Pediatrics Flash Cards - Case 18

Question 1

Measurement cut offs for FTT?

Answer 1

infant < 5th %ile for weight OR < 5th %ile in weight for length OR crossing > 2 major lines growth curve.

Question 2

Components of a complete cardiac exam in infants?

Answer 2

inspect color, palpate precordium, auscultate, assess brachial and femoral pulses

Question 3

DDx of cyanotic baby d/t cardiac cause?

Answer 3

The Five T’s: #1 = Tet; Truncus arteriosus; Transposition of the great arteries; Tricuspid atresia; TAPVR

Question 4

DDx of anatomical causes of CHF in infant?

Answer 4

VDA, AS, PDA and Coarc (not the T’s or ASD)

Question 5

DDX holosystolic murmurs?

Answer 5

VSD, mitral insufficiency, and tricuspid insufficiency

Question 6

Grading of murmurs?

Answer 6

I Faint & easily missed || II = Obvious || III = Loud || IV = Assoc’d w/ thrill; NOTE III & IV need cards referral

Question 7

Dx of continuous murmur?

Answer 7

PDA

Question 8

Mgmt of diastolic murmurs?

Answer 8

all pathologic; send to cards to eval/tx

Question 9

nl liver edge is palpated ..?.. cm below R costal margin in a young infant.

Answer 9

1 to 2 cm

Question 10

DDx of hepatomegaly in the infant?

Answer 10

CHF, anemia, congen infx, inborn error of metab, [rarely]-tumor

Question 11

What do you need to ask yourself before calling a murmum “innocent”?

Answer 11

child otherwise well? nl precordial activity? S2 normally split? > grade II/VI? nl O2 sat?

Question 12

Dx: widely split, fixed S2 in a 3-5 y/o?

Answer 12

pathgnomonic for ASD

Question 13

Tetrology of Fallot includes?

Answer 13

VSD, RV outflow tract obstruction, overriding aorta, and RVH

Question 14

How does an innocent murmur sounds and where is it best heard?

Answer 14

Vibratory and low-pitched (vibr quality is most characteristic feature), best heard @ LLSB

Question 15

Drugs for symptomatic mgmt of infants in CHF? MoA?

Answer 15

furosemide (decr pre-load, vol overload-related sx), digoxin (MoA unknown b/c infant don’t have impaired contractility in CHF), captopril/enalopril (decr afterload)

Question 16

Repair VSD before what age to prevent Eisenmenger’s syndrome?

Answer 16

6 mo if VSD is not shrinking

Question 17

Dx:3 wk old w/ FTT (despite adequate, even prolonged, feedings) and resp distress (tachypnea). EKG w/ high voltage QRS in V1 & V2

Answer 17

VSD (pathology: left-to-right shunting)

Question 18

What precent of blood in the RA goes where when exiting the RA of a fetus?

Answer 18

2/3 goes RA -> RV -> ductus arteriosus; 1/3 goes RA -> foramen ovale -> LA -> LV -> aorta

Question 19

name the heart defect: 5 y/o boy w/ grade II systolic murmur and widely split S2

Answer 19

ASD; needs work up