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ICM > PEDS 2 > Flashcards

PEDS 2 Flashcards

1
Q

EISENMENGER SYNDROME

A

pulmonary HTN
reversal of flow (L to R shunt becomes R to L)
cyanosis

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2
Q

Investigations for CHD

A

2D-echocardiography

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3
Q

RV (parasternal) heave
Fixed, widely split S2
Systolic ejection murmur at the pulmonic area

Ostium secundum -most common; often an isolated defect
Ostium primum - often associated with other cardiac defects and Down syndrome

A

ASD

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4
Q

holosystolic murmur, LLSB
High pitched, harsh
The smaller the defect, the louder the murmur
Usually not audible until age 4-10 days
↑Flow through the MV: diastolic rumble, apex (large defect)

A

VSD

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5
Q

Associated conditions with PDA

A

fetal alcohol syndrome: low palpebral fissure, thin lip,
VSD
congenital rubella
neonatal RDS

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6
Q

Respiratory distress
Bounding arterial pulses +3 always R/O
*Paradoxical splitting of S2 during expiration
Murmur continuous, rough, machine-like (‘to and fro’)
maximal at the 2nd L ICS
*Disappears with ↑pulmonary vascular resistance

A

PDA

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7
Q

Associated conditions with Coarctation of the Aorta

A

Turner syndrome

Bicuspid aortic valve

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8
Q

UE hypertension systolic BP in the arms are > 20 mmHg higher than the legs
Enlarged and pulsatile collateral vessels
ICS anteriorly, in the axilla, or posteriorly in the interscapular area
(femoral < brachial pulses)
bounding pulses in UE and carotids +3 above coarctation
Cardiac: harsh systolic murmuralong the left sternal border + systolic murmuralongL and R side of the chest with thrills

A

Coarctation of the Aorta

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9
Q

Extreme cyanosis in the first 24 hours of life without respiratory distress
Single S2
CXR: egg-on-a-string appearance

A

Transposition of the Great Vessels

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10
Q

Downward displacement of dysplastic tricuspid valve into a hypoplastic RV
Early or late cyanosis
Right heart failure
Mom used Lithium
S1 is widely split with loud tricuspid component
Holosystolic murmur of TR

A

Ebstein Anomaly

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11
Q

APGAR chart

A

pg 599 in FA

PPT SLIDE2

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12
Q

No vitamin K at birth

Exclusively breastfed

A

Classic VKDB

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13
Q

Maternal ingestion of drugs** that interfere with vitamin K metabolism

A

Early VKDB

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14
Q

Chronic diarrhea
Prolonged antibiotic therapy
Exclusively breastfed

A

Late VKDB

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15
Q

Necrotizing Enterocolitis (NEC) risk factors

A

Born at < 35 weeks

formula feeding

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16
Q

NEC Clinical features

What do you see on X RAY?

A 
*Abdominal distension
emesis
Blood in stools
*Hypothermia, temperature instability
Lethargy
Apnea, dyspnea

CXR- Pneumatosis intestinalis
AIR IN THE BOWEL WALL/ ABDOMEN

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17
Q

Umbilical Hernia prognosis ?

A

Small umbilical hernias < 1.5 cm = Spontaneous closure
Large umbilical hernias - Spontaneous closure less likely
Surgery by age 5 if persistent

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18
Q

risk factors of Gastroschisis

A

young maternal age
prenatal use of illicit drugs (metamphetamines, cocaine)
prenatal use of cyclooxygenase inhibitors (aspirin, ibuprofen

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19
Q

associations with Gastroschisis

A 
intestinal atresia (10-20%)
intrauterine growth retardation (IUGR)
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20
Q

prenatal dx of gastroschisis

A 
Second trimester ultrasound (>95% sensitive)
Elevated maternal serum α-fetoprotein: 
Open NTDs
Ventral wall defects
Multiple gestation
21
Q

Omphalocoele risk factors

A 
> 50% have an abnormal karyotype or other defects
Edwards syndrome (Trisomy 18)
Patau syndrome (Trisomy 13)
Congenital heart disease
Neural tube defects
22
Q

Defect at linea alba covered by skin
Sometimes contains bowel
Umbilical cord inserts at apex of defect

A

Umbilical hernia

23
Q

Defect to the right of the cord insertion
Contains bowel
Umbilical cord inserts next to defect

A

Gastroschisis

24
Q

Midline abdominal wall defect covered by peritoneum
Contains multiple abdominal organs
Umbilical cord inserts at apex of defect

A

Omphalocele

25
Q

risk factors for Hypertrophic Pyloric Stenosis (HPS)

A

Firstborn male (M: F = 4:1)
Caucasian
Parental Hx of HPS (higher if mother affected)
Use of erythromycin in the neonatal period

26
Q

progressively forceful/ projectile postprandial
non-bilous vomiting
‘Olive-shaped’ abdominal mass
Hyperperistalsis
SUNKEN FONTANELLE, JAUNDICE, LOSS OF SKIN TURGOR

A

Hypertrophic Pyloric Stenosis (HPS)

27
Q

labs and investigation for HPS

A

Hypochloremic hypokalemic metabolic alkalosis
↑pH, PaCO2 and HCO3
↓K and Cl

U/S: sausage mass/donut sign

28
Q

Hirschsprung Disease is Strongly associated

A

with Down syndrome

29
Q

No meconium passage in the first 48 hours
Bilious emesis
Enterocolitis in 50%:

Rectal exam
Extremely tight anal sphincter
‘Squirt sign’ or no stool in rectal vault

A

Hirschsprung Disease

30
Q

Signs of obstruction in Hirschsprung Disease on Xray

A

dilated bowel loops

absence of gas in the rectum

31
Q

Suction rectal biopsy - Definitive Dx of ?

A

Hirschsprung Disease

32
Q 
PATH: pulmonary hypoplasia
Respiratory distress at birth
Asymmetric chest movements
Tracheal deviation
Flat/ scaphoid/ concave abdomen
L-sided hernia: Absent breath sounds; may hear bowel sounds
A

Congenital Diaphragmatic Hernia (CDH)

33
Q

Complications of Congenital Diaphragmatic Hernia**

A

In utero: polyhydramnios
Postnatal:
Pulmonary HTN
Pneumotharax

34
Q

CXR findings of Congenital Diaphragmatic Hernia

A

herniation of bowel loops into the left hemithorax

cardiac and mediastinal shift to the right

35
Q

delayed clearance of fetal lung fluid
mild pulmonary edema
self-limited disease

A

Transient Tachypnea of the Newborn (TTN)

36
Q

Risk factors of TTN (4)

A

full term or late preterm
born following a short labor or C-section without labor
diabetic mother/ BW > 4500 g
maternal asthma

37
Q

CXR for TTN

A

Interstitial and alveolar edema

Fluid in the interlobar fissures

38
Q

How long does it take TTN to resolve ?

A

Clinical resolution in 48 to 72 hours

39
Q

Congenital pneumonia causitive agents

A

group B streptococci
Escherichia coli
Ureaplasma urealyticum
Staphylococcus epidermidis

40
Q

Labs of congenital pneumonia

A

CBC: absolute neutropenia (< 2000/mL)
C-reactive protein: elevated
gram stain of tracheal aspirate

41
Q

CXR of congenital pneumonia

A

nodular or coarse patchy infiltrates
diffuse haziness or granularity
air bronchogram signs

42
Q

risk factor for Meconium Aspiration Syndrome (MAS)

A

post-term delivery ( ↑risk after 41 weeks AOG)

43
Q

What happens when the meconium gets into the lungs of neonate ?

A

Deactivation of surfactant - respiratory distress

44
Q 
low APGAR score/ depression
meconium + blood in amniotic fluid
barrel chest - bc of obstruction 
crackles; coarse breath sounds
meconium-stained skin
A

Meconium Aspiration Syndrome (MAS)

45
Q

complication of Meconium Aspiration Syndrome (MAS)

A

PPHN (persistent pulmonary HTN of the newborn)

46
Q

rupture of the visceral pleura

A

Primary Spontaneous Pneumothorax

47
Q

risk factor for Primary Spontaneous Pneumothorax

A

intubated
given too much O2
meconium aspiration

48
Q

clinical feat of Primary Spontaneous Pneumothorax (4)

A

tachypnea
hyperresonance and ↓breath sounds on the affected side
heart sounds may be distant/ shifted to the opposite side
subcutaneous emphysema

49
Q

CXR of Primary Spontaneous Pneumothorax

A 
Pneumothorax                           
air in the pleural space 
hyperlucency of vascular/ lung markings
Pneumomediastinum
Atelectasis
Tracheal/ mediastinal shifting*

angel wing sign

ICM (6 decks)

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