Peds Final Flashcards
1
Q
Still Murmur
innocent
A
Most common innocent murmur in YOUNG children (2-7 YO)
2
Q
Still Murmur
innocent
A
Musical, short, high pitched, loudest LYING supine
3
Q
Pulmonary Flow Murmur
innoncent
A
Soft, loudest supine
3YO and older
4
Q
Venous Hum
innocent
A
Continuous musical hum, resolves when pt LYING supine
2YO and older
5
Q
Venous Hum
(innocent(
A
Louder in diastole and sitting position w head extended
Disappears w: turning head or lying supine
6
Q
Venous Hum (innocent) best heard @
A
Right or Left Upper Sternal Border (R/LUSB)
7
Q
Still Murmur (innocent) best heard @
A
Left LOWER Sternal Border (LLSB)
8
Q
Umbilical vein
A
brings oxygenated blood from placenta to fetus
9
Q
Ductus Venosus
A
short cut from umbilical vein to IVC
10
Q
Foramen Ovale
A
R atrium –> L atrium
11
Q
Ductus Arteriosus
A
blood from Pulmonary Artery –> Aorta (directs blood away from the lungs)
12
Q
After birth, Ductus Arteriosus:
A
shunting not needed
Blood flow can continue: 1-5 days
Closure by: 7-14 days
13
Q
Most common congenital heart defect
A
VSD
14
Q
VSD is associated with
A
Tetralogy of Fallot
Trisomy 21
15
Q
Physical Exam of VSD
A
Harsh, holosystolic murmur at LLSB (Left LOWER sternal border)
16
Q
EKG of VSD will show
A
Left Ventricular Hypertrophy
17
Q
CXR of VSD will show
A
Cardiomegaly, increased Pulmonary vascular markings
18
Q
Tx for VSD
A
May spont close
Treat CHF (diuretics)
Surgical: Septal occlusion via cardiac cath VS Surgical closure vie median sternotomy*** (preferred)
19
Q
Preferred surgical tx for VSD
A
Surgical closure via median sternotomy
20
Q
ASD
A
Classified by anatomic location
Ostium Secundum: most common (usually isolated defect)
Ostium Primum (assoc w other stuff)
Sinus Venosus (more rare)
21
Q
ASD physical exam
A
Widely split S2
Rales, Respiratory retractions
22
Q
Patent Ductus Arteriosus
A
More common in premature infants, F>M, and Maternal Rubella
23
Q
Patent Ductus Arteriosus
PDA
A
Sx depend on age, ductus size, other abn
infant: CHF, tachy, FTT, resp distress
child: SOB, easy fatigue
adult: Eisenmenger syndrome, clubbing, cyanosis
24
Q
Patent Ductus Arteriosus
PDA
A
Continuous MACHINERY like murmur
Wide pulse pressure
Bounding pulse
25
Tx for Patent Ductus Arteriosus
| PDA
Keep open: Prostaglandins
| Close: Endomethacin (Prostaglandin Inhibitor)
26
Coarctation of Aorta
Narrowing of aortic arch
27
Coarcation of Aorta
often seen w/ TURNER syndrome
Unexplained UE HTN
28
Physical Exam of Coarcation of Aorta
Absent/decreased Femoral pulse
Upper Extremity BP is 20 higher than Lower extremity
29
CXR of Coarcation of Aorta
"Figure 3 sign"
| "Inferior Rib Notching"
30
Tet of Fallot
VSD
Overriding aorta
RVH
RV outflow obstruction
31
Most common cyanotic CHD
Tet of Fallot
32
Tet spells
sudden onset or worsening of cyanosis
irritable --> LOC
start 4-6 mo
toddlers may squat to increase SVR
33
Tet of Fallot exam
Harsh SYSTOLIC EJECTION
34
CXR of Tet of Fallot
Boot shaped heart
w/upturned apex
35
Tx for Tet of Fallot
Tet spells: oxygen, knee-chest position increases SVR
surgical repair by age 1
can also do morphine, fluids, and BB or phenylephrine
36
Transposition of Great Arteries (TGA)
arteries completely switched, coming off the wrong ventricle
37
TGA
second most cyanotic CHD
38
TGA presentation
VERY BLUE BABY but without respiratory distress or significant murmur
"Blue baby"
39
CXR of Transp of Great Arteries (TGA)
Egg on a string
CXR is non diagnostic
ECHO is diagnostic
40
Tx of TGA
Cardiac cath
Prostaglandin EW - keep ductus arteriosus open
SURGERY (4-7 days)
41
Surgery for TGA
Done at 4-7 days
switch great arteries and re-implant Coronary arteries
>95% operative survival
42
Tricuspid Atresia (no tricuspid valve) BLOCKED
many other defects occur
if untreated, surv rate as low as 10% by age 1
43
Tricuspid atresia (blocked)
Central cyanosis @ birth
| single heart sound S2
44
Tricuspid atresia tx
Initial: Prostaglandin E1 to keep ductus arteriosus OPEN and supportive care
THEN: surgery
45
Truncus Arteriosus
ONE BIG ARTERY coming from the heart
| VSD always present
46
Truncus Arteriosus exam
Loud single S2
Narrow S2 Split
Prominent ejection click, systolic ejection murmur at LLSB
47
Treatment for Truncus Arteriosus
CHF tx, surgery
48
Total Anom Pulmonary Venous Return (TAPVR)
Pulm veins drain into venous system
oxygen rich and poor blood mix in R atrium
Presentation: severe cyanosis, resp distress, CHF
49
Tx for TAPVR
surgery
50
Hypoplastic Left Heart Syndrome
underdevelopment of L heart
| Stenosis of Mitral and Aortic valves
51
Presentation of Hypoplastic L heart synd
mild cyanosis, but stable at birth while Ductus Arteriosus is still OPEN
rapid deterioration when it closes
52
Tx for Hypoplastic L heart synd
Prostaglandin E1 to keep Ductus Arteriosus OPEN ESSENTIAL
then, Staged surgeries
53
Conditions in which we give Prostaglandin E1 to keep Ductus Arteriosus OPEN
Hypoplastic L Heart Synd
Tricuspid Atresia
Transposition of Great Arteries
54
Fetal Alcohol Synd
VSD
| ASD
55
Maternal Rubella
PDA
| Pulm Stenosis
56
Acute Rhemuatic Fever
2-4 wks after strep throat
| Diagnosis by jones criteria: 2 major or 1 major and 2 minor
57
Major jones criteria
for Acute Rhemuatic Fever
Pancarditis (pericarditis, endocarditis, myocarditis)
58
Acute Rheumatic Fever
Valvulitis (esp of Mitral 75% and Aortic valves- both on LEFT side of heart)
59
Tx for Acute Rheumatic Fever
ASA or corticosteriods- anti inflammatory
Abx
Heart failure management
no therapy to slow the progression of valvular damage
consider prophylactic abx if person has had this bc if they get it again, much higher risk to progress to Rhemuatic Heart Dz the next time
60
Kawasaki Dz
Vessel Vasculitis
Males > females
90% cases of children <5YO
61
Kawasaki Dz diagnosis
Fever >5 days AND
4 out of the 5 sx:
CREAM
62
CREAM sx Kawasaki dz
```
Conjunctivitis (bilateral non purulent)
Rash (maculopap)
Erythema palms and soles (w swelling)
Adenopathy, cervical (singular, unilateral node)
Mucous memb (strawberry tongue)
```
63
Tx for Kawasaki dz
High dose ASA + IVIG
64
Complications of Kawasaki Dz
Coronary artery aneurysm
can lead to MI and death
Obtain ECHO at dx, 2wks later, and 6 wks later
65
Hypertrophic Cardiomyopathy
*leading cause of sudden cardiac death in young ppl
Most common: Familial Autosomal Dominant cause
66
Hypertrophic cardiomyopathy
Exercise intolerance --> sudden cardiac death
67
Physical exam Hypertrophic Cardiomyopathy
Presence of Audible S4 (this is always problematic)
68
Tx of Hypertrophic cardiomyopathy
Exercise restriction, betablocker, calcium channel blocker, reduce septal size, defibrillator placement
69
Tanner Stage 2 Breast
Elevated small mound
| Areolar diameter increased
70
Tanner Stage 3 Breast
Breast and areolar enlarged but no contour separation
71
Tanner Stage 4 Breast
Areola and papilla form secondary mound
72
Tanner stage 2 pubic hair
sparse, straight
73
Tanner stage 3 pubic hair
Darker, beginning to curl
74
Tanner stage 4 pubic hair
Course, Curly, Abundant
75
Tanner stage 5 final pubic hair
Spread to medial thigh
76
Tanner stage 2 Male genital
Enlarged scrotum, pink, altered texture
77
Tanner stage 3 male genital
Penis lengthens, larger testicles
78
Tanner stage 4 male genital
Larger penis- glans and breadth increases; larger, scrotum Dark
79
Sequence of puberty in girls
```
Thelarce/Breast develop
Pubic hair
Height peaks
Menses
Complete
```
80
Sequence of puberty in boys
```
Testicle size
Pubic hair and penile growth
Height peaks
Sperm
Complete
```
81
Pre (early) puberty
2-3 Standard deviations
Breast before 8
Testicular enlargement before 9
82
Delayed puberty
2-3 Standard deviations
Breast haven't started by 12-13
Testicular enlargement hasn't started by 13-14
83
Mortality
Males 2-3x more likely to die
84
Screen for only those at increased risk
Hyperlipidemia
| Tuberculosis
85
Immunizations by 11-12
Having A Buddy Makes Me Realize How Much Puberty Varies In Teens
86
Immunizations
```
Hep Aand B
MMR
HPV
Meningococcal
Pneumo
Varicella
Influenza
Tdap
```
87
Questionarres
HEEADSSS- broad
CRAFFT- drugs and alcohol
PHQ-2- mental health
88
Emancipated minor
provide own consent
status of legal adulthood
(marriage, military, living on own)
89
Mature minor
recognized in some states (NOT AZ)
at least 14 YO
can consent on routine and low risk tx
90
In AZ, minors can consent to
Sexual assault and Substance abuse if 12 YO or older
91
In AZ, minor CANNOT consent to
Mental health screening
| Abortion (w some exceptions)
92
Main causes of bacterial cojunctivitis
Strep PNA
M Cat
H Flu
thick purulent discharge
93
Tx for bacterial conjunctivitis
Erythromycin Ophtho ointment
and
Trimethoprim polymyxin B drops
94
Neonatal conjunctivitis- Chlamydia
5-14 d after birth
watery to mucupurulent to bloody d/c
Chemosis, pseudomembrane
95
Dx Neonatal conj (Chlamydia)
NAAT- Nucleic Acid Amplification Test (gold standard)
96
Tx for Neonatal conj (chlamydia)
Oral erythromycin, must be oral! 50 mg
97
Hyperacute bacterial conjunctivitis (Gonorrhea)
Severe and sight threatening
Develops 2-5d after birth (sooner than the Chlamydia)
Keratitis and perforation can occur
98
Hyperacute bacterial conj (Gonorrhea)
```
sooner than other one
Rapidly progressive, more d/c
PROFUSE, purulent d/c
Marked chemosis
Often accompanied by urethritis
```
Tx: IMMEDIATE Ophtho referral and hospitalization
99
Keratitis
inflammation of cornea
Contact lens wearers
Risk of Pseudomonas Keratitis
Can happen w/in 24 hrs
100
Keratitis sx
FB sensation, blepharospasm, visible corneal opacity with penlight
101
Tx for Keratitis
Immediate ophtho referral if keratitis present
102
In the absence of keratitis
stop contact use, appropriate Anti-pseudomonal abx, urgent Ophtho referral, see w/in 12-24 hrs
103
Viral Conjunctivitis
Adenovirus
Burning, gritty sensation
Watery d/c
Rapid 10 min test for dx
104
Tx of Viral Conjunctivitis
```
Self limited, do sx relief
Warm/cool compress
Topical antihistamine/decongestant
OTC Naphcon-A >6YO
OTC Lubricant eye drop
```
105
Most daycares require at least 24 hr of topical therapy before returning
if viral, depends on sport
non contact: when they can see clearly
contact: once daytime d/c has abated, usually 5 d later
106
Allergic conjunctivitis
Stringy d/c
Pruritic
Bilateral
107
Tx for Allergic conjunctivitis
Nonpharm/sx + Pharm: Antihistamine with mast cell stabilizing IF >3YO
108
Other tx options for Allergic conj (not bolded)
Topical vasoconstrictor + antihistamine
Mast cell stabilizer >4YO
Topical NSAID
Topical glucocorticoid BY ORTHO ONLY - do not prescribe
109
Tx for Kawasaki
High dose ASA and IVIG
110
Strabismus
Potential cause of amblyopia "lazy eye"
Abnormal corneal light reflection- exo or esotropia
Refer to Ophtho
111
Dacryostenosis
Nasolacrimal duct obstruction
Persistent tearing and ocular discharge
Etio: congenital
112
Dacryostenosis sx
Mucoid discharge
Debris on lashes
Mild redness on lower eyelid from chronic rubbing
113
Tx for Dacryostenosis
90% cases resolve on own by age 6
if longer than 7-6 mo, refer to Ophto
***FIRST LINE TX: Lacrimal sac massage
***DEFINITIVE TX: Surgical probe
114
Dacryocystitis
a rare complication of Stenosis
Inflammation of lacrimal sac
ETIO: Staph Epidermidis and Staph Aureus
```
Tx: Treat promptly w Empiric Abx 7-10 d
Oral Clinda (mild)
Oral Vanco (severe) + 3rd gen Ceph
```
115
Acute otitis media- bacterial
SMH pathogens
most common dx in sick kid/ most common abx
Otalgia, fever, bulging TM, erythematous
Complications: Cholesteatoma, facial N palsy, mastoiditis
116
Tx for Acute otitis media
High dose Amoxicillin
Augmentin for recurrent
48-72 hour follow up
117
When to use Prophylaxis for ear infection
more than 3 episodes in 6 mo
more than 4 episodes in 1 yr
daily use during winter months of Amoxicillin (40 mg) or Sulfisoxazole (50 mg)
118
Swimmer's ear
Pseudomonas Aurigonasa
Otalgia, tragus tenderness, erythema and edema of external canal
Dx: RAPID onset within 48 hrs, clinical dx, culture is reserved for severe
119
Tx of swimmers ear
```
Clean canal: Aural toilet
Floxin Otic solution (Ofloxacin)
Cortisporin Otic (avoid w perforation)
Ciprodex or CiproHC
Acidifying solution
Antiseptic
Ear wick PRN
```
120
Allergic rhinitis
| Seasonal vs Perennial
Family hx of Atopy is main cause
Intermittent: <4d/week for <4 wks total
Persistent: >4d/week for >4 wks total
121
Sx of Allergic rhinitis
```
Allergic shiners
Dennie Morgan lines
Allergic salute
Pale/bluish boggy nasal mucosa
Edematous turbinates
Cobblestoning posterior pharynx
```
122
Tx for Allergic Rhinitis
Intranasal steroids- FIRST LINE
Immunotherapy as a last resort (very effective, injections, 3-5 yr total)
123
Other tx options for Allergic rhinitis
Antihistamine, decongestant, mast cell stabilizer, LTR antagonist
124
Nasal polyps
benign pedunculated, peeled grape appearance
rare under age 10
assoc w: Cystic Fibrosis, chronic sinusisis, complicated allergic rhinits
125
Samter's Triad
Nasal polyps, ASA sensitivity, Asthma
126
Tx for Nasal polyps
Decongestant, intranasal steroid spray, systemic steroid, surgical removal for serious cases
127
OTC Decongestant Caution
DO NOT USE in children <6YO
| Avoid still in 6-12
128
Acute sinusitis
6-8% cases develop into bacterial
Acute vs Chronic
129
Sx and PE of Sinusitis
nasal sx, cough, fever, HA, sinus pain
erythema and edema of nasal turbinates, mucopurulent anterior nasal d/c, postnasal drainage
130
Acute sinusitis
severe sx are >102.2 F, purulent d/c for 3 days or more, ill appearing
worsening: can have double sickening
131
Chronic sinusitis
12 weeks of greater
| 2 or more of the following: mucopurulent drainage, nasal obstruction, facial pain/pressure, decreased sense of smell
132
For acute sinusitis
X Ray, CT
| culture is not routine
133
For chronic sinusitis
X Ray, CT, MRI
Culture maybe
bloodwork and surgery maybe
134
Bacterial Acute sinusitis
try symptomatic tx first
then, Augmentin 45 mg/kg/day
135
Chronic sinusitis
Control allergies, nasal saline, steroids, maybe abx
ANTILEUKOTREINE agents
Refer out
136
Viral URI
```
common cold
last 14 d
RHINOVIRUS
non toxic
Infants: fever and nasal d/c
Children: nasal congestion, discharge, cough
```
NO abx, just supportive care
137
Viral throat pharyngitis
Adenovirus and Coxsackie
sore throat and fever
Supportive care and sx relief- miracle mouthwash
138
Mono
Epstein Barr virus
fatigue, sore throat, fever
Tender cervical lymph
Palpable splenomegaly
Heterophile antibody test- Monospot rapid serologic test
139
Mono
may last 7-21 d
supportive care
Activity restriction for 4 WEEKS
140
Group A strep
Strep pyogenes
| Abrupt onset, sore throat, exudates, palatal petech, tender cervical lymph
141
Central criteria for strep
| 4 choices
1 pt for each
- tonsillar exudate
- tender anterior cervical lymph
- fever
- no cough
<3 unlikely, no testing or abx
3 or greater: perform Rapid strep
142
If rapid strep is negative but high clinical suspicion
order culture
143
Strep throat tx
start within 48 hours to prevent complication and spread
Oral PENICILLIN, amoxicillin
1st gen Ceph
Azithro if PCN allergic
144
Acute Rheumatic Fever
| a complication of group A strep
```
5 major manifestations:
Migratory Arthritis
Carditis
CNS involvement
SubQ nodules- firm, painless
Erythema marginatum- pink, faint, red non itchy rash on trunk and limbs
```
145
Post strep glomeruloNephritis (PSGN) (a complication of strep)
Increased risk 5-12 YO
can be asympto
Sx: edema, gross hematuria, HTN
Can be FULL BLOWN Acute nephritic syndrome
Hematuria and proteinuria
146
Tx for PSGN
supportive, treat volume overload with Diuretics and sodium/water restriction
Acute renal failure-dialysis
147
When to get Tonsillectomy
7 episodes in past year
5 episodes in each past two years
3 episodes in each past three years
148
Mumps
incubation 16-18 d
infectious 3 d befor esx and 9 days after sx
usually self limiting and resolves in few wks
HIGHLY contagious, preventable with MMR vaccine
149
Parotitis develops within
48 hours of mumps sx onset
150
Parotitis
most common 2-9 YO
| if unilateral, often progresses to bilateral in 90% cases
151
Bacterial parotitis
more common in adults, d/c from Stensen's duct
152
Tx for viral parotitis
none, supportive, acetiminophen, cold/warm pack
