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PANCE review > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Types of congenital heart disorders

A 
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
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2
Q

4 features of Tetralogy of Fallot

A
  1. Ventricular septal defect
  2. Right ventricular hypertrophy
  3. Pulmonary stenosis
  4. Overriding aorta
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3
Q

Classic CXR of Tetralogy of Fallot

A

boot shaped heart due to RVH

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4
Q

What is pulmonary atresia?

A

congenital pulmonary valve closure

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5
Q

Cyanotic vs non-cyanotic congenital heart disorders

A

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

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6
Q

Pathophysiology of Hypoplastic Left Heart Syndrome

A

small undeveloped left ventricle and aorta

right side of heart pumps blood to the body through a patent ductus arteriosus

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7
Q

Congenital heart defect with crescendo-decrescendo holosystolic murmur along the left sternal border and radiating to back?

A

pulmonary stenosis of Tetrology of Fallot

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8
Q

Pathophysiology of Transposition of Great Vessels

A

complete transposition of pulmonary artery and aorta

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9
Q

What is an overriding aorta?

A

aorta attaches to both right and left ventricle

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10
Q

How are all cyanotic congenital defects treated?

A

surgery

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11
Q

Common cause of atrial septal defect?

A

foramen ovale doesn’t close or is too large

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12
Q

ECG findings of atrial septal defect

A

RVH, R bundle branch block

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13
Q

How to definitively diagnose congenital heart defects?

A

ECHO

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14
Q

What does the ductus arteriosus connect? Function?

A

pulmonary artery to aorta

allows for most blood to bypass lungs in utero

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15
Q

Pathophysiology of PDA

A

ductus arteriosus should close at birth, but in PDA it is patent/open

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16
Q

Treatment of PDA in neonate and after birth

A

neonate - NSAIDs

first 10-14 days of life - IV indomethacin

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17
Q

Congenital defect of aorta narrowing

A

coarctation of aorta

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18
Q

Congenital heart defect with machine-like murmur

A

PDA

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19
Q

What keeps ductus arteriosus open in PDA?

A

prostaglandins

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20
Q

PE findings coarctation of aorta

A

failure to thrive
delayed or weak femoral pulse
harsh systolic murmur
HTN in upper extremities and hypotension in lower

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21
Q

Treatment of ASD

A

small shunt may require no treatment

larger defect may need surgical closure

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22
Q

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?

A

Atrial septal defect

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23
Q

Ballard score

A

newborn assessment of activity, position, and tone to evaluate neuromuscular and physical maturity
rubric estimates gestational age

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24
Q

Causes of infant’s being small for gestational age

A

maternal drug use, chromosomal abnormality, viral infection, multiple birth, advanced maternal age, placental insufficiency, or lack of maternal weight gain

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25
Q

What is advanced maternal age?

A

> 35 yo

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26
Q

Most common cause of being large for gestational age

A

maternal diabetes

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27
Q

When should complete newborn exam be done?

A

within 24 hrs of birth

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28
Q

erythema toxicum

A

common rash in newborns 3-5 days old
small pustules with erythematous bases
spontaneous resolution in 1-2 wks

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29
Q

milia

A

common newborn rash
very small, white papules mostly on face
resolves w/o treatment in 1-2 months

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30
Q

miliaria

A

common newborn “heat rash”
caused by blockage of eccrine sweat glands, resulting in flushed macular appearance
light clothing and decreased humidity speeds resolution

31
Q

Mongolian spots

A

blue-black macule concentrated on back and buttocks of dark-skinned infants
most resolve in 4 yrs but may persist for life

32
Q

craniosynostosis

A

premature fusion of one or more sutures

necessary to refer to neuro

33
Q

Anterior fontanelle closes around _____ months and posterior fontanelle closes at _____ months.

A

10-26 mon

1-3 mon

34
Q

If a third fontanelle is seen along sagittal suture this may be associated with ________.

A

Trisomy 21

35
Q

caput succedaneum

A

fluid accumulation under scalp secondary to birth trauma

36
Q

subgaleal hemorrhage

A

occurs beneath scalp; uncommon but results in enough blood loss to cause hemorrhagic shock!

37
Q

Absence of red reflex in infant may suggest what?

A

congenital cataracts, glaucoma, or retinoblastoma

38
Q

Brushfield spots

A

gray/yellow spots at periphery of iris associated with Down syndrome

39
Q

strabismus in newborns

A

“cross eyed”

almost always present in newborn period and is not pathologic unless persists past 4 months

40
Q

choanal atresia

A
  • unilateral or bilateral nasal obstruction
  • bilateral results in respiratory distress as infants are obligate nasal breathers
  • obstruction confirmed with CT
41
Q

esophageal atresia presents as..

A

excessive drooling

42
Q

What indicates a submucosal cleft?

A

bifid uvula

43
Q

Mouth findings of trisomy 21 infants

A

large tongue

44
Q

webbed or redundant skin of neck may suggest _________.

A

Turner syndrome

45
Q

Midline/thyroid neck mass finding

A

thyromegaly; congenital hypothyroidism and requires immediate attention to prevent growth failure/cretinism

46
Q

neck mass finding within sternocleidomastoid suggests ________.

A

Torticollis, hematoma

47
Q

signs of respiratory distress

A

grunting, intercostal retractions, tachypnea (+60), cyanosis

48
Q

finding with pneumothorax or diaphragmatic hernia

A

decreased breath sounds unilaterally

pneumothorax would also have mediastinal shift

49
Q

Most common causes of respiratory distress in newborn

A

aspiration, congenital pneumonia, transient tachypnea

50
Q

Concerning findings on cardiovascular exam

A

rapid heart rate, cyanosis, CHF, diminished peripheral pulses

*murmurs may or may not be pathologic

51
Q

Prune belly or absence of abdominal musculature may indicate what?

A

renal anomalies

52
Q

What are prominent kidneys suggestive of?

A

hydronephrosis or cystic kidney disease

53
Q

severely scaphoid belly + respiratory distress indicates?

A

diaphragmatic hernia

54
Q

What may delayed stool production (+24 hrs) indicate?

A

Hirschsprung disease

55
Q

signs of neurotubular defect or spina bifida on exam

A

gluteal cleft with pits, birthmarks, or tufts of hair

56
Q

Normal HR at birth to 6 months

A

average 130-140, normal range up to 180-190

57
Q

Avg HR 6-14 years old

A

90

58
Q

respiratory rate at birth

A

30-60 bpm

59
Q

respiratory rate 8-15 yrs old

A

15-25 (similar to adult)

60
Q

When should testes descend?

A

usually at 3 months and 80% by 9 mon; if over 1 year refer to urologist

61
Q

Concerns of prolonged empty scrotal sac?

A

testicular cancer and infertility; refer to endocrinologist

62
Q

hydrocele

A

commonly observed (80% of newborns) collection of fluid in scrotum due to patency of vaginalis process

63
Q

How is hydrocele mass differentiated from inguinal hernia?

A

transillumination

64
Q

Which conditions are commonly associated with ambiguous genitalia?

A 
chromosomal anomalies
adrenal hyperplasia (affects testosterone)
65
Q

How to treat vaginal adhesions in newborns?

A

estrogen or beclomethasone cream x 5-10 days

if doesn’t resolve, refer to urologist

66
Q

Exams to test for developmental hip dislocation

A

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

67
Q

When should newborn’s hip clicking need ultrasound and referral to pediatric ortho?

A
  • If Barlow and/or Ortolani maneuvers are positive

- If hip click persists past 1 month old

68
Q

sucking and rooting reflex

A

earliest reflexes

when face stroked the baby will turn head towards that side and if offered nipple or finger will suckle

69
Q

Moro reflex

A

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

70
Q

grasp reflex

A

placement of finger in palmar or plantar surface elicits grasping response
disappears by 4 months old

71
Q

Babinski reflex of infant

A

test is positive with upgoing plantar

may exist until 2 yo

72
Q

traction response

A

pull infant by arms to sitting position

observe initial head lag, coming briefly to midline, then falling forward

73
Q

Placing reflex

A

when infant dangled over flat surface with toe barely touching, triggers stepping response or extremity flexion

PANCE review (18 decks)

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