis

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

Neonate sepsis

A

Clinical syndrome in the neonate characterized by systemic signs of infection with bacteremia in the first month of life

Can lead to meningitis

Both gram - and +
Late and early onset

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

Early onset neonatal sepsis

A 
First week:
Usually delivery complications
Usually from genital tract
Fulminant presentation, multisystem with frequent pneumonia
3-50% die
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Late onset neonatal sepsis

A 
7-90 days:
May not have complicated pregnancy
Can be postnatal exposure
Slow or fulminant progression
Focal meningitis frequent
2-40% die
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gram positive organisms

A

Group B strep (EOS and LOS)
Staphylococci aureus (LOC)
Coagulase negative staphylococcus (LOS)
Listeria monocytongenes (EOS and LOS)

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

Gram negative organisms

A

E. coli (EOS and LOS)
Haemophilus influenza
Citrobacter
(Candida albicans)

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

Clinical signs of sepsis

A

Hyperthermia > hypothermia

Wide variety of presentations

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

Clinical signs of meningitis

A 
Temp change
Lethargy
Anorexia or vomiting
Resp distress
Bulging fontanelle
Others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gold standard for diagnosing sepsis

A

Culture

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

Serum biomarkers serve as:

A

Adjunct to culture based diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The “ideal marker” for sepsis

A

Elevates early in the infectious process
Stays elevated to allow appropriate sampling
Have well defined values that differentiate infection from other entities
A very high sensitivity and negative predictive value

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

C-reactive protein

A 
Most commonly used biomarker
Synthesized 6 hrs after exposure
Takes 24 hrs to become abnormal
Elevates with trauma and ischemia too - Not that helpful
High specificity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If baby has been sick 72 hrs but no CRP?

A

Sepsis is unlikely

But if CRP elevated, you can’t guarantee sepsis

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

Initial management of sepsis

A 
IV access
Cultures
Blood - cyanosis via blood gas
CSF
ABG
CXR
Glucose, electrolytes, BUN, creatinine
CRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why check kidney function in septic infant?

A

Certain antibiotics effect renal function

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

CSF showed mononuclear pleocytosis of 330 cells/µL
EEG showed multifocal epileptic potentials consistent with encephalitis
CRP 5 mg/L
Thoughts?

A

Most likely viral

Add viral encephalopathy to DDx

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

Initial treatment:
Amoxicillin, gentamicin and acyclovir
Phenobarbital
Baby continues to deteriorate with tachycardia and increasing respiratory distress requiring intubation

A

Now thinking heart and lungs

Chest xray - infiltrates, pulmonary edema
EKG - ST depression (ischemia), tachy
Echo - Reduced LV contraction, EF 20%
Troponin - Elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Enterovirus Coxsackie B3 Myocarditis

A

Confirmed with PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Enteroviral Infections in the Newborn

A

Among the most common viruses causing disease in humans
Tend to have a seasonal pattern during summer and fall
Illnesses range from a nonspecific febrile illness, mild URIs, self limiting gastroenteritis to myocarditis, hepatitis and encephalopathy

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

Enterovirus Neonatal Transmission

A

Antenatally, intrapartum and postnatally

In-utero transmission can be by transplacentally or by ascending infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Common features of “Neonatal Enterovirus Sepsis”

A

Fever, irritability, poor feeding and lethargy
Non-specific rash in about half
Some have hepatomegaly

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

Treatment for the myocarditis

A

IV immunoglobulin
Decreased cardiac output and developing arrhythmias dopamine and milrinone were started
Refractory to amiodarone and electroconversion for tachyarrhythemias?
ECMO (Extracorporeal Membrane Oxygenation) was started

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
ECMO
External heart and lung machine to relieve work on the heart
26
Illnesses acting like sepsis
``` Bowel Obstruction Congenital Pneumonia Heart Failure Hemolytic Disease Meconium Aspiration Syndrome Necrotizing Enterocolitis Pericarditis, Bacterial Pulmonary Hypoplasia Respiratory Distress Syndrome ```
27
Chlorampehenicol
Gray baby syndrome Abdominal distension, vomiting, diarrhea, characteristic gray color, respiratory distress, hypotension, progressive shock
28
Thalidomide
Phocomelia Congenital abnormalities, polyneuritis, nerve damage, mental retardation
29
Sulfonamide
Kernicterus Displaces bilirubin from protein-binding sites, bilirubin deposits in the brain, results in encephalopathy
30
Glucoronidation pathways
Immature in infants
31
Gasping baby syndrome
Benzyl alcohol | Preservative
32
Gastric pH in infants
Drops to 1-3 within 24 hours Premature infants have immature acid secretion Nutrition most likely responsible for initiating acid production
33
Gastric emptying in infants
Irregular and unpredictable Slowed/prolonged in premature - more efficient absorption Approaches adult values within first 6-8 months Slower with increased caloric intake Inverse relationship between gestational age and retention
34
Intramuscular drug absorption
Inconsistent due to differences in: Relative muscle mass Poor perfusion - low cardiac output states or respiratory distress syndrome Peripheral vasomotor instability Insufficient muscle contractions - immobile = poor absorption Reserved for emergencies
35
Drug absorption through skin directly related to
Degree of skin hydration | Relative absorptive area
36
Drug absorption through skin indirectly related to
Thickness of stratum corneum
37
Substantially increased percutaneous absorption
Underdeveloped epidermal barrier Compromised skin integrity Increased skin hydration Ratio of body surface area to total body weight highest in youngest
38
Drug Absorption - Rectum
May be important alternative site when oral agents cannot be used Absorption can be erratic
39
Total body water
``` Fetus: 94% Premature infants: 85% Full-term infants: 78% Adults: 60% Total body water varies inversely with amount of fat tissue - babies have less fat ```
40
Extracellular fluid volume
Premature infants: 50% of body weight 4-6 months: 35% 1 year: 25% Adults: 19%
41
Reduction in body water compartments
Use higher doses per kg of body weight
42
TBW in premie
Less than normal
43
Protein binding in infants decreased due to
Decreased plasma protein concentration Lower binding capacity of protein Decreased affinity for drug binding Competition for certain binding sites by endogenous compounds
44
Ceftriaxone
Displaces bilirubin
45
Drug metabolism pathways in infants
Sulfation pathway well-developed | Glucuronidation pathway undeveloped
46
Acetaminophen
Metabolism partially compensated by sulfation pathway
47
Morphine
Higher serum concentrations required | Clearance quadruples between 27-40 weeks postconceptional age
48
Drug elimination
May not fully develop for several weeks to 1 year after birth Glomerular filtration Tubular secretion Tubular reabsorption
49
Ampicillin
Inhibits PBP - inhibits bacterial cell wall synthesis Dosing according to body weight Bacteremia and meningitis have different dosing Younger age, longer half life
50
Gentamicin
Binds 30S and 50S - inhibit protein synthesis Elimination directly related to renal function Dosing according to weight and GA
51
Cefotaxime
Inhibits PBP - inhibits bacterial cell wall synthesis Dose by body weight Bacteremia - mg/dose Meningitis - mg/day
52
Acyclovir
Inhibits viral DNA synthesis and viral replication | Longer half life in neonates
53
Viral Myocarditis
Acute phase: inflammatory cell invasion of myocardium and myocardial necrosis and apoptosis T-cell invasion: most destructive 7-14 days after inoculation Healing phase: myocardial fibrosis; continued inflammation and persistent viremia may lead to left ventricular dysfunction and dilation
54
Acute Phase Viral Myocarditis Treatment
``` Inotropes Afterload reduction Mechanical ventilation Extracorporeal membrane oxygenation (ECMO) Immune therapy Intravenous immunoglobulin (IVIG) Immunosuppressive agents ```
55
Intravenous Immunoglobulin
Protects recipient against infection and suppresses inflammatory and immune mediated processes Start slow Immediate levels, slow effect
56
Pretreat IV immunoglobulin
Acetaminophen, diphenhydramine, glucocorticoids, hydration
57
IV immunoglobulin adverse reactions
Chills, fever, flushing, myalgia, malaise, headache Tachycardia, chest tightness, dyspnea, sense of doom Thrombolic complications Acute kidney injury
58
Extracorporeal Membrane Oxygenation Neonatal indications
``` Primary pulmonary hypertension Meconium aspiration syndrome Respiratory distress syndrome Group B Streptococcal sepsis Asphyxia Congenital diaphragmatic hernia ```
59
ECMO Circuit
Blood siphoned, driven by right arterial pressure | Roller pump draws blood into bladder and pushes it through oxygenators and heat exchanger
60
ECMO Complications
``` Clots in circuit (19%) Oxygenator failure Seizures Intracranial bleeding Hemolysis and coagulopathy Arrhythmias Oliguria (within 24-48 hours) Metabolic acidosis ```
61
Medication Use in ECMO
Hemodilution - Circulating blood volume will double (blood mixing with priming solution) affecting drugs with small volumes of distribution and those that are highly protein bound Drug binding interactions with the circuit - Adsorption and sequestration onto plastic cannula and/or silicone oxygenator Altered renal, hepatic, and cerebral blood flow - Non-pulsatile blood flow
62
ECMO and Vancomycin and Gentamicin
Increase doses with ECMO

CV II Exam 3 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions