Pediatrics Flashcards
Types of congenital heart disorders
CYANOTIC (5T's + others) Truncus arteriosus Transposition of Great Vessels Tricuspid valve abnormalities Tetralogy of Fallot Others: Pulmonary atresia Hypoplastic Left Heart Syndrome
NON-CYANOTIC VSD PDA ASD Coarctation of aorta
4 features of Tetralogy of Fallot
- Ventricular septal defect
- Right ventricular hypertrophy
- Pulmonary stenosis
- Overriding aorta
Classic CXR of Tetralogy of Fallot
boot shaped heart due to RVH
What is pulmonary atresia?
congenital pulmonary valve closure
Cyanotic vs non-cyanotic congenital heart disorders
cyanotic: R to L shunting; deoxygenated blood returns from body and bypasses lungs and is recirculated
non-cyanotic: L to R shunting; blood skips the body
Pathophysiology of Hypoplastic Left Heart Syndrome
small undeveloped left ventricle and aorta
right side of heart pumps blood to the body through a patent ductus arteriosus
Congenital heart defect with crescendo-decrescendo holosystolic murmur along the left sternal border and radiating to back?
pulmonary stenosis of Tetrology of Fallot
Pathophysiology of Transposition of Great Vessels
complete transposition of pulmonary artery and aorta
What is an overriding aorta?
aorta attaches to both right and left ventricle
How are all cyanotic congenital defects treated?
surgery
Common cause of atrial septal defect?
foramen ovale doesn’t close or is too large
ECG findings of atrial septal defect
RVH, R bundle branch block
How to definitively diagnose congenital heart defects?
ECHO
What does the ductus arteriosus connect? Function?
pulmonary artery to aorta
allows for most blood to bypass lungs in utero
Pathophysiology of PDA
ductus arteriosus should close at birth, but in PDA it is patent/open
Treatment of PDA in neonate and after birth
neonate - NSAIDs
first 10-14 days of life - IV indomethacin
Congenital defect of aorta narrowing
coarctation of aorta
Congenital heart defect with machine-like murmur
PDA
What keeps ductus arteriosus open in PDA?
prostaglandins
PE findings coarctation of aorta
failure to thrive
delayed or weak femoral pulse
harsh systolic murmur
HTN in upper extremities and hypotension in lower
Treatment of ASD
small shunt may require no treatment
larger defect may need surgical closure
You are working in the free pediatric clinic. A one week old infant is brought it to see you. Upon listening to his chest you notice a systolic ejection murmur in the 2nd and 3rd intercostal spaces. There also seems to be an early to mid systolic rumble. What is your diagnosis?
Atrial septal defect
Ballard score
newborn assessment of activity, position, and tone to evaluate neuromuscular and physical maturity
rubric estimates gestational age
Causes of infant’s being small for gestational age
maternal drug use, chromosomal abnormality, viral infection, multiple birth, advanced maternal age, placental insufficiency, or lack of maternal weight gain
What is advanced maternal age?
> 35 yo
Most common cause of being large for gestational age
maternal diabetes
When should complete newborn exam be done?
within 24 hrs of birth
erythema toxicum
common rash in newborns 3-5 days old
small pustules with erythematous bases
spontaneous resolution in 1-2 wks
milia
common newborn rash
very small, white papules mostly on face
resolves w/o treatment in 1-2 months
miliaria
common newborn “heat rash”
caused by blockage of eccrine sweat glands, resulting in flushed macular appearance
light clothing and decreased humidity speeds resolution
Mongolian spots
blue-black macule concentrated on back and buttocks of dark-skinned infants
most resolve in 4 yrs but may persist for life
craniosynostosis
premature fusion of one or more sutures
necessary to refer to neuro
Anterior fontanelle closes around _____ months and posterior fontanelle closes at _____ months.
10-26 mon
1-3 mon
If a third fontanelle is seen along sagittal suture this may be associated with ________.
Trisomy 21
caput succedaneum
fluid accumulation under scalp secondary to birth trauma
subgaleal hemorrhage
occurs beneath scalp; uncommon but results in enough blood loss to cause hemorrhagic shock!
Absence of red reflex in infant may suggest what?
congenital cataracts, glaucoma, or retinoblastoma
Brushfield spots
gray/yellow spots at periphery of iris associated with Down syndrome
strabismus in newborns
“cross eyed”
almost always present in newborn period and is not pathologic unless persists past 4 months
choanal atresia
- unilateral or bilateral nasal obstruction
- bilateral results in respiratory distress as infants are obligate nasal breathers
- obstruction confirmed with CT
esophageal atresia presents as..
excessive drooling
What indicates a submucosal cleft?
bifid uvula
Mouth findings of trisomy 21 infants
large tongue
webbed or redundant skin of neck may suggest _________.
Turner syndrome
Midline/thyroid neck mass finding
thyromegaly; congenital hypothyroidism and requires immediate attention to prevent growth failure/cretinism
neck mass finding within sternocleidomastoid suggests ________.
Torticollis, hematoma
signs of respiratory distress
grunting, intercostal retractions, tachypnea (+60), cyanosis
finding with pneumothorax or diaphragmatic hernia
decreased breath sounds unilaterally
pneumothorax would also have mediastinal shift
Most common causes of respiratory distress in newborn
aspiration, congenital pneumonia, transient tachypnea
Concerning findings on cardiovascular exam
rapid heart rate, cyanosis, CHF, diminished peripheral pulses
*murmurs may or may not be pathologic
Prune belly or absence of abdominal musculature may indicate what?
renal anomalies
What are prominent kidneys suggestive of?
hydronephrosis or cystic kidney disease
severely scaphoid belly + respiratory distress indicates?
diaphragmatic hernia
What may delayed stool production (+24 hrs) indicate?
Hirschsprung disease
signs of neurotubular defect or spina bifida on exam
gluteal cleft with pits, birthmarks, or tufts of hair
Normal HR at birth to 6 months
average 130-140, normal range up to 180-190
Avg HR 6-14 years old
90
respiratory rate at birth
30-60 bpm
respiratory rate 8-15 yrs old
15-25 (similar to adult)
When should testes descend?
usually at 3 months and 80% by 9 mon; if over 1 year refer to urologist
Concerns of prolonged empty scrotal sac?
testicular cancer and infertility; refer to endocrinologist
hydrocele
commonly observed (80% of newborns) collection of fluid in scrotum due to patency of vaginalis process
How is hydrocele mass differentiated from inguinal hernia?
transillumination
Which conditions are commonly associated with ambiguous genitalia?
chromosomal anomalies adrenal hyperplasia (affects testosterone)
How to treat vaginal adhesions in newborns?
estrogen or beclomethasone cream x 5-10 days
if doesn’t resolve, refer to urologist
Exams to test for developmental hip dislocation
Barlow maneuver: adduct fully flexed hip while pushing thigh posteriorly; dislocation + test
Ortolani maneuver: grasp medial aspect of flexed knee and fully abduct hip; feel for spasm or clunk
When should newborn’s hip clicking need ultrasound and referral to pediatric ortho?
- If Barlow and/or Ortolani maneuvers are positive
- If hip click persists past 1 month old
sucking and rooting reflex
earliest reflexes
when face stroked the baby will turn head towards that side and if offered nipple or finger will suckle
Moro reflex
allow infant’s head to drop 1-2 cm and observe for abduction of shoulders and elbows with spreading and extending of fingers; then subsequent adduction and flexion of those same body parts
disappears by 3-4 months old
grasp reflex
placement of finger in palmar or plantar surface elicits grasping response
disappears by 4 months old
Babinski reflex of infant
test is positive with upgoing plantar
may exist until 2 yo
traction response
pull infant by arms to sitting position
observe initial head lag, coming briefly to midline, then falling forward
Placing reflex
when infant dangled over flat surface with toe barely touching, triggers stepping response or extremity flexion
