cardioped Flashcards Preview

pediatrics > cardioped > Flashcards

Flashcards in cardioped Deck (73):
1

receives the largest amount of combined ventricular output(55%) and has the lowest resistance in the fetal circulation

placenta

2

why is the fetal heart unable to increase stroke volume when the HR falls

it has a low compliance

3

why does is there functional closure of the foramen ovale

due to increased pressure in the left atrium

4

why does the ductus venosus closes

it is the result of lack of blood flow leading to faill in pulmonary artery pressure

5

trigger for closure of PDA(within 10-15hrs)

increased arterial Oxygen saturation

6

why is the ductus arteriosus more likely to remain open in preterms

because the preterm's ductal smooth muscle does not have a fully developed constrictor response to oxygen

7

congenital acyanotic heart dses

ASD VSD PDA

8

most common type of ASD

ostium secundum (at the site of fossa ovalis)

9

chamber enlargement in ASD

right sided of the heart (RA RV PA)

10

murmur in ASD

systolic ejection murmur at the 2nd left ICS due to relative stenosis of pulmonary valve; wide-split S2 resulting from RBBB which delays both electrical depolarization of the RV and the ventricular contraction resulting in DELAYED closure of PV

11

most common congenital heart diease

VSD

12

irreversible changes occur in the pulmonary arterioles leading to pulmonary vascular obstructive dse (from L-R shunt to R-L shunt)

Eisenmenger syndrome

13

pertinent PE findings in VSD

Gr 2-5/6 systolic regurgitant murmur at the LLSB; loud S2; P2 intensity is increased in large shunt

14

site of enlargement in VSD

LA LA main PA

15

site of enlargement in PDA

LA LV Aorta

16

auscultatory finding in PDA

continuous machinery-like murmur

17

manifestations in PDA

tachycardia; exertional dyspnea due to volume overload; hyperactive precordium; bounding peripheral pulses with widened pulse pressure

18

complications of PDA

CHF; recurrent pneumonia

19

contraindication to surgical of PDA

PVOD

20

most common cause of cyanotic congenital heart disease in the newbords

TOGA

21

egg-shaped cardiac silhouette with a narrow superior mediastinum

TOGA

22

balloon atrial septostomy (creating interatrial communication in TOGA)

Rashkind procedure

23

atrial septostomy (creating interatrial communication in TOGA)

Blalock-Hanlon procedure

24

Definitive repair of TOGA

switch right and left-sided blood at 3 levels atrial(SENNING or MUSTARD); ventricular(RASTELLI); great artery level(JATENE)

25

manifestations of TOF

cyanosis; tachypnea; clubbing; RV tap on the left sternal border; Gr 3-5/6 systolic ejection murmur at the mid and ULSB(PS) with radiation to the back; single S2(esp with pulmonary HTN)

26

small heart size; decreased pulmonary markings; concave main PA with an unruptured apex

Boot-shaped heart seen in CXR of those with TOF

27

natural history of TOF

polycythemia develops; growth retardation if cyanosis is severe; brain abscess and CVA rarely occur; coagulopathy is a late complication

28

paroxysm of hyperpnea; irritability; prolonged crying; increasing cyanosis; decreasing intensity of murmur

hypoxic spell

29

management of hypoxic spell

put the child in knee-chest position to decrease systemic venous return; morphine to suppress the respiratory center and hyperpnea; O2 to improve O2sat; Phenylephrin to raise SVR; Propranolol may stabilize vascular reactivity of the systemic arteries preventing decrease in SVR; Ketamine to increase SVR

30

pathogenesis of truncus arteriosus(both ventricles eject blood to a common vessel; VSD always present)

caused by a failure of development of SPIRAL septum

31

mechanism of TAPVR

all 4 pulmonary veins drain to the RA causing RV volume overload

32

snowman sign on xray

TAPVR

33

what chromosomal abnormality is associated with coarctation of the aorta

Turner syndrome

34

how does coarctation of the aorta seen in xray of children around 7yo

rib notching

35

manifestations of coarctation of the aorta

asymptomatic but can have CHF if severe; weak or delayed femoral pulses; BP higher in arms than legs; LVH in CXR or ECG

36

which part of the aorta is typically affected in coarctation of the aorta

descending aorta distal to the origin of the left subclavian artery

37

what obstructive condition is associated with congenital Rubella; Noonan and William syndrome

Pulmonic stenosis

38

auscultatory finding in pulmonic stenosis

systolic ejection murmur at the LUSB with radiation to the back; soft P2

39

ECG finding in pulmonic stenosis

right axis deviation; RBBB if mild; RVH (pure R and upright T in V1)

40

surgical tx for Pulmonic stenosis

valvotomy(Brock's procedure)

41

auscultatory finding in aortic stenosis

harsh systolic ejection murmur at the RUSB; systolic thrill (suprasternal notch)

42

surgical tx for aortic stenosis that remove patient's own pulmonary valve and using it to replace the abnormal aortic valve and a homograft is placed in the pulmonary position

Ross procedure

43

inflammatory lesions with swelling fragmentation of the collagen fibers with altered staining characteristics of connective tissue found in the atrial myocardium seen in Rheumatic fever

Aschoff bodies

44

Jones Criteria

Arthritis; Carditis; Erythema marginatum; subcutaneous nodules; Sydenham's chorea(associated with increased antineuronal antibodies); ACESS; minor:arthralgia(not considered if arthritis is present); fever(at least 38.8); elveated ESR/CRP; prolonged PR interval in ECG

45

most reliable lab evidence in Rheumatif fever

ASO (titers usually become elevated 2 weeks after strep infection; peaks at 4-6wks; and decreases after another 2wks; a 4-fold rise in titer in samples taken 10days apart)

46

Diagnosis of rheumatic fever

highly probable when either 2 major + ASO positive OR 1major and 2 minor +ASO

47

Antibiotics to eradicate Strep in Rheumatic fever

Penicillin VK 200-500mg QID x10days; Benzathine PCN 0.6 to 1.2MU IM; Eryhromycin 250mgTID x10days

48

anti-inflammatory tx for Rheumatic Fever

ASA 100mkd and prednisone 2mkd for 6-8wks

49

secondary prophylaxis (prevent recurrences of RF and RHD)

Pen VK 250mg BID; or Benzathine Penicillin 0.6-1.2MU q21days IM Duration: Arthritis: at least 5 years; Carditis: at least 10years

50

most common valvular involvement in adults

mitral stenosis

51

auscultatory finding in mitral stenosis

OPENING snap followed by mitral diastolic rumble

52

CXR finding in mitral stenosis

LA and RV enlargement; prominent MPA

53

why does hemoptysis develop in mitral stenosis

due to rupture of small vessels in the bronchi as a result of long-standing pulmonary venous hypertension

54

most common valvular involvement in children with RHD

mitral regurgitation

55

hallmark auscultatory finding in mitral regurgitation

systolic regurgitant murmur Gr2-4/6 at the apex with transmission to the left axilla

56

semilunar cusps are deformed and shortened; dilated valve ring so that the cusps fail to appose lightly

aortic regurgitation

57

manifestations in aortic regurgitation

widened pulse pressure; bounding WATER-HAMMER pulse in severe cases; high-pitched diastolic murmur at the 3rd-4th LICS (hallmark and more easily audible when sitting and leaning forward)

58

CXR finding in aortic regurgitation

Left ventricular enlargement; dilated ascending aorta and prominent aortic knob

59

most common valvular heart disease

MVP

60

most common complaint of patients with MVP

palpitations

61

major complications of MVP

infective endocarditis; sudden cardiac death; severe MV regurgitation; cerebrovascular ischemic events

62

auscultatory finding in MVP

MIDSYSTOLIC CLICK due to tensing of the MV as the leaflets prolapses into the LA during systole

63

subacute infective endorcarditis in SLE px

Libman-Sacks endocarditis or sterile endocarditis

64

etiology of infective endocarditis

Strep viridans and Staph aureus

65

manifestations in IE

prolonged fever; new murmur or a changing heart murmur; fatigue; myalgia; arthralgia; splenomegaly; petechiae; meningismus

66

tender pea sized intradermal nodules in pads of fingers and toes in IE

Osler nodes

67

painless small erythematous or hemorrhagic lesions on the palms and soles in px with IE

Janeway lesions

68

linear lesions beneath the nails in px with IE

splinter hemorrhages

69

duke major criteria in IE

(+) 2 blood cultures; evidence of endocarditis in echocradiography a.intracardiac mass on valve or other site; b.regurgitant flow near a prosthesis; c.abscess; d.partial dehiscence of prosthetic valves; e.new valve regurgitant flow

70

Tx of IE caused by Staph

Oxacillin with optional addition of Gentamicin; if resistant:Vancomycin

71

Tx of IE caused by Strep

Pen G Na or Ceftriaxone plus Gentamicin

72

Tx of prosthetic valve endocarditis due to Staph

Oxacillin + Rifampicin + Gentamicin

73

when to repeat 2d-echo in Kawasaki dse after performing 2d echo at diagnosis

repeat after 2-3wks of illness