pediatrics Flashcards
congenital cyanotic heart diseases
truncus arteriosus- 1 vessel instead of 2 normal
transposition of great arteries: 2 vessels switched
Tricuspid atresia: absense of tricuspid valve leads to hypoplastic right ventricle!!
tet of fallot: right ventricular outflow obstruction, right ventricular hypertrophy, override aorta, ventricular septal defect
total anomalous pulm venous returns: 5 vessels- all 4 pulm veins connect to superior vena cava instead of left atrium
VSD
most common congenital heart disease- hole in ventricular septum
harsh, holosystolic murmur at the lower left sternal border
echo, RVH and LVH .
transposition of the great arteries
aorta and pulm artery switched@@- SEVERE cyaosis
cyanosis and tachypnea in the new born
TX: alprostadil- prostaglandin analog- maintains patency of the ductus arteriosus- until surgical repair
atrial septal defuct
hole in atrial septum= sytolic ejection murmur
ostium secundum MC
most patients asymptomatic until more than 30 y.
WIDELY SPLIT FIXED s2!!!!!!- does not vary with respirations
patent ductus arteriosus
countinuous machinery murmur!!!
WIDE pulse pressure
IV INDOMETHACIN! to close a PDA in infants
tet of fallot
tet spells- cyanosis relieved with squatting
BOOT SHAPED HEART
alprostadil until surgery
coarctation of aorta
BICUSPID AORTIC VALVE MOSTLY
-RIB NOTICHING ON CXR
systolic blood pressure in upper extremety is higher than lower extremety
pulm atresia
blood unable to flow from right ventricle into the pulm artery
alprostadil
respiratory distress syndrome
GROUND GLASS OPACITIES +air bronchograms
- give surfactant
prevention: corticosteroids given to mature lungs- 24-36 weeks
meconium aspiration
incidence in posterm infants
jaundice in the newborn
pathologic if occurs in first 24 hours of life
physiologic- indirect bili rises in days 3-5 days
pyloric stenosis
nontender, olive shaped, mobile hard pylorus, projectile after feeding, string sign in upper gi- ultrasound 1st line
intussusception
telescopes - bowel obstruction- vomiting, abd pain, currant jelly stool - sausage shaped mass- BARIUM contrast enema
hirschprung disease
congenital absense of ganglion cells- failure to pass meocnium in more than 48 hours bilious vomiting, abdominal distention anorectal manometry- intiial screen rectal biopsy- definitive diagnosis
esophageal atresia
absense or closure of the esophagus- tracheosesophageal fistula- immediately after birth with excessive oral secreitions- surgery
duodenal atresia
gastric outlet obstruction- increased incidence i n down sydnrome- bilious vomiting- DOUBLE BUBBLE SIGN
coxsackie virus
mc viral cause of pericarditis and myocarditis
rubella
german measles- 3 day rash- togavirus
lymphadenopathy- pink, light red spotted maculopapular rash- on face and then extremities- transient join pains and photosensitivity
scarlet fever
GABHWS!!!! strep pyogenes infection- type IV delayed reaction to pyrogenic toxins!!
pharygintis, SANDPAPER REASH- desquamates over time-
STRAWBERRY TOUNGue and circumoral palor
pastia’s lignes- linear lesison on pressure points, axillary, antecubital
TX: pencillin G!! or VK
kleinfelter’s
kmales with hypognadism and small testes
neural tube defects
maternal folate deficienciy
spinal bifida with myelomeningocele: MC- meninges and spinal cord herniates through the gap in the vertebrae.
amniocentesis: increased alpha fetoprotein
live attenuated vaccines
- not given to imunocomp or preg patients
MMR *only one can be given to hiv patients)
CHicken POX
ROTAVIRUS
killed inactivated vaccines
influenza, rabies, polio salk, cholera, hep A
hep b vaccine
contraindicated in those with baker’s yeast allergy
eggs
influenza should be avoided
gelatin
avoid varicella, influenza
neomycin and streptomycin allergy
MMR And inactivated polio vaccine avoided
only vaccines safe in preg
diptheria, tetanus, inactivated influenza, HBV
NO LIVE vaccines: MMR, varicella or intranasal influenza vaccine
hep B
1st dose at birth, 2nd dose at 1-2 months, then 6-18 months
dtap
for less than 7 years old - 5 doses- 2, 4,6, 15-18, 4-6 years
hflu
2,4,6, 12-18, - 4 doses- before 2 years old
pcv 13
same as h flu
polio
same as dtap- less than 18 years-4 doses only
2,4,6-18 months, 4-6 years
MMR
after 1 year- 12 months, 4-6 years
varicella
after 1 year- 4,6 years, 12 months
hep a
12 months
cyanotic defects
tet of fallot
pulm atresia
hypoplastic left heart syndrome
transposition of the great vessels
non cyanotic congenital defects
atrial septal defect
VSD
PDA
coarctation of the AORTA
transopsition of the great areries
aorta from the right ventricle and pulmonary artery form the left ventricle —causes severe cyanosis!!!
if the infant has an intact ventricular septum- CYANOSIS AND TACHYPNEA IN THE NEWBORNS- esp when the pulmonary ductus arteriosus closes!!!- cyanosis is unchanged when you give oxygen!!!
CYANOSIS AND TACHYPNEA IN NEW BORN
egg on a string!!
echo
surgical repair!!
IF LARGE VSD: less severe cyanosis but causes CHF and poor feeding
tet of fallot
Right ventricular outflow obstruction- pulmonary artery sTENOSIS!!!
right ventricular hypertrophy
Ventricular septal defect
overriding AORTA!
blue baby syndrome!!
tet spells- relieved with squatting!!
harsh holosystolic murmur at left upper sternal border
boot shaped heart (SOUNDS LIKE Pulmonary stenosis)
pulmonary atresia
complete obstruction to right ventircular outflow if there is intact ventricular septum!!!- blood cannot fllow from the right ventricle into the pulmonary artery and the lungs!!!!!
CYANOSIS!!- improved survival if patent ductus arteriosus!!- SINGLE HEART SOUND!!!- only aortic valve is there!!!- systolic murmur of tricuspid regurg
tricuspid atresia
absense of the tricuspid valve leads to a hypoplastic right ventricle!!!
cyanosis due to right- to left shutnting!!1
hypoplastic left heart syndrome
failure of the development of the MITRAL valve, aortic valve and the aortic arch—SMALL VENTRICLE UNABLE TO SUPPLY THE normal systeic circulation requiremnts!!!
RIGHT ventriCULAR HYPERTROPHY!!!!
CARdiOMEGALy111
