Exam #4: Pediatric Thorax & Lung Exam Flashcards Preview

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Flashcards in Exam #4: Pediatric Thorax & Lung Exam Deck (45):
1

How is the chest wall in the infant and newborn different from adults?

1) At birth the ribs are composed mainly of cartilage & project at right angles from the spine
2) Rib cage is more circular
3) AP diameter to lateral diameter ratio DECREASES during the first three years
4) Stiffened rib cage (better for breathing)

2

How is the diaphragm of the infant different from the adult?

1) Angle of insertion in adults is oblique vs. HORIZONTAL in infants, which leads to DECREASED contraction efficiency
2) With age there is a change in the oxidative capacity of the muscle & neuromusuclar transmission undergoes maturation

Take home: Breathing gets easier as we get older; thus, breathing is HARDER & MORE EASILY FATIGUED for the infant

3

When does alveolar multiplication stop?

Roughly 2 years-->continues after birth

4

In addition to alveolar multiplication, what other changes happen in the lungs after birth?

1) Alveoli increase in size
2) Airway lumen increases
3) Capillary network remodels itself

*All of these improve breathing over time

5

What is the general take home message about the anatomical difference between the newborn lung & the adult lung?

1) Newborn anatomy is significantly different from the adult
2) Newborns are MORE susceptible to respiratory distress & failure

6

What are the initial steps of the respiratory examination?

General impression

A
B
Cs

7

What is the normal respiratory rate of the newborn (<28 day old)? How does this change with age?

40-60 bpm
Slows

8

Describe the breathing pattern in the infant.

- Obligate nasal breathers
- Periodic breathing is normal (irregular fast-->slow)
- Patterns differ during awake & sleep

9

What is apnea in the newborn?

Absence of breathing for >20 seconds

10

How long do you need to take a respiratory rate for in an infant?

1 min

11

How will respiratory rate change with a fever?

Increase

12

What can poor feeding be a sign of in an infant?

Respiratory distress

13

What immunization is often associated with post-tussive emesis?

Whooping cough

14

What is respiratory distress?

Both EFFORT & RATE

15

What are signs of respiratory distress in an infant?

1) Retractions
2) Head-bobbing
3) Grunting & moaning
4) Nasal flaring

16

How does sound transmission different from a pediatric patient to an adult?

Sound transmits EASIER due to relative lack of body mass

17

What is a technique to calm an older child while listening to lung sounds?

Don't look at them

18

What is a way to make kids expire forcefully for lung sounds?

Ask them to blow the otoscope light out

19

How do you quiet an infant for cardiac exam?

- Feeding
- Parent holding
- Rocking
- Sleeping
- Pacifier

20

What is acrocyanosis? Is this a normal or abnormal finding?

Peripheral cyanosis that is normal in the neonate & not worrisome
- Hands & feet are blue but center is pink

21

What is central cyanosis? Is this a normal or abnormal finding?

Cyanosis in the central regions of the body; this is ALWAYS ABNORMAL

22

What is the hyperoxitest? When should it be implemented?

This is a test to determine the etiology of central cyanosis. This is how it is performed:
1) Check ABG
2) Provide 100% for 10 min
3) Recheck ABG

*If the rise of p02 is >100mmhg, the cause is probably pulmonary

23

Where is the apical impulse in the newborn?

4th or 5th intercostal space just medial to the midclavicular line

24

What can shift the apical impulse in the newborn?

Pneumothorax
Dextrocardia
Diaphragmatic hernia

25

What can an enlarged liver be an early sign of in the newborn?

Heart failure

26

What is the normal newborn heart rate?

120-160 bpm

27

At what point is the newborn heart rate not only slow, but also concerning?

Less than 100 bpm

28

What is the diagnosis of a fixed heart rate above 220 in a newborn?

SVT

*Note that this can lead to heart failure

29

What is diminished vigor of heart sounds indicative of in infants?

Heart failure

30

What is the difference between S1 & S2?

S2 is higher in pitch

31

Is it normal to hear heart murmurs in the first dew days after birth?

Yes

32

Outline the fetal circulation and major differences from the adult circulation.

- Umbilical vein brings OXYGENATED blood to the fetus from the placenta
- Half of this blood bypasses the fetal liver via the "Ductus Venosus"
- IVC-->RA-->LA "Foramen Ovale"
- Blood that makes it into the RV goes through the pulmonary trunk to the "Ductus Arteriosus" to the descending aorta, bypassing the fetal lungs
- Blood goes back to the placenta via the "Umbilical Arteries"

33

What is a Patent Ductus Arteriosus?

- Birth defect in which the Ductus Arteriosus (pulmonary tunk-->descending aorta) does not closure
- With changes after birth in the circulatory pressures, high aortic pressure shunts blood into the pulmonary trunk

34

What are the diagnostic indicators of a PDA?

1) "Machinery Murmur"
2) Harsh, loud, continuous murmur heard at the 1st- 3rd intercostal spaces and the lower sternal border

35

What is the likely etiology of weak pulses in the infant?

Low CO
Increased peripheral vasoconstriction

36

What is a "bounding" pulse associated with?

PDA

37

What is the likely etiology of diminished femoral pulses in the infant?

Coarctation of the aorta

38

What is Coarctation of the Aorta?

Coarctation of the Aorta is characterized by constriction of the aorta (varying length)

39

What is the definition of a hypertensive newborn?

BP > 80/50 mmHg

40

What is an innocent murmur?

- Common in the 3-7 age group
- Usually at the mid left sternal border
- Midsystolic
- 2-3/6 intensity
- Heard better supine or when holding breath
- More commonly heard during periods of higher metabolic rate (i.e. fever)

*Heard least when standing

41

List the indications for referral of the newborn to a Cardiologist.

1) Abnormal cardiac size
2) Abnormal EKG
3) Diastolic murmur
4) Loud murmur accompanied by a thrill
5) Cyanosis
6) Abnormally strong or weak pulses

42

How should you check capillary refill?

Above the level of the heart

43

What is normal capillary refill?

Less than 2 seconds

44

What are the three cardinal signs of a severe (life-threatening) CHD in the newborn?

1) Cyanosis
2) Decreased systemic perfusion
3) Tachypnea

45

What is the initial step in management of a patient with signs of life-threatening CHD?

Prostaglandin E (PGE)