Exam 3 Peds

Question 1

VSD: ventricular septal defect (most common form of CHD): Pathophysiology

Answer 1

Abnormal opening between the right and left ventricles; causing increased blood volume to the lungs

Question 2

VSD: ventricular septal defect (most common form of CHD): Manifestations

Answer 2

Heart failure, loud hollosystolic (during systole) murmur (LSB), increased risk for pulmonary vascular obstructive disease

Question 3

VSD: ventricular septal defect (most common form of CHD): Management

Answer 3

surgical interventions
- small complete repair: closed with a suture
- large complete repair: Dacron patch
VSD Prognosis depends on location, number, and other associated defects

Question 4

Patent Ductus Arteriosus (PDA): Pathophysiology

Answer 4

Failure of the fetal ductus arteriosus to close; blood flows from the high-pressure aorta to the low-pressure pulmonary artery

Question 5

Patent Ductus Arteriosus (PDA): Manifestations

Answer 5

Heart failure, machine like murmur, widened pulse pressure, bounding pulses

Question 6

Patent Ductus Arteriosus (PDA): Management

Answer 6

• Medical: indomethacin (does not have great side effects)
  
  • Surgical: ligation of patent vessel
  • Nonsurgical: coils used to occlude PDA
    Prognosis: low risk; increased in preterm infants

Question 7

Role of Prostaglandin E:

Answer 7

Keeps the ductus arteriosus open; indomethacin (medication) blocks prostaglandin E and is used to help close the ductus arteriosus

Question 8

Coarctation of the Aorta (COA): Pathophysiology

Answer 8

Localized narrowing near insertion of ductus arteriosus; increased pressure proximal to the defect (head/upper extremities); decreased pressure distal to the obstruction (lower extremities)

Question 9

Coarctation of the Aorta (COA): Manifestations

Answer 9

• HTN and bounding pulses in the upper extremities
• Low BP and weak/absent pulses in the lower extremities
• dizziness, headaches, fainting spells, epistaxis (bloody nose) – HTN; All ages are at an increased risk for: HTN, ruptured aorta, aortic aneurysm, stroke
• something that is often diagnosed in infancy, sometimes it can be missed

Question 10

Coarctation of the Aorta (COA): Management

Answer 10

• surgical: treatment of choice for infants < 6 months
  
  • nonsurgical: balloon angioplasty
  • postoperative: hypertension

Question 11

Tetralogy of Fallot: Pathophysiology

Answer 11

MAJOR DEFECTS:

1. pulmonary stenosis
2. right ventricular hypertrophy 
3. overriding aorta 
4. ventricular septal defect

Question 12

Tetralogy of Fallot: Manifestations

Answer 12

Mild to severe cyanosis; systolic murmur

Question 13

Tetralogy of Fallot: Management

Answer 13

• palliative shunt: modified blalock-taussig shunt
  
  • complete repair: usually in the first year of life
  • indications for repair: increasing cyanosis, increase in hypercyanotic spells
  • close VSD, resect infundibular stenosis with placement patch to enlarge RVOT