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Pediatrics > Pediatrics Exam 2 > Flashcards

Pediatrics Exam 2 Flashcards

1
Q

What are causes of shock lesions in the newborn?

A
  • Critical Pulmonary Stenosis
  • Aortic Coarctation/Interrupted Aortic Arch
  • Critical Aortic Stenosis
  • Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)
  • Tachyarrhythmias
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2
Q

what are examples of systemic obstructive lesions?

A
  • Aortic Stenosis
  • Interrupted Aortic Arch
  • Aortic Stenosis
  • Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)
  • Tachyarrhythmias
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3
Q

Newborn presents with poor feeding, tachypnea, decreased LE pulses, and gradient by cuff pressure >10 mm Hg; however, it passed the newborn pulse oximetry test. What is the diagnosis?

A

Coarctation of the Aorta

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4
Q

What should a Coarctation of the Aorta be treated with?

A

Prostaglandin E1

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5
Q

In a Patent Ductus Areriosus (PDA) pt, what may not be detected in a newborn with coarctation of the aorta?

A

gradient by cuff pressure >10 mm Hg (may not detect until PDA closes)

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6
Q

Why should a coarctation of the aorta be followed for lifetime?

A

A coarct will develop collaterals over time and have rib notching on X-ray
Older presentation: systolic HTN, fatigue, leg pain (claudication)

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7
Q

Pt presents with poor cardiac output, irritability, CHF, and poor feeding at 2 minutes. What is the dx?

A

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)

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8
Q

What initial management steps should be taken for suspected newborn cardiovascular issues?

A

Airway, Breathing, Circulation (ABC’s)
Vascular access (IV-resuscitate)
Antibiotics (always start)
Prostaglandin E1

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9
Q

For any newborn in shock, what should be considered?

A

Prostaglandin E1

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10
Q

What should always be checked in newborns?

A

pulses, if there is ANY doubt –> refer

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11
Q

If 3 month old presents w/ tachypnea, what do you suspect?

A

ALCAPA

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12
Q

Which newborn lesions have less sensitivity with screening?

A

Left sided lesions

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13
Q

Pulse oximetry screening is a poor test for?

A

lesions that cause systemic obstruction (coarctation, aortic stenosis)

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14
Q

What should you do w/ newborn who presents with blue brain and pink feet?

A

Suspect D-Transposition of the Great Arteries (D-TGA)
Immediately refer to open atrial septum (add PDA)
put in IV, resuscitate to reverse differential saturations
Start Prostaglandin E1

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15
Q

What should be obtained in all children who fail the hyperoxia test?

A

An echo or transport

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16
Q

What are important things on the newborn physical exam to note for cardiac issues?

A

liver edge (heptomegaly)
feeding endurance
check pulses in upper and lower extremities
characterize chest pain

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17
Q

What are signs of cardiac ischemia?

A

happens w/ activity
chest pain
extreme SOB
radiating pain

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18
Q

If pt has a single ventricle (e.g., Hypoplastic Left Heart Syndrome (HLHS)), what is required for treatment?

A

3 staged surgery repairs over the first 3 years

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19
Q

Which stage in a single ventricle condition is most high risk?

A

Stage 1

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20
Q

What type of management does a single ventricle require?

A

cardiologist

lifelong f/u due to increased risk for arrythmias

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21
Q

feeding intolerance is a red flag for?

A

single ventricle

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22
Q

shunting at the atrial level is determined by what?

A

ventricular compliance (how stiff ventricles are) NOT pressure difference

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23
Q

shunting at the ventricular level is determined by what?

A

relative SVR and PVR (resistance)

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24
Q

What is the outpatient management for congestion in CHD?

A

adequate calories until child is “big enough” for surgery (fortify feeds, tubes, etc.)
diuretics

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25
Q

When should a cardiologist be notified in outpatient management of congestion in CHD?

A

excessive changes in weight (up or down)

new symptoms or progression of current symptoms

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26
Q

In Atrioventricular Canal (AVC), shunting occurs due to what?

A

increase in qP (pulmonary flow)- (oxygen poor blood)

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27
Q

T or F: In Atrioventricular Canal, there is early congestion

A

True

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28
Q

When does differential cyanosis occur?

A

when the PDA shunts R to L blue blood to the lower extremities

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29
Q

what is the timing of CHF for Patent Ductus Arteriosus (PDA)?

A

days to weeks

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30
Q

what is the timing of CHF for Atrioventricular Canal?

A

weeks to months

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31
Q

what is the timing of CHF for Ventricular Septal Defect (VSD)?

A

weeks to months

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32
Q

what is the timing of CHF for Atrial Septal Defect (ASD)?

A

years to decades

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33
Q

what are stills?

A

innocent murmur- no intervention needed, but f/u all innocent murmurs in children <2 yrs old

vibratory ejection murmur louder when lying down (“flicking guitar string”)

34
Q

What murmur is never innocent?

A

diastolic murmur

35
Q

In a hyperoxia test, if PaO2 <150 mmHg after 100% O2 delivery suggest what?

A

blood is bypassing the lungs via a congenital heart defect

36
Q

What are normal physiological responses to fever?

A

increased heart rate and respiration rate

37
Q

fevers seen in what age should be sent to the ER?

A

<2-3 months old

high fever can precipitate seizures

38
Q

What temperature defines pediatric fever?

A

> 100.4 degrees F taken via the rectum, ear, or temporal artery

39
Q

Should you believe the parents when they state that they feel their child has a fever?

A

Yes, this is a reliable predictor of fever

40
Q

What should be recommended if a fever is detected via a route other than the rectum?

A

Recommend to parents to double check an infant w/ a rectal temperature

41
Q

What should be included in the pt history if a child presents with fever?

A
  • Recent immunizations
  • Hx of sick contacts (especially siblings)
  • Treatments, including abx/antipyretics
  • Travel
  • Hospitalizations or hx of immune compromise
  • Change in mental status, eating, drinking, lethargy, apnea, irritability
42
Q

What history questions should be asked if a neonate presents with fever?

A
  • Is there poor feeding?
  • Vomiting or signs of dehydration?
  • Apneic episodes?
  • Changes in the social interaction or in crying?
  • Birth history (to explore prematurity, maternal infection, or congenital conditions)
43
Q

What age group should avoid NSAIDs (e.g., motrin)?

A

<6 months old

okay to give acetaminophen

44
Q

In a child w/ fever, what should you note in general appearance?

A

-Social smile is reassuring
-Children >8 months old should normally fear strangers,
serious illness likely if child doesn’t respond in this fashion

45
Q

If a child presents w/ fever and petechiae/rashes, what should you suspect?

A

bacterial infection

46
Q

If a child presents w/ fever and mottling, what should you suspect?

A

toxicity

47
Q

In a child w/ fever and capillary refill >2 seconds, what should you be concerned about?

A

hypoperfusion/hypovolemia

48
Q

What should be done if a child presents w/ fever and dyspnea/tachypnea/grunting/flaring/retractions?

A

further workup with pulse ox and chest x-ray

49
Q

What are signs of dehydration in an infant?

A

dry mucosa, lack of tears, sunken fontanelle, decreased urine output by hx (typically 3+x/day )

50
Q

What are signs of lethargy in an infant/child?

A

decreased level of consciousness
absent eye contact
decreased ability to recognize parents

51
Q

child presents w/ fever and lethargy w/ poor perfusion. What do you suspect?

A

toxicity

52
Q

child presents w/ fever and cyanosis, what do you suspect?

A

toxicity

53
Q

child presents w/ fever and respiratory distress, what do you suspect?

A

toxicity

54
Q

child presents w/ fever and cold hands/feet, limb pain, mottled/pale skin. what do you suspect?

A

toxicity

55
Q

What factors increase the risk of bacteremia/sepsis?

A
  • < 2 months old
  • immunocompromised (low WBC, cancer)
  • under/unvaccinated
  • hypothermia (<98 degrees) or hyperthermia (>105 degrees)
  • implanted medical devices (pacemaker, shunt, central line)
  • sickle cell disease
  • asplenic
  • HIV (+)
56
Q

Children w/ cystic fibrosis are susceptible to what?

A

pneumonia

57
Q

Infants <60 days old should be referred to an ED for what?

A

full sepsis workup

58
Q

In a bacterial infection, what lab values can you expect in a CSF analysis?

A

WBC count >15,000 (neutrophils >1000), protein >200, glucose <40

59
Q

When is an evaluation for herpes simplex indicated for a febrile infant?

A
  • < 3 wks old
  • vesicles are present
  • seizures
  • toxic/ill appearance
  • maternal hx of herpes and vaginal brith
60
Q

febrile neonates are often ______ while pending outcome of cultures

A

hospitalized and treated w/ empiric antibiotics

61
Q

what should be included in the workup for infants <28 days old, hx of prematurity + underlying medical condition, or high risk of serious bacterial infection?

A
  • urine
  • CBC
  • blood culture
  • CSF
  • chest x-ray
  • viral panel
62
Q

what is the appropriate action if a full sepsis workup is needed in an infant?

A

hospitalize and treat w/ IV antibiotics pending culture outcome

63
Q

What are indicators of low risk for serious bacterial infection in infants?

A
  • nontoxic (no lethargy or poor perfusion)
  • previously healthy
  • no bacterial focus skin, skeletal or soft tissue
  • good social interaction (alert, looking around)
  • normal WBC in UA and stool (5000-15000)
64
Q

Why is epiglottitis nearly eliminated?

A

HIB vaccine

65
Q

Children ages 2-24 months w/ fever >102.9 are at risk for what?

A

occult bacteremia (especially if under-immunized or immunocompromised)

66
Q

febrile children ages 2-24 months w/ symptoms of bronchiolitis are a lower risk for what?

A

both bacteremia and UTI

cultures w/ healthy appearing children unneccesary

67
Q

what labs are discouraged in febrile but well-appearing immunocompetent children ages 2-24?

A

CBC and blood cultures

68
Q

what antibiotics are not recommended in febrile children ages 2-24?

A

broad spectrum

69
Q

what lab is recommended in ALL febrile females w/o source?

A

urine culture

70
Q

what lab is recommended in febrile males <6 months old?

A

urine culture

71
Q

what labs should be obtained in febrile children ages 2-24 w/ lethargy, toxicity, irritability, inconsolableness, signs of shock, or petechial rash?

A

urine, blood, and CSF cultures

72
Q

what are common causes of fever in children ages 2-24 months?

A

viral: RSV, influenza A/B, HHV-6 “roseola”, enterovirus in the summer, adenovirus, COVID
bacterial infection: OM, nasal FB, periorbital cellulitis

73
Q

fever w/ diarrhea is typically viral except if ____

A

it contains blood/mucus or there has been recent antibiotic use

74
Q

what course of action should be taken for a fever <102.2 degrees in a child aged 2-24 months?

A

evaluate, antipyretics and f/u

if fever lasts >5 days –> concerning

75
Q

what course of action should be taken for a fever >102.2 degrees in a child aged 2-24 months?

A

if toxic or immunodeficient: full septic workup, IV antibiotics
Non-toxic: guided by screening tests

76
Q

What testing is recommended for febrile children ages 2-24 months presenting w/ complex febrile seizure, full anterior fontanelle, persistent irritability, lethargy/inconsolability, or petechial rash?

A

lumbar puncture

77
Q

What course of action should be taken with children >24 months w/ low grade fever, no risk factors, no focus and no irritability?

A

treat symptomatically, no labs needed

78
Q

innocent murmurs always have ____ S1, S2

A

normal

79
Q

chest pain/syncope with exertion is a red flag for?

A

CARDIAC ISSUE

80
Q

which cardiac lesion causes 2/6 SEM at the LUSB?

A

pulmonary stenosis

81
Q

large male newborn w/ single S2, no murmurs

O2 sats 55% on hand and 75% on foot

A

D-TGA (D- Transposition of the Great Arteries)

pre-ductal/brain O2 SAT > feet O2 SAT

82
Q

which cardiac lesion causes 4/6 SEM at the LUSB, high pitched?

A

pulmonary stenosis

Pediatrics (7 decks)

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