Specialty Disciplines -- Handler, Hoffman, Bordeau, Wiese, and Sears Flashcards
What is the most common congenital heart defect?
Ventricular Septal Defect
Hypoxemia confirms suspected ________ heart disease
Cyanotic
What is the mainstay of imaging for anatomy and hemodynamics of the heart?
Echocardiography
Cyanosis is more common with L to R shunt or R to L shunt?
R to L
What may find you find on physical exam when cyanosis is long standing?
Clubbing of fingers
If you give someone oxygen with a R to L shunt, will it help?
Nope
What do we call destruction of pulmonary vasculature (arteriolar) bed in presence of continuous pressure overload?
Pulmonary Vascular Obstructive Disease (PVOD)
Are small “restrictive” VSD’s well tolerated?
Yes!
Large resistance to flow through small hole; normal RVP and PAP; small L to R shunt
Most of these will close on their own
Harsh, holosystolic murmur along LSB should make you think of?
Ventricular septal defect
If someone has a large VSD, how will they present?
With symptoms of heart failure
What test identifies the size and location of the defect and the presence of shunting? This test is also diagnostic of VSD.
Echo-doppler
Having a large VSD also puts people at risk for developing?
Pulmonary Vascular Obstructive Disease (PVOD)
How do we properly manage someone with a small VSD compared to a large VSD?
Small – regular check ups. Periodic echo-doppler studies to confirm eventual closure.
Large – treat as if HF. Surgical repair once HF symptoms improve.
What is Eisenmerger’s physiology?
When a L to R shunt becomes a R to L. Shunt reversal!
In reference to the atrial septum, where do most Atrial septal defects occur?
Mid septum – due to lack of tissue for overlap.
80% of the time, atrial septal defects are due to this not completely developing
Ostium secundum
I don’t know how to make this a question but…
volume overload is a major issue with ASD
What type of symptoms does an ASD patient present with and at what age do they typically begin to show symptoms?
Start in early 20s with very vague symptoms – fatigue, dyspnea, decreased stamina
A fixed, widely split S2 through inspiration and expiration should make you think of?
ASD
As an ASD progresses, the murmur will change from a widely split S2 to??
Mid-systolic crescendo-decrescendo murmur at LSB
Incidence of this arrhythmia increases with each decade for someone with an ASD
A fib (and a flutter)
When this occurs, the RV develops concentric hypertrophy and reflects degree of obstruction at the valvular level.
Pulmonic stenosis
PV area must be reduced by how much (or more) to be hemodynamically significant?
60 percent
What is the major hemodynamic burden with pulmonic stenosis?
Rt ventricular pressure overload
Tell me about the murmur of pulmonic stenosis?
Early systolic click upper LSB
It is loud!
What is the first approach to management of pulmonic stenosis?
Balloon valvuloplasty
This normally closes within 2-3 days after birth. It runs from the origin of the LPA to the lower aortic arch just beyond the left subclavian artery.
Patent Ductus Arteriosus
Murmur is continuous (through systole and diastole) “machinery murmur”. This describes?
Patent Ductus Arteriosus
Maternal exposure to this disease may cause PDA?
Rubella
What drug do we give for closure of the ductus as 1st line therapy?
Indomethacin – causes constriction of the ductus
What do we call discrete narrowing of the distal segment of the aortic arch?
Coarctation of the aorta
What may you see on chest x-ray of someone who has coarctation of the aorta?
Rib notching
What is rib notching caused by?
Development of collateral arteries
What will an ECG of someone with coarctation of the aorta show?
Left ventricular hypertrophy
What is crucial for safe repair of the coarctation?
Adequate collaterals
What is tetralogy of fallot?
Biventricular origin of the aorta
What is the most common cause of sudden death in athletes
Hypertrophic cardiomyopathy
What should you think of you see a small child with profound dyspnea, that is relieved by squatting?
Tetralogy of Fallot
the squatting puts more blood into the the RV and more blood through pulmonary valve
What will you see on x-ray of someone with tetralogy of fallot?
“boot-shaped” heart
How will blood pressure above and below the coarctation compare?
Above the coarct will be high, below the coarct will be low.
What is “atopy”?
Asthma, allergic rhinitis, and atopic dermatitis
Allergic rhinoconjunctivitis (“hay fever”) frequently coexists with?
Asthma
What is the difference between intermittent and persistent allergies?
Intermittent – sx present less than 4 days/week
Persistent – sx present more than 4 days/week for greater than 4 weeks
What are some findings on physical exam of a child suffering from allergies?
“Allergic salute” and “allergic shiners”
What will the nasal turbinates look like in someone suffering from allergies?
Pale blue, edematous
What drugs should we use for prophylaxis for allergies?
Mast cell stabilizers and corticosteroids.
Antihistamines will help with control of itching, sneezing, and rhinorrhea
Nasal polyps in a kid should make you think of?
Cystic fibrosis
How do we manage children with eczema?
Hydration – stick them in luke warm water and then use moisturizer
Moisturizers – really thick ointments like vaseline
This occurs when large quantities of histamine rapidly release from mast cells and basophils after exposure to allergen
Anaphylaxis
- For children and adolescents, anaphylaxis is most often due to?
- Middle-aged adults?
- Older adults?
- Food-induced
- Venom-induced
- Medication – induced
What are the three most common food allergies?
- Cow’s milk
- Eggs
- Peanuts
What is the gold standard in detecting food allergies?
Blinded food challenge
What is the mainstay of management for food allergy sufferers?
Stay away from the food!
Kids with this disorder will commonly present with recurrent/severe bacterial infections and/or developmental delay.
Primary Immunodeficiency (PID)
This syndrome typically presents with recurrent URI’s, +/- otitis media and bronchitis. Spontaneous recovery usually occurs by 9-15 months of age.
Transient hypogammaglobulinemia (THI)
This syndrome presents with recurrent infections – opportunistic infections is they key. On exam you’ll find lack of lymphoid tissue.
Severe Combined Immunodeficiency (SCID)
Syndrome with repeated seizures without evidence of acute cause of provocation
Epilepsy
What is the most common neurlogic disorder of infants and young children?
Febrile seizures
What is status epilepticus?
Seizures lasting at least 15 minutes or series w/out complete recovery >30 minute period
What are the most common types of headache seen in children?
Migraine HA and tension-type HA
“Red flags” for headaches prompt further workup – what are some of these red flags?
Headache in child less than 5 years
Worst headache of life
Unexplained fever
Headache worse with straining
Postural headache
Posterior headaches
Physical exam that demonstrates spasticity, hyperreflexia, +/- ataxia, and involuntary movements should make you think of?
Cerebral palsy
What is the most common etiology of cerebral palsy?
Prematurity
Neurologic disorder manifested by motor and phonic tics
Tourette Syndrome
What is considered an abnormal head size?
2 standard deviations above/below mean
Microcephaly is most often due to?
genetic issue
What is a common sign of macrocephaly?
Transillumination of the skull
When does the anterior fontanelle typically close?
18-24 months
What is the most common cause of conjunctivitis in a newborn?
Chlamydia from mom
Wide spacing, deep spacing eyes, flattening of nasal bridge are symptoms of?
Down Syndrome
Ear pits may be connected to what type of abnormality?
Kidneys.
What is prune belly syndrome?
Muscle wall doesn’t form well in the abdomen, only skin is keeping innards in
What is the Morrow reflex?
Pick up babies arms about one inch off table, and drop. Arms should go out then come back in
What is nevus flammeus?
“Stork bite” – usually on back of neck or forehead
What is a mongolian spot?
Usually on butt and back, looks like a bruise.
What is the number one cause of infant death in the US?
1.Congenital malformations or chromosome abnormality
Low birth weight is number 2
What does IUGR stand for?
Intra-uterine growth retardation
What is LGA typically associated with?
Gestational diabetes
Smoking puts babies at increase risk for?
IUGR and SGA – SIDS
How many weeks is baby considered term?
37-42
How many weeks is late pre-term?
34-36/7
How does mom get toxoplasmosis?
exposure to cats and/or raw meat
Hutchinson teeth and bone abnormalities should make you think of?
Syphilis
Blueberry muffin rash, B and T cell deficiency – which TORCH infection?
Rubella
Blueberry muffin rash, deafness, pneumonia – which TORCH infection?
CMV
If mom has active Hep B, what should we give baby at birth?
IVIG
We test all women for this at 36 weeks
Group B strep
At what temperature should parents call peds?
100.4
What is the most common cause of neonatal sepsis?
Group B strep
How does hyperbilirubinemia presents?
Jaundice/scleral icterus and kernicterus
Direct (conjugated) bilirubin is always pathologic, physiologic or both?
Pathologic.
How soon after birth does direct hyperbilirubinemia typically present?
Within first 24 hours
How soon after birth does indirect hyperbilirubininemia typically present?
After 24 hours
Indirect hyperbilirubinemia is pathologic, physiologic, or both?
Can be both
How do we treat hyperbilirubinemia?
Treat cause, phototherapy, exchange transfusion
What is hematuria?
Blood in the urine
What is hemoglobinuria?
The presence of hemoglobin FREE from red blood cells.
Occurs with rapid disintegration of red blood cells, exceeding the ability of blood protein to bind with hemoglobin
If myoglobinuria is present, what else is likely to elevated?
Serum creatinine kinase
If you have a child who is not acutely ill, and no other worrisome findings on exam besides hematuria. What do you do?
Repeat UA (first AM) on two other occasion within 1-2 weeks.
If hematuria persists, order urine culture, renal u/s, renal panel, CBC.
What is benign familial hematuria?
Defined as isolated asymptomatic hematuria without renal abnormalities in multiple family members
Most common bacteria causing UTI’s?
E. coli
What presents with abdominal pain, flank pain, fever, lethargy, nausea, vomiting?
Pyelonephritis
What is the DOC for pyelonephritis?
Macrobid
What presents with dysuria, frequency, urgency, and sometimes odor. RARELY fever
Cystitis
We must treat cystitis promptly to prevent progression to?
Pyelonephritis
Asymptomatic bacteriuria is nearly exclusive to these two populations.
Girls and people with long-term catheters
If a child’s first UTI is before the age of 5, what else should be done in terms of management?
Voiding cystourethrogram – typically done about 2 weeks after UTI to allow inflammation to resolve
If proteinuria is found on dipstick with absence of other findings or concerns, what should you do?
repeat the dipstick on 2-3 other occasions (preferably first AM urine)
If proteinuria persists after 3 dipsticks, what should the next step be?
24 hour collection
What is the most common cause of persisting proteinuria in kids?
Orthostatic proteinuria
This is benign.
Primary Nephrotic Syndrome is the loss of?
Protein
We discussed three types of primary nephrotic syndrome – Minimal change disease, mesangial proliferation, and focal segmental glomerulosclerosis. Which one is the least common, most common, and most serious?
Least common – mesangial proliferation
Most serious – focal segmental glomerulosclerosis
Most common – minimal change disease
How does primary nephrotic syndrome typically present?
Initial episode usually follows illness, facial and lower extremity edema, abdominal pain, diarrhea, and irritability
Are HTN and hematuria common in primary nephrotic syndrome?
No
How do we treat primary nephrotic syndrome?
Diuretics – closely monitored and corticosteroids
In patients greater than 8 that presents with HTN, persisting hematuria, renal dysfunction, rash and/or arthralgia think of?
Secondary Nephrotic Syndrome
This is caused by mutation of the NPHS1 gene on chromosome 19 – happens within first 3 months of life
Congenital Nephrotic Syndrome
This is characterized by interstitial inflammation with sparing of the vessels and glomeruli. Triad of symptoms – fever, rash, arthralgia with steadily increasing creatinine. Hematuria and proteinuria are absent.
Tubulointerstitial Nephritis (Acute)
How is chronic tubulointerstitial nephritis diagnosed?
Escalating creatinine levels, small kidneys on ultrasound, and history of chronic disease or exposure
Sudden onset of hematuria, edema, HTN, and renal insufficiency should make you think of?
Post-streptococcal glomerulonephritis
Will kidneys appear small or large on imaging with post-streptococcal glomerulonephritis?
Large
What is the most common cause of acute renal failure in kids?
Hemolytic Uremic Syndrome
What precedes 80% of cases of hemolytic uremic syndrome?
Acute GI illness
This typically presents as an isolated disease. Diagnosis is made by biopsy, usually done in cases of persisting hematuria and proteinuria and lack of their explanation.
Membranous Glomerulopathy
This is small vessel vasculitis characterized by purpuric rash, arthralgia, abdominal pain, and glomerulonephritis.
Henoch-Scholein Purpura Nephritis
When should routine blood pressure screenings be done in children?
3 years
What is vesicoureteral reflex?
Defined as retrograde flow of urine from bladder and renal pelvis
How is vesicoureteral reflex diagnosed?
VCUG (voiding cystourethrogram??) something like that
What is the cornerstone of treatment for vesicoureteral reflex?
Antibiotic prophylaxis.
DOC is bactrim.
At what age are most kids dry through the night?
5
What is it called when the urethral opening is located on the ventral surface of the penis?
Hypospaidus
What is phimosis?
Inability to retract the foreskin
What is the treatment for phimosis?
Circumcision
What is it called when the foreskin is retracted beyond the glans penis and cannot be pulled forward again?
Paraphimosis
This is a medical emergency!
What vaccinations are required for kindergarten entry?
5 DTP
4 Polio
2 MMR
1 Varicella
As of 2010, how many vaccines are recommended for children?
16
What is the bottom line in measuring effectiveness of vaccines?
You need LARGE field trials to measure effectiveness/complications.
What is the virus that causes measles?
Paramyxovirus
Children need 1 or 2 doses of MMR vaccine?
2
first dose at 12-15 months of age
second dose at 4-6 years of age
What are the 3 stages of whooping cough?
- Catarrhal – watery eyes, low-grade fever, malaise, runny nose, late-phase nonproductive cough
- Paroxysmal – paroxysms (burst of coughing during a single exhalation) followed by an inspiratory “whooping” sound, post-tussive cyanosis, and vomiting
- Convalescent – paroxysms gradually improve but recur with respiratory infections
How long is whooping cough considered infectious?
21 days after onset or until 5 days of abx completed
__________ of susceptible persons is most important prevention strategy.
Vaccination
What is the difference between DTap and Tdap?
Dtap – diphtheria and tetanus toxoid
Tdap – tetanus toxoid and reduced diphtheria toxoid
How does Diphtheria present?
Insidious onset of exudative pharyngitis
What is the ACIP?
Advisory Committee on Immunization Practices
Is natural immunity better than vaccine-acquired immunity?
No.
Natural immunity may last longer – but not worth the risk.
What three VPD are seen most commonly in schools?
- Influenza
- Pertussis
- Varicella
If a child feels weak, has itchy rashes or blisters and complains of a headache, think of?
Varicella
What are the two most common complications of shingles?
- Post herpetic neuralgia
2. Secondary bacterial skin infections
What is the difference between the shingles vaccine and the varicella vaccine?
The shingles vaccine contains live attenuated varicella virus in an amount that is 14 times greater than that in regular varicella vaccine
Abrupt onset of fever, chills, muscle aches, headache, and fatigue. Think of?
Influenza
Low-risk HPV types cause?
High-risk cause?
Low-risk – genital warts
High-risk – serious cervical lesions, cervical cancer, and other genital cancers
Over ____ percent of cervical cancers have HPV DNA detected with the tumor
99%
Types 6 and 11 cause?
Types 16 and 18 cause?
6 and 11 – genital warts
16 and 18 – cervical cancer
