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545 > Week 11 CVS heme > Flashcards

Week 11 CVS heme Flashcards

1
Q

Cardiac murmurs

red flags on history?

red flags on physical?

A

hx:

  • SOB, palpitations
  • exercise intolerance
  • dizziness, syncope
  • chest pain on exertion

PE:

  • cyanosis, clubbing, cap refill
  • weak or absent femoral pulses
  • hepatomegaly

**any flag on history or physical makes it pathologic murmur regardless of auscultation

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2
Q

Characteristics of innocent murmur

  • timing?
  • quality?
  • intensity?
  • louder with…?
  • extra heart sounds?
A
  • systolic
  • soft
  • grade II or less
  • exercise, anemia, fever
  • no extra heart sounds, normal S2
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3
Q

Characteristics of pathologic murmur

  • timing?
  • quality?
  • intensity?
  • louder with…?
  • extra heart sounds?
A
  • diastolic, holosystolic
  • harsh
  • grade III or higher with possible thrill
  • NO change with position
  • click, S3, S4
  • fixed split S2
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4
Q

when would you refer to peds cardio for murmur?

A
  • suspect pathologic cause/uncertainty
  • FHx congenital heart disease in first degree relative
  • FHx Marfan or sudden cardiac death in young person
  • genetic abnormality (eg trisomy 21)
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5
Q

characteristics of Still’s murmur

  • age
  • quality
  • timing
  • location
  • increase with?
A

2-7 years old

musical/vibratory, sounds like a groan

systole
low pitched

LLSB/apex
louder with supine, quieter with Valsalva

-best heard with bell

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6
Q

characteristics of cervical venous hum

  • age
  • quality
  • timing
  • location
  • increase with?
A

2-7
R>L
continuous rumbling
sternoclavicular junction

increased with turning head AWAY and lifting chin
disappears in supin

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7
Q

____% of healthy children have heart murmurs

_____% are innocent murmurs

A

50%

98%

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8
Q

questions to ask re: symptoms when cardiac murmur detected?

All the F’s

A
  • fatigue
  • feeding/failure to thrive
  • family hx (think Marfan, congenital heart disease, sudden cardiac death at young age)
  • face turning blue (cyanosis)
  • feeling unwell (SOB, dizzy, CP, palpitations)
  • femoral pulses weak/absent
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9
Q

murmurs are best heard with ____ of stethoscope

A

diaphragm

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10
Q

what are the 3 rhythms associated with pathological sudden cardiac death?

A

PEA
VF
pulseless VT

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11
Q

what testing should surviving first degree relatives of patients with sudden cardiac death undergo?

A
  • ECG
  • holter
  • stress test
  • echo
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12
Q

all children should under lipid screening once during this age range

A

9 to 11 years old

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13
Q

lipid screening is NOT recommended during this age range due to changes in lipids with puberty

A

12 to 16 years old

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14
Q

can start screening for risk factors for dyslipidemia at age_____

-testing tailored to risk profile (q1-3 years depending)

A

can start at age 2 if risk factors identified

lipid screening not needed before age 9 if no risk factors

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15
Q

diagnosis of dyslipidemia in children requires fasting lipid bloodwork done ____ times within _____ (time frame)

A

two separate measurements
*2 fasting measurements preferred

between 2 to 12 weeks apart

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16
Q

Sickle cell anemia

pain crisis related to _______ (patho)

A

vaso-occlusion

  • leading cause of acute chest syndrome
  • can be quite severe with central sensitization and hyperalgesia, altered opioid metabolism
17
Q

red flag sign in pt with sickle cell disease?

A

fever

  • medical emergency, needs to be evaluated within 4 hours of onset of fever
  • child can die within 6 hours of fever
  • aplastic crisis and splenic sequestration

pts with sickle cell are on prophylactic penicillin until at least age 5

18
Q

what are the 3 categories of syncope?

what are the hallmarks of cardiac-related syncope?

A
  • neurocardiogenic (ie vasovagal)
  • cardiac (arrhythmia, defect, disease)
  • noncardiac (breath-holding, seizures, hyperventilation)

often no prodrome
can have chest pain and palpitations

19
Q

what is the workup for syncope?

A

ECG for all
holter (only catches 20% of arrhythmias)
loop recorder
stress test

20
Q

iron storage is regulated by ______ synthesized by _____ (organ), absorbed in _____ (organ)

A

hepcidin

synthesized by liver

absorbed in intestine at brush border

21
Q

recommended daily intake of iron

babies 7-12 months:
kids 1-3 years:
kids 4-8:

A

babies 7-12 months: 11 mg/day elemental iron

kids 1-3 years: 7 mg/day

kids 4-8: 10 mg/day

22
Q

risk factors for IDA in babies before 2 years of age

complications associated with IDA in first 2 years of life?

A
  • preterm birth
  • low birthweight babies
  • limited food access
  • prolonged breastfeeding
  • poverty
  • Chinese
  • early introduction of milk before age 12 months
  • babies born to mothers with anemia or obesity
  • early umbilical cord clamping
  • male sex
  • lead exposure
  • chronic infection
  • Indigenous communities

complications:
-lower cognitive and motor function (may persist beyond childhood)

23
Q

what is the most common bleeding disorder?

A

Von willebrand disease

von Willebrand factor attaches to exposed collagen and binds to platelets –> aggregation –> clot

VWD is deficiency

24
Q

what are some risk factors for chronic ITP

A

chronic = > 6 months

age >10
female
autoimmune disease
insiduous onset

25
Q

acute ITP

patho
-common age group

-time course

A

age 2-4

autoantibodies against platelet
triggered by infection

  • onset of epistaxis, GI bleed, gingiva
  • self limiting, usually resolves by 6 months
26
Q

red flag signs for lymphadenopathy (what would be suspicious for malignancy)?

A
  • fixed
  • firm
  • nontender

constitutional symptoms

  • fever
  • night sweats
  • weight loss
27
Q

what is the management of reactive lymph nodes?

A

monitor, observe and reassess in 2-4 weeks

545 (6 decks)

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