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6337 > Test #2 (PDA, PPHN, Cardiac probs, Hydrops) > Flashcards

Test #2 (PDA, PPHN, Cardiac probs, Hydrops) Flashcards

1
Q

Which of the following lesions results in active congestions of the pulmonary vasculature?

A

Truncus arteriosus

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2
Q

The most common heart defect presenting in the first 24 hours of life with cyanosis and increased vascularity is

A

transposition of the great arteries

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3
Q

Other defects associated with d-transposistion of the great arteries include?

A

aortic arch defects

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4
Q

Congestive heart failure develops early in d-transposition of the great arteries in the presence of?

A

PDA or VSD

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5
Q

What shape of the heart is characteristic of TGA on chest x-ray?

A

egg

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6
Q

In cases of d-TGA, the aortic arch is usually?

A

left-sided

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7
Q

Heart Failure typically presents at ____ days in cases of coarctation of the aorta

A

7-14day

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8
Q

Which type of coarctation is typically identified in the neonatal periods?

A

preductal

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9
Q

In coarctation of the aorta with a discrete constriction the constriction typically occurs at the opposite side of the insertion of the

A

ductus arteriosus

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10
Q

Congestive heart failure causes by coartation of the aorta is exacerbated by the presence of

A

VSD or PDA

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11
Q

X-ray findings consistent with coarctation of the aorta include which of the following heart shapes?

A

Globular

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12
Q

In the presence of T of F with pulmonary atresia, pulmonary perfusion may be supplied by flow through a

A

PDA

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13
Q

The timing of the presentation of TOF is dependent on the degree of

A

Right ventricular outflow obstruction

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14
Q

Initial signs of TOF in the NB period inculde

A

respiratory distress, cyanosis, murmur

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15
Q

TOF includes which of the following findings?

A

Pulmonary stenosis

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16
Q

Chest x-ray findings in TOF include pulmonary arteries which appear>

A

thin and stringy

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17
Q

The heart size in an infant with TOF is typically

A

Normal or slightly enlarged

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18
Q

Infant with TOF, the heart assumes which shape?

A

Boot

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19
Q

Congestive heart failure accompanies TOF in the presence of

A

Tricuspid regurgitation

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20
Q

Clinical presentation of pulmonary atresia with intact septum include which of the following?

A

severe cyanosis, mild tachypnea, murmur

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21
Q

In cases of pulmonary atresia with intact Ventricular septum the cardiac size is dependent on the

A

amount of tricuspid regurgitation

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22
Q

In obstructive lesions, cardiomegaly occurs because of

A

hypertrophy

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23
Q

The greatest source of error in interpreting cardiac size is

A

poor inspiration

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24
Q

the neonate’s heart is normally globular at birth because the

A

right ventricular is enlarged (in adults its smaller than the left ventricular)

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25
Q

In the neonate what is the normal orientation of the heart in the chest cavity?

A

almost equally to the R and L of the mediastinum

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26
Q

An LGA infant with hypertrophic cardiomyopathy (IDM) with have what heart issue?

A

LV outflow obstruction

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27
Q

Cynosis in the Neonate will have decrease pulmonary blood flow bc of what heart defect?

A

tricuspid atresia

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28
Q

what do infants do to compensate for decrease cardiac output?

A

Increase HR (CO=SV x HR)

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29
Q

What is a sign of diminished CO?

A

poor peripheral pulses

30
Q

What are 3 medical mgnt of CHF?

A

Fluid restriction, daily wt, follow electrolytes

31
Q

What would you do if the sats remain

A

Start Prostin

32
Q

What are the 4 combinations of defects in TOF?

A

Pulmonary stenosis, Ventricular stenosis, over-riding aorta, Hypertrophy of R Ventricle

33
Q

What defect AO originates from R vent and PA from LV?

A

Transposition of the Great Vessels

34
Q

What defects of more common in term males 2:1

A

Transposition of the Great Vessels

35
Q

What treatment is recommended for Transposition of the Great Vessels?

A

Prostin first and then balloon septostomy to improve interatrial mixing

36
Q

when the BP is >15mmHg higher in the upper than the lower?

A

Coarctation of aorta

37
Q

What defect is when the RV supplies pulmonary and systemic blood flow via PDA?

38
Q

What happens when the PVR starts to decrease in an ASD?

A

L to R shunt develops

39
Q

What are two major SE of Prostin?

A

Temperature increase (fever) and Apnea

40
Q

In PPHN what causes hypoxemia?

A

extrapulmonary R to L shunting to the FO/ PDA

41
Q

What is the oxygen index equation?

A

FiO2 X mean airway pressure / Postductal PaO2 = 100

42
Q

What obstruction may have transient improvement with iNO followed by deterioration

A

Pulmonary venous obstruction

43
Q

iNO causes toxicity by hemoglobin turning into Methemoglobin then causing ____

A

tissue hypoxia

44
Q

What is another name for PDA; it links main pulmonary artery with descending aorta?

A

Fetal Ductus

45
Q

What is the PATHOphysiology of PDA?

A

resistance of pulmonary and systemic circulations

46
Q

What is the #1 mngt for PDAs?

A

fluid restriction

47
Q

What is the respiratory mngt for PDA is already on vent?

A

Increase CPAP or iTime

48
Q

What are 4 transient SEs of indomethacin?

A
  • Renal dysfunction (decrease renal output)
  • hyponatremia (dilutional)
  • Plt dysfunction
  • Displacement of bili from sites
49
Q

What are 3 contraindications for tx with indomethacin?

A

Cr > 1.7mg/dL
BUN > 25mg/dL
Plt

50
Q

What causes hydrops in the fetus?

A

when there is an Rh incompatibility btwn mom and fetus. Anti-D (Rh alloimmune hemolytic diesease

51
Q

What is when there is generalized total body edema with no hepatoslpenomegaly or abn erythropoiesis?

A

Non-immune hydrops

52
Q

What is another name for non-immune hydrops?

A

fetal Anasarca

53
Q

Decrease the pathophysiology of hydrops.

A

low colliod oncotic pressure from low albumin (fluid can’t come into vessels) and high hydostatic pressure in caps (leaky caps)

54
Q

What is a condition assoc. with Turner’s Syndrome with dilation of pulmonary lymphatics that causes pleural effusions?

A

Lymphangiectasis

55
Q

What is a virus that could cause fetal hydrops?

A

parvovirus (5th disease)

56
Q

What is the most common cause of hydrops (25%)?

A

Cardiac probs - SVT, Congenital heart block

57
Q

How do you treat fetal Tachy in hydrops?

A

Maternal dig - propranolol

58
Q

What shape does the chest make with hydrops?

A

Bell shaped

59
Q

What are the first two steps when resuscitating a hydrops infant?

A 
#1 - establish airway
#2 - Place lines
60
Q

When is the fetal gut anatomically complete?

A

20-22 weeks

61
Q

When is the most abundant weight gain in an infant’s life?

A

between 26-36 weeks

62
Q

Protein malnutrition in utero causes what in an infant?

A

Decrease pancreatic cells and insulin secretion, and increase in BP

63
Q

What are two long term effects of poor growth?

A

Short stature and poor neurodevelopmental outcomes

64
Q

How much protein (AA) should be started on day 1 to prevent a neg nitrogen balance??

A

1.5-2 gm/kg/day

65
Q

What is a negative effect of delaying the onset of enteral feedings?

A

late onset sepsis

66
Q

When should you start to fortify Human milk?

A

when you reach 100ml/kg/day

67
Q

What are the normal lab values for

BUN, Albumin, TP, and Ca

A

BUN 5-20
Album 3.9-5
TP 6.3-7.9
Ca 7-12

68
Q

What is the main consequence of low Ca?

A

bone demineralization, with increase in Alk phos, and decrease in length

69
Q

What type of milk offered no benefit over preterm formula?

A

Pasteurized donor milk

70
Q

What type of formula is not good for growing preemies and has poor protein quality

A

Soy formula

71
Q

What is the recommended enteral protein intake?

A

3.5gm/kg/day

72
Q

When should parenteral nutrition be maintained?

A

when enteral feeding are less than 80 CAL/kg/d

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