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11 Neonatology > Respiratory and Cardiac Conditions > Flashcards

Respiratory and Cardiac Conditions Flashcards

1
Q

factors that impair fluid removal in the lungs

A

CAESAR SURFS END HY SEDATES

caesarian birth
surfactant deficiency
endothelial cell damage
hypoalbuminemia
sedation of the baby
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2
Q

t/f rds is 60-70% more common in <28 aog

A

false, 60-80%

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3
Q

main features of rds

A

surfactant deficiency -> increased alveolar surface tension -> ateletasis or atelectrauma and impaired frc

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4
Q

establishment and maintenance of ____ leads to optimal exchange of oxygen and carbon dioxide between alveoli and blood

A

functional residual capacity (expiratory reserve volume + residual volume)

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5
Q

mature levels of surfactant are present at ___

A

35 aog

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6
Q

sequelae of rds

A

atelectasis (perfused but not ventilated alveola) -> hypoxia, hypercapnia, acidosis, pulmonary arterial vasoconstriction, epithelial cell injury -> hyaline membrane formation

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7
Q

clinical manifestations of rds

A 
rapid shallow breathing
expiratory grunting
chest retractions
nasal flaring
cyanosis
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8
Q

preventive management for rds

A

avoid cs for <39 aog

antenatal steroids before 37 aog (esp with premature)

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9
Q

how to establish frc for rds management

A 
ncpap
mechanical ventilation (for respiratory failure or persistent apnea)
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10
Q

what is apnea

A

prolonged cessation of breathing

  • > 20 s
  • <20 s + change in tone, pallor, cyanosis, bradycardia
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11
Q

surfactant replacement therapy in rds

A

INSURE = INtubate, administer SURfactant through et, Extubate

MIST / LISA = invasive

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12
Q

self limited tachypnea associated with delayed clearance of fetal lung fluid. early onset tachypnea in term infants.

A

transient tachypnea of the newborn

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13
Q

pathogenesis of ttn

A

ineffective expression or activity of enac and na-k atpase -> decreased pulmonary compliance and impeded gas exchange

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14
Q

clinical manifestations of ttn

A

respiratory distress with rapid recovery

no radiographic findings of rds

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15
Q

management for ttn

A

supportive care

inhaled b2 agonist albuterol

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16
Q

t/f meconium aspiration is most common in preterm neonates

A

false, post term after 42 aog

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17
Q

meconium aspirated in utero or with first breath can result to

A

small airway obstruction and respiratory distress = grunting and cyanosis

18
Q

complete obstruction of airway = _______

partial obstruction = ____

A

complete obstruction = atelectasis and ventilation-perfusion mismatch
partial obstruction = half valve effect, air trapping, and air leaks

both = acidosis, hypoxemia, hypercapnia

19
Q

xray for meconium aspiration

A

patchy infiltrates coarse streaking of both lung fields
increase in ap diameter
flattened diaphragm

20
Q

management for meconium aspiration

A

preventive: identify and deliver
supportive: exogenous surfactant, inhaled NO, mechanical ventilation, extracorporeal oxygenation

21
Q

pathogenesis of congenital pneumonia

A

aspiration or ingestion of bacterial in amniotic fluid (maternal chorioamnionitis)

22
Q

clinical manifestations of congenital pneumonia

A

before delivery: fetal distress, tachy

during: failure to breathe, rd, shock
after: rd and shock

23
Q

treatment for congenital pneumonia

A 
ampicillin iv (g+)
gentamicin (g-)
ampicillin + cefotaxime (after discharge)
24
Q

vessel transpositions in toga

A

aorta from rv

pulmonary artery from lv

25
Q

obligatory shunts in toga

A

patent foramen ovale

patent ductus arteriosus

26
Q

t/f in a pfo oxygenated blood will be shunted from left to right atrium

A

true

27
Q

t/f in a pda in toga, oxygenated blood from the aorta will go to the pulmonary artery

A

false, pulmonary artery to aorta

28
Q

clinical manifestations of toga

A

tachypnea and cyanosis in the first hours of life
moderate to severe hypoxemia
nonspecific pe findings

29
Q

diagnostic findings in toga

A

cxr: egg shaped heart
diagnostic ecg
cardiac catheterization

30
Q

management of toga

A

pge1 (for pda)
rashkind ballon atrial septostomy (to enlarge pfo)
jatene procedure (arterial switch within first 2 weeks)

31
Q

pathogenesis of tapvr

A
  • pulmonary veins connect to ra = oxygenated blood goes to right side
  • volume overload -> pressure increases -> ra and rv enlarge
  • —> pulmonary hypertension, pulmonary congestion, pulmonary edema = pediatric cardiac surgical emergency
32
Q

clinical manifestations of tapvr

A

respiratory distress and severe cyanosis not responsive to mechanical ventilation
crackles (pulm congestion/edema)
no murmur
loud single second heart sound

33
Q

diagnosis for tapvr

A

ecg: rvh + rad
echo w doppler: asd

demonstration of any vein wiith doppler flow away from the heart is pathognomonic

34
Q

management for tapvr

A

surgical correction

extracorporeal membrane oxygenation (ecmo)

35
Q

components of tof

A

SHOP for a TOF

ventricular septal defect
rv hypertrophy
overriding aorta
pulmonary stenosis

36
Q

pathophysio of tof

A

vsd: malalignment between canal septum and lower portion of ventricular wall

37
Q

clinical manifestation of tof depends on __

A

degree of rv outflow tract obstruction (stenosis)

38
Q

diagnostics of tof

A

boot shaped heart

39
Q

management of tof

A

resection of obstructive muscle bundle
patch closure of vsd
blalock taussig shunt: palliative systemic pulmonary artery shunt to augment pulmonary artery blood flow

40
Q

pathophysio of pulmonary atresia with intact ventricular septum

A

absent or poor pulmo valve + intact ventricular septum

source of pulmonary blood flow is pda

41
Q

blood flow in pulmonary atresia with intact ventricular septum

A

blood from rv regurgitates into ra -> shunts to la via fo -> lv

42
Q

management of pulmo atresia

A

pge1 infusion

surgery

11 Neonatology (9 decks)

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